Refractory Idiopathic Thrombocytopenic Purpura Tcm Syndromes Analysis

Background:Idiopathic thrombocytopenic purpura(ITP) is an autoimmune disease characterized by low platelets and bleeding.About one thrid of adults with ITP do not respond to standard doses of corticosteroids and aplenectomy and require anther therapy to raise their platelet count,which belong to Refractory Idiopathic thrombocytopenia purpura(RITP).To treat RITP by Western medicine associated with easier to relapse,more side effects,and more expensive,compare with by TCM. However,from wide view of literature,the study of Traditional Chinese Medicine(TCM) treatment of RITP still on initial stage and lack of system research in aspect of standardized TCM syndrome.Through clinic observing for several years,we concluded that blood stasis due to qi deficiency is the essential mechanism of RITP. According to this theory,we use supplementing qi and promoting blood circulation for removing blood stasis as therapeutic principle,and use traditional Chinese compound which is mainly composed of Hangqi,Chuanshanlong to treat patients.This study is the component part of clinical application of Qi Long granule reseach,which is authorized self-determination innovated study in traditional chinese medicine in 2005 by the fund of medicine development in Beijing(number:SF-2005-031).We hope we could get the primary summery of RITP syndrome features by retrospective investigate 75 cases of RITP,in order to verify our previous experiences,contribute to standardize syndrome differentiation and treatment of RITP,and direct the coming research.Methods:75 cases of RITP patients,who were admitted to the Donghzhimen hospital and Dongfang hospital after 1st January,2003 from 10 to 80 years old,were studied retrospectively.We analyzed the patients' data,including gender,age,course of disease,peripheral hemogram,bone marrow morphology,symptom,tongue condition, pulse condition,etc.Sum up the distribution of syndrome,and use factor analysis to discover the significance of the symptoms' different occurrence frequencies in aspect of syndrome.Results:①Baseline data:Female patient is significant more than male(P＜0.05). The average age was 47.56±18.96.The median of course of disease was 27 month, while the maxima may over 10 years.②Lab examination data:The main character of peripheral hemogram was the decrease of platelet,and the average platelet count was 28.84±13.64(×109/1),however the RBC,HGB,WBC could be normal.Megakaryocyte was overabundance or normal with maturation arrest.③Four diagnostic methods information:the most common symptom was lassitude,and the secondary was purpura. We had selected 12 symptoms to dedicate to 4 factors by factor analysis.The 12 symptoms were fatigue and lassitude,insufficiency of Qi,disinclination of talk,purpura, dark purple face,dark purplemenstrual blood,burning sensation of five centres,tidal fever and night sweating,dry mouth and dry pharynx,constipation,reddish yellow urine,anorexia.And the 4 factors represented qi deficiency and blood stasis,yin deficiency,heat syndrome,and the symptoms related to spleen respectively.Pale and dark tongue body and white tongue coating was the most common tongue condition, and the secondary was red and dry tongue body and little tongue coating.The most common pulse conditions were weak thready pulse,unsmooth thready pulse,rapid thready pulse.④distribution of syndrome:the most common syndrome fundamental elements were qi deficiency and blood stasis.And among the complex syndrome,the fundamental syndrome was qi deficiency and blood stasis,mainly accompanying with yin deficiency.Conclusion:Qi deficiency and blood stasis is not only the main etiology and pathogenesis,but also the main type of RITP syndrome in terms of TCM.And this accords with our clinic experiences.