Research On The Relation Between TCM Distribution Of Idiopathic Thrombocytopenic Purpura With Haemopoiesis Of Bone Marrow

Objective:Idiopathic Thrombocytopenic Purpura (ITP) is also callcd autoimmune thrombocylopenic purpura, which is blood disease commonly seen in clinical practice. Currently, the glucocorticoid is the first line drug treatment for adult ITP. However, some of this ITP patients can not be well treated by glucocorticoid or could not tolerate long-term use of it. Tradition Chinese Medicine has its advantages in improve their quality of life,but the differentiating syndromes in the term of TCM is lack of standard, so we investigated the TCM differentiating syndromes of ITP and the relationship with medullary hematopoiesis through clinical epidem-iological Research, in order to establish the differentiating syn-drome standard of ITP.Methods:To investigated Idiopathic Thrombocytopenic Purpura (ITP) through the review of the literature and clinical epidemiology study.First to Review the Literature of Traditional Chinese Medicine Research on ITP. Then to investigate clinical epidemiological research of 189 cases from Guangdong Provincial Hospital wards between September 2006 to January 2010, whose were diagnosed with ITP, then Collect TCM diagnostic information, symptom characteristics and label index of idiopathic Thrombocytopenic Purpura through epidemiological survey. SPSS13.0 was used to analysis 189 cases of ITP patients.Results:Idiopathic Thrombocytopenic Purpura(ITP)can be divided into two categories: acute ITP and chronic ITP. syndrome differentiation of ITP must been based on the spleen, liver and kidney syndrome in viscera syndrome differentiation, five viscera, which had relation with ITP were spleen, liver, kidney, lung, heart, and the ratio were 54.3%,25.4%,11.5%,5.8%,3.0%. Acute ITP has Close relationship with the spleen and liver, and most of the chronic ITP spleen, kidney, the difference between the two above was Significant (P<0.05). However, as to Yin and Yang Qi and Blood Qi Deficiency syndrome (86.7%) and Blood stasis syndrome(61.3%)were the main, with significantly different(P<0.05). Most of the Idiopathic hrombocytopenic purpura TCM syndrom was deficiency-excess complication, accounting for 60.3%. the other was the deficiency, accounting for 39.7%. In Acute ITP patients, the deficiency syndrome and the deficiency-excess complication was half of each. In chronic ITP patients, the majority syndrome is eficiency-excess complication, accounting for 79.6% of 63 cases. And the Associated syndromes were blood stasis syndrome, Blood heat syndrome, damp syndrome, syndrome of stagnation of QI. Associated with blood stasis were 116 cases, including cases of acute ITP 59 cases, chronic ITP 57 cases, both with no significant difference(P>0.05).Idiopathic Thrombocytopenic Purpura (ITP) is a category of Zidian in TCM. This research is to ensure TCM differentiation Syndromes by cluster analysis of clinical TCM syndrome. There are six TCM differentiation Syndrome types:spleen deficiency, liver-spleen disharmony, blood stasis syndrome, hyperactivity of fire due to yin deficiency, Spleen Weakness Phlegm syndrome. Differentiation Syndrome was basic on viscera syndrome differentiation. In acute patients, spleen deficiency, liver-spleen disharmony is the major types, each acount for 23.8%,16.7%; while as to chonic ones, spleen deficiency, Spleen and Kidney Deficiency were the major, each acount for 34.9%,14.5%. Both were significantly different (P<0.05). Therefore acute ITP patients should be treated congcerning on spleen, liver organ. While chronic ITP concerning on spleen and kidney, and the associated blood stasis, blood heat. Therefor it should be treated with some clearing Heat and invigorate the circulation of blood herbal drug while tonifying spleen and kidney.Relations between differentiation Syndrome and bone marrow:Spleen and Blood deficiency, Spleen and kidney deficiency type with mainly moderate to severe thrombocytopenia. Liver-spleen disharmony, blood stasis syndrome contact to very severe, severe thrombocytopenia. hyperactivity of fire due to yin deficiency syndrome contact to moderate thrombocytopenia, the very severe acount for one third. Bone marrow Normal hyperplasia. Obvious hyperplasia,Extreme hyperplasia contact to spleen deficiency, Spleen Weakness Phlegm syndrome, Spleen and Kidney of Deficiency syndrome, and all of them basic on Spleen Deficiency. Bone marrow Hypoplasia and Extreme hypoplasia contact to and Kidney of Deficiency syndrome. All above has significant difference.Conclusions:With the Concerning the Disease and TCM syndrome, the basic differentiating syndrome of acute ITP were spleen deficiency, liver-spleen disharmony, blood stasis syndrome, hyperactivity of fire due to yin deficiency. While chronic ITP were spleen deficienc. Deficiency of Spleen and Kidney, blood stasis syndrome, hyperactivity of fire due to yin deficiency. Acute ITP patients were half of Deficiency and half of eficiency-excess complication.It should be concern on liver and spleen when treat the patients with herbal, chronic ITP patients should be treated concern on liver and spleen, and the blood stasis syndrome,using tonifying kidney, tonifying spleen, tonifying Qi and nvigorate the circulation of blood. Both the acute or chronic ITP show the relationg with the bone marrow.It can provides some evidence for the spleen liver and kidney differentiation system of ITP. Because the cases were limited, and most of them from the blood wards, there are some biased conclusions.The large sample and multi-center research should be in the future research.