Study Of The Therapy Of Harmonizing The Liver And Strengthening The Spleen For ITP

BackgroundIdiopathic thrombocytopenic purpura (ITP) is a thrombocytopenia syndrome induced by means of an immune mechanism, which is the most common hemorrhagic disease in the clinic, accounting for 30% of the total hemorrhagic diseases. It is in a high incidence in the blood system diseases. The skin and the mucous membranes varying different degrees of hemorrhage are the most clinical manifestations, which is persistent or repeated attacks. In China, glucocorticoid and gamma globulin are the first line therapy. But gamma globulin is so expensive that it is generally as a first aid medicine merely; although the glucocorticoid is not expensive, it is easy to relapse in the process of reduction and produce steroid-dependent. Morever, a long-term use of glucocorticoid causes adverse reaction, which brings pressure to patients and seriously impacts on quality of their life.And patients with intolerance to the drugs have to stop it. According to the literature reports, the efficacy of Chinese medicine treatment for ITP is characterized by improving symptoms, without toxic side effects, and reducing the relapse rate. Treatment in coordination with Western medicine is proved superior to single treatment. Integrative treatment for ITP can complement each other and reduce toxicity. Based on the summary of clinical observation we found that the liver and spleen disharmony in ITP patients is in the majority. The theory of TCM believes that the liver stores blood and spleen controls the blood. If the liver fails of conveyance and dispersion, it is out of storing blood. The spleen is so deficient that it can't control the blood. As is stated above, these are the main reasons for bleeding. My tutor summed up a experiential effective recipe for the treatment of ITP on the basis of long-term clinical practice—Yi Dian drink to harmonize the liver and strengthen the spleen:Bupleurum and Scutellaria dispersing stagnated liver qi for relieving qi stagnation and clearing heat, Rhizoma Pinelliae harmonizing the liver and stomach (spleen), Astragalus strengthening spleen qi, Radix Phytolacca (clearing liver-fire and) cooling blood, peony softening the liver and nourishing the blood, licorice root reconciling the drugs above. All the drugs have the effect of reconciling and dispersing stagnated liver qi, clearing liver-fire for cooling blood, invigorating spleen and replenishing qi.ObjectiveTo objectively assess the efficacy of Yi Dian drink for curing the ITP, enhance the clinical efficacy of ITP, reduce the relapse rate, alleviate the clinical symptoms, and discuss how the Chinese medicine relieve the side-effect and withdrawal rebound rate of steroid.MethodThis clinical study retrospectively analyzes all my tutor's 61 outpatients of ITP during June 2007 and March 2010 in TCM hospital of Guangdong Province, in accord with the diagnosis of western and traditional medicine, including initial, relapsing, steroid dependent and refractory patients, which were all given oral Yi Dian drink. Patients with oral glucocorticoids therapy at the beginning took doses as they used to and gradually reducing until withdrawal. Patients who have to stop glucocorticoids because of intolerance of the side effects of steroid simply took traditional Chinese medicine therapy. The follow-up time is 2-33 months. Compare the change of the platelet count, clinical symptoms and the side effects of steroids, such as moon faces, mental excitement, alopecia and acne etc. before and after the treatment, and sum up the withdrawal rebound rate of steroid. Then contrast to the comparison group with steroids in the existing core journal literature.Results1,Clinical efficacyAfter treatment, the platelet count of this treated group arose from(25.25±18.27) to (116.59±73.44) significantly (P<0.05). among which,4 cases achieve substantially healing (6.6%),25 excellent effect (41.0%),20 well effect (32.8%),9 improvement (14.7%) and 3 non-response (4.9%) summing up the effective rate of 95.1%. The advantage compared with the steroid therapy control group in the domestic literature is significant (P <0.05).Both patients with HP infection or not have efficacy, which platelet counts after treatment had significantly increase(P<0.05). The platelet counts of incipient and relapsed patients increase to normality and maintain stably. And the platelet counts of steroid-dependent patients remain stably improved while reducing the steroid which is significant improved after treatment.2,Efficacy of Chinese traditional medicine symptomsAfter treatment, all the patients'symptomatic scores decreased significantly, especially the bleeding symptoms, which are improved significantly (P<0.05). There are 1 case(1.6%) in clinical cure,57 (93.4 %) in excellent effect,3 (4.9%) in well effect and non inactive, summing up the effective rate as 100%.3,Abatement of steroid side-effect and withdrawal rebound rateAfter treatment, there are 10-20% of patients with initial therapy suffering side effects of steroid, mainly a little fat face, but no any other obvious adverse effects on life, while the other patients with side effects of steroid, such as moon face, acne and mental excitement etc. have relieved significantly (P<0.05). In this study with 54 patients treated by steroid, the number of patients with withdrawal rebound is 11, mainly because of the time extension of withdrawal, accounting for 20.3%, while the adverse effects obtain relieving instead of aggravation.ConclusionThe use of the therapy of harmonizing the liver and strengthening the spleen for ITP can increase the platelet count stably, especially definitely with steroid dependent patients who had obvious adverse effects in the clinic. It can also relieve the bleeding and improve the quality of the patients. It provides a new effective therapeutic approach for the steroid dependent and refractory patients.