Chief Physician Yu Huiping's Experience In The Treatment Of Childhood Immune Thrombocytopenia And Clinical Observation

Objective:To retrospect the development of Chinese and western medicine in diagnosing and treating childhood immune thrombocytopenia (ITP), and learn the clinical experience of my tutor Huiping Yu, a chief physician in treating childhood persistent and chronic ITP primarily.Methods:This essay contains three parts-a review of ITP in western medicine, a review in Chinese medicine and a clinical observation. The first part begins with the brief outline of childhood ITP in definitions, epidemiologic features, clinical manifestations and pathogeneses. Then I analyzed the cognitive process of the disease by pointing out the change on terms and typical diagnostic criteria domestically and abroad in recent 30 years. As the diagnosis of ITP requires other diseases excluded, this part also introduces some related conditions which can be confused with ITP in mechanism briefly. There follows the summary of western medicine treatment through sorting out articles from China National Knowledge Infrastructure(CNKI) database about treatments for children of "immune thrombocytopenia", "immune thrombocytopenic purpura" and "idiopathic thrombocytopenic purpura". The second part focuses on the theories and clinical researches of traditional Chinese medicine related to childhood ITP. For one thing, I searched and analyzed the typical ancient opinions on symptoms and ailments similar to ITP from "Encyclopedia of Traditional Chinese Medicine" database. For another, I looked up books and magazines reporting modern Chinese medicine's treatment of ITP in CNKI database in recent 5 years. My tutor's basic view is also attached to this part. The third part tells of my observation on some persistent and chronic cases who have received treatments by Doctor Yu, via counting the frequency of each Chinese medicinal substance in their first formulas according to different medicinal properties, and comparing their blooding conditions, blood platelet counts and curative effects before and after treatments. Thus the outcome is the primary reflection of my tutor's experience.Results:ITP is an acquired disorder of autoimmunity characterized by isolated thrombocytopenia (blood platelet count<100×109/L) without other causes. It is also called idiopathic or immune thrombocytopenic purpura. The diagnosis of ITP lacking gold standard still relies on clinical manifestations and examinations like blood routine. Atypical cases can choose marrow examination and assays like items of immune series and virus pathogens to exclude other diseases. Phases of the disease consist of newly diagnosed ITP, persistent ITP and chronic ITP based on different courses. Modern first-use drugs include corticosteroids and intravenous immunoglobulin. The failed cases may try other therapies such as taking anti-CD-20 antibodies, TPO-receptor agonists, immunosuppressive agents and splenectomy. Contrast to adult, most children can recover from ITP sooner or later, however 3% of chronic ITP will develop into systemic lupus erythematosus or other severe autoimmune disease. We can refer the discussions of "blood syndrome", "nosebleed" and "purpura" in traditional Chinese medicine works for the treatment of ITP. On the basis of ITP's feature, modern Chinese medicine doctors treat it under the guidance of disease and pattern identification, which differentiates phases, aspects of the tip and root, and deficiency and excess patterns of five viscera and their qi, blood, yin and yang. Some doctors also attempt to combine Chinese and western medical therapies. The result is satisfying on the whole. My tutor holds that frenetic movement of blood due to heat is the main mechanism in the early phase of ITP, and the syndrome of blood stasis, dual deficiency of qi and blood, or yin deficiency with effulgent fire may occur later. Heat and blood stasis are key factors. So my tutor treats ITP with Chinese medicine formulas based on her "Hairy Vein Agrimonia, White Peony Root, Tree Peony Bark, Chinese Angelica and Callicarpa Leaf Decoction". The treatment is individual and combined. Some chronic or failed cases may take additional immunoregulants, antibiotics or other drugs. With these multiple drugs, the result is also satisfying. This study of my essay observes 22 cases of persistent and chronic ITP in my tutor's out-patient clinic of pediatrics. The Chinese medicine formulas based on pattern identification include qi-tonifying and yang-warming agents (e. g. Radix Astragali Praeparata cum Melle, Radix Pseudostellariae, Radix Codonopsis, Fructus Jujubae, Semen Cuscutae and Cortex Cinnamomi), yin-nourishing and blood-tonifying agents (e. g. Fossilia Ossis Mastodi, Fructus Corni, Radix Paeoniae Alba and Radix Angelicae Sinensis), heat-clearing and detoxicating agents and blood-cooling and stasis-resolving agents(e.g. Radix Scutellariae, Rhizoma Smilacis Glabrae, Rhizoma Imperatae, Radix Rehmannia, Cortex Moutan and Herba Agrimoniae) and so on. A few qi-moving and blood-activating agents (e.g. Rhizoma Chuanxiong), wind-dispelling and exterior-releasing agents (e. g. Radix et Rhizoma Asari and Ramulus Cinnamomi) and spleen-fortifying agents (e.g. Rhizoma Atractylodis and Endothelium Corneum Gigeriae Galli) are also useful. Patients take Chinese medicine with vitamins, and some even with deceasing doses of corticosteroids and suitable calcium.11 of 15 patients who have been treated for 3 months don't bleed, and the medians of their platelet counts in these 3 months change little. Taking the cases who have not been treated for 3 months into consideration,15.0% of them get complete response or response after treatments for 1 month,15.8% after treatments for 2 months and 33.3% after treatments for 3 months. During my whole observation over 1 year,36.4% of the 22 cases have ever got complete response or response, and 5 cases relapse. The effectiveness of this therapy and its persistence need further reseaches with more cases and longer observation periods. So does its adverse effect.Conclusions:My tutor Huiping Yu, the chief physician of Chinese medicine treats children who suffer from persistent and chronic ITP with the principle of reinforcing the healthy qi and detoxifying. The methods contains tonifying qi, warming yang, nourishing yin, tonifying blood, clearing heat, detoxicating, cooling blood, resolving stasis and so on. She grasps their constitutions on the whole and analyzes the waxing and waning of deficiency and excess patterns in the process of ITP to treat them based on pattern identification considering the mutual rooting of yin and yang, regulating qi and blood, and dissipating stasis to create new blood. Most patients get relief from bleeding, and the levels of their platelet counts have not changed statistically after treatments for 3 months.