Treatment of Primary Thrombocytopenic Purpura by Modified Minor Decoction of Bupleurum

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Journal of Traditional Chinese Medicine 15 (2): 96-98, 1995.

Duan Yu, et al, Department of Traditional Chinese Medicine, People's Hospital of Langfang City, Hebei Province.

Primary thrombocytopenic purpura is a hemorrhagic disease induced by rapid destruction of blood platelets through autoimmunity. The authors treated 10 cases of the disease with modified Minor Decoction of Bupleurum with good results as reported in the following:

All 10 patients were primary cases treated in the ward (6 cases) or the OPD (4 cases). The diagnosis was based upon: (1) repeated blood platelet counts under 100x10**9/L; (2) hemorrhages in the skin, mucosa or viscera without splenomegaly; (3) active or marked myeloidosis with normal or increased megakaryocytes; (4) thrombocytopenic diseases such as lupus erythematosus were ruled out. The series of 10 cases comprised 5 males and 5 females; the ages were 5-14 years in 4 cases and 151-52 years in 6. The duration of the disease was 4-72 days, averaging 30.4 days. All cases manifested purpura in the skin and mucosa, with epistaxis in 7 cases, gingival hemorrhage in 4 cases, uterine bleeding in 2 cases and hematohydrosis in 2 cases...

METHOD OF TREATMENT

The classical Minor Decoction of Bupleurum consists of Radix Bupleuri, Radix Ginseng, Radix Codonopsis Pilosulae, Rhizoma Pinelliae, Radix Scutellariae, Radix Glycyrrhizae, Rhizoma Zingiberis Recens, and Fructus Ziziphi Jujubae. The authors modified the prescription by eliminating Rhizoma Pinelliae and Rhizoma Zingiberis Recens and adding Herba Equiseti Hiemalis 15 gm, Herba Verbenae 15 gm, and Radix Rehmanniae 15 gr. For patients with severe hemorrhage such as epistaxis, gingival or uterine bleeding and hematohidrosis, the hemostatic mixture was administered once daily by intravenous drip. The mixture consisted on 5% glucose solution, 250-300 ml, dicynone 2.0 gm, adrenobazone 20 mg, vitamin K 8-12 mg, vitamin C 500 mg, and p-aminomehyl benzoic acid .3 gm. For cases with dripping uterine bleeding, pituitrin 5-10 IU was added. The intravenous medication was terminated when hemorrhage was alleviated. For anemia due to blood loss, ferreous agents were administered.

RESULTS OF TREATMENT

The duration of treatment was 14-44 days, averaging 28 days. The hemostatic mixture was used in 6 cases for 2-6 days, averaging 3.2 days. Skin and mucosa hemorrhages stopped in all cases and the blood platelet count rose to 82-200x10**9/L averaging 121x10**9/L. Blood routine examination was normal in all cases. According to the criteria for assessment of therapeutic effect in primary thrombocytopenic purpura stipulated at the Luoyang Conference in 1984, the therapeutic results were deemed markedly effective in 6 cases and fairly effective in one; the remaining 3 cases dropped out of follow-up.