Simple purpura has been taking medicine for 20 days. Why?

Purpura refers to the color change of skin and mucosa after blood. The clinical manifestations are bleeding spots, purpura and ecchymosis, which are generally not higher than the skin surface. Only when allergic purpura occurs, it can be slightly raised, starting with purple, not fading after being pressed, then gradually becoming shallow, and turning yellow and fading after about two weeks. Purpura is the most common clinical manifestation of hemorrhagic diseases. Once purpura is found, the following possibilities are suggested: ① vascular purpura. Very common, it is caused by vascular wall injury or its brittleness and permeability increase. Common in immunity (such as allergic purpura), infection (such as sepsis), abnormal vascular structure (such as hereditary hemorrhagic telangiectasia) and other diseases (such as abnormal proteinemia, simple or senile purpura, etc.). ). Check that there is no abnormality except that the beam arm test may be positive. ② Platelet abnormal purpura. The most common is caused by thrombocytopenia, thrombocytopenia and dysfunction. If purpura or blood blister appears in the oral cavity and buccal mucosa, it often indicates serious bleeding and should be treated actively. ③ Obstacles in coagulation mechanism, including lack of coagulation factors, anticoagulant substances in circulation or hyperfibrinolysis. Generally speaking, the bleeding caused by the disorder of coagulation mechanism is mainly manifested as joint hematocele, muscle hematoma and visceral bleeding, with less skin purpura and only large ecchymosis. Moreover, the coagulation picture is obviously abnormal, which can be distinguished from purpura and platelet abnormality caused by vascular purpura. The treatment of purpura varies according to illness. The causes of purpura hemorrhage can be divided into two categories: (1) vascular system diseases, such as vascular wall damage or increased permeability and brittleness of vascular wall, which lead to the leakage of red blood cells in the blood and form purpura. Lack of bacterial toxins, chemicals and vitamins can lead to vascular injury. Such as simple purpura, allergic purpura, allergic purpura with increased intravascular pressure. (2) Bleeding caused by coagulation disorder. Such as thrombocytopenic purpura, hemophilia, fibrinogen-reducing purpura, prothrombotic purpura caused by liver disease, and purpura caused by excessive anticoagulant drugs. The above lesions not only lead to skin bleeding, but also lead to other tissues and internal organs bleeding. Purpura should not only consider bleeding, but also carefully examine the organs of each system to rule out blood system diseases. There are also some special types of purpura, such as rheumatic purpura and thrombotic purpura. , need a system check to find out the cause and symptoms. Therefore, purpura should not be taken lightly. There are many ways to classify purpura, which can be divided into thrombocytopenic purpura and non-thrombocytopenic purpura according to general habits. Some people divide it into inflammatory purpura and non-inflammatory purpura according to the changes of blood vessel wall. Others are classified according to etiology and clinical manifestations. Common purpura and its classification are as follows: According to the etiology of patients, there are three main types: (1) Simple purpura has unknown etiology, generally mild onset, no obvious changes in blood vessels, and occasional mild coagulation dysfunction. (2) Henoch-Schonlein purpura often occurs due to the increase of permeability and brittleness of blood vessel wall, and the vascular system changes, but the blood itself does not change. Therefore, the number of platelets, coagulation time and prothrombin time are all in the normal range. (3) Idiopathic thrombocytopenic purpura, also known as hemorrhagic purpura, the cause of which is unknown. However, antiplatelet factors can be found in the blood of some patients, which can reduce platelets and lead to bleeding. According to the clinical manifestations, there are four main types: (1) Purpura simplex generally has no systemic symptoms, and bright red petechiae scattered about the size of a needle can appear on both lower limbs, which will not fade after pressing. After seven days, the color gradually faded. But there are new petechiae. (2) Idiopathic thrombocytopenic purpura can be divided into acute type and chronic type. Acute type is rare, can occur in children, and often has a history of infection before onset. The characteristics of the disease are sudden onset, fever, extensive bleeding of the skin, massive ecchymosis, hematoma, bleeding of mucous membrane and urogenital tract, and obvious decrease of platelets, which can be less than 5000 /mm3. Chronic type is more common, with more young women and slower onset. Persistent or repeated bleeding. It not only occurs in the skin, mucous membrane or internal organs, but also bleeds in severe cases. (3) Rheumatic Purpura has slight ecchymosis of the size of rice grains on both lower limbs, and ecchymosis, wheal or edematous erythema may also appear. At the same time, joint swelling and pain can occur, and systemic symptoms such as fever and limb weakness can also occur. (4) The skin manifestations of abdominal purpura are the same as those of rheumatic purpura, but there may be abdominal pain, vomiting, diarrhea, acute diarrhea, stool bleeding and other symptoms. Severe cases can be complicated with intussusception [edit this paragraph] The diseases caused by epilepsy and allergic epilepsy are collectively called purpura, and most of them are allergic purpura caused by vascular system disorder (Scheer-Heinz disease) and primary thrombocytopenic purpura caused by thrombocytopenia. Henoch-Schonlein purpura (Henoch-Schonlein purpura) is a systemic acute reaction in allergic reaction (allergic reaction), which is an allergic disease caused by injection of horse serum to treat diphtheria. Similar to the symptoms of this vascular purpura. So it was named after allergic purpura. Henoch-Schonlein purpura in children, also known as purple spots, is a common disease in children's hemorrhagic diseases. The clinical manifestations are bleeding under the skin mucosa, petechiae and ecchymosis, and the color does not fade after pressing. This disease mostly occurs in school-age children and is common in thrombocytopenic purpura and allergic purpura in western medicine. The main points of diagnosis of children's purpura are acute onset and recurrent purpura, which can occur in the skin and mucosa of all parts of the body. Rashes are varied, ranging from pinprick-like to ecchymosis or hematoma, and can also be fused into blocks. The color of the rash is reddish or bright red at first, and it will not fade after pressing. After a few days, it will turn into lavender and light blue, and gradually fade. Acute onset is often accompanied by nosebleed, bite, bloody stool, hematuria or vomiting, abdominal pain, joint swelling and pain and other symptoms. This disease belongs to the category of blood syndrome and should be differentiated from the macula caused by fever. The occurrence of febrile diseases is mostly related to the abnormal qi at four seasons. Every infectious disease is characterized by high fever and headache, followed by macula, acute onset, rapid spread, and even coma and convulsion. Laboratory examination: if thrombocytopenia, prolonged bleeding time, normal coagulation time, poor contraction of blood clot, positive anti-platelet antibody test and positive beam arm test, it is suggested that it is thrombocytopenic purpura; If the platelet count, bleeding time, coagulation time and blood clot contraction are normal, it indicates allergic purpura. Other treatments for children's purpura 1. External treatment: grass fog15g, keel 30g, dried alum 30g, * * * ground into fine powder, and the nose can be stopped with a wet cotton swab. 2. Acupuncture therapy (1) Zusanli, Quchi, Hegu and Xue Hai. Suitable for allergic purpura. (2) Ear acupuncture takes spleen, endocrine, adrenal gland, lung, etc. Suitable for allergic purpura. 3. Diet peanut coat jujube soup: peanut coat 5 ~ 10g, jujube 10g, codonopsis pilosula 15g. Decoct with water, daily 1 dose. It is suitable for purpura with qi failing to absorb blood. Jujube Shengdi Drink: 65,438+00 jujubes, 30 grams of Radix Rehmanniae, 65,438+00 grams of Arnebia euchroma and 65,438+00 grams of Glycyrrhiza uralensis Fisch, decocted in water to make tea. Qiangen Shuiyu Soup: 1 Shuiyu (soft-shelled turtle), Qiangen 10g, Agrimonia pilosa 10g, and proper amount of seasoning. Can you fish in water? Wash, stir-fry the roots and hairs of Agrimonia pilosa, remove residues, stew fish in water and add seasonings. 1 Dose Take 8- 10 continuously every day or every other day. It is suitable for purpura with yin deficiency and excessive fire. Cogongrass rhizome drink: buffalo horn 30g, radix rehmanniae 15g, cortex moutan 10g, cogongrass rhizome 15g, and proper amount of sugar. Decoct with water, daily 1 dose. It is suitable for purpura caused by blood heat rash. ● Introduction Simple purpura refers to a hemorrhagic disease that has no other symptoms, appears spontaneously and repeatedly in the skin, especially in the lower limbs, and can disappear without treatment. The etiology and pathogenesis of the disease are still unclear. It may be caused by abnormal capillary wall. The beam arm test was positive, and other hemostasis functions were normal. No bleeding occurred in internal organs and other parts. This disease often occurs in a family. Mainly seen in women, men are rare. Because this disease is sexual orientation, and mainly appears before menstruation, it may be related to endocrine. In addition, it has also been suggested that abnormal platelet function in some patients is also one of the mechanisms leading to this disease. This disease is mainly manifested as bleeding symptoms, especially skin bleeding spots and bleeding spots, so it belongs to the scope of "purple spots". There is a profound understanding of the physiology and pathology of blood in the medical work Neijing. For example, "On the Nose" says: "The essence is also in harmony with the five zang-organs, and it can be distributed in the five zang-organs, so it passes through the five zang-organs with the pulse." This "camp" refers to "blood" It is pointed out in the summary of blood loss in medical records that "skin bleeding is called muscle bleeding". As for the pathogenesis of this disease, The Surgical Authentic Grape Epidemic says: "The abnormal qi at four seasons lingers on the skin, forming green spots, and the color is like grapes ...". Zhu Danxi thinks that the hair spots are mainly caused by excessive heat, and Danxi's hand mirror says that "hair spots are also hot". Regarding the location of the disease, there is a clear understanding of the location of the disease in Jin Jian of Medical Zong, Heart of Surgery and Grape Epidemic: "It occurs all over the body, but mostly in the leg gaskin". Physicians in past dynasties have their own advantages in treating "blood syndrome", which is fully described in The Complete Book of Jingyue in Ming Dynasty. Zhang Jingyue pointed out: "Those with blood deficiency and slight fever should be cooled and supplemented"; "If blood is due to qi deficiency, it should be supplemented with qi"; "If there is chaos in the blood, it is the sum of the officials and the Qing Dynasty." In Tang Rong's theory of blood syndrome, he put forward four steps to treat blood, pointing out: "Only stopping bleeding is the first important method. After the bleeding stops, it is blood stasis that stays in menstruation but doesn't spit it out ... So eliminating blood stasis is the second method. After stopping vomiting and removing blood stasis, drugs are needed to stop blood from flowing again, so the method of calming blood is the third method. When evil is put together, the right thing will be empty. Removing more blood, yin is not empty, is a method of tonifying deficiency and collecting. The four are the guidelines for treating blood syndrome. " In the Song Dynasty, represented by Taiping Shenghui Prescription, there were many prescriptions mainly for clearing away heat and toxic materials, cooling blood and eliminating spots. ● Etiology and pathogenesis (1) It is felt that the external evil pulse is the house of blood, and the blood circulates in the pulse and throughout the body, nourishing the viscera, flesh and bones. When the external evil invades, it turns into heat poison, sears the blood, and the heat forces the blood to rush, and the blood overflows the pulse, thus forming muscle spasm. (2) Overwork caused by long-term illness hurts the spleen and stomach, or spleen deficiency caused by long-term illness, spleen weakness, spleen failure to control blood, and blood overflow. Long-term illness injures yin, body fluid is not abundant, yin deficiency and fire are flourishing, and deficiency fire forces blood to flush blood. (3) Repeated bleeding due to internal resistance of blood stasis, or blood circulation obstruction due to qi deficiency, or body fluid damage due to yin, so that blood stasis is blocked, new blood is not born, blood does not return to meridian, and blood overflows the pulse, resulting in bleeding performance. For example, Lingshu Jing said: "If the hand is deficient in yin, the pulse will be blocked, and the blood will not flow if the pulse is blocked." ● Clinical manifestations (1) Bleeding from heatstroke 1 Main symptoms: acute onset, short course of disease, sometimes accompanied by fever, blue spots or patches on the skin, mostly in the lower limbs, dry throat, thirst, yellowing, irritability, sleepless nights, sometimes accompanied by aversion to cold, fever, headache, joint pain, red tongue and fur. Syndrome analysis: pathogenic heat is abundant in the interior, forcing blood to rush to ren, and blood overflows into the skin, forming muscle spasm. Internal heat stagnation will cause fever; When the body fluid is exhausted by heat, the throat is thirsty; Disturbed by heat, the gods are restless; Heat turns bladder muscles yellow; The evil of wind and heat attacks the exterior, and the good and evil contend. If the camp is not in harmony with the guard, it will produce aversion to cold and fever, headache and joint pain. Tongue pulse belongs to heat image. (2) Deficiency of kidney essence 1 Main symptoms: purple spots on the skin, soreness and weakness in the waist and knees, tinnitus, fever in hands and feet, hot flashes and night sweats, menorrhagia, dreaminess at night, red tongue with little fur, and heavy pulse. Syndrome analysis: chronic illness fatigue, kidney essence failure, deficiency fire blazing inside, burning pulse, forcing blood to rush to ren, so purple spots on the skin occur from time to time; The waist is the home of the kidney, and the kidney begins to understand the ear. Kidney deficiency leads to soreness in the waist, weakness in the knees and tinnitus. Kidney governs uterus, and kidney yin is insufficient. Deficiency will hurt the pulse, and collateral rupture will lead to blood overflow, leading to menorrhagia. Virtual fire disturbs the mind, and when you are distracted, you dream more at night; The remaining syndromes, tongue and pulse are all symptoms of deficiency of kidney yin. (3) Deficiency of both qi and blood 1 Main symptoms: scattered purple spots on the skin, repeated attacks, pale color, accompanied by shortness of breath, fatigue, anorexia, pallor, dizziness and palpitation; The tongue is pale, the coating is thin and white, and the pulse is thin and weak. Syndrome analysis: Qi handsome is blood, pneumatic is blood, qi deficiency is blood out of control, blood does not follow menstruation, so the skin is purple and white; Repeated bleeding, qi goes with blood, leading to deficiency of qi and blood, malnutrition of viscera, meridians and limbs, so fatigue and shortness of breath; Lack of effort, palpitations when the heart loses support; Empty malnutrition will make you dizzy; Blood deficiency can lead to pale tongue and white face, and insufficient pulse can lead to weak pulse. (4) The main symptoms of blood stasis 1: dark purple skin, dizziness and palpitation, especially when moving; Or accompanied by low fever, fever in hands and feet, emaciation and dry eyes; But it is light in weight, with ecchymosis and petechiae, and the pulse is fine and astringent; Or red tongue, ecchymosis or ecchymosis, thin pulse. Syndrome analysis: repeated bleeding and blood stasis hinder the growth of new blood; Or vaginal fluid loss, blood vessels can not be filled, resulting in poor blood circulation, blood stasis. Symptoms of dizziness, palpitation, exercise, especially deficiency of qi and blood; Low-grade fever, fever of hands and feet, emaciation and dry eyes are the symptoms of yin deficiency of liver and kidney; Pale tongue, thready pulse, ecchymosis on tongue, blood deficiency and blood stasis; Red tongue, ecchymosis and thready pulse are symptoms of yin deficiency of liver and kidney. Diagnosis ● Diagnosis and differential diagnosis [diagnosis] 1 Pathogenic characteristics: patients with heat syndrome and blood overflow syndrome belong to excess syndrome and heat syndrome, sometimes accompanied by a history of exogenous diseases; The other three types of recurrent attacks. The purple spots on the skin are sometimes heavy and sometimes light, the disease develops slowly, the course of disease is long, and the accompanying symptoms are mild, which is often ignored. Syndrome characteristics (1) The skin is blue-purple spots or patches with different shapes, which are hidden in the skin and can be caressed without disturbing the hands. (2) Common in limbs, especially lower limbs. (3) Women are more common, and menstrual period is aggravated with menorrhagia. . (4) Self-healing tendency. (5) The course of bleeding is short except for blood fever, and the onset is urgent. Other types of bleeding have long course, recurrent attacks and a chronic process. [Differential diagnosis] erysipelas: It is a surgical disease, so it is named because its skin color is as red as red Dan. Light press will fade, and heavy press will not fade, but local skin is hot and red, which is different from purple spots. ● Diagnosis and differential diagnosis of western medicine [diagnosis] 1 Clinical manifestations are spontaneous and mild skin ecchymosis or ecchymosis, mainly in lower limbs, upper limbs occasionally, trunk rarely, without inducing factors. The ecchymosis or ecchymosis is uneven in size and distribution, does not rise above the surface, and does not fade or hurt when pressed. Before ecchymosis appears, there may be slight pain locally. I often feel dull pain in my leg skin when I dress the next morning, and I found ecchymosis after examination. If left untreated, ecchymosis can subside by itself, leaving blue-yellow pigment patches, which will gradually disappear later. Purpura often recurs and gets worse during menstrual period. Patients generally have no bleeding from internal organs or other parts. Mucosal bleeding is rare, sometimes there is a small amount of bleeding in the gums, increased menstrual flow and prolonged menstruation. The amount of bleeding during tooth extraction, surgery, trauma and delivery can be slightly more, but it will not cause serious bleeding. Laboratory examination (1) showed that the beam arm test was positive or negative, but the routine examination of hemostasis function was normal. (2) A few patients had abnormal platelet aggregation induced by ADP and epinephrine, and the adhesion rate to glass beads column decreased. 3 Diagnostic criteria (1) are always healthy. Most of the lower limbs spontaneously appear ecchymosis or ecchymosis, which can disappear by itself. No family history. (2) The beam arm test is positive or negative, but the routine examination of hemostasis function is generally normal. (3) Purpura caused by other reasons can be excluded. [Differential diagnosis] 1 Aspirin-like defect: it is an autosomal dominant hereditary disease with dysfunction of platelet release. Patients are particularly sensitive to aspirin; Platelet count is normal; The effectiveness of PF-3 is abnormal. Clinical epithelial lesions are unevenly distributed, mucosal bleeding is obvious, and bleeding is more serious during trauma or operation. 2 Mild von Willebrand disease: there is mucosal or visceral bleeding. The bleeding time of some patients was prolonged; Aspirin tolerance test was positive; ⅷ: C decreased, ⅷ R: Ag decreased obviously; Platelet adhesion rate can be reduced; Platelet aggregation of listeriomycin is weakened. Henoch-Schonlein purpura: It is a vascular allergic hemorrhagic disease, that is, immune vascular disease. There are usually symptoms of fever, infection and general malaise. Purpura is distributed symmetrically in limbs and appears in batches, and ecchymosis and ecchymosis are mainly on the extension surface of hands and feet. Often accompanied by abdominal pain. Joint pain or swelling, bloody stool, hematuria and edema in some patients. Laboratory examination showed that platelet count, bleeding and clotting time, blood clot retraction test were normal, bone marrow examination was normal, and bundle arm test was positive. Outcome and prevention ● Outcome and prognosis The prognosis of this disease is generally good and will not cause serious harm to health. Mild purple spots can heal themselves without treatment. If it is a new disease, it belongs to excessive healthy qi and excessive pathogenic factors. If treated correctly, 1 month can be cured. However, this disease is a recurrent process, with long course, mixed deficiency and excess, and dysfunction of viscera, which should be actively treated to avoid syndrome changes over time. ● Recuperate and strengthen the body to prevent the invasion of external evils; People with yin deficiency in diet should avoid spicy food; People who repeatedly bleed should live a good life and not be too tired, so as not to aggravate their condition. ● Prevention Because this disease is spontaneous bleeding, there is no obvious inducement and no obvious accompanying symptoms, so it is difficult to prevent it. According to the pathogenesis of this disease in traditional Chinese medicine, measures should be taken to strengthen physical fitness, live moderately, work hard in a hurry, and pay attention to rest after the onset. What is thrombocytopenic purpura? What are the characteristics and hazards? Thrombocytopenic purpura is characterized by a significant decrease in platelets, accompanied by cutaneous mucosal purpura. In severe cases, bleeding may occur in other parts, such as nosebleeds, gingival exudation, menorrhagia or severe hematemesis, hemoptysis, hematochezia and hematuria. Intracranial hemorrhage is the fatal cause of this disease. Henoch-Schonlein purpura is characterized by scattered spots on the skin of limbs or spreading to the whole body. Severe cases are accompanied by joint pain or abdominal pain, bloody stool, vomiting blood, collapse and so on. In severe cases, it can develop into henoch-schonlein purpura nephritis. Thrombocytopenic purpura can be divided into primary and secondary. Primary thrombocytopenic purpura is an immune syndrome and a common hemorrhagic disease. It is characterized by the existence of anti-platelet antibodies in blood circulation, which makes platelets destroy too much and causes purpura; However, the megakaryocytes in bone marrow are normal or increased, which is childish. Clinically, it can be divided into acute and chronic, and its pathogenesis and manifestations are obviously different. The acute type is mostly 10 children, both male and female. There is no difference between the sexes. Most of them occurred in winter and spring, and there was a history of virus infection before illness, mostly upper respiratory tract infection, rubella, measles and chickenpox. After vaccination, the incubation period of infection and purpura is mostly within 1~3 weeks. Adult acute type is rare, often related to drugs, and the condition is more serious than that of children. Have a sudden fever. Mainly skin and mucous membrane bleeding, often more serious. Skin bleeding is petechiae with different sizes and uneven distribution, which mostly occurs in limbs. Mucosal bleeding includes nosebleed, gingival bleeding, oral and tongue mucosal blood bubbles. There are often gastrointestinal bleeding, urinary tract bleeding, subconjunctival bleeding and a few retinal bleeding. Common spinal cord or intracranial hemorrhage can cause paralysis of lower limbs or intracranial hypertension, which can be life-threatening. Chronic type is more common, accounting for 80% of primary thrombocytopenic purpura, and most of them are 10~40 years old, and women are 3~4 times as many as men. Sneak when you are sick. Patients may have persistent bleeding or recurrent attacks, and some may show local bleeding tendency, such as recurrent epistaxis or menorrhagia. Congestion and ecchymosis can occur in any part of skin and mucosa, but more often in distal limbs. There may be gastrointestinal and urinary tract bleeding. Deep hematoma can also occur after trauma. Intracranial hemorrhage is rare, but it can still occur during acute attack. You can occasionally touch the spleen when inhaling deeply. The etiology and pathogenesis of primary thrombocytopenic purpura have not yet been clarified. It is considered as an immune-related disease. At present, the first choice for western medicine to treat thrombocytopenic purpura and allergic purpura is hormone. Platelets can generally increase after taking it, but the side effects of hormones are very great. While increasing platelets, it will also increase many new diseases, such as centripetal obesity, hypertension, diabetes, osteoporosis and so on. After reducing the dosage of hormone, platelets will drop again, and will still recur after stopping taking the drug. Splenectomy is dangerous and difficult for patients to accept. Spleen is the immune organ of human body. After splenectomy, the patient's immune function is low, which is easy to cause serious infection and bring great pain to the patient's body and mind. The recurrence rate after splenectomy is about 58%. China International Institute of Biomedical Engineering, affiliated to the Blood Center of Beijing Huajun Hospital of Traditional Chinese Medicine, specializes in treating purpura, and is the authoritative institution for treating purpura in traditional Chinese medicine. The expert group headed by Professor Shi has made a breakthrough in the treatment of allergic purpura \ thrombocytopenic purpura, which can fundamentally treat purpura.