Idiopathic Thrombocytopenic Purpura ITP is a somewhat archaic term click here a condition of low platelets thrombocytes.
Idiopathic means that the cause is unknown; with advances in modern technology, a substantial amount has been learned about the causes. While one may not be able to definitively point to all the causative factors and agents involved in any one patient, as is the case with many diseases, now it is often possible to describe much of the etiology and pathology of ITP quite accurately.
Purpura refers to the splotches seen on the skin where capillaries have leaked blood to yield a bruise or many red or purple petechia flat, pin-head sized spots. However, with careful monitoring of the platelet counts and appropriate treatment when the platelets approach a low level, people with this disease may rarely show any such symptom. Nonetheless the moniker ITP has stuck in the medical literature and will, as a result, continue to be click here here.
The deficiency of platelets has two basic origins: In primary ITP, the bone marrow produces platelets as fast as usual at least in the early stages of the diseasebut even before they have a chance to mature, they are taken out of circulation. It is likely that individuals who suffer this disease have a genetic propensity to get it, and that a viral disease triggers it.
Many autoimmune disorders have this characteristic. In such cases, treatment is often aimed at inhibiting the immune source with corticosteroids e.
If necessary, the spleen is removed splenectomy in order to both reduce the production of anti-platelet antibodies and to slow the clearance of the platelets Heat Treatment Literature Review the system the spleen filters out the platelet-immune complex.
A suitable name for this disease is autoimmune thrombocytopenia. Autoimmune thrombocytopenia occurs mostly in children and young adults typically before age 30though it can rarely occur later in life. Many times, it manifests as an acute disease, lasting a few weeks and then clearing up completely.
It might recur again later after another viral infection or with reactivation of a chronic virus, but eventually it ceases to be a problem in the majority of children who experience it.
The acute manifestation can usually be controlled by a course of therapy using steroids to Heat Treatment Literature Review the immune response for a period of several weeks. Chronic autoimmune thrombocytopenia develops in a small percentage of patients.
In that case, steroid therapy eventually fails due to the side effects from prolonged administration. Until recently, the main therapy for chronic autoimmune thrombocytopenia has been splenectomy, which is sometimes curative, but at least reduces the disease severity.
More recently, intravenous IV infusion of normal IgG hence the treatment initials: IVIG has also been proposed as an alternative to the initial therapy with prednisone. Other therapies are also being developed.
Medical opinion appears to be leaning towards finding an alternative to splenectomy. A defect in the production of platelets by the bone marrow, resulting in ITP, can occur as part of a general bone marrow dysfunction, in which both red and white blood cells are also produced insufficiently.
Or, it can occur secondary to leukemia, in which the stem cells that yield white blood cells proliferate and crowd out the stem learn more here that produce platelets and red blood cells yielding high white cell count and low RBC and platelet counts. Low platelets can also occur as the result of certain medical treatments, such as chemotherapy for cancer. Some chronic diseases that affect the immune system, such as HIV, hepatitis C, and Heat Treatment Literature Review lupus, may yield a combination of inhibited platelet production and shortened time that platelets persist in the blood, with resulting ITP.
For these situations, the platelet deficiency is called secondary ITP, because there is something else going on first or at the same time that yields the clinical Heat Treatment Literature Review.
The platelet disorder that may be resolved if the other disease process or medical treatment is removed.
In China, both primary and secondary ITP are noted in the medical literature, though primary ITP is the main subject of the reports and is the object of the current article. Treatment, other than Western medical therapies, is based on using Chinese herbs: The Chinese herbal therapies vary markedly from one physician to the next and sometimes among different patients, depending on the differential diagnosis.
This web page general theory of treating primary ITP, at least as it occurs in children and young adults, is that there is a heat syndrome causing the blood to escape the vessels.
Therefore, clearing heat is the primary concern. Also, since bleeding is the symptom, treatment with hemostatic herbs, especially those which are also Heat Treatment Literature Review, is standard procedure. There are two major causes of the blood heat, one being an excess heat syndrome that might be associated with a viral infection and the other is a yin deficiency syndrome, which may arise from nutritional deficits, prior diseases, or inherent factors.
In the case of the yin deficiency syndrome, nourishing yin tonification is deemed the most important aspect of therapy. Except in the cases of dominant excess syndrome, there are usually some herbs included in the ITP treatment to tonify the spleen, owing to the concept that the spleen restrains the blood within the vessels and the spleen helps produce new blood and replenishes the yin.
In patients who show an evident spleen qi deficiency syndrome, the qi tonics may become a major part of the therapy, with less emphasis on clearing heat or nourishing yin. In cases where there is prolonged disease, the deficiency of qi often extends to a deficiency of the kidney and additional tonic therapies may be added. For most cases of secondary ITP, the theory is that the bone marrow is inadequate to produce the cells and this is addressed by tonifying the kidney to invigorate marrownourish the liver to increase the blood storageand tonify the qi to help produce blood and essence.
Within the theoretical framework, a number of different herbs are selected. Among the most commonly used herbs for primary ITP are the ones listed in Table 1. Heat Treatment Literature Review
1 A Project Report on HEAT TREATMENT OF LOW CARBON STEEL In partial fulfillment of the requirements of Bachelor of Technology (Mechanical Engineering). Despite enumerable studies on the prevention and treatment of heat illness, exertional heat stroke not only continues to be a leading cause of death among young. Heat treatment is an operation that is both time consuming and costly. It can affect the strength and toughness of a welded joint, its corrosion resistance and the. TREATMENT OF ITP WITH CHINESE MEDICINE. by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon. Idiopathic Thrombocytopenic. The fundamentals of flame treatment for the surface activation of polyolefin polymers – A review.
Note that some of the herbs are classified differently than the standard Materia Medica categories. Within these four groups are herbs that vitalize blood circulation red peony, moutan, salvia, san-chi, tang-kuei, millettiawhich is another method of therapy that has been proposed, to be described later in this article. According to the Chinese medical reports, administration of decoctions made with the above-mentioned herbs in appropriate combinations will raise the platelet levels in patients with persistent ITP, often to an acceptable level, though only rarely will they return to the normal range.
Normal platelet levels are usually defined as or above billions of platelets per liter of blood. According to the clinical reports, the use of herbs will often raise the platelets from the unacceptable level below 50, at which bleeding that is difficult to stop may occur to an average of about 75— Some patients described in the literature had their platelet levels reach over and very few attained a completely normal level. If the Chinese herb therapy can raise the platelets to an acceptable level, the condition may stabilize for most individuals within a few days or weeks; if there is a relapse, then the same kind of treatment might be applied again.
For persisting ITP, which is a greater concern because of the difficulty of finding suitable modern medical therapy, Chinese herbal treatment will usually be administered for several weeks or months.
In the Chinese clinical evaluations, the success of the therapy for the chronic disease is often monitored in terms of the relapse rate after the herbs have been stopped. Herbal therapy is reported to be of some benefit to nearly all patients, though the degree of improvement varies markedly and the relapse rate within a year, if monitored that long is often high.
The Chinese herbal therapies are claimed to be superior in their results and lacking in the characteristic side effects of the drugs. Because the randomization and matching of patients in the herb treatment and control groups is usually not clear in the Chinese reports, the value of the comparisons can be questioned.
Further, it is unclear in the reports to what extent the corticosteroid dosage is manipulated according to methods commonly recommended in modern clinical practice. Therefore, in the summaries of the medical journal articles presented here, the results for the control group are usually not indicated.
The main purpose of conveying the information presented in the Chinese journal articles is to illustrate the selection of herbs, the dosage described in a separate section of this article Heat Treatment Literature Review, duration of therapy, time to obtain changes in platelets, and the claimed results of therapy. Heat Treatment Literature Review very large college has a number of affiliated hospitals where studies can be carried out.
There are also other medical universities in Shanghai that cooperate with the TCM College in conducting some of the studies. The majority of the recent Chinese clinical reports describe trials involving a Heat Treatment Literature Review herb formula that may be modified slightly according to presenting conditions. However, outside of the trial setting, differential diagnosis is the Heat Treatment Literature Review, so this aspect is presented first.
A study of patients with ITP according to their traditional Chinese diagnostic category was carried out by the Shanghai College of Traditional Chinese Medicine and published in 1. It involved patients 75 female with an age range of 12—58 years. The differentiation went this way:. Mean Age Mean Duration of Disease. The qi-deficiency group was described as a spleen-deficiency type; the blood-heat type Heat Treatment Literature Review described as an excess syndrome, the yin-deficiency type was described as a syndrome secondary Heat Treatment Literature Review chronic spleen deficiency; and the yang-deficiency type was said to be a deficiency of spleen and kidney.
The control group of non-ITP patients involved 20 individuals with a similar ratio of the two sexes, mean age of 30, and similar range of ages as the differentiation group.
The control group was included for obtaining relative blood values. Looking at the mean values for patient age and disease duration only, it can be seen that the disease generally started before age 30 and falls in the category of chronic ITP.
According to the analysis, the most common type of the disease is a yin-deficiency syndrome. The deficiency of qi and of yang correlated with the most dramatic elevation of IgG. In the report, there were also slight elevations noted in IgA and IgM for click here the ITP patients, but not sufficient to explain the disease manifestation.
The platelet numbers did not vary much from one group to the next the control group level is quite low to begin with, suggesting that these numbers are not directly comparable to those from other laboratories.
Heat Treatment Literature Review report also presented information on T-cell subsets, but there were no significant differences Heat Treatment Literature Review their numbers or ratios among the different groups, including the controls.
The trial group of 36 patients receiving this formula ranged in age from 13—60 years. Treatment time was at least three months average days and it was reported that all but 3 of the patients had improvement of symptoms. The average increase of platelets was from 38 to 79, and the average decrease in IgG was from 74 to The formula included herbs for tonifying qi astragalus, codonopsis, licoricenourishing yin rehmannia and ecliptaclearing heat moutan, isatis leaf, raw rehmanniaand inhibiting bleeding agrimony and eclipta.
The use of perilla stem zisugeng is unique; it is not found in other formulations for ITP see key herbs section, below. This basic formula was later adopted by another group at the same college using differential diagnosis and treatment 3. According to their report, there were four categories of disorder and treatments, but the data for all the Heat Treatment Literature Review were then pooled for analysis rather than divided by group.
The above-mentioned formula was adopted for the yin-deficiency group and modifications of it were used for the other groups as shown in Table 3. Differentiation Group Number of Patients. All of the formulas included moutan, perilla stem, and licorice, and all but the qi-deficiency formula included raw rehmannia, while all but the blood-heat formula included astragalus, codonopsis, tang-kuei, and agrimony. For the kidney-deficiency cases, the formulas included cooked rehmannia and eclipta.
The herb formulas were prepared as a liquid syrup and consumed three times per day. A control group was given prednisone; treatment time was at least three months. Side effects of the herb therapy were limited to a few cases of check this out of appetite and thin stools.
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The prednisone group presented side effects in half the patients including the typical increase of body weight and upset stomach. Mean values for platelets in the herb group rose from 38 before treatment to 68 after treatment. The control group had nearly identical mean values. Some patients were treated for six months to a year, and the platelet values continued to rise slowly in the herb treatment group, reaching 75 at six months and 88 at one year.
The IgG values in the herb treatment group declined from 99 at the beginning of treament to 41 at the end of treatment three months ; the values for the control group were similar. The authors claimed that the best therapeutic responses were among the patients suffering from qi deficiency and yin-deficiency syndromes. The herbs for the yin deficiency type were made as a decoction with 10—15 grams of each herb except cuttlebone at 25 grams.
A control group was treated with prednisone.
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At the end of four weeks, 35 of the herb treated patients had some level of improvement; after one year, 56 of the 61 herb treated patients had some degree of improvement.