How TCM Treats Purpura on the Skin of Advanced Cancer Patients
Some cancer patients in the advanced stage repeatedly develop purpura on the skin. Modern medicine recognizes three possible causes: first, thrombocytopenia; second, capillary lesions; third, coagulation disorders. All three are highly likely in advanced cancer patients, so purpura frequently appears on their skin.
Whatever the cause, the appearance of purpura indicates increased capillary fragility and permeability, with blood extravasation leading to bleeding of the mucosa and certain organs. This is accompanied by small-vessel vasculitis; if not treated promptly, it may affect the skin, gastrointestinal tract, joints and kidneys. Skin purpura is especially common in leukemia and lymphoma patients.
So how does TCM view skin purpura? Generally, TCM considers it caused by reckless movement of hot blood or by qi and blood deficiency. Clinical treatment should mainly follow the methods of clearing heat and cooling blood, activating blood and stopping bleeding, and supplementing qi and blood. The author has treated many advanced cancer patients with skin purpura, using a combination of supplementing qi and blood, activating blood and stopping bleeding, and clearing heat and cooling blood; the effect is definite and reproducible. This article introduces the author's approach.
The author's experienced formula is a modified combination of Siwu Decoction, Huangqi Danggui Buxue Decoction and Erzhi Pill, comprising: Taizishen (Pseudostellariae Radix) 30 g, Sheng Huangqi (Astragali Radix) 60 g, Danggui (Angelicae Sinensis Radix) 12 g, Shengdi (Rehmanniae Radix) 12 g, Chishao (Paeoniae Rubra Radix) 15 g, Mudanpi (Moutan Cortex) 15 g, Shudi (Rehmanniae Radix Praeparata) 12 g, Zicao (Arnebiae Radix) 15 g, Qiancao (Rubiae Radix) 15 g, Xianhecao (Agrimoniae Herba) 30 g, Shengdiyu (Sanguisorbae Radix) 12 g, Hanliancao (Ecliptae Herba) 15 g, Nüzhenzi (Ligustri Lucidi Fructus) 15 g, Sheng Huaimi (Sophorae Flos Immaturus) 15 g, Ceboye (Platycladi Cacumen) 15 g, Fengweicao (Pteris Herba) 30–50 g, Chanyi (Cicadae Periostracum) 15 g, Digupi (Lycii Cortex) 12 g, Daji (Cirsii Japonici Herba) 15 g, Xiaoji (Cirsii Herba) 15 g, Jinyinhua (Lonicerae Flos) 30 g, Yejuhua (Chrysanthemi Indici Flos) 15 g, Fuping (Spirodelae Herba) 15 g, Sanqi powder 6 g (taken in 3 divided doses infused in warm water).
This formula is further modified according to the patient's condition. Patients with spleen deficiency additionally need Fuling (Poria), Baizhu (Atractylodis Macrocephalae Rhizoma), Huaishanyao (Dioscoreae Rhizoma) and Zhigancao (Glycyrrhizae Radix Praeparata) in appropriate amounts; those with indigestion should add Jiao Sanxian and Jineijin and other digestive-dispersing herbs; patients with concurrent edema may judiciously add water-disinhibiting, edema-reducing herbs such as Cheqianzi, Cheqiancao, Niuxi, Hanfangji, Fuling, Zhuling, Yiyiren, Dongguapi, Yimucao and Zexie.
It should be noted that if purpura is accompanied by edema, the patient's renal function may already be impaired; the physician must closely follow the Western-medicine renal-function lab results. During inquiry, also ask whether the urine is tea-colored or red, and whether it contains much foam.
Once purpura appears, avoid fragrant, drying medicinals. TCM holds that fragrant, drying herbs have the side effect of consuming and moving blood; in practice most of them tend to increase the patient's bleeding tendency. If they must be used as a last resort, control the dosage and pair them with herbs that restrain their side effects.