Xiao Ban Qing Dai Yin, a Formula for Treating Purpura
Purpura is a common clinical sign, presenting as red or dark-red spots or ecchymoses under the skin. Purpura is a pathological phenomenon not caused by a single etiology. When the body is injured, purpura may easily appear on the skin; purpura caused by minor trauma resolves on its own and generally needs no treatment.
Pathological purpura does not resolve easily. Purpura is related to diseases of the blood vessel wall or to hematological disorders. According to etiology, purpura is divided into four main categories: vascular purpura (such as hereditary telangiectasia), thrombocytopenic purpura (such as purpura due to thrombocytopenia from aplastic anemia or leukemia), allergic purpura, senile purpura, and simple purpura.
Ancient physicians also observed this pathological phenomenon and developed many treatment approaches. This article introduces the proven purpura formula “Xiao Ban Qing Dai Yin” from Lu Fu Jin Fang, and, using it as a basis, expands on the TCM approach to treating purpura.
The original text in Lu Fu Jin Fang describing the indications and composition of Xiao Ban Qing Dai Yin is as follows: “It treats heat evil transmitting to the interior, interior excess with exterior deficiency, blood heat not dispersing, and heat taking advantage of the deficiency to emerge through the skin as spots. Mild cases look like measles rash; severe cases show the skin mottled. Or the patient is originally yang but was mistakenly given hot herbs; or sweating was not done when it should have been, or purging not done when it should; or after purging the disorder did not resolve—all can cause this. One must not induce sweating, as further opening and dispersing will only worsen the mottling. If there is spontaneous diarrhea, oppression and shortness of breath, or dry stool obstruction with black spots, the prognosis is poor. Whenever, after sweating and purging fail to resolve, there is deafness, cold feet, oppression, cough and vomiting, this is the precursor to eruption. Ingredients: Chaihu (Bupleuri Radix), Xuanshen (Scrophulariae Radix), Huanglian (Coptidis Rhizoma), Zhimu (Anemarrhenae Rhizoma), Shigao (Gypsum), Shengdihuang (Rehmanniae Radix), Shanzhi (Gardeniae Fructus), Xijiao (Rhinocerotis Cornu), Qingdai (Indigo Naturalis), Renshen (Ginseng Radix et Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma); add one slice of Shengjiang and two Dazao; decoct, add one spoonful of vinegar, and take. If the stool is excess (constipated), remove Renshen and add Dahuang.” Xijiao (rhinoceros horn) in this formula is now prohibited for use; clinically it is replaced by water buffalo horn (Bubali Cornu).
Xiao Ban Qing Dai Yin is a classic formula for treating purpura. Its author, Gong Tingxian, was a famous physician of his generation with rich clinical experience. According to traditional TCM terminology, this is a formula dominated by heat-clearing and blood-cooling herbs: Xuanshen, Huanglian, Zhimu, Shigao, Shengdihuang, Zhizi, water buffalo horn, and Qingdai are all heat-clearing herbs.
Clearly, Gong Tingxian believed purpura is caused by “blood heat causing reckless movement of the blood,” so treatment should center on clearing heat and cooling the blood. This approach is correct: whether for allergic purpura, vascular purpura, or thrombocytopenic purpura, treating along these lines has some effect. However, if the purpura is due to thrombocytopenia, the author recommends also heavily using Xianhecao (Agrimoniae Herba; adult dose 100 g), Diyu Tan (carbonized Sanguisorbae Radix), Huaruishi (Talcum/Calcitum), and Baiji (Bletillae Rhizoma). For allergic purpura, consider adding Baitouweng (Pulsatillae Radix), Huaihua (Sophorae Flos), Zicao (Arnebiae/Lithospermi Radix), and Mudanpi (Moutan Cortex).
Qingdai in this formula is a commonly used herb in treating leukemia. Therefore, using this formula as a base and adding related anti-leukemia herbs (such as Sanleng, Ezhu, raw Huangqi, and Xionghuang, Realgar) can also serve as an adjunctive treatment for purpura caused by leukemia.
Gong Tingxian’s passage also notes that sweating herbs must not be used for purpura, which is a very apt, practical observation. Since purpura is caused by a bleeding disorder, using sweating herbs will aggravate the condition.