Summary of Senior Physician Zhu Yongxian's Experience in Treating Allergic Purpura (Part 1)

Senior physician Zhu Yongxian was an expert in dermatology, skilled in treating a wide range of skin diseases. Among his case records there are 26 cases of allergic purpura. Although the medication regimens differed slightly from patient to patient, the overall therapeutic approach was broadly similar. The following presents his prescriptions for these 26 patients, grouped into several major categories and introduced one by one. This article presents three cases treated by the method of cooling blood and stopping bleeding.

Case 1: A 13-year-old male pediatric patient.

This patient first consulted Dr. Zhu on October 17, 2010. By the time of the visit he had already had a two-month history, repeatedly treated without cure and relapsing. At presentation, dense petechiae the size of needle points to mung beans appeared subcutaneously on both lower limbs, bright red or dark red in color, not fading on pressure, with the rash slightly raised above the skin surface and partly confluent into patches. Dr. Zhu differentiated the child as having blood-heat internally harbored, contracted wind-heat pathogen that had stagnated over time into toxin-heat, forcing the blood to flow recklessly; treatment was given by the methods of resolving toxin and resolving stasis, cooling blood and stopping bleeding.

Prescription: Chishao (Paeoniae Radix Rubra) 12g, Shengdi (Rehmanniae Radix) 10g, Mudanpi (Moutan Cortex) 10g, Zicao (Arnebiae Radix) 12g, Zizhucao (Callicarpae Formosanae Herba) 12g, Xianhecao (Agrimoniae Herba) 15g, Shengdiyu (Sanguisorbae Radix) 15g, Hanliancao (Ecliptae Herba) 15g, Nüzhenzi (Ligustri Lucidi Fructus) 20g, Sheng Huaihu (Sophorae Flos Immaturus) 15g, Sanqi Fen (Notoginseng powder) 4g, Chan'yi (Cicadae Periostracum) 15g, Jiangcan (Bombyx Batryticatus) 12g, Digupi (Lycii Cortex) 12g, Fuping (Spirodelae Herba) 15g, Baitouweng (Pulsatillae Radix) 15g; 7 doses, decocted in water for oral use.

After taking the medicine, the child's condition improved gradually. Across five subsequent visits the rash resolved, and follow-up over half a year showed no recurrence.

Case 2: A 10-year-old female pediatric patient, surnamed Huang.

The child first consulted Dr. Zhu on August 10, 2007. Before coming to Dr. Zhu she had been treated by the director of the Western dermatology department in the same hospital, who prescribed Western drugs such as compound rutin, dipyridamole and ketotifen, with poor effect. Dr. Zhu likewise treated her according to the principles of clearing heat, cooling blood, activating blood and stopping bleeding.

The prescription was as follows: Chishao 15g, Shengdi 12g, Mudanpi 15g, Zicao 15g, Zizhucao 15g, Xianhecao 18g, Shengdiyu 12g, Hanliancao 15g, Nüzhenzi 20g, Sheng Huaihua 15g, Sanqi Fen 6g, Chan'yi 15g, Digupi 12g, Baitouweng 12g, Fuping 15g, Daji (Cirsii Japonici Herba) 12g, Xiaoji (Cirsii Herba) 12g, Jinyinhua (Lonicerae Flos) 15g, Juhua (Chrysanthemi Flos) 15g, Jiangcan 10g, Taizishen (Pseudostellariae Radix) 10g; 7 doses, decocted in water.

The child later consulted Dr. Zhu three more times. Dr. Zhu's prescription remained essentially unchanged, with only occasional minor adjustments to the dosage of individual herbs. After 42 doses, the child's rash disappeared. Follow-up over half a year showed no recurrence.

Case 3: A 9-year-old female patient, surnamed Hu.

The child first consulted Dr. Zhu on March 12, 2011. By then the illness had already lasted four months; she had been hospitalized in pediatrics with poor effect and recurrent episodes, hence she came to Dr. Zhu. Apart from allergic purpura, this child also had joint pain. Dr. Zhu again treated with the methods of cooling blood and clearing heat, activating blood and stopping bleeding.

Initial prescription: Chishao 10g, Shengdi 9g, Mudanpi 10g, Zicao 10g, Zizhucao 10g, Xianhecao 12g, Shengdiyu 12g, Hanliancao 12g, Nüzhenzi 12g, Sheng Huaihua 10g, Sanqi Fen 4g, Chan'yi 15g, Jiangcan 12g, Baitouweng 12g, Digupi 12g, Tuniuxi (Eupatorii Herba, wild) 15g, Jinyinhua 15g, Qianghuo (Notopterygii Rhizoma) 6g, Duhuo (Angelicae Pubescentis Radix) 6g, Sheng Baishao (Paeoniae Radix Alba) 10g, Zhi Gancao (honey-fried Glycyrrhizae Radix) 8g; 8 doses, decocted in water.

After taking the medicine, the purpura markedly decreased and the pre-existing joint pain also lessened. Dr. Zhu then increased Tuniuxi to 16g and Jinyinhua to 20g. Across four visits the rash resolved and laboratory tests normalized. Thereafter the child took further medicine in a stepwise manner to consolidate the effect, with the prescription essentially unchanged; follow-up of over one year showed no recurrence.

The prescriptions for these three children were broadly similar. They were all variations built on the combination of Erzhi Wan (Two-Melody Pill, consisting of Hanliancao and Nüzhenzi), Shengjiang San (Ascending-Descending Powder, consisting of Chan'yi, Jiangcan, Jianghuang and Dahuang), and Liangxue Jiedu Tang (Blood-Cooling Toxin-Resolving Decoction, consisting of Shuiniujiao, Shengdi, Chishao, Xuanshen and Mudanpi).

Erzhi Wan is a famous formula for nourishing yin and enriching blood; Shengjiang San is known for treating nameless swellings/toxins and stagnant heat; Liangxue Jiedu Tang is the representative formula for cooling blood and dissipating macules. Dr. Zhu combined these three formulas, and his fundamental approach was to nourish yin, clear heat, cool blood and stop bleeding. This approach has good efficacy in allergic purpura, and the underlying core formula yields reproducible results, making it of reference value.