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PURPURA

GENERAL

Clinical Manifestations	Purpura is a condition of red or purple discolored spots on the skin that do not blanch on applying pressure. The spots are caused by bleeding underneath the skin usually secondary to vasculitis or dietary deficiency of vitamin C. They measure 0.3–1 cm (3–10 mm), whereas petechiae measure less than 3 mm, and echymoses greater than 1 cm
Treatment Principle
Herb Formulas
Points

YANG MING JING

Clinical Manifestations	High fever Profuse perspiration Great thirst with a desire to drink Abdominal pain Purpura Dryness Irritability Restlessness Feverish body parts Red face Dry stools No constipation No aversion to Cold T: Red, dry C: Dry yellow P: Rolling and rapid (gigantic)
Treatment Principle	Clear Heat Reduce fever Moisten and replenish fluids
Herb Formulas	Zhu Ling Tang
Points	DU-14, KI-3, KI-6, LI-4, LI-11, SP-6, ST-44 With Qi and Body Fluid Deficiency: DU-14, LI-11, REN-6, REN-12, SP-3, ST-36, ST-44, UB-20 With diarrhea: To Expel Wind Cold: Sedate DU-16, GB-20, LI-4, SJ-5, UB-12 To Disperse the Lungs: LU-7, UB-13 To stop diarrhea: Moxa REN-8, REN-12, ST-25, ST-36 With vomiting but no diarrhea: To Expel Wind Cold: Sedate DU-16, GB-20, LI-4, SJ-5, UB-12 To Disperse the Lungs: LU-7, UB-13 To stop vomiting: PC-6, SP-4

SHAO YIN HEAT

Clinical Manifestations	Dry throat and/or mouth Chronic sore throat (not acute) Restlessness Malar flush Purpura Insomnia Disturbed speech Low grade fever, worse in afternoon Yellow urine Irritability with a sensation of Heat in the chest Palpitations with anxiety Sores in the mouth or on the tongue More Heat than in Yin Deficiency (chronic low grade fever) T: Red, deep red C: None P: Deep, thready and rapid
Treatment Principle	Nourish Yin Reduce Heat
Herb Formulas	Zhu Ling Tang
Points	DU-14, HT-5, HT-7, KI-3, KI-6, KI-7, LIV-3, SP-6, UB-10, UB-15, UB-23

QI STAGE: LUNG HEAT

Clinical Manifestations	Purpura High fever No chills Aversion to Heat Cough Asthma Restlessness Thirst Dark yellow urine Dyspnea Chest pain Shortness of breath Thick yellow Phlegm T: Red C: Thick and yellow, maybe dry and sticky P: Rapid, maybe slippery, maybe forceful
Treatment Principle	Clear Heat in Lungs Strengthen when weak or elderly
Herb Formulas	Huang Lian Jie Du Tang
Points	Dingchuan, DU-13, DU-14, LI-11, LU-5, LU-10, ST-44. UB-13

YING STAGE HEAT: YING RE

Clinical Manifestations	Purpura Muscle aches Joint pain Radiating pain in the legs Low back pain Edema Numbness in the lower extremities Pain in the trunk and extremities Abdominal pain Sciatica Aversion to Wind and Cold Knee pain T: Pale or Pink with purple spots C: Normal P: Choppy or Taut
Treatment Principle	Unblock and relax the channels Invigorate the Blood Break up Blood Stasis Dispel Wind-Dampness Strengthen the tendons
Herb Formulas	Shu Jing Huo Xue Tang
Points

XUE STAGE HEAT WITH BLOOD STAGNATION

Clinical Manifestations	High fever Bleeding Hematemesis Epistaxis Hemoptysis Hematochezia Hematuria Purpura Purplish-red or black skin rashes (maculae) Forgetfulness Irritability Chest pain Black, tarry stools Abdominal distension and fullness Thirst with an inability to swallow Menorrhagia Mania Delirium Desire to rinse the mouth with water without swallowing it Black tarry stools Hematuria T: Scarlet with prickles or Deep purplish P: Thin and rapid
Treatment Principle	Clear Heat Relieve Fire toxicity Cool the Blood Nourish the Yin Dispel Blood Stasis Stop bleeding
Herb Formulas	Xi Jiao Di Huang Tang
Points

WIND-DAMP-BI WITH BLOOD DEFICIENCY AND BLOOD STASIS

SPLEEN NOT GOVERNING THE BLOOD

Clinical Manifestations	Sallow or pale complexion Anorexia Four limbs feel tired and heavy Physical and mental exhaustion Abdominal and epigastric distention after eating Maybe acid regurgitation or vomiting Loose or unformed stools Shortness of breath Dizziness Palpitations Functional Uterine Bleeding Purpura Epistaxis Hemafecia Hematuria Menorrhagia Metrorrhagia T: Pale and flabby - may have teethmarks C: White P: Thready and weak
Treatment Principle	Benefit Qi Conserve Blood
Herb Formulas	Jiao Ai Tang Bu Wei Fang Shou Pi Jian
Points	SP-1, SP-3, ST-36, UB-20

LIVER QI STAGNATION INVADING THE SPLEEN

Clinical Manifestations	Purpura Abdominal distention and pain Gas Borborygmus Diarrhea Distention and pain in the sides or flanks Suffocating sensation in the chest Tendency to sigh Melancholy Depression Irritability Inappropriate anger Women: Irregular menses Dysmenorrhea Breast distention and pain before and during menses T: Pink C: White and greasy P: Slippery and wiry
Treatment Principle	Soothe the Liver Invigorate the Spleen
Herb Formulas	Shao Yao Gan Cao Tang
Points	LIV-3, LIV-13, SP-6, ST-25, ST-36, ST-37

BLOOD STAGNATION

Clinical Manifestations	Purpura Fixed, stabbing hypochondriac pain which is worse at night and with pressure Hepatosplenomegaly Dark or purplish spider naevi on the ribs, face and on the inner ankle and knee Dark ashen, sallow or purplish complexion Dark purplish lips and conjunctiva Dark rings under the eyes Easily bruised Purpura Mild fever, worse at night Pain in the iliac fossa on palpation Dry mouth and throat with a desire to drink Emaciation Abdominal fullness and pain Anorexia Rough, dry and scaly skin May be localized abdominal pain and tenderness Amenorrhea A dull, dark appearance of the eyes Tidal fever Maybe dry stools Maybe black, tarry stools Maybe an epigastric mass T: Petechiae or Purplish or Reddish C: Little or None P: Wiry and choppy or Wiry, small and smooth or Thready and choppy
Treatment Principle	Invigorate the Blood Remove Stasis Alleviate jaundice Calm the Liver
Herb Formulas	Ge Xia Zhu Yu Tang modified Chinese patent medicines: Qi Li San Bie Jia Jian Wan
Points	GB-24, LI-4, LIV-14, SP-6, SP-7, SP-10, UB-17, UB-18, UB-19, UB-20

BLOOD DEFICIENCY

Clinical Manifestations	Purpura Postpartum emaciation and weakness Persistent, tight abdominal pain Abdominal pain with spasms or radiates to back and waist Cannot eat Shortness of breath Dyspnea Pale face Intermittent spasmodic abdominal pain which is better with Heat and pressure Epigastric pain Lusterless complexion Fidgeting Reduced appetite Maybe low-grade fever Palpitations Irritability Cold and sore extremities Nonspecific discomfort Dry mouth and throat Nocturnal emission Five sole Heat Debilitated constitution in children Enuresis in children Insomnia Fatigue Anemia Bleeding Abdominal weakness Epistaxis Habitual constipation Maybe warm extremities Night sweats Tired limbs Frequent urination Night crying Diarrhea in children Habitual headache in children Hernia pain in children Chronic constipation Asthma T: Pale C: White P: Weak and slow or Thready, wiry and even or Thready and weak
Treatment Principle	Warm and tonify the Spleen and Stomach
Herb Formulas	Dang Gui Jian Zhong Tang Shou Wu Sheng Fa Yin Tuo Fa Zai Sheng San
Points

TOXIC HEAT

Clinical Manifestations	Purpura Hypochondriac pain Headache Dizziness Red sore eyes Hearing loss Swelling in the ears Bitter taste in the mouth Irritability Short temper Difficult and painful urination with a heat sensation in the urethra Swollen and itchy genitalia Yellow, foul smelling leukorrhea Short menstrual cycle with reddish-purple blood Ear discharge Yellow urine Chest pain Constipation Turbid urine Dry throat Hematuria Pain in the armpits Sweating in the groin T: Red or Red edges C: Yellow or Yellow and greasy P: Wiry, Excess and rapid
Treatment Principle	Clear and Drain Damp-Heat
Herb Formulas	Qing Dai Ku Jiao San Qing Jie Pian Zhi Zi Jin Hua Tang
Points