Description of the problem:
My loved one has purpura nephritis, now see a few months, and not much better, and then transferred to the specialist hospital, the doctor is now allowed to take the medicine: timosartan tablets a day a piece of, tretinoin-type tablets three times a day once two tablets, Pansantene three times a day once three tablets, prednisone six tablets a time to reduce the number to two tablets. I'm not sure if it's a good idea to take these medications. Is it possible to get better with these medications? Does anyone have any other cure for this disease? I would like to thank you for your help!
Ans:
The defects of western medical treatment of anaphylactic purpura:
1, first of all, the pathogenesis of this disease is allergy, but in addition to the allergens that have been found, there are many substances that have not been found or are unlikely to be found, but also allergy, and the existing allergens test, but only a part of the substances detected, the vast majority of them can not be detected, so the requirements of the patient to find and avoid the source of the allergy with which the patient has been found. Therefore, it is unrealistic to ask patients to find allergens and avoid contact with them for most patients.
2, glucocorticoid side effects:
1) long-term use, can cause centripetal obesity, which is commonly known as the full moon face, buffalo back, can cause hyperadrenocorticism syndrome.
2)After taking it, patients are prone to concurrent infections with fungi, Pseudomonas aeruginosa, tuberculosis, metaplasma staphylococcus and various herpes viruses.
3)After long-term use, there will be bleeding tendency, poor wound healing, acne, menstrual disorders, necrosis of the humerus or femoral head, muscle weakness, muscle atrophy, swelling of the lower limbs, hypokalemia syndrome, therefore, patients with hypothyroidism should be used with caution.
4) Taken by children, it can inhibit the growth and development of the affected children.
5) Menopausal women use, easy to aggravate osteoporosis.
6)Used by elderly patients, it is easy to produce hypertension and diabetes.
7)Use in pregnant women may increase the incidence of placental insufficiency, newborn weight loss, and stillbirth.
8) Hypertension, thrombosis, cardiac infarction, glaucoma, psychosis, gastric and duodenal ulcers, electrolyte metabolism abnormalities, and visceral surgery patients with glucocorticosteroids will have the possibility of deterioration of the condition, therefore, generally should not be used.
Characteristic treatment of allergic purpura
Vast and profound traditional Chinese medicine has its unique and miraculous efficacy in the treatment of allergic purpura, as in the treatment of other diseases. The research group of hematology headed by Kang Yong, director of Inner Mongolia Medical College Zhongmeng Hospital, has conducted decades of careful research on allergic purpura, and has finally worked out a set of successful programs for the treatment of allergic purpura. It has been tested in the clinic with outstanding efficacy. They believe that the allergic purpura can be summarized by the six words "wind-heat, dampness, toxicity, stasis and deficiency", the so-called wind that is externally induced wind, wind attack on the muscle surface, resulting in blood and can be accompanied by itchy skin, urticaria, etc.; the so-called heat, that is, externally induced heat, or dietary spicy, alcohol, alcohol and thick flavors, the endogenous dampness and heat, or the liver depression heat, heat, blood, forcing the blood to run wild, and the spillage of the skin. The so-called wet that is exogenous dampness or internal phlegm and dampness, can lead to blood transport is not smooth, overflow in the skin, so that the purpura disease lingering; the so-called poison that is the fire and heat of the evil excessively tormented into a poison, heat and toxicity is too much, purpura dense and heavy color, wet and heat over a long period of time will be dampness and toxicity. The fact is, if you're not sure what you're looking for, you're not going to get it. The so-called "stasis" is the blood overflow under the skin, that is, the blood from the menstruation, the blood from the menstruation is stasis blood, stasis blood must be transformed, so the method of activating the blood to eliminate stasis runs through the whole process of treating purpura. The so-called virtual is positive, purpura lesions for a long time, will hurt the positive qi, a hurt qi, two hurt yin, three hurt yang; support the positive in order to get rid of the evil. Because of the long time patients must make up for the positive gas, can completely cure the purpura.
To cure the purpura, we need to recognize the difference between the evil and the positive, or dispel the wind, clearing heat, dampness, detoxification, phlegm to dispel the evil, or benefit the qi and yin and warming the yang to support the positive, or support the positive and dispel the evil at the same time.
The pathogenesis of anaphylactic purpura is that the patient's body is not strong, the innate endowment is insufficient, and the external sense of the four seasons is not correct, the evil poison into the blood, forcing the blood to go, and overflowed in the subcutaneous purpura, or the evil poison is too much, the lesions are further developed, and can be invaded to the joints, the gastrointestinal tract and the kidneys, resulting in the related organ lesions.
1, for the skin type of allergic purpura treatment; the key is to dispel the evil, dispel the wind and clear the heat, the dampness of the detoxification, blood circulation, so that the evil from the surface of the dissolution, the blood can be dissolved, the qi and blood smooth, the blood is no longer overflowing in the pulse, the blood can be returned to the meridian, according to the normal way and the line. For patients with simple skin-type purpura who often have wind-heat-dampness toxicity and ecchymosis for many years, the group focuses on the use of medicines that can clear away heat and detoxify toxins, dispel wind and dampness, and activate blood circulation and remove blood stasis without hurting the positive qi, such as: antifungal, ginkgo berry, conchiolus, yellow rhizoma root, scutellaria baicalensis, cypress cypress, Job's tear grains, peach kernel, safflower, wu ling yu, frankincense, and salvia divinorum etc. These medicines can well clear away heat and detoxify toxins, dispel wind and dampness, and activate blood circulation and remove blood stasis to lighten and fade the color of purpura slowly to subside. These medicines can clear away heat and remove toxins, dispel wind and dampness, activate blood circulation and remove blood stasis, so that the color of purple spots will slowly become lighter and subside, and achieve the purpose of complete cure.
2, for the treatment of joint-type allergic purpura
The principle is to cultivate positive qi on the basis of supporting the wind dispersal of cold, remove dampness and pass through the collaterals, activate blood circulation and eliminate blood stasis, for the joint pain in the lower limbs of the knee joints, in the series of the main prescription on the basis of the addition of Duhuo, Gentiana, windbreaks, Xinxin, Chuan Niu Knee, Wyoming Knee and other medicines in order to dispersal of wind and cold, and to remove the dampness and pass through the collaterals to alleviate the pain.
3, gastrointestinal type allergic purpura, due to the "spleen and stomach is the foundation of the latter day", gas, blood, essence and fluid production depends on the transportation of the spleen and stomach, therefore, gastrointestinal type purpura patients, in addition to the innate deficiency, resistance to weak reasons, there is also another important reason is that the spleen and stomach is weak, can not resist the evil, and thus the evil gas! Once invaded, it can directly enter the spleen and stomach, resulting in bleeding of the mucous membrane of the stomach and intestines, abdominal pain, blood in the stool and other symptoms. Because of the insufficiency of both "innate kidney qi" and "acquired spleen and stomach", patients with this type of purpura are prone to kidney damage within a few weeks after the appearance of gastrointestinal symptoms, and most of them are accompanied by joint symptoms, so they are mostly mixed-type purpura. Gastrointestinal purpura is a more complicated type, and the treatment is also relatively complicated. The treatment of this type is based on the principle of replenishing both the innate kidney qi and the acquired spleen and stomach, and while replenishing the kidney qi and regulating the spleen and stomach, the medicines used are to invigorate blood circulation, stop bleeding, dispel cold and remove dampness, etc. The medicines used to expel the evil spirits from the body will help the patient to recover. At the same time, it is accompanied by medicines that activate blood circulation and stop bleeding, dispel cold and dampness, and so on, to drive out the evils. As the "Neijing" said, "when the positive qi exists inside, the evil can't be dried up". The specific drugs used are "ripened earth, yam, cornelian cherry, wolfberry, eucommia, cuscuta, etc. to supplement the kidney essence, Codonopsis, atractylodes macrocephala, Poria, licorice, Chinese yam, lentils, yellow essence, astragalus, etc. to strengthen the spleen to help transport.
4, purpura nephritis is the last type of allergic purpura, but also the heaviest type, which occurs due to the previous types (simple, joint, gastrointestinal type) repeated attacks, the day does not heal, the evil invades the kidneys, and the kidneys are affected by the performance. As the patient's body kidney qi insufficiency, the evil qi inside, coupled with the lack of treatment or improper treatment, so that the evil poison further penetrate into the kidneys, the kidneys lose intake, so that the urine can appear a large number of protein, red blood cells and tube type. Treatment should focus on the principle of cultivating and replenishing the innate, benefiting qi and activating blood, so that the damaged renal tissues can be repaired and their normal function restored, so that they will no longer leak out proteins, red blood cells and tubular patterns. In the medication, Radix Rehmanniae Praeparata and Cornu Cervi Pantotrichum are used to tonify the kidney and nourish yin, while fixing astringency and stopping bleeding, while Rhizoma Coptidis, Radix Rehmanniae Praeparata, Semen Cuscutae, Rhizoma Eucommiae, Rhizoma Eucommiae, Chuanjie, and Cortex Cuscutae are used to tonify the kidney and fix essence, and to improve the renal function through diuretic and swelling. Adding Zeran, Panax notoginseng, Pu Huang and Bai Mao Gen to resolve blood stasis and stop bleeding, so as to reduce renal stasis. Through the above series of treatments, completely restore the excretory function of the kidneys, so that protein and hematuria gradually return to normal, thus completely curing purpura nephritis.
Elimination of urinary protein effective drugs are: Codonopsis, Astragalus, Atractylodes macrocephala, Poria, Rhizoma Polygonati Odorati, Chinese yam, lentil, Rhizoma Polygonati Odorati, Gorgon fruit, Succinum Huperziae, Bacopa Monnieri and so on, and elimination of blood in the urine effective medicines are: Senecio, Artichoke, Siberian Leaf, Syzygium, Panax Quinquefolii, Jasminum Flosum, Peanut Clothing, Chicken Crow Flower, Zizyphus, and so on.
(1) static immunoglobulin: 0.4g/kg for 5 days, every 10-15 days and then static injection of 0.4g/kg, or in the platelet reduction cycle to give 0.5g/kg, 2-10 days after the use of platelets rose significantly and can be maintained for several days or dozens of days, can be done as one of the most effective methods of emergency treatment. Its mechanism of action is: ① closed monocyte-macrophage FC receptor; ② interfere with monocyte-macrophage immune serum effect; ③ increase the inhibition of T-cell function, inhibit the production of antibodies; ④ to remove the presence of chronic viral infection foci in the body. But it is expensive.
(2) Danazol: a class of synthetic androgens without masculinizing side effects, the possible mechanism is to inhibit the role of T cells, so that antibody production is reduced, and increase the platelet count. The dosage is 200-400mg per day, which can be combined with hormones, and needs to be taken for more than 2 months before the efficacy can be seen. Domestic reported efficiency of 60%, but expensive, liver damage side effects.
(3) Tamoxifen: can compete with estrogen two immune cells on the estrogen receptor, reduce estrogen and T8 binding caused by functional defects. Usage: 100mg each time, 3 times a day, after meals. The effect is slow, should continue to use more than 3 months, platelets normalized after two months of service and then stop, the domestic reported efficiency of about 50%.
(4) plasmapheresis: can remove the plasma in the presence of a large number of antiplatelet antibodies, so that the condition of relief, can be one of the emergency measures. The replacement fluid can be fresh plasma 1~3L/time, at least 2~3 times in a row.
Thrombocytopenic purpura Western medical treatment defects
1, thrombocytopenic purpura preferred drug is glucocorticoid, glucocorticoid has many side effects. (See above)
2, blood transfusion and platelet transfusion, although there is a better hemostatic effect, but its role is short-lived, repeated transfusion, easy to occur after the formation of homologous antibodies, which will cause more rapid destruction of platelets, so transfusion of platelets is only suitable for the rescue of patients with critical bleeding, or in the splenectomy before or during the operation, should not be used as a general treatment.
3, splenectomy: not as the first choice of treatment, but in the glucocorticoid treatment for more than 6 months is ineffective, or still recurring authors, or after glucocorticoid treatment, there is still serious bleeding, life-threatening people choose to carry out splenectomy, and splenectomy efficacy is not the same, some patients after splenectomy will still appear bleeding symptoms and recurrence of the disease, and still need to take glucocorticoid.
4, immunosuppressive therapy: the clinical use of vincristine, cyclophosphamide and other drugs are leukemia or other cancer chemotherapy drugs, itself for the chemical agents. 1) can inhibit the bone marrow hematopoietic function, resulting in a decline in white blood cells. Discontinuation of the drug makes the condition more recurrent.2) It also causes reduced immunity, increased infection rate, nausea, vomiting and other gastrointestinal side effects.3) Significant hair loss.4) Hemorrhagic cystitis, herpes zoster, gonadal suppression, elevated gammaglutamylase, which leads to liver function abnormalities.5) The drug can be used to treat leukemia or other cancers, but it is also used as a chemotherapeutic agent.
5, although there are some western drugs such as danazol, tamoxifen may have some efficacy, but the efficacy is not certain, and has toxic side effects, expensive, the general public is not easy to accept.
Characteristic treatment of thrombocytopenic purpura
Dr. Kang believes that the etiology of thrombocytopenic purpura is the following: the patient's congenital endowment is insufficient, or overwork and overdose, and the patient loses nourishment later in life, and then he is infected with external evils, which results in the entry of evils into the bone marrow and attacks the marrow, so that the bone marrow and hematopoietic function of the bone marrow decreases, and the bone marrow of the kidneys, and if the kidneys are deficient, then the bone marrow is exhausted, and the spleen is a source of qi and blood, and if the spleen is deficient, then the qi and blood will not be able to be generated. If the spleen and kidney are deficient, there will be a deficiency of both blood and qi, so platelet generation will be insufficient. Therefore, the treatment of thrombocytopenic purpura, the key is to cultivate the spleen and kidney, spleen and kidney supplementation is the source of qi and blood biochemistry, kidney full of the marrow full of platelet generation increase, thrombocytopenic purpura can be completely cured. The first thing that you need to do is to get rid of the bad stuff, so you need to use some of the good stuff to get rid of the bad stuff.
In terms of medication, focus on the use of kidney qi of ripened earth, yam meat, goji berries, lewd goat horns, cactus, antler, mealybugs, lock yang, cistanchis and spleen ginseng, ginseng, atractylodes macrocephalus, cloud ling, astragalus, yellow essence, yam, lentils, cinnamon, etc., tonifying spleen and kidney, improve the quantity and quality of platelets, detoxification drugs to silver flowers, forsythia, gardenia, dicotyledonous, dandelion and so on for the better. As long as the clinical diagnosis is accurate, the use of fine medicine, can receive the best therapeutic effect.
Our hospital to Kang president headed by the hematological research group since the beginning of the clinic, have received very good results, for the majority of patients with purpura in addition to reduce the pain of the disease, by the majority of patients praise.