Introduction
Primary thrombocytopenic purpura, also known as spontaneous immune thrombocytopenic purpura, is a commonly seen disease in hematopathy. The clinical manifestations are spontaneous ecchymoses and hemorrhage from mucus and viscera. It is either acute or chronic. Acute primary thrombocytopenic purpura is usually selflimited and often seen among children. Chronic primary thrombocytopenic purpura is usually seen among young women. This disease is similar to macules and blood syndrome in TCM. Acute primary thrombocytopenic purpura is caused by interior accumulation of heat-toxin that drives blood to flow abnormally; while chronic primary thrombocytopenic purpura is often caused by asthenia-damage of the liver, spleen and kidney, asthenia-fire scorching the collaterals or failure of qi to check blood.

Syndrome Differentiation
1. Interior Accumulation of Heat-Toxin
Sudden onset, purplish patches on the skin, often accompanied by hemorrhage, hematuria and hematochezia with fresh red color, or fever, feverish sensation over the palms, soles and chest, yellow and brown urine, deep-red tongue with thin and yellow or yellow and dry fur, slippery and rapid pulse.

2. Yin Asthenia and Fire Exuberance
Slow onset, purpura with frequent changes of aggravation and alleviation, especially on the lower limbs, or epistaxis, dental bleeding, profuse menstruation, often accompanied by tidal fever, flushed cheeks, dysphoria, night sweating, dizziness, amnesia, aching and weakness of loins and knees, red tongue with scanty fur, thin and rapid pulse.

3. Failure of Qi to Check Blood
Prolonged duration, sparse and light-colored purpura, recurrence, aggravation after overstrain, or accompanied by epistaxis, dental bleeding, hematuria, hematochezia, profuse menstruation, pale complexion, spiritual lassitude, insomnia and anorexia, dizziness, light-colored tongue with white fur, thin and weak pulse.

Treatment
Prescription: Xuehai (SP 10), Geshu (BL 17) and Sanyinjiao (SP 6).

Modification: For interior accumulation of heat-toxin, Quchi (LI 11) and Neiting (ST 44) are added; for yin asthenia and fire exuberance, Taixi (KI 3), Taichong (LR 3), Ganshu (BL 18) and Shenshu (BL 23) are added; for failure of qi to check blood, Pishu (BL 20), Shenshu (BL 23), Qihai (CV 6) and Zusanli (ST 36) are added.

Performance: For interior accumulation of heat-toxin, reducing needling technique is used; for yin asthenia and fire exuberance, reducing needling technique is used first and then reinforcing technique is applied, or mild reinforcing and reducing technique is resorted to; for failure of qi to check blood, reinforcing needling technique is used and moxibustion can also be applied.

Ear Acupuncture
Prescription: Adrenal Gland (TG2p), Endocrine (CO18), Lung (CO14), Heart (CO15), Spleen (CO13), Liver (CO12) and Middle Ear (HX1).

Performance: Embedment of needles is used. Or ear pressure with Wangbuliuxingzi (Semen Vaccariae) is applied, pressing three times a day and 3 minutes each time. Two ears are pressed in alternation.