The differentiation of the disease is to clarify whether the case is the deficiency or the excess type. Acute type is usually referred to the excess type and the treatment should primarily aim at clearing away heat and cooling blood to stop bleeding; chronic type is usually referred to the deficiency type or the deficiency-excess type, so the treatment is nourishing yin and lowering fire, or benefiting qi and keeping the blood flowing within the vessels. For pronounced blood stasis, activating blood circulation to dissipate blood stasis should be the principal treatment.

Syndrome Differentiation and Treatment
1. Blood Attacked by Hyperactivity of Heat
Chief Manifestations: Abrupt onset with petechiae and purpuras in the skin, fever, thirst, often accompanied by gingival bleeding, epistaxis, even hematochezia, hematuria, red tongue with yellow coating and rapid pulse.
Therapeutic Methods: To cool blood to stop bleeding.

2. Failure of Qi to Control Blood
Chief Manifestations: Slow onset of scattered purpuras which are aggravated by overwork, and appear and fade intermittently, dizziness, lassitude, poor appetite, sallow complexion, pale tongue with white coating, thready and weak pulse.
Therapeutic Methods: To benefit qi, control blood and stop bleeding.

3. Hyperactivity of Fire due to Deficiency of Yin  
Chief Manifestations: Slow onset with longer course, mild or serious ecchymosis at frequent intervals, or accompanied by epistaxis, feverish sensation of the palms, soles, and chest, dry mouth and throat, red tongue without coating or geographic tongue, thready and rapid pulse.
Therapeutic Methods: To nourish yin and subdue fire to stop bleeding.

4. Obstruction of Collaterals by Blood Stasis
Chief Manifestations: Prolonged and intractable purpura with dark purple ecchymosis, dim complexion, dark purple tongue, thready and unsmooth pulse.
Therapeutic Methods: To remove blood stasis and stop bleeding.