New mechanisms of the TCM spleen-based treatment of immune thrombocytopenia purpura from the perspective of blood neurotransmitters

To explore new mechanisms of the traditional Chinese medicine (TCM) spleen-based treatment of immune thrombocytopenic purpura (ITP) from the perspective of blood neurotransmitters.

In this randomized controlled multi-center clinical study, 271 ITP patients who met the diagnostic criteria of “syndrome of spleen failing to manage blood” were randomized into three groups: group A administered Jianpi Yiqi Shexue (JYS) granules, 1 bag per treatment, bid; group C administered prednisone as a draught at an initial dose of 1.0–1.5 mg/kg/day at 8:00 AM; and group B administered a combination of the interventions in groups A and C. Each treatment cycle lasted 21 days.

After treatment, scores of platelet distribution width (PDW) were significantly decreased in groups B and C, and there were significant differences among the three groups (P = .0131). Pairwise comparisons showed that PDW was significantly different between group A and group B (P = .005) and between group A and group C (P = .041) but not between group B and group C. Hemorrhage grading scores were significantly different between day 1 and day 7 in group A and group B (P < .001) but not in group C. The hemorrhage grading scores on day 14 and day 21 were significantly different from that on day 1 in all three groups (P < .001). Serum 5-hydroxytryptaminelevels did not change significantly before and after treatment in the three groups (P > .05). Serum β-endorphin and vasoactive intestinal peptide levels were significantly different between group A and group B (both P < .001).

The JYS prescription may regulate the expression levels of blood neurotransmitters via the brain-gut axis in patients with “spleen deficiency” ITP and thus activate hemostatic mechanisms to promote hemostasis. β-EP and VIP are key neurotransmitters of the JYS-induced functional regulation.