1. No treatment- Patients can be kept under observation alone, if they are asymptomatic even if the platelet count is low.
2. Prednisolone as mentioned before is the mainstay of therapy or pulses of high dose of Dexamethasone or Methyleprednisolone during crisis.
3. Dapsone
4. Danazole
5. IV Immunoglobuline in emergencies to temporarily increase the count and to tide over the crisis.
6. Anti D
7. Azathioprine/ Cyclophosphamide/ Vincristine/ Rituximab
8. Splenectomy in resistant cases.

There are so many options in Ayurvedic literature and modern medicine, but none of them is perfect and offers unpredictable response. Most useful in the majority is steroid therapy which has to be sometimes continued indefinitely and therefore patients are at risk of side effects of steroids. At the same time lack of predictability for splenectomy which is considered as the standard therapy in resistant cases besides the morbidity resulting from the procedure. At this juncture alternative options are essential in the treatment of Chronic ITP, as illustrated by the following history.

25 year old female who has diagnosed with ITP in 1992, who was under treatment has tried all drugs including Anti D and was on maintenance oral corticosteroid and was not willing for splenectomy. While on steroid maintenance the patient has developed cushingoid features. After a trivial trauma the patient had developed a subdural hematoma and her platelet count was low which had to be managed with higher dose of steroids to keep her platelet count elevated and later she developed avascular necrosis of both femoral heads in the year 2000. To avoid the use of steroid her physician referred the case to me.

Within no time Ayurvedic treatment was started and her platelet count which was in the range 16000 to 30000 has been increased to the range of 80000 to 110000 without any oral corticosteroids. After the treatment patient was under strict follow up and her platelet count was within normal limits and also the cushingoid features and avascular necrosis were found relieved. My experience with this patient prompted me for a pilot study in this disease with informed consent and the following are the observations found in this study.-

To study the efficacy of Ayurvedic medicines in Chronic ITP.

51 patients who were presented with thrombocytopenia for more than one year were included in this study. All of them had either clinically significant bleeding or the platelet counts were very low (less than 30000). The study was selected started in 2000. I have included patients who were under my treatment from 1993, and are still continuing.

The patients were selected based on:

1. Those who were developed side effects to steroids.
2. Those who were resistant to standard therapy and was unwilling for splenectomy.

Written informed consent was obtained from patients. There were 14 patients with age less than 20, 28 between the age of 20 to 40 and nine was above 40 years. Out of 51 patients 37 were females and 14 were males.

They were extensively evaluated for other diseases causing decreased platelet count including SLE, HIV, Hepatitis B, C and chronic liver disease. Those who have failed to respond properly to any of the modern regimes and those who have developed severe side effects due to steroid therapy were submitted Ayurvedic therapy, with informed consent.

The treatment included two combinations of drugs which were all natural products. These included one iron rich herbal formulation in natural form and the other one ghee based plant preparation. These medicines can be made in large scale if needed without any scarcity. These medicines has to be taken daily for three years orally

Those who showed tendency to have a drop in platelet count on discontinuation of steroid were continued on steroid till the effect of Ayurvedic treatment is achieved.

Patients in this study endorse the general observation that Immune Thrombocytopenic Purpura is more common in females especially between the age group of 20 to 40 years. For patients who had no active bleeding were given Ayurvedic medicines after stopping steroid. Those with active bleeding continued the steroid temporarily till the effect of the Ayurvedic medicines was obvious. There was no patient who failed to respond to the treatment. Apparently there were no side effects during the treatment for three years. Due to bitter taste of the medicines some of them were initially compelled to drop out but later accepted because they wanted to avoid splenectomy at any cost.

Ayurvedic therapy was found to be as effective as modern medicine in the treatment without many side effects. This study is done to highlight the therapy in Ayurveda for Chronic ITP, which was shown to be highly effective in those patients who have not respond with high dose of prednisolone, thereby preventing the patient from morbidity and mortality of splenectomy.

Spontaneous remissions are common especially in children. And also many patients have dropped out due to unpleasant taste and lack of immediate response for which steroid had to be used again. For which further studies have to be done in larger number of patients before conclusions are drawn. I am planning a larger study to prove the efficacy of Ayurvedic medicine beyond any doubt, for the treatment of Immune Thrombocytopenic Purpura.