Chinese and Western medicine treatment for aplastic anemia, especially the characteristic treatment of Chinese medicine, has become an important tool for effective treatment of reblastosis, and is gradually accepted and favored by more and more domestic and foreign experts and scholars and patients.
The treatment of aplastic anemia in TCM is based on the diagnosis, and the treatment is divided into types according to acute and chronic reoccurrence. Chronic reblastosis belongs to the category of “deficiency of blood in deficiency of labor” in TCM, so the treatment is based on kidney, distinguishing yin and yang, adding prescriptions to invigorate blood circulation and remove blood stasis and liver depression, and appropriately combining herbs that stimulate the growth of hematopoietic cells according to the pharmacological research of TCM to improve the efficacy. In view of the evolution of chronic reoccurrence, the treatment is divided into three stages: initial, middle and final. For acute reoccurrence, the treatment is based on “acute labor and marrow withering and warming type”, with emphasis on cooling the blood and detoxifying method to achieve therapeutic effect.
The treatment is based on evidence.
I. Slow-type aplastic anemia.
We believe that chronic aplastic anemia is caused by excessive exertion, external infection with evil toxins and indiscipline in the room, resulting in damage to the yin and yang of the internal organs, deficiency of qi and blood, and deficiency of labor. The main clinical manifestations are white face, tiredness and fatigue, palpitation and shortness of breath, dizziness and tinnitus, and other signs of blood deficiency and loss of glory, so the diagnosis is summarized by “marrow labor and blood deficiency”; because “the kidney is the main bone, collects essence and produces marrow” and “essence and blood are of the same origin”. “If the kidney is deficient, the essence is less and the marrow is dried up, and the blood cannot be produced. Therefore, the essence of chronic recurrent disease is “kidney deficiency”. In clinical diagnosis and treatment, patients are further identified as kidney yin deficiency type, kidney yang deficiency type, and kidney yin and yang deficiency type according to their partial yin and yang images.
1, slow medullary labor (slow type of aplastic anemia) Yin deficiency and fire, forced blood delusion type.
Heat toxin enters the body, consumes essence and hurts yin, forcing blood to move delusively.
Symptoms: dizziness and weakness, pale face, two cheekbones flushed, five hearts troubled and hot, night sleep, soreness and weakness of the waist and knees, hot flashes and night sweats, thirst and thirst, skin petechiae and petechiae, bright blood, tender purple-red tongue with thin moss or less moss, thin pulse.
Treatment: Nourishing Yin and lowering fire, cooling the blood to stop bleeding.
Prescription: Zhi Bai Di Huang Wan with Rhizoma Di Huang Tang plus or minus.
Prescription: 30g of Buffalo Horns, 20g of Radix Rehmanniae, 15g of Dampi, 15g of White Peony, 10g of Zhi Mu, 9g of Phellodendron, 15g of Radix Rehmanniae, 15g of Cornu Cervi Pantotrichum, 20g of Chinese Yam, 18g of Ze Di Di, 15g of Turtle A, 30g of White Mao Root, 30g of Xian He Cao, 30g of Fresh Lotus Root.
If bleeding is obvious: add 30g of Ziziphiopogon, 15g of Baihe, 15g of Xiaoxi, 10g of Shengdiyu, 10g of Phellodendron, 10g of Fritillaria, etc. according to different bleeding sites.
Chinese patent medicine: Antelope Yellow Blood Cooling Granules (containing antelope horn powder, peony peel, red peony, and cynthia) 12g, taken twice daily (morning and evening).
2, slow medullary labor (slow type of aplastic anemia) kidney yin deficiency type.
Commonly found in chronic remittent anemia or acute remittent anemia after treatment into the yin deficiency type.
Symptoms: hot flashes and night sweats, heat in the hands and feet, white face and red cheek, little sleep and dreams, lumbago and leg weakness, palpitations and easy to be frightened, blood color is bright, the tongue is tender red with thin moss and less fluid or less moss, the pulse is fine.
Treatment: Nourishing Yin and benefiting kidney, benefiting Qi and generating marrow.
Remedy: Zuo Gui Wan with addition and subtraction.
Prescription: Radix Rehmanniae 15g, Rhizoma Dioscoreae 15g, Cornu Cervi Pantotrichum 15g, Radix et Rhizoma Huaiyang 15g, Radix et Rhizoma Polygonati 18g, Radix et Rhizoma Polygonati 15g, Radix et Rhizoma Polygonati 15g, Radix et Rhizoma Drynariae 15g, Semen Cuscutae 15g, Radix Cuscutae 15g, Radix et Rhizoma Bidentatae 15g, Radix et Rhizoma Polygonati 15g, Radix et Rhizoma Polygonati 15g, Radix et Rhizoma Astragali 24g, Radix et Rhizoma Lycii 18g The Chinese medicine: Astragalus membranaceus 15g (melted).
Prepared Chinese medicine: Astragalus Blood Granules (containing Radix Astragali, Radix et Rhizoma Polygonati, Fructus Lycii, Colla Corii Asini, etc.) 15g, taken once daily (at noon) (prepared by the hospital).
This disease is caused by the loss of Yin of the liver and kidney, and the failure of vital energy and blood. Yin deficiency of liver and kidney results in lumbar soreness, dizziness and night sweating; Qi deficiency results in less Qi to breathe, shortness of breath when moving, less sweating and weakness. Blood deficiency results in palpitations, less florid lips, and thin pulse. It is because the liver and kidney deficiency, hair for the blood deficiency of the marquis. The main treatment is to nourish the kidney, so a large amount of raw earth, shouwu, shamrock, yam, wolfberry, aconite to produce blood and nourish the liver, with astragalus, atractylodes, jujube, licorice to benefit the spleen, through the essence of grain and water to help the qi. Blood depends on qi, qi depends on blood to nourish, so effective.
3, slow medullary labor (slow type of aplastic anemia) kidney yang deficiency type.
Commonly found in chronic reblastosis or acute reblastosis after treatment turned into Yang deficiency type.
Features: white face, cold body and limbs, pale lips and nails, shortage of breath and lazy speech, lumbar acidity and weakness, little food and loose stools, pale blood, fat tongue with white coating and teeth marks, sunken and weak pulse.
Treatment: Warming the kidney and strengthening the yang, benefiting the qi and generating marrow.
Remedies: Right Return Pill with addition and subtraction.
Prescription: Radix Rehmanniae 15g, Cornu Cervi Pantotrichum 15g, Chinese Yam 15g, Radix et Rhizoma Polygonati 18g, Poria 15g, Radix et Rhizoma Polygonati 15g, Semen Cuscutae 15g, Radix et Rhizoma Bidentatae 15g, Radix Xian Ling Pi 15g, Radix Xian Mao 15g, Radix Bidentatae 9g, Radix Angelicae Sinensis 15g, Radix Rehmanniae 15g, Radix Xian He Cao 30g, Radix Rehmanniae 15g, Fructus Crataegi 15g, Radix Cinnamomi 6g, Radix Astragali 24g, Radix et Rhizoma Ginseng 20g, Radix Antler Gum 10g (melted).
If loss of appetite: add Chen Pi, Radix Panax notoginseng, Lycopodium, Gynostemma, Jiao Liu Qu, etc.
Chinese patent medicine: Ginseng and blood granules (containing ginseng, astragalus, bone marrow and spleen) 15g / Ginseng and ear blood granules (containing red ginseng, Tianjihuang, strychnine, etc.) 10g three times a day.
This case is characterized by deficiency of spleen and kidney yang and great loss of qi and blood. In this formula, fried schisandra and longan are used to warm the heart and Yang; deer horn gum is an important blood tonic, used to nourish blood and help to produce blood; aconite is used to increase protein and also has the effect of stopping bleeding and nourishing blood. The kidney is the main water, the kidney water is strong, the liver is soft, the liver is calm and does not offend the spleen, the spleen is strong, the water and grain essence into the blood to replenish the blood, the blood is full of gas, the disease is healed. The black fungus is sweet and flat, with the function of nourishing, nourishing the stomach, invigorating blood and moistening dryness. Jujube, sweet in taste and flat in nature, nourishes the stomach and strengthens the spleen, nourishes the blood and strengthens the mind, and enters the heart, benefiting the qi, easing the middle, resolving food, relieving pain, moving the blood, and nourishing the blood. The three flavors share the same food therapy, aiding the efficacy of drugs, so it is easy to receive results.
4, slow medullary labor (slow type of aplastic anemia) kidney yin and Yang deficiency type.
Commonly found in chronic reblastosis or acute reblastosis after treatment into the yin and yang two deficiency type.
Symptoms: pale face, sometimes cold, sometimes hot, spontaneous sweating and night sweating, little food, soreness and weakness of the waist and knees, spermatorrhea, pale tongue with thin white coating or no coating, sunken and weak pulse or sunken and fine count.
Treatment: Nourishing Yin and strengthening Yang, benefiting Qi and generating marrow.
Remedies: Zuo Gui Wan combined with Right Gui Wan plus or minus.
Prescription: Radix rehmanniae 15g, Cornu Cervi Pantotrichum 15g, Radix shouwu 18g, Radix chasteberry 15g, Radix aristolochiae 15g, Radix boneset 15g, Radix deer antler gum 15g, Radix cistanches 9g, Radix spleen 15g, Radix et Rhizoma Huaiyang 15g, Poria cocos 15g, Radix sanguinariae 30g, Radix ciliatae 15g, Radix angelicae 15g, Radix et Rhizoma cocklebur 15g, Radix astragali 30g, Radix jiaozha 15g.
Chinese patent medicine: Xianqi blood granules (containing princely ginseng, chasteberry, wolfberry, aconite, etc.) 15g three times a day (our preparation); Ginseng and gum blood granules (containing red ginseng, Tianjihuang, strychnine, etc.) 15g three times a day.
Combine with the evolution of evidence and follow the treatment rules.
At the beginning of chronic remittent disease, most of the symptoms are Yin deficiency of kidney (liver), kidney does not collect essence, essence does not transform blood, Yin and blood deficiency, and internal heat is generated, resulting in five heart troublesome heat, night sleep and night sweating, sleeplessness, blood oozing from gums, light and dry tongue, thin pulse, which is a sign of compensatory hyperfunction of bone marrow hematopoietic function and reduction of whole blood cells. This is a deficiency of heat, treatment should be nourishing Yin and tonifying the kidney, filling the marrow, accompanied by cooling the blood to stop bleeding, because the deficiency is not tonic, so should not be a tonic; by nourishing Yin and tonifying the kidney, Yin deficiency and fire is gradually removed, the disease is relatively stable, at this time the symptoms of Yin deficiency and internal heat gradually disappear, and Yang deficiency symptoms appear, or Yin deficiency, Yang deficiency symptoms alternately, the disease process into the middle, the treatment is intended to nourish the kidney (liver) Yin and warming the kidney (spleen) Yang and the dual tonic method of Yin and Yang. We believe that this stage is not long, and the disease will soon enter the late stage of further stabilization of blood production, that is, the pulse and evidence match the (spleen) kidney Yang deficiency type, or some patients are mainly Yang deficiency, the beginning of the disease is (spleen) kidney Yang deficiency, the treatment is to warm the kidney Yang, fill the marrow, “the water of the abyss does not give birth to fish and dragons, the cold land is difficult to produce all things “Warming the kidney yang and filling the marrow can promote the growth of yang and yin and the production of essence and blood, which can improve the anemia, reduce the bleeding symptoms and restore the blood picture. This enters the end of the disease process, which is the consolidation treatment after remission of remittance. In order to promote further recovery of blood picture and reach the degree of cure, on the basis of nourishing Yin and Yang and filling the marrow treatment, it is appropriate to add pungent and hot products of great tonic such as cinnamon and sapodilla, which can achieve the expected purpose.
During the treatment of chronic reoccurrence, we have figured out the evolution of the evidence type and the change of treatment rules. In other words, at the early stage of the disease, nourishing Yin and tonifying the kidney, promoting the reduction of fever and bleeding symptoms to stabilize the disease; at the middle stage, nourishing Yin and helping Yang to relieve the symptoms and consolidate the disease; at the end of the disease, warming and tonifying the kidney and Yang, filling the marrow, promoting the production of blood and restoring the hematopoietic function.
Second, acute aplastic anemia.
Acute aplastic anemia is caused by warm-heat evil toxin, invading bone marrow and internalizing blood; clinically, the whole body is rapidly and extensively damaged and even exhausted, presenting the evidence of acute labor and blood deficiency; yellow face, dizziness and tiredness and other signs of blood deficiency progressively intensify, which is the acute exhaustion of kidney marrow, the source of blood production, that is, the evidence of acute labor and marrow depletion; warm-heat evil toxin is externally felt, then high fever does not subside; internalizing blood, then epistaxis, blood in urine, black stool, blood in mouth and tongue, etc. Therefore, it is summarized by “acute labor and marrow depletion of warm-heat type”, whose tongue is mostly light red, red tongue tip, thin white tongue coating, and smooth and large pulse.
Acute medullary strain (heavy aplastic anemia type I) with heat and toxicity, forcing blood to travel.
It is common in the early stage of acute re-infection when heat toxin enters directly and burns the blood channels, forcing the blood to travel.
Features: rapid onset, pale face, strong fever that does not subside or persistent low fever, skin petechiae, red-purple spots, epistaxis, epistaxis, irritability and thirst, dense urine, dizziness and weakness, red tongue with yellow coating, and large and torrential pulse.
Treatment: Clearing heat and detoxifying the toxin, cooling the blood and stopping bleeding.
Direction: Clearing the fever and defeating the toxin with Rhizoma Dihuang Tang plus or minus.
Prescription: 30g of water hyacinth tablet (first decoction), 20g of raw earth, 15g of dandruff, 15g of white peony, 30g of raw gypsum (first decoction), 10g of Zhi Mu, 30g of rice kernel, 15g of Scutellaria baicalensis, 15g of Panax quinquefolium, 15g of Xuan Shen, 6g of licorice, 30g of white foxglove, 15g of honeysuckle, 15g of forsythia, 0.6g of antelope horn powder (punch).
If there is hyperthermia and constipation, add Rhubarb 9-12g, Citrus aurantium 12-15g, etc. If bleeding is obvious: according to the different bleeding parts, add 15g of Xianhe Cao, 30g of Zi Zhu Cao, 15g of Lotus root, 15g of Bai He, 15g of Xiao Ji, 10g of Sheng Di Yu, 10g of Phellodendron leaf, 10g of Flower Rui Shi, etc.
Chinese patent medicine: Antelope Huang Liang Blood Granules (containing Antelope horn powder, Peony skin, Red peony, Xin Yi, etc.) 12g～24g three times a day.
External warmth and heat is the cause of the disease, which is the symptom of the disease, and the root cause of the disease is acute labor and marrow depletion. In the treatment, for the evidence of external warm-heat in the upper jiao, Cang Er Zi San from Ji Sheng Fang is used to disperse wind-heat. For the symptoms of warm-heat and evil toxin internalized in the blood, Rhizoma Dihuang Tang from Qian Jin Fang was taken to clear heat and cool the blood. For the symptoms of acute labor and marrow deficiency, San Cai Feng Marrow Dan from Health Bao Jian was added to tonify the kidney and lower the fire, and the three parties were added to cool the blood and stop bleeding, disperse wind and heat, nourish yin and tonify the kidney.
Despite the progressive aggravation of symptoms such as deficiency of blood and labor, it is not appropriate to treat deficiency, and using the traditional method of tonifying the kidney to treat acute re-infection, it is easy to make up Yang heat more incandescent and nourish Yin blood, and most patients die of hemorrhage or serious infection within a short period of time. The application of cool medicine is preferable to early rather than late. The new way of treatment of cool blood detoxification enables timely removal of warm-heat-causing evil toxins, timely control of bleeding and fever symptoms, timely stabilization of the disease, and promotion of the transformation of essence and blood.
The treatment of alternating cooling and warmth aims to stabilize the disease, eliminate the fever and bleeding symptoms, and if necessary, add the Chinese herbal medicine of nourishing yin and tonic yang to nourish the kidneys (self-designed Ginseng and Astragalus Xian Tonic Tang with reduction: ginseng, Radix Codonopsis pilosulae, princely ginseng, Astragalus astragalus, bone marrow, Xian Ling spleen, etc.), which can promote the restoration of hematopoietic function and the production of essence and blood. This method is more effective than the treatment of mere tonic deficiency.
The principle of treatment for this disease is to prolong the survival period, rather than urgently raising hemoglobin and other organic components, as the saying goes, “urgency is the cure for its symptoms”. The treatment is based on cooling the blood and detoxifying the toxin, which is internalized by warm toxin, injuring the blood and depleting the kidney essence. The formula uses antelope horn to clear heat and detoxify the blood, cool the blood and stop bleeding; Dampi and Guanzhong to clear heat and cool the blood and disperse stasis; Shengdi and Medlar to clear heat and nourish Yin; Banlangen and Huangling to clear heat and detoxify the blood; Xie Cao, Panax notoginseng and Amber to activate the blood and cool the blood and eliminate stasis. This is a critical condition, so it is advisable to cooperate with western medicine to stop bleeding and control infection, and to strengthen various supportive therapies. After the acute phase, the disease can be treated as chronic aplastic anemia.