Bone erosion is a malignant tumor of the hematopoietic system due to congenital deficiency of endowment, deficiency of kidney qi, inability to master water, and internal stagnation of water-dampness; compounded by drug toxicity or other physical and chemical factors that injure the righteousness, the evil toxicity becomes fire, and refines liquid into phlegm, resulting in kidney deficiency and interconnection of water-dampness, phlegm and blood stasis, with bone pain, pathological fracture, bleeding, anemia, complete blood cytopenia, hyperviscosity, kidney damage, amyloidosis, and easy infection as the main manifestations. It is equivalent to multiple myeloma in Western medicine.
1.Diagnosis basis
1.1 The diagnosis of this disease requires one of the following major indicators and one of the secondary indicators, or three of the following secondary indicators, but the first and second secondary indicators must be included, and the patient should have MM-related clinical manifestations.
1, 2 primary diagnostic indicators
1,2,1 Plasmacytosis greater than 30% in the bone marrow.
1, 2, 2 Biopsy confirmation of plasmacytoma.
1, 2, 3 M component: serum IgG > 35g/L; IgA > 20g/L; urine periprotein 1g/24h.
1,3 Secondary diagnostic indicators
1,3,1 Plasmacytosis in bone marrow: 10%-30%.
1,3,2 M component present but at a level lower than the primary diagnostic indicator.
1,3,3 Osteolytic lesions are present.
1,3,4 Decreased normal immunoglobulins (less than 50% of normal): IgG less than 6g/L; IgA less than 1g/L; IgM less than 0,5g/L.
2.Evidence classification
2.1.Deficiency of liver and kidney: soreness of waist and knees, bone pain, unfavorable flexion and extension of limbs, or bone steam and hot flashes, dizziness and tinnitus, redness of cheek and night sweats, irritability of the heart, dry throat and mouth, or thinness of the body, spermatorrhea in men, menstrual irregularities or even menorrhagia in women, dark red tongue, thin tongue, or petechiae and petechiae, little coating, fine pulse or stringiness.
2.2.Qi and blood deficiency: slow onset, continuous bone pain, pain is fixed, and it is worse in case of strain, accompanied by pale face, fatigue, dizziness and palpitations, especially when moving, shortage of breath and lazy speech, or dullness and loose stools, light fat and dark tongue, or petechiae, thin white moss, sunken thin and astringent pulse.
2.3.Phlegm stasis and paralysis: severe pain in the waist and back, chest and hypochondrium, head and limbs, fixed pain, refusal to press, or lumps, accompanied by pale yellow and dark face, distention and fullness in the abdomen and stomach, poor appetite, good breath, light and dark lips and tongue, thick and greasy moss, sunken and thin pulse.
2.4. Internal heat poisoning: severe bone pain, strong heat with spotting, epistaxis, epistaxis, high breath, irritability and constipation, or cough with yellow phlegm, or even delirium, vile mouth and tongue, short urine, red and vivid tongue, yellow greasy moss or less moss, large pulse.
2.5.Yang failure of spleen and kidney: cold pain in the lower back, swollen knees and limbs, with s white or sallow complexion, fatigue and tiredness, cold fear of limbs, dullness and loose stools, little or long urine, nausea and vomiting, pale and dark tongue with fat and tender, white smooth coating, sunken and thin pulse.
3.Complications
The complications of multiple myeloma are mainly infection, pathological fracture, chronic renal insufficiency and bleeding, which are the main causes of death.
4.Indications for hospital admission
4.1.Patients with multiple myeloma in primary treatment, induction remission, maintenance, consolidation, intensification, or re-induction or in need of combined chemotherapy with Chinese and Western medicine.
4.2.Patients with multiple myeloma combined with fracture.
4.3. Those with combined infection, high fever, or renal insufficiency uremia, or internal bleeding (including gastrointestinal, fundus, etc.) or intracranial bleeding tendency.
5.Treatment plan
5, l. Identification and treatment
5, l, 1. Liver and kidney deficiency. Treatment: Nourish the liver and kidney, strengthen the bones and fill the essence. Recipe: Zhi Bai Di Huang Tang or Zuo Gui Wan plus or minus.
5. l. 2. Deficiency of both qi and blood. Treatment: Nourishing Qi and Blood, filling essence and strengthening bones. Remedy: Bajhen Tang with Zuo Gui Drink plus or minus.
5, l, 3. Phlegm and stasis paralysis. Treatment: Removing phlegm, resolving stasis, tonifying the kidney and filling the essence. Treatment: Removing phlegm, resolving stasis, tonifying the kidney and filling essence.
5, l, 4, internal heat toxicity. Treatment: Clearing Qi and Blood, benefiting Qi and nourishing Yin. Treatment: Clear Ying Tang with Bamboo Leaf and Gypsum Tang, plus or minus.
5,1,5, Yang failure in the spleen and kidney. Treatment: Strengthening the spleen and warming the kidney, resolving turbidity and lowering rebellion. Treatment: Warming the spleen and warming the kidney, resolving turbidity and subduing rebellion.
5.2.Other treatments
5, 2, l. Chinese patent medicines: for liver and kidney deficiency type, 4 tablets of Clear Toxin Tablet, 2-3 times daily, plus 6g of Liu Wei Di Huang Wan, 3 times daily; for qi and blood deficiency type, 4-6 tablets of Yang Zheng Tablet, 3 times daily, or 6g of Gui Shen Wan, 3 times daily, or 6g of X Quan Da Teng Wan, 3 times daily; for phlegm and stagnation paralysis type, 4 tablets of Warm Gallbladder Tablet, 3 times daily, plus 6g of Stasis Toxin Clear Wan, 3 times daily; for heat toxin internal ambush type For the type with internal heat toxicity, 10-20ml of Qingkailing Oral Liquid can be used 3 times a day, or 30-40ml of Qingkailing Injection can be used for intravenous infusion, and 50ml of Zidi Combination can be used 3 times a day for bleeding.
5, 2, 2, single prescription: raw carrot, 500 ~ 1,000g per day, squeeze juice, need to drink for a long time; chicken blood vine 30 ~ 60g, mountain cichlid mushroom 15g, Panax ginseng 10g, bone marrow 30g, yellow essence 30g, cuscuta 20g, water decoction; mountain water turtle, the number of arbitrary, each wrapped with yellow clay, outside reinforced with wire, placed on the wood fire calcined, the turtle shell can be broken by hand as degree The turtle shells should be broken by hand, then grinded and set aside, 3g each time, taken once in the morning and once in the evening.
5.3.Western medicine treatment
For multiple myeloma, it should be combined with chemotherapy, and MP, M2, VAD and other programs can be chosen according to the condition; it can also be combined with the use of thalidomide, and bortezomib + dexamethasone and other basic programs can be used if necessary, which can help reduce multidrug resistance and improve the efficacy.
5.4.Critical care rescue treatment
If peripheral blood leukocytes <1, 0×109/L, should be transferred to isolation ward; if leukocytes <0, 5×109/L, should be transferred to laminar flow room for isolation treatment. Blood transfusion is appropriate. Patients with multiple myeloma should maintain hemoglobin above 60-80g/L to ensure blood and oxygen supply to vital organs; platelets <15×109/L and those with intracranial bleeding tendency can be transfused with platelet concentrate and used with hemostatic drugs. In case of combined infection, it is advisable to use 2 to 3 kinds of sensitive, adequate and bactericidal antibiotics to control the infection in time; in case of combined sepsis, it is better to use intravenous gammaglobulin, G-CSF or GM-CSF, etc.; in case of renal insufficiency or uremia, hemodialysis or compound rhubarb enema should be given as appropriate. In cases of renal insufficiency or uremia, hemodialysis or peritoneal dialysis such as retention enema with compound rhubarb enema should be given as appropriate.
6.Indications for discharge
6, 1, hemoglobin ≥ 70g / L, white blood cells > 2, 0 × 109 / L, platelets > 30 × 109 / L.
6.2. The fever has subsided, the infection is under control, the internal bleeding has stopped, the skin and mucous membrane bleeding has basically stopped, the uremia is effectively controlled, and the fracture is basically recovered.
7.Follow-up plan
7.1.After discharge from the hospital, the patient should adhere to the outpatient treatment for more than 1,5~3 years until clinical cure, and follow up every 1~2 weeks regularly during the period to observe the change of condition and adjust the treatment medication in time.
7, 2, regular return to the hospital chemotherapy; anemia, bleeding, fractures, renal insufficiency and other symptoms of patients relapse or re-aggravation, or combined infection, hyperthermia, at any time to return to the hospital treatment.
8.Efficacy criteria
8.1.Direct index
8.1.1.M protein in serum or urine is reduced by more than 50% compared with that before treatment.
8.1.2.The product of the two largest diameters of plasma cell tumor is reduced by more than 50%.
8.1.3.Osteolytic damage recalcification.
8.2.Indirect indicators
8.2.1.Bone marrow plasma cells reduced by more than 80% or to <5%.
8, 2, 2, Rise in hemoglobin by 20 g/L or rise in erythrocyte pressure volume by 0, 06 (without blood transfusion) for more than 1 month.
8, 2, 3, High blood calcium (>2, 982 mmol/L) decreases to normal.
8.2.4.Blood urea nitrogen (≥10.71mmol/L) decreased to normal.
8.2.5.Improvement of self-care status of daily life by more than two levels.
8.3.Conditioning criteria
8, 3, 1, partial remission: with the following two conditions 1 and 2.
8.3.1.1.At least one of the direct indicators meets the requirements.
8.3.1.2.At least two of the indirect indicators meet the requirements.
8, 3, 2, Progress: Those who have at least one of the following conditions.
8.3.2.1.Only one direct indicator meets the requirement.
8.3.2.2. 20-50% reduction of M protein in serum or urine compared with that before treatment.
8, 3, 2, 3, Plasma cell tumor shrinks 20 to 50%.
8, 3, 2, 4, At least two indirect indicators were met.
8,3,3,3, Ineffective: Those who meet the following two conditions.
8, 3, 3, 1, None of the abnormal values meet the progress requirement.
8.3.3.2.Only one indirect indicator meets the requirement.