Aplastic anemia (AA) is a bone marrow hematopoietic failure caused by some or a combination of factors, mainly manifested by bone marrow hypopoietic function, complete blood cell reduction and anemia, bleeding, infection syndrome. Acute Aplast ic Anemia (AAA) has an acute onset, with progressive worsening of anemia, often accompanied by severe infections and internal bleeding, and rapid progression. Currently, hematopoietic stem cell transplantation and intensive immunotherapy are the first choice of treatment for AAA, and because transplantation is limited by the patient’s age, donor selection and economic conditions, anti-human thymocyte globulin (ATG) combined with cyclosporin A (CSA) is the main treatment for AAA. According to foreign literature, the efficiency of ATG+ CSA intensive immunotherapy is 60-80% [1]. However, in China, many SAA patients cannot receive these treatments or even receive first-line treatments due to financial constraints, difficulty in finding bone marrow donors, patient age, and lack of efficient drugs. AA is one of the key and advantageous diseases in TCM hematology, and has been studied in TCM for nearly 60 years, especially in the treatment of CAA. The research on AA has a history of nearly 60 years, especially in the treatment of CAA has achieved obvious results, and has gradually been recognized by the domestic medical community. At present, there are many types of TCM classification for AAA, and no independent TCM classification standard has been formed for AAA, which reduces the reference value of efficacy evaluation [2]. In our long-term clinical practice, we have achieved some success in treating AAA with the fundamental guiding principle of evidence-based treatment, and have initially formed our characteristic advantages in this field. CAA has the characteristics of slow onset and long duration, and the first symptoms are mostly pale, weakness, weakness of waist and knees, sinking pulse and other signs of deficiency, which belong to the category of “deficiency labor” and “chronic marrow labor” in Chinese medicine. “In 1982, the first national symposium on Chinese and Western medicine in hematology formulated the combined Chinese and Western medicine typing criteria for CAA, which divided it into kidney yin deficiency, kidney yang deficiency, and kidney yin and yang deficiency, and the treatment follows the principle of tonifying the kidney as the outline. AAA is mainly based on the actual evidence of evil and toxicity, mainly in view of the following points: from its pathogenesis, the disease is rapid, heavy and evolves quickly, with clinical manifestations of high fever, bleeding, large pulse count and other signs of evil, belonging to Chinese medicine “warm disease”, “blood evidence”, “acute medullary labor”, etc. It belongs to the categories of “warm disease”, “blood evidence” and “acute marrow labor” in Chinese medicine. Jisheng Fang ? Epistaxis” says: “The delusional movement of blood has not been caused by heat, cover the blood to heat will be Nao overflow, blood and gas with heat, blood with gas on, is epistaxis. From the analysis of its etiology, AAA has clear causes such as chemical poison, physical radiation, toxic drugs, viral infection, etc., and belongs to TCM warm-heat poisonous evil; from the analysis of its pathogenesis, warm-heat poisonous evil invades human body, directly hits the marrow and blood, injures yin and consumes blood, resulting in deficiency of kidney essence, and qi and blood are unable to transform into AAA. heat poison is the main pathological factor of the disease, clearing heat and detoxifying, cooling blood and stopping bleeding is the key to treatment. If the traditional remedy for the spleen and kidney is applied, it will make the Yang heat hotter and nourish the Yin blood, which may cause the patient to die of hemorrhage or sepsis in a short period of time. It can be seen that CAA is mainly based on the original deficiency, the method should be supplementation, and AAA is based on the actual evil, it is appropriate to clear the drainage. As the Su Wen? To the true to the great said: “careful to guard the disease mechanism, each division of its genus, those who have sought, those who do not seek, Sheng is responsible for, deficiency is responsible for, must first five wins, dredge its blood and Qi, so that it is adjusted to reach, and to peace, this is also called.” Of course, CAA and AAA are not absolutely isolated, and in TCM they have the potential to transform into each other. As mentioned above, the initiating factor of AAA is the poisonous evil, and the poisonous evil runs through the whole process of its development. Therefore, the treatment should be early and exhaustive to eliminate the evil. The clinical focus is on clearing heat and detoxification, as the saying goes, “Non-clearing heat cannot slow down its urgency, and non-detoxification cannot settle its blood”. If CAA is not treated in a timely manner or treated appropriately, resulting in deep heat toxicity, easy to cause disorders of the internal organs, Qi and blood disorders, decoction of fluids and fluid, resulting in endogenous evil toxins such as blood stasis, further injury to fluids and depletion of Qi, that is, the formation of CAA due to toxicity causing deficiency, the interaction of pathological factors such as toxicity, deficiency, and stasis, so that a variety of symptoms, lingering difficult to cure. Kou Mengke et al [3] summarized the pathogenesis of AAA as a cyclic process of “poisonous evil entering the marrow – loss of qi, blood, fluid and essence – qi does not take in blood – bleeding – blood does not nourish essence – essence dries up – essence does not transform blood – blood is empty – suffering from poisonous evil”. Huang’s [4] divided the whole course of AAA (onset-remission-basic cure) into three “disease stages”, namely, progressive, stable and remission stages. 2, good at learning from each other, the disease and evidence of mutual reference due to the limitations of historical conditions and the theory of Chinese medicine has its own characteristics, Chinese medicine has not yet fully understood the AA, there is still a need to improve and develop the necessity and feasibility. The development of TCM not only requires inheritance, but also must be good at drawing on the achievements and technologies of modern medicine and modern science and technology. As far as the theoretical system of TCM about AA is concerned, it is necessary to firstly draw on the understanding of modern medicine about the pathogenesis of AA, and secondly to select drugs in combination with modern pharmacological research.The pathological mechanism of AA is mainly the immune damage of hematopoietic tissues, i.e. autoimmune diseases [5]. Immune abnormalities are manifested by hyperfunction of T lymphocytes such as increased type I lymphokines (especially INF-γ, IL-2), CD8+ T lymphocytes, Thl cells, increased Fas-mediated apoptosis of CD34+ cells, appearance of oligoclonal proliferating T lymphocytes stimulated against certain antigens, imbalance and increased number of type I dendritic cell subtypes that activate Thl cells. Through relevant studies and clinical practice, clearing and detoxifying herbal medicines have immunomodulatory effects [6], and I believe that clearing and detoxifying herbal medicines are suitable for AAA. studies have shown [7] that the treatment of AAA based on Radix Polygoni (GTW) was able to achieve an effective rate of 48.1%, which was better than the control group using androgen-based combination therapy without the addition of GTW. the mechanism is that this drug can antagonize The mechanism is that this drug can antagonize the inhibitory effect of CD8+ T lymphocytes on the proliferation of CD34+ cells in vitro in AAA patients, thus increasing the proliferation rate of CD34+ cells in vitro. In other words, the immune disorder is corrected by improving the pathological balance among the immune cell subsets in AAA patients, which indirectly promotes hematopoiesis. Yang Shulian et al [8] showed that Cool Blood Detoxification Tang soup (composed of antelope horn powder, peony bark, red peony, raw groundnut, ripe groundnut, asparagus, cyperus, scutellariae, scutellariae, guanzhong, cang erzi, xinyi, raw keel, raw oyster, panax notoginseng powder, cypress and licorice) could inhibit the secretion of IFN-γ and slL-2R in most patients, i.e., Cool Blood Detoxification Tang can cool blood, stop bleeding, clear heat, detoxify and at the same time In other words, cooling the blood, stopping bleeding, clearing heat and detoxifying the toxin, and at the same time treating acute remittance by down-regulating the negative hematopoietic factors. The results of Hu Yongzhen et al [9] showed that cooling blood detoxification soup could effectively improve the imbalance of apoptosis between bone marrow T cells and hematopoietic stem cells and reduce the level of hematopoietic negative regulatory factors in mice with reblastosis. It can be seen that the new results of modern research innovatively reveal the nature of AAA pathogenesis and the mechanism of action of TCM, which not only facilitates the diagnosis and treatment of the disease in TCM and enriches the theory of TCM about hematopoietic regulation and has great clinical significance, but also gives us profound inspiration: comprehensive research is of importance in the development and innovation of TCM today, and the comprehensive use of some new theories, methods and techniques and It is important to use some new theories, methods and techniques and “transplant” them to our discipline to improve the overall knowledge and understanding of the disease and to broaden our horizon in order to achieve the essence of the disease. Western medicine believes that AAA is mainly related to immune mediators and therefore recommends the early use of immunosuppressants (e.g., ATG, CSA, etc.), which is based on disease-level understanding. In contrast, Chinese medicine recognizes the disease based on symptoms such as fever, bleeding, and anemia, and believes that it is mainly caused by warming and poisonous evil that depletes essence and blood, and follows the principle of differentiation and treatment, which is based on poison and deficiency. The two theoretical systems, Chinese and Western medicine, have different mechanisms of action, and can play a synergistic role in the treatment of AAA by referring to each other’s disease and evidence.3. Treating both the symptoms and the root cause, and taking care of the spleen and stomach In the theoretical system of Chinese medicine, the symptoms and the root cause are opposing concepts, and the two are relative. In terms of AAA, in terms of evil and positive, positive qi is the basis and heat toxin is the standard; in terms of disease mechanism and symptoms, disease mechanism is the basis and symptoms are the standard; in terms of disease sequence, the first onset is the basis and secondary onset is the standard. According to the principle of “treating the symptoms when it is urgent and treating the root cause when it is slow”, AAA should focus on treating the symptoms, i.e., eliminating heat toxins, controlling bleeding and fever, and preventing evolution. The drugs used are Yinhua, forsythia, scutellaria, gardenia, Qingdian, swollen wind, leigongteng, xuangshen, tanpi, red peony, etc. Because of the rapidity of AAA and the evolution of the disease mechanism, it is necessary to take into account the root of the disease while treating the symptoms, such as protecting the righteousness of the successive heavens, penetrating the evil and detoxifying the poison to avoid the latent poisonous evil, and avoiding the aggravation of the disease and the death of yin and yang or recurrence. As mentioned above, poisonous evil is present throughout the pathogenesis of AAA, and the main pathological feature of AAA is the prevalence of positive and negative evil, while blood stasis is the main pathological product of the course of AAA. The disease often has a history of recurrent bleeding and subcutaneous petechiae, and these “blood away from the menstruum” are stasis blood. Blood stasis can be caused by warmth, heat, and toxicity burning the blood channels and causing stasis of blood away from the meridians, or by loss of qi and blood flow, causing stagnation of blood and stagnation of blood. It can be seen that the formation of blood stasis in the course of AAA is related to the complex pathological mechanisms such as the inability to move blood due to deficiency, the refinement of blood into stasis by heat and toxicity, and the presence of stasis in blood leaving the meridian. Therefore, it is important to effectively eliminate blood stasis as a pathological factor in the body. To activate blood stasis means to remove the pathological stagnation caused by the competition between evil and positive, and to improve the microenvironment of blood production, so as to achieve the purpose of “to pass through as use”. In the treatment of SAA by detoxifying and clearing heat, emphasis is often placed on the application of cold medicines, which hinder the flow of blood, so the treatment should also invigorate the blood to disperse the evil, in order to cool the blood without attaching to the evil, and to eliminate the evil, that is, invigorating the blood to remove blood stasis can also disperse the heat and poisonous evil in the blood, combined with the detoxification of heat, which means “cooling the blood to disperse the blood”. Clinically, attention should be paid to the use of drugs that nourish the Blood and invigorate the Blood, stopping bleeding without leaving stasis, such as chicken blood vine, cyperus, panax pseudoginseng, angelica, salvia, etc. The “Blood Evidence” cloud: “Blood stasis does not work, then the new blood is broken without physiology,? Gai blood stasis goes then new blood has been born, new blood is born then blood stasis goes since.” Experimental studies have shown that herbs that activate blood circulation and resolve blood stasis not only improve the bone marrow hematopoietic microenvironment and promote stromal growth, but also stimulate the proliferation and differentiation of bone marrow hematopoietic stem/progenitor cells [10-11]. It is worth emphasizing that because AAA patients need to use cold herbal medicines and western medicines such as cyclosporine and androgens, it is very easy to damage the postnatal spleen and stomach, which are the basis of the postnatal life. Therefore, the treatment process should be guided by the theory of “earth is the mother of all things” and “spleen and stomach are the essence of the latter”, and the principle of taking care of the spleen and stomach qi, dispensing medicines such as Fu Ling, Atractylodes Macrocephalae, taking into account both the coordination of overall functions and the regulation of spleen and stomach functions. This is to ensure that the person and the medicine are in harmony to achieve the best therapeutic effect. In addition, the liver function damage, masculinization, gingival hyperplasia and hirsutism caused by long-term use of cyclosporine and androgens in AAA patients are important factors affecting the quality of life and work of patients, and even the risk of secondary tumors. The early intervention of Chinese medicine, using the formula of nourishing the liver and softening the liver, strengthening the spleen and benefiting the kidney to regulate the overall balance of yin and yang of the body, can play a role in increasing the effectiveness and reducing the toxicity, which also belongs to the category of treating the symptoms. 4. Case example Patient Zhang, female, 52 years old, went to the local hospital in August 2012 for “fever with dizziness and weakness”. Bone marrow smear: granulocytes and red lineage hyperplasia were severely reduced, and the proportion of lymphocytes was increased; bone marrow pathology: bone marrow tissue hyperplasia was reduced, and adipocytes were significantly increased. He was diagnosed as “acute aplastic anemia”, and was treated with Anxiong, cyclosporine A, glucocorticoids, gammaglobulin, hematopoietic growth factor and Chinese herbal medicines to strengthen the spleen and kidney, but the effect was not significant, and he developed liver function damage. First diagnosis: fever (temperature 38.6℃), fatigue, dizziness, chest tightness and shortness of breath after activity, dry cough, purpura of the skin of both lower limbs, dry mouth with a tendency to drink, lack of food and drink, dry stools, small amount of urine with yellow color, red tongue, yellowish greasy coating, thin and slippery pulse. Hematology: leukocytes 2.9×109/L, hemoglobin 58g/L, platelets 10×109/L; ghrelin 81 U/L, total bilirubin 22umol/L, direct bilirubin 12.2 umol/L. Differentiation: Acute consumption – marrow withered and warm; Treatment: Clearing heat and detoxifying, cooling blood to stop bleeding, nourishing Yin and nourishing blood. Herbs: 15g of honeysuckle, 15g of forsythia, 5g of blue daisy, 15g of swollen wind, 15g of summer cress, 30g of money grass, 10g of light scutellaria, 10g of peony bark, 10g of red peony, 10g of cyperus, 10g of genistein, 15g of comfrey, 20g of raw groundnut, 6g of white peony, 15g of water hyacinth (first decoction), 15g of dry lotus grass, 10g of porcupine, 10g of raw atractylodes, 5g of roasted licorice. 7 doses, decoction in water, 1 dose daily, warm in the morning and evening. Western medical treatment was maintained with cyclosporine and supported by blood transfusion if necessary. Second Diagnosis: The patient’s body temperature peaked down and was feverish in the afternoon, skin purpura faded, still felt weak, dry mouth, appetite improved, normal stool, light red tongue, white coating, thin pulse. Blood picture: leukocytes 8.8×109/L, hemoglobin 78g/L, platelets 9×109/L, liver function returned to normal. On the basis of the preceding, 5g of Radix Rehmanniae was added and 7 doses were continued. The natural course of acute medullary labor is about 6 months, with a mortality rate of more than 90% within 1 year, and is generally considered to be divided into two phases: the acute phase and the stable phase [12]. In the acute stage, the condition is critical, with obvious fever and severe bleeding, and according to the principle of “treating the symptoms when it is urgent” in traditional Chinese medicine, the treatment should be to clear heat and detoxify, cool the blood and stop bleeding, so that the patient can successfully pass the life-threatening period, as called in Su Wen and Zhi Zhen Yao Da Lun: “Be careful to observe the disease mechanism, each division of its own genus, those who have seek it, those who do not, those who are in full bloom, and those who are responsible for it. The first five wins must be to dredge the blood and qi, so that it can be regulated and brought to peace, this is also called.” There are many drugs in the treasury of Chinese medicine to clear heat and detoxify the toxin. In the dispensing of these drugs, we mainly focus on the understanding of modern medicine on the pathogenesis of acute re-infection and draw on the results of modern pharmacological research to match the medicine with the disease. As mentioned above, modern medicine believes that the pathological mechanism of AA is mainly the immune damage of hematopoietic tissues, and modern pharmacological research has shown that Scutellaria baicalensis, Qing Dai, Swollen Gourd, Yin Hua, Forsythia lanceolata and Leigong Vine have immunomodulatory effects. The formula is supplemented with Fu Ling and Atractylodes macrocephala, which aims to protect the spleen and stomach without any adverse effects. The patient has been taking androgens, cyclosporine and other drugs for a long time, and the detoxifying and cooling herbs tend to cause excessive suppression of cold, damaging the spleen and stomach and aggravating the disease. Third examination: the patient was slightly weak, no fever or bleeding, normal sleep and stool. The patient’s condition was stabilized with the removal of honeysuckle and forsythia from the original formula, and the addition of 30g of chenopodium and 30g of chicken blood vine. The patient’s condition has stabilized, and the repeated blood tests showed that the white blood cell count was normal, the hemoglobin was above 95g/L, and the platelets fluctuated at (40-60)×109/L. The patient is still being followed up and maintaining a normal quality of life.