Abstract: This paper discusses the idea of identifying and treating primary thrombocythemia from the perspective of the etiology and pathogenesis of primary thrombocythemia in Chinese medicine, and proposes the treatment principle of “young patients are mostly suffering from liver depression, blood heat and blood stasis, so the treatment should be to clear liver heat and cool blood stasis; old patients are mostly suffering from kidney deficiency and blood stasis, so the treatment should be to benefit the kidney and remove blood stasis, taking into account tonifying the liver and strengthening the spleen”. In order to provide a new reference for Chinese medicine treatment of primary thrombocythemia. The primary thrombocythemia (ET) is a chronic myeloproliferative disorder manifested mainly by thrombocytosis, spontaneous bleeding tendency and/or thrombosis, and half of the patients may have splenomegaly. The disease is most common in older patients, but also in younger patients. Based on the pathogenesis and main clinical manifestations of this disease, it can be classified as “blood accumulation”, “pulse paralysis”, “blood evidence”, and “Y obstruction” in Chinese medicine. “The authors concluded from their observations that the disease is a result of the blood stasis. The authors concluded from observation that the symptoms of this disease differ significantly between young and old patients, and the clinical treatment of this disease should be tailored to the patient’s age in order to receive good results. I. The etiology and pathogenesis of the disease Modern medicine believes that ET belongs to chronic myeloproliferative diseases, the specific cause of which is unknown. It has been confirmed that acquired mutations in genes such as JAK2V617F and MPLW515L/K cause excessive platelet proliferation through activation of downstream signaling pathways, resulting in a series of clinical manifestations such as thrombocytosis, hemorrhage, thrombosis, splenomegaly, etc. Patients may have non-specific symptoms such as fatigue, malaise, some patients have headache, dizziness, blurred vision, numbness and burning sensation in the extremities, etc. . From the analysis of Chinese medicine pathogenesis, many of the above clinical symptoms and signs can be summarized by the term “blood stasis evidence”. ET patients may have headache, numbness or burning pain at the end of the limbs, and even pain in the limbs due to thrombosis, chest pain, abdominal pain, and hypochondriac pain, etc. The pain is fixed and refuses to be pressed; 2. ET patients may have pain, swelling and gangrene due to blood clots in the limbs, or they may have bruised skin and petechiae due to bleeding, or they may have a large spleen or even a large liver internally. 3. Patients with ET have these manifestations in terms of examination and pulse. In addition, due to blood stasis blocking the ligaments, qi and blood are not conducive to moistening and nourishing functions, patients may have fatigue, weakness, dizziness, etc. Thus, the blood stasis evidence in TCM can basically summarize the clinical manifestations of ET. From the point of view of identifying the causes, the main causes of blood stasis in ET are as follows: 1. External evil and poison: external fire and heat, or external cold and dampness, enter the interior and turn into heat from Yang, resulting in internal heat, heat stagnation in the blood and internal attack on the bone marrow, resulting in heat stagnation in the blood and Qi stagnation. 2. Excessive emotion and will: unrestrained emotion and will, liver qi, or liver depression and fire, liver heat and blood stagnation, blood qi is full and solid. As the “Ling Shu – the beginning of all diseases” said: “If internal injury and anger will be the Qi upward rebellion, the Qi upward rebellion, the six transfusion is not accessible, the warmth of Qi does not work, blood condensation and does not disperse”. 3. Kidney and spleen deficiency: due to old age and weakness, or acquired strain, disease impact. Kidney deficiency, Yin deficiency and fire, bone marrow contains heat, or Yang deficiency and loss of warmth, cold condensation, blood stagnation, triggering the disease. Acquired deficiency, deficiency of positive qi, and blood stasis due to lack of qi to control blood. In conclusion, the disease is located in the bone marrow and belongs to the blood component of the disease. All the above-mentioned causes can lead to imbalance of yin and yang in the body, imbalance of qi and blood in the viscera, blood stasis and qi stagnation, stagnation of blood vessels and veins, bone marrow proliferation, blood stasis and blood stasis. The symptoms always belong to the symptoms of actual deficiency or pure deficiency, with blood stasis, blood heat, and qi stagnation as its symptoms and qi deficiency and yin deficiency as its origin. Young patients are mostly suffering from liver stagnation, blood heat and blood stasis, so the treatment should be to clear liver heat and cool blood to remove stasis. The deficiencies in the internal organs of the liver, spleen and kidney are rare. The reason for this is that the disease starts with internal injuries caused by the seven emotions, resulting in liver depression and qi stagnation, liver heat and blood stasis, such as “Danxi Xinfa” cloud: “qi and blood rushing and harmony, all diseases do not arise, once there is fries, all diseases are born”, “qi surplus is fire”; or feel the fire and heat poisonous evil, heat depression blood, or the physique The body may feel fire and heat and poisonous evil, heat stagnation in the blood, or the body may have a strong yang and fire in the heart and liver, which attack the bone marrow, resulting in heat stagnation in the blood and qi stagnation. It can be seen that ET young patients show a school of liver depression, blood heat and stagnation, and their treatment should be based on the method of draining the liver and Qi, dipping the fire and detoxifying the toxin, cooling the blood and eliminating stasis. As stated in the “Evidence and Treatment Replenishment”, “Although there are many depressions, all of them are due to gas not flowing around, so the method should be to smooth the gas first, and open up the secondary, as for lowering fire, resolving phlegm and eliminating accumulation, it should be treated by how much.” It can be seen that draining the liver and relieving depression is the most basic principle, under this principle, combined with the patient’s specific pulse evidence, and then refer to the treatment method of clearing heat and fire, drying dampness and phlegm, eliminating accumulation and dispersing nodules, etc., in order to hit the main points of treatment. In the treatment of Chinese medicine, we should use Chai Hu, Radix Aromaticus, Yu Jin, Neem, Buddha’s Hand, and August Zha to de-stress the liver and regulate Qi and move Qi; gypsum, gardenia, gentian grass, scutellaria, Huang Lian, Huang Bai, bitter ginseng, and Xia Ku Cao to clear heat and fire; honeysuckle, forsythia, dacquoise leaf, septoria, Chonglou, tiger scepter, and Qing Dai to clear heat and detoxify; and water hyacinth, niu huang, xuan shen, raw earth, danpi, red peony, and leech to clear heat and cool the blood. The combination of these drugs is used to activate blood circulation and resolve blood stasis. If liver heat, stagnant fire, stagnant heat and poisonous evil injure the vital energy, resulting in injury to both qi and yin, products that nourish liver yin or benefit qi and nourish yin should be added. Nourishing liver yin can be Sha Shen, Tian Men Dong, Huang Jing, dry lotus grass, lady’s maidenhair, wolfberry, etc., and nourishing yin can be applied to prince’s ginseng, party ginseng, Xuan Shen, Sheng Di, Mai Dong, Zhi Mu. Third, the elderly patients are mostly kidney deficiency and blood stasis, treatment from the benefit of the kidney to eliminate blood stasis, taking into account the liver and spleen. Elderly patients are mostly deficient in the righteousness, the essence is gradually declining, the kidney, liver and spleen deficiency, such as “Suwen – Yin and Yang should be like the great theory” said: “40 years and Yin Qi since the half also, living decay. ET occurs between 50 and 70 years old, with an average age of 60 years old, which is closely related to kidney deficiency in old age. The disease can be formed due to deficiency of kidney qi, qi deficiency and blood stasis, or kidney deficiency and evil stagnation and stasis. In other cases, spleen deficiency, liver weakness, and the inability of the right qi to move blood, and the stagnation of qi and blood are also important mechanisms of the disease. It can be seen that the pathogenesis of ET in the elderly is mainly kidney deficiency and blood stasis, or also spleen deficiency, or liver weakness, which is always the evidence of actuality in deficiency, which is quite different from the pathogenesis of ET in the young patients, where the symptoms are mainly actual. In the clinical evidence, the patient may have cold pain in the waist and knees, cold body and limbs, tiredness and fatigue, bloating and dullness, loose stools, frequent urination, pale tongue with white fur, and sunken and weak pulse; or dizziness and dizziness, soreness and weakness in the waist and knees, emaciation, numbness in the limbs, fever in the heart, hot flashes and night sweats, dry skin, red tongue with little or no moss, and astringent or fine pulse, etc. with deficiency in the liver and kidney. The treatment should be both offensive and complementary, taking into account both the symptoms and the root cause, tonifying the kidneys, liver and spleen, as well as activating blood circulation and removing blood stasis. The treatment should be based on a combination of both attacking and tonifying, taking both the symptoms and the root cause into account, tonifying the kidney, liver and spleen, and at the same time activating the blood to eliminate blood stasis, such as tonifying the spleen and kidney, warming the Yang and benefiting the Qi, and activating the blood to eliminate blood stasis. Due to the deficiency of spleen and kidney, it is easy to combine water-dampness and phlegm obstruction, and should be supplemented with products that warm Yang, promote water, dispel dampness and resolve phlegm, such as Zhen Wu Tang and Er Chen Tang. Furthermore, in elderly patients, it is not advisable to apply too many blood-breaking and blood-drying products such as trigonella, curcuma, turtle worms, gadfly, leeches, etc., so as not to injure the righteousness. Therefore, when treating elderly patients with ET, we should take into account the physical characteristics of elderly patients and take into account benefiting the kidneys, strengthening the spleen and tonifying the liver while resolving blood stasis, so as to balance both the symptoms and the root cause, and to support the righteousness and resolve blood stasis, so that the righteousness will prevail and the evil will be eliminated, but without stagnation. Therefore, the treatment should be combined with the patient’s age, physique and specific pulse evidence to identify and apply blood-stasis-activating drugs, and master the characteristics and dosage of different types of blood-stasis-activating drugs and make flexible combinations in order to hit the target. If the patient is suffering from blood stagnation and heat, he should be combined with heat-clearing and blood-cooling drugs such as Radix Paeoniae, Dampi, Dilong, and Leech; if qi stagnation is obvious, he should be combined with qi-regulating and qi-activating drugs such as Radix Aromaticus, Yujin, and Neem; if qi deficiency is obvious, he should be combined with qi-benefiting and qi-supplementing drugs such as Radix Astragali, Radix Codonopsis, Radix Codonopsis, and Rhizoma Atractylodes; if yang deficiency is obvious, he should be combined with deer antler gum, Radix et Rhizoma Bacopa, Radix et Rhizoma Cinnamomi, etc. to warm the yang and dispel cold, and with yang-warming and blood-stasis-transforming drugs such as Wu Ling Lipid. In case of yin deficiency and fire, it is necessary to nourish yin and lower the fire to resolve the stasis, and it is necessary to use Huang Bai, Xuan Shen, Artemisia, Di Bone Bark and Zhi Mu. If the patient has a strong constitution and no signs of deficiency, he can boldly apply products to invigorate blood circulation and eliminate blood stasis, with less adjuvant products to break blood and remove blood stasis, such as San Ling and Curcuma, or apply worm medicines, such as turtle worms, leeches and whole scorpions to enhance the efficacy, especially leeches are beneficial to control thromboembolism. If the elderly are deficient or weak, they are not included in this case. If combined with heat and toxicity, the patient has red face and eyes, hot body and thirst, dry stool and urine, red tongue with yellow coating, and should be cleared of heat and detoxification and laxative medicines such as Niuhuang detoxification tablets, Banlangen, Flea Huo, Lianxiao, Xuan Shen, Da Qing Ye, etc. In combination with phlegm and dampness, it should be combined with dampness-drying and phlegm-transforming herbs such as Semen, Nanxing, Cat’s Claw, Bayberry, Guahu Piper, etc., and with less spleen-strengthening and qi-regulating herbs such as Atractylodes, Yam, Poria, and White Lentil, in order to eliminate the source of phlegm production. If the physique is deficient, it is necessary to appropriately match the products to support the righteousness, to attack and supplement at the same time, to invigorate blood circulation, to take into account both the symptoms and the root cause, to invigorate blood circulation and resolve blood stasis, to apply blood invigorating and nourishing drugs such as Angelica sinensis, Chuanxiong rhizoma, Salvia miltiorrhizae, Gynostemma spp. In elderly patients, there are many cases of combined phlegm and dampness, and weakness of positive qi, so it is necessary to take into account the method of drying dampness and resolving phlegm, nourishing blood and invigorating blood.