According to its clinical manifestations, true erythrocytosis belongs to the category of “obstruction” and “stasis evidence” in Chinese medicine. The pathogenesis is mainly related to blood heat and blood stasis, and the clinical treatment mostly adopts the method of differentiation and typing according to the pathogenesis, which is combined with Western medicine diagnosis and treatment to divide it into three types. Blood stasis is treated by activating blood circulation and resolving blood stasis, and the formula is based on Peach-Hong Si-Wang Tang with addition; blood heat and bleeding is treated by clearing heat and cooling blood, and the formula is based on Rhizoma Rhizoma Dihuang Tang with addition and subtraction of Gentian Liver Diarrhea Tang. The treatment of Qi and Blood (Yin) deficiency is to benefit Qi and nourish Blood, and the formula is to add flavor to Bajhen Tang. By mastering the characteristics of each type and grasping the main pathogenic mechanism, we can achieve obvious clinical results. Li Dongyun, Department of Hematology and Oncology, Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, China. 1 Blood stasis evidence Main symptoms: ① cyanosis of skin; ② cyanosis of lips, tongue and fingers; ③ dark red face; ④ lumps under the duress; ⑤ dark red tongue with petechiae; ⑥ astringent pulse. Concurrent symptoms: (1) depressed mood, dizziness and pain, chest tightness, fullness and pain, menstrual disorders in women; (2) phlegm obstruction, dull complexion, vomiting, paralysis, dizziness of head and eyes, or even confusion, white and greasy tongue coating; (3) qi deficiency, dizziness and weakness, tiredness and sweating, abdominal distension and dullness, itchy skin, insomnia and fatigue, fat tongue and weak pulse. Characteristics of this evidence: ① Chronic onset, mainly seen in the erythrocyte and hemoglobin increase phase of true erythrocytosis and bone marrow fibrosis phase. The course of the disease is long and can last for many years; ②hepatosplenomegaly is obvious, and patients are often accompanied by varicose veins, thrombosis and phlebitis; combined with hypertension is common. Legislation: Invigorate blood circulation and remove blood stasis. Prescription: Peach-Hong Si-Wu Tang with added flavor. Example formula: peach kernel, safflower, angelica, Chuanxiong, red peony, raw earth, salvia, stinging insect, rhubarb. For ①Qi stagnation, combining with Blood Mansions and Stasis Removal Tang and Chai Hu and Liver Dispersion is recommended. Example formula: peach kernel, safflower, angelica, Chuanxiong, red peony, raw earth, niger, Chai Hu, Citrus aurantium, Xiang Shen, San Ling, Curcuma longa; (2) for phlegm stagnation, combining with Wenzhi Tang and Diaphragmatic Stasis Removal Tang. Example formula: peach kernel, safflower, angelica, red peony, half ansia, poria, bamboo rhizome, tannin, wuling fat, heliotrope shell, yujin, Chenpi; (3) for Qi deficiency, Ginseng and Spleen Soup and Sijunzi Tang are used. Example formula: Peach kernel, safflower, Radix et Rhizoma Ginseng, Radix Astragali, Atractylodes Macrocephala, Radix Angelicae Sinensis, Rhizoma Chuanxiong, Rhizoma Ginseng, Radix Paeoniae Alba, Radix et Rhizoma Glycyrrhiza Uralensis, Radix Rehmanniae Sinensis, Radix Salviae Miltiorrhizae. Note: (1) this type of blood stasis into accumulation, blood stasis as the basis, due to stasis caused by accumulation, so the elimination of stasis is the first method; (2) the clinical evidence more use of rhubarb stinging worm pill to break blood and eliminate accumulation, as the symptomatic treatment of the symptoms; (3) in the treatment process should not be too cold, nourishing and greasy products, so as not to aggravate blood stasis. (2) Blood-heat and bleeding symptoms: (1) dizziness and tinnitus; (2) bitter mouth and dry throat; (3) epistaxis and epistaxis, skin petechiae; (4) skin bruising; (5) red urine and dry stool; (6) red tongue with yellow coating; (7) slippery pulse. Concurrent symptoms: (1) deafness of the eyes, deafness of the heart, vomiting, dullness, insomnia and irritability, menstrual disorders in women; (2) hot flashes and night sweats, skin nail fault, dry mouth and throat, epistaxis, epistaxis of the five hearts, red tongue with little coating and fine pulse in cases of Yin deficiency and fire. Characteristics of this evidence: (1) Mostly seen in the late stage of true erythrocytosis, with a tendency to transform into acute leukemia; (2) Patients mostly have peripheral blood hypoplasia, bleeding and infection are common; (3) May be accompanied by hypertension, hyperlipidemia, and some patients have combined cardiovascular and cerebrovascular diseases. Legislation: Clearing heat and cooling blood. Prescription: Rhizoma Rhizoma Dihuang Tang combined with Gentian Diarrhea Liver Tang plus or minus. Example formula: Shuanghuajiao, Radix Rehmanniae, Dampi, Chuanxiong, Radix Paeoniae Alba, Salviae Miltiorrhizae, Gentianae, Chaihu, Scutellariae. Combining with Angelica sinensis and Dragon Aloe Pill in cases of solid heat in the liver and gall bladder. Example formula: Gentian Herb, Chai Hu, Scutellaria Baicalensis, Zedoary, Moutong, Angelica Sinensis, Radix Paeoniae Alba, Radix Rehmanniae Praeparata, Semen Lonicerae, Jiu Jun; ②Liu Wei Di Huang Wan is used for those with Yin deficiency and fire. Example formula: Sheng Di, Dan Pi, Red and White Peony, Yam, Yam Pulp, Lady’s Mantle, Dry Lotus Grass, Poria, Xuan Shen, Mai Dong, Ze Xie; Precautions: ① Blood heat, bleeding evidence to heat-based, blood heat break blood delusion. The main purpose is to clear heat, and caution in the use of pungent warming and dispersing drugs; ② clearing heat and diarrhea, must take into account the cooling of blood, blood circulation, eliminating stasis and eliminating accumulation; ③ fire and heat of the evil of inflammation, easy to cause agitation, so you can add sedative, tranquilizing products. 3 qi and blood (yin) deficiency evidence: ① lazy speech; ② sweating or night sweats; ③ palpitations and insomnia; ④ dull face; ⑤ abdominal lumps; ⑥ light tongue with white fur; ⑦ astringent pulse. Concurrent evidence: in case of kidney yin deficiency, hot flashes in the afternoon, dry mouth without desire to drink, soreness and weakness of the waist and knees, red tongue with little coating and fine pulse. Characteristics of this evidence: (1) Mostly seen in the third stage of true erythrocytosis, i.e. anemia and bone marrow failure; (2) Patients are mostly in poor general condition after repeated chemotherapy and radiotherapy, and the efficacy of chemotherapy and radiotherapy is not obvious or cannot be tolerated; (3) Combined cerebral hemorrhage and coronary heart disease are common. Legislation: Benefit Qi and nourish Blood. Prescription: Bajhen Tang with added flavor. Example formula: Radix Codonopsis, Radix Astragali, Radix Angelicae Sinensis, Rhizoma Chuanxiong, Radix Paeoniae Alba, Radix Rehmanniae Praeparata, Radix Salviae Miltiorrhizae, Atractylodes Macrocephala, Poria, Agaricus, Radix Glycyrrhiza Uralensis. In case of Qi detachment, combining with Doshen Tang and Shengwasan is recommended. Example formula: Ginseng or prince’s ginseng, Astragalus, Huang Jing, Radix Rehmanniae, Mai Dong, Wu Wei Zi, Red and White Peony, Fried Atractylodes, Radix Angelicae Sinensis, Salviae Miltiorrhizae. Note: ① this evidence is mainly to nourish deficiency, should not use attacking drugs; ② late stage of the disease, appear off the evidence, emergency to return Yang medicine to fix off; ③ time to care for the righteousness, support the righteousness, support the righteousness is to eliminate evil. Due to the differences in the theoretical systems of Chinese and Western medicine, their approaches to disease understanding are also different. Chinese medicine emphasizes evidence-based treatment, while Western medicine emphasizes disease identification. If the treatment can be based on evidence-based treatment, combined with Western medicine’s understanding of the disease, so that their advantages complement each other, the efficacy will be more significant. In the early stage of the disease, when the increase of red blood cells is not very obvious and the possibility of embolism complications is small, venous bloodletting and the use of Chinese medicine can be used to consolidate the effect. Because the positive qi is not deficient, herbal treatment should be based on eliminating the evil, and the basic treatment is to invigorate blood circulation and remove blood stasis. However, Qi-boosting and Qi-supplementing products should not be used in excess, otherwise they will violate the precept of actuality and cause excess Qi and blood. If the clinical symptoms are prominent, the peripheral blood erythrocytes are obviously elevated and the bone marrow proliferation is vigorous, because the effect of traditional Chinese medicine is slow, it is advisable to use western drugs such as hydroxyurea, marilan, trichothecene or cyclophosphamide to fold the disease directly, inhibit the red line proliferation as soon as possible and reduce the emergence of complications. Because chemotherapy drugs are carcinogenic and have the possibility of inducing leukemia, they should not be applied for a long time and should be combined with Chinese medicine to minimize the dose and shorten the time of using cytotoxic drugs. After the stabilization of the disease, the main herbal medicine should be used to invigorate blood circulation and eliminate blood stasis. On the basis of dialectic evidence, blood-breaking products of worms, such as leeches, crude worms and turtle worms, can be added to resolve accumulation and eliminate tumors and maintain the therapeutic effect. At the same time, herbs for clearing heat and detoxification and toxicity, such as dandelion, white flower and snake tongue herb, half branch lotus, Qing Dai and Huang Yao Zi, etc., should be applied to enhance the therapeutic effect. For the treatment of bleeding, the stage of the disease should be distinguished. Early bleeding is mostly due to stasis of blood, blood does not return to the meridian, or blood heat burns the veins and ligaments, and heat forces the blood to move; late bleeding is mostly due to qi not taking in blood, and blood overflows outside the veins. The pathogenesis is different, the treatment is very different, do not commit the precaution of deficiency. In case of severe hypertension, Western medicine can be used to control the condition urgently, while Chinese medicine can be added to nourish Yin and submerge Yang. In addition, this disease has a high red blood cell load and is prone to complications of gallstones, so you can take additional agents to clear heat and promote bile. Foreign data show that the main causes of death are thrombosis, hemorrhage, leukemia and bone marrow fibrosis. Modern pharmacological research shows that these drugs can also inhibit the proliferation of fibrous tissue, so it is possible to delay the development of the disease to the end stage of myelofibrosis. Chinese medicine does not inhibit bone marrow and does not induce leukemia, so it has a promising future in the maintenance treatment of true red smooth stage. The disease progresses slowly, and patients are prone to paralysis, non-adherence to treatment or delayed treatment and complications, so patients should be warned to pay attention to this.