Chronic primary myelofibrosis is a myeloproliferative disease of unknown origin, characterized by anemia, significant enlargement of the spleen, dry bone marrow aspiration and sclerosis of the bone. The Department of Hematology, Guangdong Provincial Hospital, Guangdong Province, China, Dai Xiping, Jin Kui Essentials cloud “men’s pulse is weak and sunken, no cold and heat, short of breath and urgent, unfavorable urination, white face, sometimes eyes close, and epistaxis, less abdominal fullness, this is the result of labor”; the treatise on the origin of diseases contains “the diagnosis of liver accumulation, the pulse is string and thin, the two hypochondriac pain, the …… the men’s hernia in the lower part of the abdomen” all describe the characteristics of this disease such as anemia and giant spleen respectively. Therefore, the anemia and giant spleen of this disease can be classified under the category of “medullary labor” and “Y accumulation” in TCM, and the clinical features of this disease can be summarized by “labor Y” in TCM. We believe that this disease is characterized by pale complexion, palpitation, shortness of breath, tiredness and weakness, low fever and sweating, soreness and weakness of the back and legs, which are manifestations of “medullary labor”, such as deficiency of spleen and kidney essence and deficiency of qi and blood; it is also characterized by stagnation of liver qi and stagnation of silt and blood, which are manifestations of “Y-cumulation”, such as accumulation of lumps under the dorsum, hardness and pain in the abdomen. Therefore, the diagnosis is always the evidence of deficiency of the origin and the symptoms, and the evidence of mixed deficiency and reality; the pathogenesis is mainly the deficiency of spleen and kidney, liver depression and blood stagnation; Chinese medicine treatment should be to nourish the kidney, strengthen the spleen, and dredge the liver to eliminate stagnation, so as to nourish its source of transformation, disperse stagnation and eliminate stagnation, and take care of both the symptoms and the root cause. In clinical practice, Chinese herbal soup is used: Bianzhi ginseng 15 g, roasted astragalus 20 g, Xianling spleen 15 g, bone marrow 15 g, chicken blood vine 30 g, Chai Hu 15 g, purple salvia 30 g, curcuma 30 g, trigonella 30
g, safflower 15 g, peach kernel 15 g, etc.) as the mainstay; for kidney yang deficiency, add Radix et Rhizoma rehmanniae 10 g, deer horn gum 15 g (melted); for kidney yin deficiency, add Radix rehmanniae 15 g, Cornus officinalis 15 g, yellow essence 15 g.
For giant spleen, add 10 g of Citrus aurantium, 30 g of turtle shell (first decoction) and 30 g of ground turtle worm; for thrombocytosis, add 15 g of leech and 15 g of dilaemon; for treatment of Qing Dai Si Huang San: mix 60 g of Qing Dai powder with 20 g of Si Huang powder (our preparation: Rhubarb, Phellodendron, etc.), mix with water to form a char, apply to spleen area, cover with plastic film, fix with adhesive tape, apply for 6~8
For giant spleen, increase the dosage of Qing Dai as appropriate. In combination with western medical treatment: oral small doses of hydroxyurea or leucovorin for those with increased peripheral blood cells during the myeloproliferative phase; oral prednisone, Anxon or Conilon for those with anemia, transfusion of concentrated red blood cells for support if necessary, platelet transfusion for those with low platelets and bleeding tendency to control bleeding; oral rocalciferol and reaction stop for some patients, and intramuscular injection of interferon. We currently counted the results of 26 patients, 8 cases improved, 14 cases progressed, and 4 cases were ineffective, with a total efficiency of 85.5%. It shows that this combination of Chinese and Western medicine treatment has good efficacy.