周郁鸿教授从脾肾论治免疫性血小板减少症的经验总结

Summarize Professor ZHOU Yuhong’s Experience in Treatment of Immune Thrombocytopenia(ITP) from Spleen

[目的]总结周郁鸿教授从脾肾论治免疫性血小板减少症(immune thrombocytopenia,ITP)的辨证诊疗思维和临证拟方用药经验。[方法]通过概述ITP的现代医学认识、历代中医沿革,收集、整理、归纳周郁鸿教授治疗ITP的典型医案,从脾肾论治ITP的理论渊源、加味黄芪建中汤组方阐释及其药理学剖析等方面论述周教授从脾肾论治ITP的学术观点及临证诊疗思维,并举验案一则以佐证。[结果]现代医学认为,ITP是一种获得性自身免疫性疾病,而历代中医则认为ITP是一种血证。周郁鸿教授认为ITP患者常属"脾胃亏虚、肾精不足"之证,应以脾肾为着眼点辨证论治ITP,以"健脾补肾"为基本治则,以温中补虚立法。加味黄芪建中汤健脾补肾,现代药理研究证明其可能通过调节Th17/Treg细胞而有效治疗脾肾阳虚型慢性ITP。所举验案属脾肾阳虚型血证,方用加味黄芪建中汤,温补脾肾、养血止血,取得较好疗效,展示了该病的辨证诊疗思路。[结论]周郁鸿教授从脾肾论治临床上部分难治ITP患者,中医理论依据充分,临床效果显著,值得推广。

[Objective] To summarize Professor ZHOU Yuhong’s experience in the diagnosis and treatment of immune thrombocytopenia(ITP) from the spleen and kidney, and the experience of clinical trial use. [Methods] Through the arrangement, induction and analysis of Professor ZHOU Yuhong’s treatment of spleen and kidney deficiency type ITP typical medical cases, from the aspects of etiology, pathogenesis and prescriptions, Professor ZHOU’s academic viewpoint and clinical diagnosis and treatment thinking from the spleen and kidney are discussed. One case is presentel for evidence. [Results]Professor ZHOU believes that some patients with clinically refractory ITP, especially those with long-term, high-dose glucocorticoids and poor efficacy,are of mostly spleen and kidney deficiency, and the treatment of ITP should be based on syndrome differentiation of spleen and kidney. At the same time,Professor ZHOU believes that the treatment of this syndrome can take Jiawei Huangqi Jianzhong Decoction, and it is analyzed from the modern pharmacology. Finally, in the case here, after symptomatic treatment, the symptoms and indicators of ITP were significantly relieved, and good results were obtained.[Conclusion] Professor ZHOU Yuhong treats partially refractory ITP patients based on theory of the spleen and kidney, TCM theoretical basis is sufficient, clinical results are significant, it is worth promoting.