从“血行失常”辨证论治原发免疫性血小板减少症

Treatment of primary immune thrombocytopenia based on syndrome differentiation of hematogenous disorder

原发免疫性血小板减少症(Primary Immune Thrombocytopenia,ITP)是现代血液系统疾病中常见且多发的一种出血性疾病,发病与自身免疫机制相关,儿童和成人皆可发病,成人多发于中年女性,各占出血性疾病的很大比例,严重者可进展为重症或难治性免疫血小板减少症,目前脾切除手术不可逆转,激素、免疫抑制等药物的疗效维持时间有限,易反复发作,缠绵难愈,存在诸多不良反应,影响患者长期的治疗及生活质量。中医认为原发免疫性血小板减少症病程可分为急性期和慢性期,基本病机为瘀,肝疏泄、藏血,脾运化、统血,肾藏精生血,与血相关,病位涉及肝、脾、肾三脏,肝脾肾三脏失调,血行失常,溢于脉外,发为紫癜;致病因素有虚实之分,急性期以实证、热证为主,慢性期多以虚证为主。本病瘀血为主要临床表现,证型繁多,虚实夹杂,既可相互转化,又能各自不断地演变、发展,故应重视脏腑辨证,由繁化简,力求证型准确。近年来ITP在中医药治疗方面不断地发展,有其独特的优势,治疗时不能一味地补血,应明辨阴阳,分清虚实,以脏腑论治,治疗原则为补虚以统摄血运,泻实以调畅血运,虚证应运用补气生血、滋阴养血、温补阳气等治法,实证可运用清热凉血、化湿解毒、活血化瘀等治法,尤重视虚实同调,使血生成,运行如常。

Primary immune thrombocytopenia is a common and frequently occurring hemorrhagic disease in modern blood system diseases.The onset is related to the autoimmune mechanism,it can occur in both children and adults,mostly in middle-aged women,which account for a large proportion of hemorrhagic diseases.In severe cases,it can progress to severe or refractory immune thrombocytopenia.At present,splenectomy is irreversible,the efficacy of hormones,immunosuppression and other drugs is limited,it is easy to relapse,the disease is lingering and difficult to heal,there are many adverse reactions,affecting the long-term treatment and quality of life of patients.According to Chinese medicine,the course of ITP can be divided into acute stage and chronic stage.The basic pathogenesis of ITP is stasis,liver is in charge of drainage and blood storage,spleen is in charge of translocation and blood circulation,kidney is in charge of translocation and blood production related to blood,the disease involves liver,spleen,kidney,of which disorders and blood overflowing outside the veins lead to purpura.The pathogenic factors can be divided into false and solid ones.The acute stage is mainly excessive and heat syndrome,while the chronic phase is mainly deficiency syndrome.The main clinical manifestation of this disease is blood stasis,which is characterized by various syndromes and the inclusion of deficiency and substance,which can be transformed into each other and continuously evolve and develop separately.In recent years,ITP has been continuously developing in the treatment of Traditional Chinese medicine,with its unique advantages,when treatment is not geared to blood,we should distinguish between Yin and Yang(阴阳),deficiency and excess based on zang-fu differentiation,the principle of treatment is to replenish deficiency by controlling blood circulation,to relive deficiency by regulating blood circulation,and the deficiency syndrome should be treated by invigorating qi,nourishing Yin and nourishing blood,supplementing Yang,etc.The excessive syndrome can be used to clear heat and cool blood,detoxifying dampness,activating blood and removing blood stasis,etc.especially attaching importance to regulating deficiency syndromes and excess syndromes,so that the blood can be generated and run as usual.