刘宝文以“热、虚、瘀”论治免疫性血小板减少性紫癜经验

LIU Baowen’s Experience in Treating Immune Thrombocytopenic Purpura with “Heat,Deficiency and Stasis”

辽宁中医药大学附属医院刘宝文教授为辽宁省名中医、全国首批优秀中医临床人才,从事血液病工作三十五年余,对中西医结合治疗血液病有丰富的临床经验,尤其是辨证论治血小板减少性紫癜,疗效颇丰。刘教授认为该病病因无外乎血热妄行、气不摄血、阴虚火旺、瘀血阻络四方面。病机的关键是热、虚、瘀。主要病机是热扰营血、迫血妄行,或脾气亏虚、气不摄血,或阴虚火旺、灼伤脉络,而致血不循经,血溢脉外。以气阴亏虚为本,热迫血行、血溢脉外、瘀血阻络为标。将其分为血热妄行型、气不摄血型、阴虚火旺型,遵循《血证论》"止血、消瘀、宁血、补虚"治血四法,遣方用药,分别给予紫癜汤、加味四君子汤、滋阴凉血汤治疗,临床疗效显著。临证中总结了四法合参、中西合参、分清部位、补气护脾、牢记化瘀、生活调理等经验,值得推广应用。

Professor LIU Baowen is a famous doctor of traditional Chinese medicine in Liaoning province. He is one of the first batch of excellent clinical talents of traditional Chinese medicine in China. He has been engaged in hematology for more than 35 years. He has rich clinical experience in the treatment of hematologic diseases combined with traditional Chinese and Western medicine,especially in the treatment of thrombocytopenic purpura based on syndrome differentiation. Professor LIU believes that the cause of the disease is nothing more than blood heat,Qi does not take blood,Yin deficiency and fire,blood stasis. The key of pathogenesis is heat,deficiency and blood stasis. The main pathogenesis is that the heat disturbs the blood and forces the blood to act in a wrong way,or the spleen is deficient and the Qi is not taking the blood,or the Yin is deficient and the fire is strong,which burns the vein and causes the blood to not follow the meridians and the blood overflows out of the vein. It is based on deficiency of Qi and Yin,with heat forcing blood circulation,blood overflowing and blood stasis blocking collaterals as the standard. It can be divided into three types:the type of blood heat,the type of Qi not taking blood,the type of Yin deficiency and fire hyperactivity. It can be divided into four types according to the theory of blood syndrome:hemostasis,removing blood stasis,calming blood and tonifying deficiency. It can be treated with Purpura Decoction(紫癜汤),Modified Sijunzi Decoction(加味四君子汤)and Ziyin Liangxue Decoction(滋阴凉血汤)respectively,which has a significant clinical effect. The experience of four methods combined with reference,Chinese and Western combined with reference,distinguishing parts,invigorating Qi and protecting spleen,remember to promote blood circulation and remove blood stasis,and life conditioning are summarized in clinical syndrome,which is worth popularizing and applying.