髓热理论辨治免疫性血小板减少症的临床实践

Clinical practice of medullary heat theory in the treatment of immune thrombocytopenia

免疫性血小板减少症是儿童时期常见的自身免疫性出血性疾病,现代医学多应用免疫干预治疗,具有明显局限性。中医药治疗本病具有明显优势,髓生血,血证可从髓论治。翟文生教授认为本病热为诱因,虚为根本,瘀贯始末。“髓热”一词自《黄帝内经》提出后,其内涵及相关理论逐渐丰富完善,“髓热”既为一种特殊的病理状态,又强调病情至深,此均是由髓之特殊生理所决定。本文以“髓热”为理论基础,结合导师临床经验,将本病病因病机概括为“六淫灼髓”“伏毒在髓”“髓虚热蒸”,分别应用“清肺凉髓”法、“清髓解毒”法、“填髓清热”法,方药均选取可清髓中热邪之品,结合患儿生理病理特点,标本兼顾,临证取得较好疗效。

Immune thrombocytopenia is a common autoimmune hemorrhagic disease in childhood.In modern medicine immune intervention is often used and has obvious limitations.Traditional Chinese medicine has obvious advantages in the treatment of this disease.It is believed that marrow generates blood and blood syndrome can be treated based on marrow.Professor Zhai Wensheng believes that the disease is caused by heat,deficiency is the root,and stasis lasts from the beginning to the end.Since the word"medullary heat"was proposed in"Huangdi's Inner Canon",its connotation and related theories have gradually been enriched and perfected."Medullary heat"is not only a special pathological state,but also emphasizes the depth of the disease,which is determined by the special physiology of the medulla.Based on the theory of'medullary heat'and my tutor's clinical experience,the etiology and pathogenesis of this disease are summarized as'six evils burning marrow','latent toxin being in marrow'and'marrow deficiency and heat steaming'.The methods of'clearing lung and cooling marrow','clearing marrow and detoxification'and'filling marrow and clearing heat'are applied respectively.The herbs that can clear heat evils in marrow are selected.Combined with the physiological and pathological characteristics of children,the symptoms and causes are both taken into account in the treatment,and good clinical results are achieved.