麻柔主任医师经验总结及中西医分型治疗再生障碍性贫血临床研究

发布时间：2018-01-09 10:04

本文关键词：麻柔主任医师经验总结及中西医分型治疗再生障碍性贫血临床研究　出处：《中国中医科学院》2012年硕士论文　论文类型：学位论文

【摘要】：目的：本研究通过对麻柔主任医师学术思想形成渊源及临床经验的整理与总结,分析提炼他独到的用中医理论阐释疾病发生发展规律的方法及在诊病过程中体现的独特诊病经验；通过典型医案的搜集总结,结合中医古典医籍,使他的学术思想得到进一步的理论升华。本研究还重点对麻柔主任医师中西医结合分型治疗再生障碍性贫血经验进行了总结与临床研究,通过临床客观数据证实他诊治再障的临床疗效并分析其诊病用药特点。本研究人群为笔者师承临证学习期间,麻柔主任医师所治疗的再生障碍性贫血患者,结合既往基础研究结果,进一步总结和研究他对不同分型(急性或慢性)及中医不同证型(肾阴虚或肾阳虚)再生障碍性贫血(aplastic anemia, AA)患者的临床疗效及证候疗效,探讨对AA不同分型及证型患者的中医及中西医结合诊治规律,探寻中医或中医与适当西药联合的规范化治疗方法,以克服过度治疗,提高临床疗效及充分发挥中医药治疗再障的优势。另外通过对麻柔主任医师补肾为核心的中医辨证分型治疗再障病例的总结,掌握其辨证及用药规律,以利于进一步传承与推广。方法：前瞻性纳入并系统随访总结麻柔主任医师诊治的60例AA患者。据其临床经验结合西医分型及中医证型分为三组行中西医结合分型治疗：1.单纯补肾中药治疗组,病例为慢性再障轻型、小儿患者以及西药无效或不能耐受患者；2.补肾中药+免疫抑制治疗组,病例以免疫抑制导致骨髓衰竭为主要病理机制的急重型再障患者；3.补肾中药+雄激素治疗组,病例以骨髓造血功能衰竭为主要病理机制,诊断为慢性再生障碍性贫血或免疫抑制剂无效或疗效不完全以及慢性重型再生障碍性贫血Ⅱ型患者。其中对病史长于20年以上的重型再障Ⅱ型患者尝试补肾兼化瘀联合雄性激素治疗。从中医辨证(肾阳虚/肾阴虚)、西医诊断(急重性再障/慢性再障)、疗效(缓解/进步/无效)和治疗方法(雄激素有效/无效和免疫抑制剂有效/无效)四个角度,对AA患者进行不同组别、不同中医证型治疗前后疗效及症状积分进行总结分析,阐释麻柔主任医师诊治本病的分型疗效、证候疗效及用药特点和规律。结果：1.总结60例AA患者,至少接受6-12个月的治疗进入疗效总结。总有效率93.00%。 2.分型治疗及疗效：单纯补肾中药治疗组10例,基本治愈4例,缓解6例,其中6例为小儿患者；雄性激素联合补肾中药组24例,基本治愈4例,缓解10例,明显进步8例,无效2例；免疫抑制剂环孢菌素A和/或ATG联合雄性激素及补肾中药组26例,基本治愈4例,缓解12例,明显进步8例,无效2例。 3.中医分型特点分析：肾阳虚组主要为慢性再障患者(58.8%,20/34),肾阴虚组主要为急重型再障患者(57.6%,15/26)。这说明中西医分型标准虽不具备精确对应关系,但存有一定的关联性。其中4例为病程长于20年的重型再障Ⅱ型患者,辨证属肾阳虚兼血瘀,探索性采用具温阳化瘀功效的雄黄联合雄性激素及补肾中药治疗,1例基本治愈,2例有效。 4.中医分型与西医分型治疗相关性及结果：①肾阳虚组和慢性再障组使用单纯中药(80.0%,8/10)或雄激素(66.7%,16/24)患者比例较高；肾阴虚组和急重型再障组使用免疫抑制剂的患者比例较高(61.6%,16/26；76.9%,20/26)。单纯中药治疗组小儿比例高(6/10)且疗效显著。表明中医分型与选择用药(雄激素或免疫抑制剂)有相关性,中医分型有助于临床用药的选择；②肾阳虚型和肾阴虚型总有效率分别为100.0%和83.3%,急重型和慢性再障的总有效率分别为84.6%和100.0%。单纯中药治疗组小儿比例高(6/10)且疗效显著。说明通过中西医分型原则的综合运用有助于提高临床疗效。③肾阳虚和肾阴虚组治疗前的白细胞、血红蛋白、血小板均低于正常值,治疗后肾阳虚组和肾阴虚组外周血白细胞、血红蛋白、血小板均显著上升(P0.01),但治疗后肾阳虚型患者白细胞、血红蛋白、血小板达正常水平均显著高于治疗后肾阴虚型患者(P0.01),说明治疗后肾阳虚组外周血象恢复快且完全。 5.中医证候特点分析：肾阴虚和肾阳虚组腰膝酸痛出现频率均较多,说明腰膝酸痛是再障肾虚辨证的主要症状。治疗前肾阳虚组以畏寒、耳鸣及水肿为主要见症,经补肾中药治疗后,症状较易改善恢复。肾阴虚组以五心烦热、午后潮热、咽干、便结而尿短赤和盗汗等症状为主,治疗后症状减轻；肾阴虚组出血症状较肾阳虚组多见,但经中药治疗后大多得以改善。舌苔舌质基本能作为区分肾阴虚、肾阳虚的关键性客观指标。 6.中医证候疗效判定特点：治疗后临床痊愈的症状是便结而尿短赤；显效的症状是腰膝酸痛、畏寒肢凉、耳鸣或耳聋、盗汗；有效的症状是发脱或齿摇、水肿、尿后余沥或失禁、五心烦热及舌质舌苔；无效的症状是性功能减退和咽干口燥。说明中医辨证肾阳虚型患者的临床症状轻,预后好；肾阴虚型患者临床表现重,预后相对较差,舌质苔的改善也相对较慢。结论： 1.麻柔主任医师治疗急重型再障和慢性再障的有效率分别为84.6%和100.0%,总有效率93.0%。与国内报道的中西医结合治疗从有效率70.0%～80.0%比较,证实采用中西医结合分型治疗再障的方法具有一定的疗效优势； 2.进一步证实慢性再障以肾阳虚型为主,重型再障以肾阴虚型为主； 3.单纯补肾中药在轻型患者、小儿患者及西药疗效不佳或不能耐受患者确能发挥中医药优势； 4.对各种类型再障,合理使用雄性激素及免疫抑制剂联合补肾中药治疗均能获得较好疗效,既提高了疗效又避免过度治疗所导致的毒副作用； 5.探索性应用具温阳化瘀功效的雄黄联合雄性激素及补肾中药治疗病史长于20年的重型再障Ⅱ型患者,取得1例基本治愈,2例有效,1例无效(因观察时间较短),初步显现出较好的苗头； 6.麻柔主任医师临床应用补肾中药与不同西药联合治疗,认为只要找准切入点就能取得良好疗效,避免了不必要的过度治疗。提出并证明再障的发病大致可分为以异常免疫为主和以骨髓衰竭为主2个阶段,前一阶段以免疫抑制剂+补肾中药为主治疗；后一阶段应以雄性激素+补肾中药为主治疗,两者之间可能存在过渡阶段；适时减量或停用免疫抑制剂或雄性激素,较好贯彻了能中不西的原则。 7.中医证型特点：肾阴虚组和肾阳虚组腰膝酸痛出现的频次均较多,说明腰膝酸痛是再障肾虚辨证的主要症状,中医症状判定标准对肾阴虚阳虚的判定区分有意义,舌质舌苔基本能作为区分肾阴虚、肾阳虚的关键性客观指标；中医辨证肾阳虚型再障的临床症状的改善优于肾阴虚型；慢性再障或病程长的重型再障患者多表现为肾阳虚型,适宜于温肾填精中药为主或联用雄激素治疗,而急重型再生障碍性贫血多为肾阴虚型,多适于滋肾填精中药为主联用免疫抑制剂治疗。按中医证候疗效判定标准说明中医辨证肾阳虚型患者的临床症状轻,预后好；肾阴虚型患者临床表现重,预后相对较差。还发现舌质苔的改善也相对较慢。 8.麻柔主任医师诊治再生障碍性贫血临床用药特点：补肾调阴阳为主,兼顾脾胃,阴中求阳,阳中求阴,阴阳双补；坚持守方治疗,他认为慢性疾病如证型未变,则应坚持主方不变,仅据阴阳寒热偏衰及脾胃盛衰做加减化裁。麻柔主任医师认为,首先要正确把握中医对疾病发生发展规律的认识,必须从中医理论渊源水平找到纲领。因此,他以其独到的“发病观”、“治病观”和“防病观”统领中医疾病的发生及防治。首先从阴阳角度认识疾病的发生,阴阳平衡即健康,阴阳失衡即患病；从正邪关系概括疾病的发生无非正虚与邪盛。他认为中医药治疗疾病就是通过阴阳自和的能力燮理机体阴阳、正邪等矛盾关系,把“失和”调为“和”,把“偏”调为“平”,从而达到治疗疾病的目的,医生的作用仅仅是顺势利导,纠偏,调整阴阳偏胜而已。还认为顺应天地自然才能更好的防病治病,辨证论治才卓有成效。其健脾调胃扶正以祛邪及祛邪不忘兼顾脾胃的组方用药处处体现出老师以“脾胃为本”的“未病先防”的防病观。他认为中医治病是从整体、系统角度看问题,强调因人、因时、因地制宜,因势利导。中医的治疗体系应以辨证论治为核心,以病人表现出的“证”为靶点,针对动态过程,认知的是在时间过程中病人整体变化的本质和规律。体现在治疗再生障碍性贫血、骨髓增生异常综合征等疾病,针对肾阴阳亏虚的根本病机,辨治以补肾调阴阳为主；针对慢性免疫性血小板减少症等出血性疾病,认为以气虚兼血瘀为根本病机,采用益气通阳,调和气血治疗,明显提高了疗效。还探索性采用具解毒散瘀功效的古方青黄散治疗骨髓增生异常综合征的各型取得了良好疗效,他认为本病病机为正气虚损,复感邪毒,因毒致瘀,毒瘀互阻。并扩大应用于慢性骨髓增殖性疾病及部分类型的急性非淋巴细胞白血病,认为因毒致瘀,毒瘀互结为其根本病因病机,运用解毒散瘀功效的青黄散泄其实,紧紧围绕毒瘀这个根本病机。近年还探索性用含砷中药治疗病程较长的慢性重型再生障碍性贫血患者,认为其病机为“久病入络”、“因虚致瘀”,而非“因毒致瘀”,故治疗上单用性温散瘀之雄黄,其温热之药性可助阳生血,化瘀功效针对“瘀血”病机,取得初步疗效。麻柔主任医师认为探索中医药治疗疑难性血液病的关键在于对疾病病机的准确认识,与中医“治病求本”、“谨守病机”的理论异曲同工。麻柔主任医师在临床立法、组方、用药上时刻不忘顾护脾胃,认为血液系统疾病一般病程较长,素体脾胃亏虚,长期服药易伤脾胃,故临证为补而不壅滞、泻而不伤中,常合用四君子汤等补气健脾,防治脾虚影响到药物疗效。其健脾调胃扶正以祛邪及祛邪不伤脾胃的组方用药,处处体现出其以“脾胃为本”的学术思想。他独到采用经方桂枝汤为主治疗慢性和难治性免疫性血小板减少症(cITP和rITP),认为经方具有组方精简、配伍严谨、方证相应、疗效确切等特点。对cITP和rITP辨证以脾虚气弱,阴阳失和为主者,拟桂枝汤治疗,取其“内调阴阳”之特性,取得良好疗效。他认为多种慢性血液系统疾病的发生根本原因是“正气亏虚”,在诊病中处处体现扶正即祛邪的学术思想。具体体现在治疗白血病缓解期表现为正虚邪恋阶段,注重健脾补肾调阴阳扶正治疗,少用清热解毒抗癌祛邪之品。还体现在治疗自身免疫性溶血性贫血等自身免疫性疾病,认为本病的根本病机为“正虚”与“血瘀”,通过以扶正为主及扶正固本“防患于未然”的治疗策略取得良好疗效。他认为与自身免疫相关的病证中医药调理应以扶正为主,所谓扶正即可祛邪。病证结合是目前中西医结合的重要手段之一。麻柔主任医师在多年的临床实践中一方面坚持以中医辨证论治思想探索中医药治疗血液系统疑难性疾病的方法,其临床实践中同病异治,异病同治还是专验方的应用均是体现中医辨证论治思想,另一方面重视辨“病”,血液病尽量基于细胞学、免疫学、细胞遗传学及基因等疾病诊断,从宏观到微观、从整体到局部、从一个阶段到整个病程全面认识疾病后,客观制定出中医或中西医结合治疗策略,一以贯之,收效明显。还致力于通过临床实践发现苗头,总结规律,回到实验研究达到理论升华,再回到临床普遍实践,这是中医及中西医结合临床及研究方向,也是辨证与辨病结合优化研究模式的具体体现。总之,麻柔主任医师在临证实践中,坚持以中医理论为指导,时时贯彻天人相应的整体观、治病求本的治病观、阴阳平调的平衡观、血液病的扶正治疗观、注重顾护脾胃、独到使用经方、探索性运用古验方、辨病与辨证相结合等学术思想,经过多年的历练形成了自己独特的诊治血液病临床经验。
[Abstract]:Objective: This study of Ma Rou director academic thought origin and clinical experience summary, analysis and refine his method of using law of the development of TCM theory and interpretation of disease occurred in the process of diagnosis is reflected in the unique experience of diagnosis by collecting original; summarize the typical cases, combined with traditional Chinese medical classics, his academic thought to be sublimated further theory. This research also focuses on the combination of traditional Chinese and Western Medicine Director Ma Rou typing experience in treating aplastic anemia were summarized by clinical and clinical research, clinical diagnosis and treatment of objective data confirmed he aplastic anemia and analyze the diagnosis of drug characteristics. The study population for the clinical teachers during the study, Ma soft physician patients with aplastic anemia, combined with previous research results, summarized and further his research on different types of acute (or Chronic) and different syndromes (deficiency of kidney or kidney yang) of aplastic anemia (aplastic anemia, AA) the clinical curative effect and curative effect in patients with the syndrome, to explore the regularity of TCM and Western medicine combined with the treatment of AA of different types and syndromes of patients, to explore the treatment method combined with the appropriate specification Chinese or western medicine traditional Chinese medicine, in order to overcome the excessive treatment, improve the clinical efficacy and give full play to the advantages of Chinese medicine treatment of aplastic anemia. In addition to the TCM Ma Rou director as the core of the kidney type treatment of aplastic anemia were summarized, the differentiation and medication rule, in order to further inheritance and promotion.
Methods: We prospectively enrolled 60 patients with AA system and follow up the diagnosis and treatment of director Ma rou. According to the clinical experience with western medicine and TCM syndrome type divided into three groups with western medicine treatment: 1. types of the Chinese herb treatment group, cases of chronic aplastic anemia in children patients with light, and Western medicine or invalid intolerant patients; 2. kidney tonifying herbs + immunosuppressive treatment group, patients with immune suppression leads to bone marrow failure is the main pathological mechanism of acute severe aplastic anemia patients; 3. kidney tonifying herbs + androgen treatment group, patients with bone marrow failure is the main pathological mechanism, diagnosis of chronic aplastic anemia or immunosuppressive effect is invalid or incomplete chronic and severe aplastic anemia patients with type II. The history of severe aplastic anemia patients with type II is longer than 20 years to try and male hormone therapy combined with Bushen Huayu.
From the TCM (kidney yang deficiency and kidney yin deficiency / diagnosis of Western Medicine), (acute / chronic aplastic anemia, aplastic anemia) effect (remission / progress / invalid) and treatment (androgen and immunosuppressant valid / invalid valid / invalid) four angles of different groups of AA patients, summarize and analyze the curative effect and symptom score before and after the TCM syndrome of different types of treatment, curative effect of Ma Rou interpretation of physician diagnosis and treatment of this disease, symptoms and medication characteristics and principles.
Results: 1. a total of 60 patients with AA were summed up for at least 6-12 months of treatment. The total effective rate was 93.00%.
2. typing and therapy: the Chinese herb treatment group of 10 cases, 4 cases were cured, remission in 6 cases, including 6 cases of pediatric patients; male hormone combined with Tonifying Kidney Chinese medicine group of 24 cases, 4 cases were cured, 10 cases were relieved, 8 cases improved, 2 cases ineffective; immunosuppressant cyclosporin A and / or ATG with male hormone and Bushen Chinese medicine group of 26 cases, 4 cases were cured, 12 cases were relieved, 8 cases improved, 2 cases were invalid.
Analysis of characteristics of 3. TCM syndrome: kidney yang deficiency group were mainly chronic aplastic anemia patients (58.8%, 20/34), kidney yin deficiency group were mainly severe aplastic anemia patients (57.6%, 15/26). This shows that Chinese and Western Medicine classification criteria do not have precise correspondence, but there is a certain correlation. Including 4 cases of course more than 20 years of severe aplastic anemia in type II patients, syndrome of kidney yang deficiency and blood stasis, explore realgar male hormone and kidney tonifying herbs combined with Wenyang Huayu with effect, 1 cases were basically cured, 2 cases were effective.
The 4. type of traditional Chinese medicine and Western medicine treatment of type and correlation results: kidney yang deficiency group and chronic aplastic anemia group using Chinese traditional medicine (80%, 8/10) or androgen (66.7%, 16/24) a higher proportion of patients; kidney yin deficiency group and severe AA group using immunosuppressant higher proportion of patients (61.6%, 16/26; 76.9%, 20/26) the TCM treatment group. A high proportion of children (6/10) and significant effect. That TCM type and choice of drugs (androgen or immunosuppressant) the relationship between TCM type is helpful for the selection of clinical medicine; the kidney yang deficiency of kidney yin and total effective rate were 100% and 83.3%, severe acute and chronic aplastic anemia the total effective rate was 84.6% and 100.0%. pure Chinese medicine treatment group in high proportion (6/10) and significant effect. Through the integrated use of traditional Chinese medicine and Western Medicine classification principle is helpful to improve the curative effect. The kidney yang deficiency and kidney yin deficiency group before treatment White blood cells, hemoglobin, platelets were lower than normal, after the treatment of kidney yang deficiency group and kidney yin deficiency group of peripheral white blood cells, hemoglobin, platelet were significantly increased (P0.01), but after the treatment of patients with kidney yang deficiency of white blood cells, hemoglobin, platelet to normal level were significantly higher than that after the treatment of kidney yin deficiency patients (P0.01), after treatment of kidney yang deficiency group peripheral blood recovery quickly and completely.
Analysis of 5. TCM syndrome characteristics: Yin deficiency and kidney yang deficiency group were more frequently waist and knee pain, waist and knee pain is the main symptom of aplastic anemia that syndrome differentiation of kidney deficiency and kidney yang deficiency group. Before treatment with chills, tinnitus and edema are the main symptoms, with kidney tonifying herbs, are easy to improve symptoms of kidney yin deficiency group in five. Fanre, afternoon fever, throat, and constipation symptoms such as sweating and short red urine, alleviated after treatment; kidney yin deficiency and kidney yang deficiency group bleeding symptom is rare, but after traditional Chinese medicine treatment to improve. Many big tongue and fur can be used to distinguish kidney yin deficiency, a key objective index of kidney yang deficiency.
6. TCM syndrome curative characteristics: after treatment, clinical cure symptoms and urine short red knots; effective symptoms of waist and knee pain, aversion to cold sweats, tinnitus or deafness; effective symptoms of hair off or tooth shake, edema, urinary incontinence or after heeltap, Fanre and tongue fur invalid; the symptoms of hypogonadism and dry throat. The clinical symptoms of TCM syndrome of kidney yang deficiency in patients with mild, the prognosis is good; the clinical manifestations of kidney yin deficiency patients, the prognosis is relatively poor, improve the quality of tongue coating is relatively slow.
Conclusion:
1. Ma Rou chief physician for treatment of acute severe aplastic anemia and chronic aplastic anemia rates were 84.6% and 100%, the total effective rate of treatment from 70% to 80% with the efficiency of 93.0%. and domestic reports of traditional Chinese medicine and Western medicine, confirmed by typing method in treating aplastic anemia has some advantages in efficacy with traditional Chinese medicine and Western medicine;
2. further confirmed with chronic aplastic anemia of kidney yang deficiency, kidney yin deficiency type in severe aplastic anemia;
3. the traditional Chinese medicine for tonifying the kidney in light patients, children and Western medicine have poor curative effect or intolerance of the patients can give full play to the advantages of traditional Chinese medicine.
4. various types of aplastic anemia, reasonable use of male hormone and immunosuppressant combined with kidney tonifying herbs can obtain better curative effect, the curative effect is improve and avoid excessive treatment of side effects caused by;
5. to explore the male hormone and tonifying kidney combined with realgar treatment history of Wenyang Huayu effect more than 20 years of severe aplastic anemia patients with type II, 1 cases were basically cured, 2 cases effective, 1 cases were invalid (because of the shorter observation time), initially showing good signs;
6. Ma Rou director of clinical application of Bushen Chinese medicine and Western medicine combined with different treatment, as long as the starting points can achieve good effect and avoid unnecessary over treatment. We put forward and prove the incidence of aplastic anemia can be divided into the abnormal immune and bone marrow failure mainly in 2 stages, the Chinese Medicine + immunosuppressant after the treatment of Tonifying the kidney; a stage should take Chinese medicine of tonifying kidney + male hormone therapy, there may be a transitional phase between the two; timely reduction or withdrawal of immunosuppression or male hormone, can not carry out better in the West principle.
7. characteristics of TCM Syndrome Type:
Kidney yin deficiency and kidney yang deficiency group appear more ache of waist, waist and knee pain is the main symptom of aplastic anemia that symptoms of TCM syndrome differentiation of kidney deficiency, deficiency of kidney yang deficiency criteria distinguish meaningful, tongue fur can basically distinguish Yin deficiency, a key objective index of kidney yang deficiency syndrome of kidney yang deficiency anemia; the clinical symptoms improved better than kidney yin deficiency; chronic aplastic anemia or long duration of severe aplastic anemia patients with multiple manifestations of kidney yang deficiency, kidney essence is suitable for traditional Chinese medicine or treatment with androgen, and acute severe aplastic anemia for kidney yin deficiency, more suitable for replenishing kidney essence combined with traditional Chinese medicine immunosuppressive therapy. According to TCM syndrome efficacy criteria of clinical symptoms of TCM syndrome differentiation of kidney yang deficiency in patients with mild, the prognosis is good; the clinical manifestations of kidney yin deficiency patients, the prognosis is relatively poor. It is also found that the tongue The moss are also relatively slow.
8. Ma Rou chief physician for diagnosis and treatment of aplastic anemia clinical features: Invigorating the kidney and regulating yin and Yang, both spleen and stomach, yin and Yang, Yang and Yin, nourishing yin and Yang; adhere to the treatment, he believes that chronic diseases such as type has not changed, should adhere to the main square unchanged, only partial failure and cold heat according to Yin and Yang the spleen and stomach and do chmical process.
Ma Rou director believes that the first to correctly grasp the Chinese understanding of disease occurrence and development rule, must find the program from the Chinese medicine theory origin level. Therefore, with his unique "view of pathogenesis", "the occurrence and prevention of disease" and "prevention concept" to guide the TCM diseases. Firstly, from the angle of yin and yang to understand the disease occurs, the balance of yin and Yang is healthy, the imbalance of yin and Yang is sick; summarize the disease from the good relationship between the occurrence of it is false and evil Sheng. He believed that traditional Chinese medicine treatment of the disease is the imbalance of Yin and Yang the ability of regulating yin and Yang, and contradictory relationship, "and" notes "and", "partial" to "flat", so as to achieve the purpose of treating disease, the doctor's role is merely naturltopography homeopathy, correction, adjustment of yin and Yang. Too much also believes that nature can better conform to the disease prevention and cure, treatment based on syndrome differentiation only effective the health. In the course of spleen stomach regulating Fuzheng and Quxie prescription and not forgetting both embody the teacher with "spleen and stomach" and "disease prevention prevention first" concept.
He believes that Chinese medicine is from the whole system perspective, emphasizing the human, because, according to local conditions, the treatment of Chinese medicine. In the light of its general trend system should be based on syndrome differentiation as the core, to show the patient's "card" as the target, the dynamic process of cognition is the essence and rule of the whole change of patients in the course of time reflected in the treatment of aplastic anemia, myelodysplastic syndrome and other diseases, the basic pathogenesis for kidney deficiency of yin and Yang, yin and Yang in treating the kidney; for chronic immune thrombocytopenia and hemorrhagic diseases, recognize the fundamental pathogenesis of qi deficiency and blood stasis, Qi and Yang, Qi and blood the treatment, can significantly improve the curative effect. The type of the most also explore the detoxification effect of Stasis Formula Qinghuang powder in the treatment of myelodysplastic syndrome has good curative effect, he believed that the pathogenesis of this disease is Qi, complex sense of toxin Because, poison and blood stasis, toxin and blood stasis. And expand the application of acute non lymphocytic leukemia in chronic myeloproliferative disease and some types of thought because of poison and blood stasis, toxin and blood stasis is the basic pathogenesis, the detoxification effect of stasis Qinghuang powder relief in fact, focus on the fundamental disease toxin and blood stasis the machine is also exploring. In recent years, with longer duration of arsenic containing Chinese medicine for the treatment of patients with chronic severe aplastic anemia, its pathogenesis is "long into the network", "due to Qi Deficiency", rather than "poisoned blood stasis", the treatment with realgar warm Sanyu, its warm resistance blood stasis can help Yang, the efficacy of "blood stasis" disease and achieved preliminary curative effect. Ma Rou director believes that the key to explore the Chinese medicine treatment of difficult blood disease lies in the accurate understanding of disease pathogenesis, and the traditional Chinese medicine "cure for this", "so

【学位授予单位】：中国中医科学院
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R556.5

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