| Objective:Firstly, Professor Pei Zheng-xue’s clinical experience on treatment of aplastic nemiais is summarized through the author’s clinical observation. Secondly, Professor Pei’s dialectical thinking scheme on the treatment of aplastic anemia is analyzed in this paper. For the purpose of improving the therapeutic effect, traditional Chinese medicine (TCM) syndrome differentiation and treatment should be followed after the Western medicine diagnosis. At last, this paper summarizes Professor Pei’s unique herbs administering characteristics and rules.Methods:1. Theoritical Research Methods:(1) Professor Pei’s essence theory for the treatment of aplastic anemia is condensed and excavated by comprehensively summarizing, sorting and inducting his clinical data, along with the analyzing and summarizing his clinical experience in the treatment of chronic aplastic anemia.(2) From the clinical practice point of view, Professor Pei Zheng-xue’s theory on the development of Chinese medicine can be summarized into’Diagnosed by Western medicine; Discriminated by traditional Chinese medicine; TCM should be as the fundamental treatment method while Western medicine diagnosis as the supplemented way’. Finally, the essence of the theory has to be put into theoretical study and clinical practice.2. Clinical Research Methods:68cases of chronic aplastic anemia patients were divided into treatment group (53cases) and control group (15cases), separately. Depending on their specific TCM syndromes, the treatment groups can be divided into three types, namely, kidney yin, kidney yang, both kidney yin and yang. The prescription contained dangchuanheji, stanozolol, and cyclosporin A. Regarding to the control group (15cases), the prescription only contained pure stanozolol and cyclosporine A. The treatment period of the two groups are lasted over6months. The clinical efficacy of the TCM symptom improvements in peripheral blood cell counts, peripheral blood and bone marrow blast percentage, and liver function are observed during the treatment process, and are compared with the condition before the treatment.Results:1.Theoritical Research Results:(1) Professor Pei holds the view that the key methods to treat aplastic anemia are tonifying kidney and strengthening spleen, promoting blood and removing blood stasis, as well as clearing heat and removing toxin. Tonifying kidney plays the dominant role in the treatment process, with strengthening spleen as the subsidiary means. Meanwhile, promoting blood and removing blood stasis run through the whole treatment process. Tonifying kidney and strengthening spleen, promoting blood and removing blood stasis are used in mild cases, whereas cleaning heat and removing toxin, clearing heat and stopping bleeding are used in emergency cases. Professor Pei also explained that the cause and the process of aplastic anemia are due to the toxin invading bone marrow. He pointed out that clearing heat and removing toxin can help blood generation.According to the TCM theory:Kidney governs bone, bone stores up marrow, marrow and blood are from the same source. From modern medical point of view, the pathological basis of aplastic anemia is bone marrow failure. Professor Pei holds the view that aplastic anemia is rooted in the kidney. The traditional Chinese medicine dialectical and modern medicine diagnosis should be closely combined in the treatment of aplastic anemia. In other words, tonifying kidney should be kept on during the whole treatment process of aplastic anemia. In order to achieve individualized medicine, we should systematically take the syndrome differentiation, disease and syndrome, syndrome differentiation into consideration. The spleen is the foundation of after birth, and is the source of Qi and blood. Pixu (spleen deficient) will lead to Qi and blood deficiency, thus results in dizziness, fatigue, anemia symptoms. Pixu (spleen deficiency) will not be able to control blood, therefore, it can lead to bleeding.’Qi is the head of the blood, and blood is the carrier of Qi Professor Pei used the method of strengthening spleen in the treatment of aplastic anemia. The commonly used herbal formula are Taizishen and ginseng.Professor Pei found than the detoxification method can improve aplastic patients’ platelet. Combining with the pathogenesis on the aplastic anemia, and the detoxification, cooling hemostatic treatment principles, Professor Pei considered that the marrow toxicity is one of the pathogenesis of aplastic anemia. Then, he used the detoxification method to treat the aplastic anemia patients. It is found that detoxification method not only can reduce intense heat and stop bleeding, but also can generate blood during the slationary phase. Pei holded the point that the marrow toxicity is one of the pathogenesis of aplastic anemia, detoxification method can be used as the treatment. The etoxification method is lasted during the whole treatment process. He used soil rhubarb, coptis, scutellaria root, honeysuckle, dandelion, forsythia, herba patriniae etc as the prescription for the treatment of aplastic anemia.Professor Pei held the view that if congestion doesn’t eliminate, the new blood will not be produced. Therefore, blood circulation drugs are often used in the treatment of aplastic anemia, such as chuanxiong, red sage root, red peony root, angelica, millettia, panax notoginseng, leeches and so on. Pei paid particular emphasis on leech, he believed that this drug can increase the patient’s recovery speed, and promote the healing of patients.Blood stasis is the pathological product of the pathogenesis of aplastic anemia, it can occur at any time in the pathogenesis of aplastic anemia. Besides, it is the risk factor that can increase the bleeding, induce infection and create a vicious cycle.Professor Pei believed that the traditional Chinese medicine should be combined with the variety of micro-data of modern medicine for the purpose of treating aplasitc anemia. The patient with low white blood cells is characterized by fatigue, not to like to talk more. This phenomenon is defined as Qi (gas) deficiency. For the improvement of the illness, large dose of the drugs that are beneficial to Qi should be used, such as ginseng, radix pseudostellariae, dangshen, astragalus membranaceus etc. He also generalized five drugs that can increase white blood cells, namely, breaking paper, millettia, salvia, flavescens, polygonatum, etc. The patient with low red blood cell is characterized by dizziness, pale face, blood deficiency. For the improvement of the illness, large dose drugs that are beneficial to blood should be used, such as rehmanniae, polygonum multiflorum, ligustrum, eclipta, polygonatum, polygonatum odoratum, jujube, donkey-hide gelatin and so on. The patient with low platelet is characterized by gingival hemorrhage, epistaxis, subcutaneous ecchymosis, and so on. Professor Pei generalized five drugs for increasing blood platelet, namely, polygonatum odoratum, polygonatum, rehmannia root, forsythia, Tu Dahuang, soil rhubarb. The white blood cell can rise fast during the treatment of aplastic anemia. However, the rising speed of red blood cells and platelets is slowly compared with white blood. Therefore, after a long period of medication, the treatment efficacy can be achieved.’Kidney governs bone, bone stores up marrow’. Professor Pei thought that the aplastic anemia patients with the bone marrow hematopoietic stem cell damaged were mostly related to kidney.’Spleen controls the blood’, the aplastic anemia patients with immune function mediated were mostly related to spleen. Detoxification drugs should be related to the immune system, which is similar to the immunosuppressant. The patients with bone marrow microcirculation were mostly related to bleeding resistance. So, based on Professor Pei’s diagnosis and treatment theory, we should combine the modern medical pathology and pharmacology research results on the treatment of aplastic anemia, and synthetically consider tonifying kidney and strengthening spleen, promoting blood and removing blood stasis at the same time, so as to achieve the multi-target on the treatment of aplastic anemia.(2) Professor Pei Zheng-xue’s theory point out a effective way for the development of traditional Chinese medicine, that is’Diagnosed by Western medicine; Discriminated by the traditional Chinese medicine;TCM should be as the fundamental treatment method while Western medicine diagnosis as the supplemented way’Pei Zhen-xue took’Diagnosed by Western medicine and then discriminated by traditional Chinese medicine; TCM should be as the fundamental treatment method while Western medicine diagnosis as the supplemented way’as the guiding ideology. He fully utilized the modern medical diagnostic advantages to explore etiology and the nature of illness, so as to grasp the development and evolution rules of aplastic anemia. Furthermore, he organically combined the traditional Chinese medicine and Western medicine in clinical practice.’Diagnosed by Western medicine and discriminated by traditional Chinese medicine’, which is a good method that help TCM to accurately grasp the evidence of a particular stage of the disease. It also can achieve a better clinical efficacy, and is the extension and development of traditional Chinese medicine diagnostics method.’TCM should be as the fundamental treatment method’, which means TCM should be focused on the treatment of the disease, we must systematically consider both the TCM and Western medicine, so that the TCM theory and practice can be inherited.’Western medicine diagnosis as the supplemented way’, which refers to that Western medicine has obvious advantages on a number of diseases, we have to use the complementary advantages of Western medicine.2. Clinical Research Results:According to the clinical observation, the total efficiency (relieved+improved) of the observation group treated by Western medicine was79.24%, which is significantly higher than that of the control group of60%. And there were significant differences between the two groups (P<0.05). The total efficiency (clinical cure+significant effect+effective) of the observation group treated by TCM was83.01%, which is also significantly higher than that of the control group of53.33%. And there were also significant differences between the two groups (P<0.05). Above all, the symptom score of the observation group treated by TCM is better than the control group (P<0.05). Before treatment, there are no significant differences on the peripheral blood (WBC, HB, PLT number) in the two groups (P>0.05). After treatment, the peripheral blood is increased in both the two groups, but, the observation group increased significantly higher than control group. Meanwhile, there are significant differences between the two groups (P<0.05). The bone marrow efficiency count also increased significantly after the treatment, and there are obvious differences between the two groups (P<0.05). In the observation group, CD+3and CD+4are improved while CD+8is reduced after treatment, there are obvious differences (P<0.05). In the control group, CD+3and CD+4are reduced while CD+8is improved, there also exists significant differences. Furthermore, there are no significant changes observed in the patients’liver function in both of the two groups after treatment, and there are no significant differences (P>0.05).Conclusion:The clinical study confirmed that the prescription contained dangchuanheji, stanozolol and cyclosporine A can effectively improve the chronic aplastic anemia. It can improve the clinical symptoms (mainly Chinese medicine symptom) and peripheral blood, bone marrow and regulate the immunity. Last but foremost, this prescription has no side effects on liver. It can significantly improve the quality of life of patients.This study suggests that the traditional Chinese medicine treatment mechanisms of chronic aplastic anemia are as follows:1:Tonifying kidney and strengthening spleen can promote bone marrow stem cell development.2:By adjusting blood T cell subsets, correcting T cell immune dysfunction, thereby lifting the suppression of bone marrow function, finally, therapeutic effect can be achieved.3:The bone marrow microenvironment can be improved by blood circulation.4:Detoxification can promote bone marrow.The author’s innovation points and thinking on aplastic anemia:Firstly, by means of summarizing Professor Pei’s medication features on treating aplastic anemia, the author draws the following conclusions:Detoxification can promote bone marrow to produce blood. Detoxification is not only the principles of treatment of aplastic anemia in patients with bleeding or bleeding tendency, but also can promote bone marrow of patients with aplastic anemia. Secondly, the judgment criterion on the efficacy of treatment should be combined with traditional Chinese medicine, which plays a vital role in improving the quality of life of patients. Therefore, the efficacy of treatment shouldn’t be assessed only by the Western medicine standards.The author’s thinking in the current study of aplastic anemia. First, aplastic anemia has special characteristics that are different from other’Consumption’ syndrome, therefore, the pathogenesis foundation and differentiation system of the aplasitc anemia has its particularity. Second, in order to reveal the nature of symptoms of aplastic anemia, the material basis of aplastic anemia syndrome differentiation type and syndrome type need to be further studied. Furthermore, the symptoms of aplastic anemia should be determined by microscopic indicators for the purpose of well guiding clinical treatment and improving treatment efficacy. Third, the experimental method and clinical observation should be combined together in the research of aplastic anemia. On one hand, we have to explore objective and practical means of modeling. On the other hand, we should strengthen the clinical observational study. As a result, good reliability and repeatability of clinical efficacy can be obtained. Fourth, in the experimental level, the study of the efficacy mechanism of aplastic anemia in Chinese medicine must continue to learn from the latest research methods and ideas of Chinese medicine and modern medicine, such as molecular biology, apoptosis, cell cycle, protein expression, serum pharmacology and other aspects of the binding studies. Fifth, the combination of Western disease differentiation and TCM syndrome differentiation results in two different effects. Optimistically speaking, it can promote the progress of the clinical research of TCM. However, it can cause a certain adverse effect on individualized diagnosis and treatment. Sixth, currently, the traditional Chinese medicine only is only considered as a supplementary mean in the treatment, we haven’t pay enough attention on the complementary between Western medicine and traditional Chinese medicine. |
