Clinical Experience And Study On Professor Ma Rou’s Treatment Of Aplastic Anemia Based On Western Medicine Classification And TCM Syndrome Type

Objective:By collecting the aplastic anemia (AA) cases treated by Professor Ma Rou and his past research achievements and clinical experience, to study the clinical curative effect with different AA western medicine (WM) classification and different traditional Chinese medicine (TCM) Syndrome types, and to explore Professor Marou’s treatment law and regularity of AA (acute or chronic) with different WM classification and different TCM Syndrome types. Based on this, to find out the appropriate TCM and ITCWM (Integration of traditional Chinese and western medicine), and to improve the TCM clinical effect of AA. In addition, through the summarization on the AA patient cases treated by Professor Ma with kidney-tonifying as the core method, to make it possible for the further inheritance and application.Methods:Sixty AA cases were divided into3treatment groups according to Professor Ma’s clinical experience. The specific grouping methods are as followings:(1) single TCM kidney-tonifying treatment group, in which the patients are mainly chronic AA with mild condition, pediatric patients and invalid or intolerance to western medicine;(2) combined TCM kidney-tonifying treatment and androgen group. In this group, the AA patients are often in chronic stage and mainly due to bone marrow failure, and are still effective to immunosuppressive but not completely, so the normal peripheral blood picture can not be restored. Considering the pathogenic immune chain has been cut off, and the bone marrow failure is still a primary problem in this stage, therefore the immune inhibitors are reduced to stopped, and TCM kidney-notifying treatment or TCM kidney-notifying treatment together with androgen are used to promote the recovery of hemopoietic function; for the severe type II AA patients with a history of longer than20years, the TCM kidney-tonifying and blood stasis removing treatment combined with male hormone treatment are applied;(3)urgent severe AA patients with immune pathogenic factors are given immunosuppressive early, with the TCM kidney-tonifying herbs as joint treatment. Based on TCM syndrome differentiation (kidney Yang/kidney Yin deficiency), western medicine diagnosis (acute AA/chronic AA), curative effect (recovery/progress/invalid) and treatment methods (effective/invalid to androgens, effective/invalid to immunosuppressive), the data of AA patients in different groups are concluded, and TCM syndrome scores before and after treatment in different TCM syndrome types are calculated, and Professor Ma’s different WM classification curative effects and different TCM syndrome type curative effects and the treatment features and laws on AA are analyzed.Results:All the60A A patients were subjected to6to12months of treatment, and the total effective rate was93%.Disease course1month-25years, time median4years, age4-73years old, age median32.4years.TCM treatment based on syndrome types and it’s curative effect: there are10cases In group1,4patients basically cured,6cases relieved;there are24cases In group2,4patients basically cured,10cases relieved,8patients got obvious progress and invalid in2cases; there are26cases subjected to cyclosporine and or ATG with TCM kidney-notifying herb as joint treatment In group3,4patients basically cured,12cases relieved,8patients got significant progress and invalid in2cases. Among the patients in group3, kidney Yang deficiency was the primary syndrome for chronic AA patients while kidney Yin deficiency was the primary syndrome for severe AA patients. In the4cases of severe type II AA with a long disease course, the exploratory treatment of male hormone with TCM kidney-tonifying herbs and Xionghuang (to warm Yang and to get rid of blood stasis) by Professor Ma, and1case basically cured,2cases are effective, no curative effect is observed in1case because of the short treatment cycle.The results and characteristics of TCM Syndrome differentiation:The patients in kidney Yang deficiency group were mainly CAA patients (58.8%,20/34) while patients in kidney Yin deficiency group were mainly severe AA patients (57.69%, 15/26). This shows that in the WM classification and TCM Syndrome types. although there exists no strict one-to-one relationship, there are certain relevance. This phenomenon. could even be seen in the4type Ⅱ severe AA patients with a long history. The single TCM treatment was used in patients of Kidney Yang deficiency (80%,8/10) while androgen was used in CAA patients (66.7%,16/24).IST was used with a high proportion for patients of Kidney Yin deficiency (61.6%,16/26) and urgent severe AA patients (76.9%,20/26), indicating there is correlation between TCM Syndrome types and treatment selection. By implementing the method of treatment choice based on TCM Syndrome types between TCM Syndrome types, a total effective rate of100%and83.3%for Kidney Yang deficiency patients and kidney Yin deficiency patients, and a total effective rate of84.6%and100%for AAA and CAA patients respectively were realized.Characteristic of TCM Syndromes in AA patients:feeling of fatigue in waist and spinal areas is frequent in patients of both kidney Yin deficiency group and kidney Yang deficiency group, indicating a main symptom for the determination to the kidney deficiency Syndrome. Chill-feeling, tinnitus and edema are the main symptoms in AA patients of kidney Yang deficiency syndrome before treatment, and are easy to improve with kidney-tonifying herbs. In kidney Yin deficiency patients, the feeling of vexed hot in palm and arch, afternoon hot flashes, dry throat, constipation, less urine and urine red and night sweats are the primary symptoms, also could be relieved by treatment with kidney-tonifying herbs. Bleeding is more frequently occurred in patients of kidney Yin deficiency than in patients of kidney Yang deficiency, but could be alleviated with TCM herbs. In addition, tongue coating and tongue nature could be considered as the key objective indicators to distinguish kidney Yin deficiency Syndrome and kidney deficiency Syndrome.Features of TCM Syndrome efficacy evaluation:In evaluating the TCM Syndrome efficacy, constipation, less urine and urine red were evaluated as clinically recovered; feeling of fatigue in waist and spinal areas, Chill-feeling, tinnitus, afternoon hot flashes and night sweats as significantly improved; hair off or tine shakes, edema, urine incontinence, feeling of vexed hot in palm and arch and changes in tongue coating and tongue nature as effective, while sexual function decline and dry throat as Invalid. This means that AA patients with kidney Yang deficiency Syndrome usually have lighter symptoms and a better while AA patients with kidney Yin deficiency Syndrome with severer symptoms and a relatively worse prognosis in whom the improvement of tongue coating and tongue nature is slow. The results show that, treatment based on disease types of WM combined with TCM Syndromes could improve clinical efficacy. The white blood cells, hemoglobin, platelet of peripheral blood increased significantly in patients of both the kidney Yang deficiency group and kidney Yin deficiency group after treatment (P<0.01). The white blood cells, hemoglobin, platelet of peripheral blood after treatment increased to normal level and have no significantly difference with normal controls(P>0.05). Meanwhile, the after treatment white blood cells, hemoglobin, platelet of peripheral blood in patients of the kidney Yang deficiency group are significantly higher than those Yin deficiency group (P<0.01), indicating the after treatment peripheral blood index in patients of the kidney Yang deficiency group got recovered quickly and completely.Conclusion:1. Compared with the outcome reported in the major clinical research literature at home and abroad, the treatment based on disease types of WM combined with TCM Syndromes in AA patients by Professor Ma Rou has obvious advantages in connection with clinical curative effect.2. The study proves that AAA patients TCM Syndrome is while severe aplastic anemia patients TCM Syndrome is mainly kidney Yin deficiency.3. In A A patients, for those with slight illness, children, and those are invalid or can not tolerate western medicine, the single use of TCM kidney-tonifying herbs can still play its unique advantages.4. No matter what type of aplastic anemia of WM, the reasonable use of male hormone and immunosuppressant combined with kidney-tonifying herbs has ideal curative effect.5. Professor Ma exploratory use the treatment of male hormone with TCM kidney-tonifying herbs and Xionghuang (to warm Yang and to get rid of blood stasis) in severe AA patients with longer than20years,1case basically cured,2cases are effective, no curative effect is observed in1case because of the short treatment cycle, indicating a preliminary good appearance.6. In Professor Ma’s treatment procedures of TCM kidney-tonifying herbs combined with various western medicines, he thinks the key diagnostic and treating points should be mastered to achieve good curative effect and to avoid unnecessary excessive treatment. He proposed and proved new points that in the onset of aplastic anemia, it can be roughly divided into two stages. In the early stage, the abnormal immune function plays a key role, so the treatment model of immunosuppressive+TCM kidney-tonifying herbs should be applied, while in the later stage, the bone marrow failure is a primary pathogenic procedures, so the treatment model of androgen+TCM kidney-tonifying herbs be used. Between the two stages there exists the transitional phase in which a timely dose reduction or stop using of immunosuppressive must to be emphasized.7. Features of TCM Syndrome in AA patients:The improvement of symptoms in patients of kidney Yang deficiency Syndrome group is superior to those in kidney Yin deficiency Syndrome group. Chronic aplastic anemia patients or those with long disease course mostly represented kidney Yang deficiency Syndrome, and are suitable for the therapy of single TCM warm-Yang and essence-tonifying herbs or combined with androgen; otherwise, severe AA patients mostly represented kidney Yin deficiency Syndrome, and are suitable for the therapy of single TCM kidney-tonifying herbs combined with immunosuppressant. AA patients with kidney Yang deficiency Syndrome usually have lighter symptoms and a better prognosis while AA patients with kidney Yin deficiency Syndrome with severer symptoms and a relatively worse prognosis in whom the improvement of tongue coating and tongue nature is slow.8. The therapy characteristics of Professor Ma in the diagnosis and treatment on AA: tonifying kidney and regulating Yin-Yang is a key treating principle in which both spleen and kidney should be considered, Yin should be tonified from Yang and vice versa. For chronic disease, if the TCM Syndrome unchanged, the main prescription should not be changed.