Aplastic anemia is a clinical syndrome caused by a variety of
etiological factors (some of them are unknown) which lead to
hematopoietic disorder of bone marrow. Clinically, it is
characterized by panhematopenia resulting in anemia, hemorrhage
and infections. The disease often occurs in young adults. It is
more common in males than in female. In TCM, it is categorized
as "xu lao" (consumptive disease), "xue zheng" (blood trouble),
etc.
Main Points of Diagnosis
According to the clinical features and pictures of bone marrow, the
disease can be divided into two types¡ªacute and chronic.
1. Acute aplastic anemia: The onset is abrupt with rapid progress
of the disease. There are marked symptoms of anemia, hemorrhage
and infection, particularly symptoms of severe and extensive
bleeding. Intracranial hemorrhage is the leading cause of death.
2.Chronic aplastic anemia: The onset of the disease is slow, and
the course is persistent. Anemia is the major symptom, while the
symptoms of hemorrhage and infection are relatively mild and
easy to be controlled.
3. Physical examination generally finds no enlargement of liver and
spleen except the manifestations of anemia and hemorrhage.
4. The blood picture shows the decrease in whole blood cells,
normochromic anemia, reticulocytopenia, thrombocytopenia and
increased serum iron. the picture of bone marrow in acute type
presents obvious hypoplasia, characterized by the decrease of
three blood cell systems and elevation of non-producing blood
cells. In chronic type, relatively mild retardation of
proliferation may be the feature in bone marrow, associated with
right shift of classification.
Differentiation and Treatment of Common Syndromes
1. Deficiency of Both Qi and Blood
Main Symptoms and signs: Slow onset ,dizziness, palpitation,
shortness of breath, fatigue and weakness, pale complexion and
pale tongue with white fur, deep and thready pulse.
Therapeutic Principle: Supplementing qi and nourishing blood.
Recipe: Modified Eight Precious Ingredients Decoction.
salvia root
white atractylodes rhizome
poria
prepared licorice
Chinese angelica,
prepared rehmannia root
white peony root
astragalus root
donkey-hide gelatin
All the above ingredients, except donkey-hide gelatin which is to
be melted in the finished decoction, are to be decocted din
water for oral administration.
In addition to the above ingredients, 30 grams of hairy vein
agrimony and 10 grams of stir-baked argyi leaf ought to be
employed if there is bleeding; 10 grams of bupleurum root, 10
grams of scutellaria root and 20 grams of honey-suckle flower be
administered if the case is accompanied with fever.
2. Deficiency of the Liver-Yin and Kidney-Yin
Main Symptoms and Signs: Dizziness, tinnitus, aching pain of the
waist and knees, hot sensation in the palms and soles, or low
fever in the afternoon, dry mouth, night sweat, insomnia,
excessive dreaming, menorrhagia, red tongue with little fur,
thready and rapid pulse.
Therapeutic Principle: Nourishing the liver and kidneys.
Recipe: Modified Prescriptions of Decoction for Invigorating
Primordial Qi and of Glossy Privet Fruit and Eclipta Pill.
codonopsis root
dried rehmannia root
prepared rehmannia root
Chinese angelica
siberian solomonseal rhizome
wolfberry fruit
glossy privet fruit
eclipta
cornus fruit
fleece-flower root
mulberry
prepared licorice root
All the above herbs are to be decocted in water for oral
administration.
For the case with fever, 12 grams of sweet wormwood, 12 grams of
wolfberry bark and 10 grams of anemarrhena rhizome should be
added; For the case with marked bleeding, additional drugs are
stir-baked sanguisorba root 12g, donkey-hide glue 10g and biota
tops 10g.
3. Deficiency of the Spleen-Yang and Kidney-Yang
Main Symptoms and Signs: Mental debility, disinclination to talk,
aching pin of the waist and weakness of the legs, aversion to
cold, cold limbs, spontaneous perspiration, edema, loose stool,
pale complexion, corpulent and pale tongue with thin and white
fur, deep and thready pulse.
Therapeutic Principle: Invigorating the spleen and warming the
kidneys.
Recipe: Modified Prescriptions of Decoction of Four Noble
Ingredients and Kidney-Yang-Reinforcing Bolus.
codonopsis root
astragalus root
white atractylodes rhizome
Chinese yam
tangerine peel
prepared rehmannia root
Chinese angelica
psoralae fruit
antler glue
cinnamon bark
morinda root
epimedium
All the above herbs are to be decocted in water for oral
administration.
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