基于伏邪托透理论探讨再生障碍性贫血病机与治疗

To explore the pathogenesis and treatment of aplastic anemia based on the theory of Fuxie Tuotou

关键词:  再生障碍性贫血  髓劳  伏邪致病  托透法  发作期  平台期

Key words:  aplastic anemia  marrow fatigue  inducing pathogenic factors  torsion method  episodic period  platform period

摘要:

再生障碍性贫血是一种免疫功能紊乱的骨髓造血功能衰竭症，目前诊疗过程中极易出现出血及感染，病情凶险。临床多采用免疫抑制治疗，复发率高，多数患者仍需坚持规律输血；中医药通过益精填髓等治疗对再生障碍性贫血颇有成效，但多着眼于再生障碍性贫血平台期，对其急性发作期的中医药治疗经验不足。通过对“伏邪托透”理论溯源，阐述伏邪托透的内在规律与免疫学逻辑，通过六经与卫气营血辨证，构建“平台期-发作期”的桥梁，针对伏邪托透的不同病位与疾病状态，采取相应的诊治思路，一则通过益精填髓、健运中焦等治法滋养骨髓、扶助正气；一则通过辨证运用具有辛散、托透功效的药物，将有形之邪从骨髓透散至肌表，形成痈肿疮疡，给邪以出路，可逐渐将邪气透尽，降低再生障碍性贫血急性发作频率，减少甚至摆脱输血依赖。其创新之处在于通过观察疾病的动态变化，在药物作用下“主动”将疾病从“平台期”过渡到“发作期”，扶助正气与托透伏邪并施，打破免疫稳态，恢复气机的升降出入，重建机体的阴阳平衡，从根本上解决再生障碍性贫血反复发作这一难题，对完善该病的理论和临证有重要意义。

Abstract:

Aplastic anemia is a type of bone marrow hematopoietic failure with immune dysfunction. Currently，it is highly susceptible to bleeding and infection during diagnosis and treatment，and the condition is dangerous. Immunosuppressive therapy is commonly used in clinical practice，with a high recurrence rate. Most patients still need to adhere to regular blood transfusions；traditional Chinese medicine has been effective in treating aplastic anemia through methods such as nourishing the essence and filling the marrow. However，more attention is paid to the plateau stage of aplastic anemia，and there is insufficient experience in traditional Chinese medicine treatment forits acute attack stage. This article traces the origin of the theory of “Fuxie Tuotou” and elaborates on the internal laws and immunological logic of “Fuxie Tuotou”. Through the differentiation of the six meridians and the Weiqi Yingxue syndrome，a bridge is constructed between the “platform stage and the attack stage”. Corresponding diagnosis and treatment ideas are adopted for different disease positions and states of “Fuxie Tuotou”. One is to nourish the bone marrow and support the positive qi through treatment methods such as nourishing the essence and filling the marrow，and promoting the circulation of the middle jiao；One method is to use drugs with the effects of Xinsan and Tuotong through differentiation of symptoms and signs to diffuse visible evil from the bone marrow to the muscle surface，forming carbuncle and sores，providing a way out for the evil. This can gradually penetrate the evil energy，reduce the frequency of acute onset of aplastic anemia，and reduce or even get rid of blood transfusion dependence. Its innovation lies in observing the dynamic changes of the disease，actively transitioning the disease from the “platform stage” to the “attack stage” under the action of drugs，supporting the combination of positive qi and supporting the penetration of evil，breaking the immune homeostasis，restoring the ascending and descending of qi，rebuilding the balance of yin and yang in the body，fundamentally solving the problem of recurrent episodes of aplastic anemia，which is of great significance for improving the theory and clinical practice of the disease.