史哲新教授治疗原发性骨髓纤维化经验总结  

Professor SHI Zhexin’s experience in treating primary myelofibrosis

作　　者：郭旭彪 闫理想 史哲新[1] GUO Xubiao

机构地区：[1]天津中医药大学第一附属医院/国家中医针灸临床医学研究中心,天津300381

出　　处：《中医临床研究》2024年第10期116-119,共4页Clinical Journal Of Chinese Medicine

摘　　要：原发性骨髓纤维化是以骨髓不同程度的纤维组织增生为特征的骨髓增殖性肿瘤,属于血液系统疾病。该病常伴有不同程度的贫血、白细胞增多、髓外造血导致的脾肿大及疲乏、早饱感等一系列疾病特异性症状,少数患者可进展为急性白血病,该病严重影响患者的生活质量。中医药在治疗原发性骨髓纤维化方面具有自身优势及特色。史哲新教授从事中西医结合治疗血液病临床工作多年,总结归纳出该病中医病机与肝、脾功能失调密切相关,在疾病发生、发展过程中,痰浊、血瘀等病理产物生成并逐渐积累,其中以血瘀为主导,着而不去成积,邪盛毒生,毒邪侵犯骨髓而发病。原发性骨髓纤维化病位可累及髓,损伤在气血,显现于腹内癥积。史师围绕其核心病机,采取辨病与辨证相结合的方式治疗疾病。史哲新教授认为原发性骨髓纤维化的治疗重点在活血化瘀,痰瘀兼治、解毒散结以消阻滞;同时强调顾护脾胃的重要性,养后天以固先天;分辨机体疲乏病机,据此施以补气或化气之法。中医药参与治疗原发性骨髓纤维化临床效果更佳。故文章结合医案一则对史哲新教授治疗原发性骨髓纤维化的经验进行总结,以期为临床提供一定参考。Primary myelofibrosis characterized by different degrees of fibrous tissue proliferation in the bone marrow is one of myeloproliferative neoplasms.Primary myelofibrosis is a hematological disease,which is often accompanied by a series of diseasespecific symptoms such as spleen enlargement,fatigue,and early satiety caused by different degrees of anemia,leukocytosis,and extramedullary hematopoiesis.A few can progress to acute leukemia,which seriously affects the quality of life of patients.Traditional Chinese medicine has its own advantages and characteristics in treating primary myelofibrosis.Professor SHI Zhexin has been engaged in the clinical work of integrated TCM and Western medicine on hematological diseases for many years,concludes that the TCM pathogenesis of the disease is closely related to the dysfunction of liver and spleen viscera.In the process of disease occurrence and development,phlegm turbidity and blood stasis pathology product generated and accumulated gradually,forming the splenomegaly,and toxic production was caused by excessive pathogenic factors,and the pathogenic toxin invaded the bone marrow.The lesion is located in the bone marrow,resulting in Qi(气)and blood iniury,and the hepatosplenomegaly is obvious.Focusing on its core pathogenesis,Professor SHI Zhexin adopted the combination of disease differentiation and syndrome differentiation to treat the disease.The professor believes that the key to the treatment of bone fiber is to promote blood circulation and remove blood stasis,and to eliminate phlegm and detoxification.At the same time,the teacher emphasized the importance of taking care of the spleen and stomach,nourishing the acquired to consolidate the congenital,distinguishing the pathogenesis of fatigue and disease,and administering the method of replenishing or dissolving Qi.The clinical effect of TCM on primary myelofibrosis is better,so Professor Shi Zhexin’s experience in the treatment of primary myelofibrosis in combination with a medical case was summarized,in order to prov

关 键 词：原发性骨髓纤维化 用药经验 活血化瘀 

分 类 号：R273[医药卫生—中西医结合]