活血化瘀法在慢性原发免疫性血小板减少症辨治中的循证探索  

Evidence-based exploration of promoting blood circulation and removing blood stasis in the differentiation and treatment of chronic primary immune thrombocytopenia

作　　者：白玉盛[1] 李晓征[1] 马西虎[1] 黄志惠[1] 吴雪琴[1] 崔祎晢 魏建孔 BAI Yusheng;LI Xiaozheng;MA Xihu;HUANG Zhihui;WU Xueqin;CUI Weizhe;WEI Jiankong

机构地区：[1]新疆医科大学附属中医医院,新疆乌鲁木齐830000 [2]新疆医科大学,新疆乌鲁木齐830000

出　　处：《中医临床研究》2024年第9期111-113,共3页Clinical Journal Of Chinese Medicine

基　　金：国家自然科学基金(81560727)。

摘　　要：目的:基于临床和中西医理论的整合,探索中医活血化瘀法在慢性原发免疫性血小板减少症(Primary Immune Thrombocytopenia,ITP)治疗中的临床应用循证依据。方法:结合临床总结分析中西医对ITP的病机认知,结合临床辨证和研究结果进行综合比照分析。结果:①慢性ITP虽然是以出血为主要表现的疾病,但是临床中仍然有发生血栓的现象,即出血与血栓的发生并存;②由中医学理论和临床辨证对ITP出血与瘀血状态的认识可知两者互为影响,验证了“离经止血,虽为清血,亦为瘀血”“瘀血不去,新血不生”的理论;③ITP的发生、发展过程中病机演化对瘀血形成的认识,提示了“久病多瘀”的证据;④中医药辨证论治的过程中,不失时机地选择应用活血化瘀法,不仅有效地治疗了ITP的出血症状,而且通过活血化瘀法还能够预防血栓的发生,提供了临床疗效证据。结论:基于临床疗效和ITP病机、病程的综合分析,中医活血化瘀法在慢性甚至是难治性ITP的治疗中不仅可以改善临床症状,还能够预防血栓的发生,为临床广泛应用提供很好的循证依据。部分患者的血小板水平也有提升。至于提升血小板的机制还有待于进一步的临床研究。Objective:To explore the evidence-based basis for the clinical application of the traditional Chinese medicine method of promoting blood circulation and resolving stasis in the treatment of chronic primary immune thrombocytopenia(ITP)based on clinical practice and the integration of traditional Chinese medicine and Western medicine theories.Methods:A comprehensive comparative analysis was conducted based on clinical summary and analysis of TCM and Western medicine theories on the pathogenesis of ITP,which was combined with clinical characteristics differentiation and research results.Results:①Although chronic primary ITP is a disease characterized by bleeding,there are still cases of thrombosis in clinical practice,where both bleeding and thrombosis occur simultaneously.②The understanding of traditional Chinese medicine theory and clinical differentiation on ITP bleeding and stasis states shows that the two interact each other,verifying the theory of although the blood that leaves the meridian is clear,it still is static blood and“If the stasis is not removed,new blood will not be generated”.③The understanding of the evolution of pathogenesis during the occurrence and development of ITP on the formation of blood stasis suggests evidence of“prolonged illness tends to lead to blood stasis”.④In the process of syndrome differentiation and treatment of traditional Chinese medicine,the method of promoting blood circulation and resolving blood stasis is chosen at the right time,which not only effectively treats the bleeding symptoms of ITP,but also prevents the occurrence of thrombosis through the method of promoting blood circulation and resolving blood stasis,which provides clinical efficacy evidence.Conclusion:Traditional Chinese medicine method of promoting blood circulation and resolving stasis can not only relieve the clinical symptoms,but also prevent the occurrence of thrombosis in the treatment of chronic or even refractory ITP based on the comprehensive analysis of clinical efficacy,pathogenesi

关 键 词：原发免疫性血小板减少症 慢性 活血化瘀 循证 

分 类 号：R225.7[医药卫生—中医基础理论]