基于玄府理论探讨骨髓增生异常综合征的病机与治疗  

Pathogenesis and Treatment of Myelodysplastic Syndromes Based on Xuanfu Theory

作　　者：曾清 谌海燕[2] 刘军霞[2] 丁晓庆[2] ZENG Qing;CHEN Haiyan;LIU Junxia;DING Xiaoqing(Graduate School of Beijing University of Chinese Medicine,Beijing China 100029;Dongfang Hospital,Beijing University of Chinese Medicine,Beijing China 100078)

机构地区：[1]北京中医药大学研究生院,北京100029 [2]北京中医药大学东方医院,北京100078

出　　处：《中医学报》2025年第4期762-767,共6页Acta Chinese Medicine

基　　金：北京市科技计划项目(Z161100000516059);中华中医药学会课题项目(202169-004);北京中医药大学2023年新教师启动基金项目(2023-JYB-XJSJJ-044);中国中医科学院科技创新工程重大攻关项目(CI2021A01701)。

摘　　要：玄府维系周身气血津液等精微物质的运行流转,与骨髓增生异常综合征(myelodysplastic syndrome,MDS)的发病、诊治息息相关。MDS患者长期感受外邪、外毒,损伤玄府结构,玄府怫郁闭阻,加之患者正气亏虚,玄府失养,开闭无力,进一步加重气滞血瘀、痰饮内停,瘀积日久,内外合邪,酿生髓毒,进一步破坏、阻塞玄府,使气血津液不得流通化生瘀毒等内邪,并损耗正气。正虚无力抵抗内外毒邪,从而助长了邪气,二者相互作用,久而久之形成了正虚邪实,痼结难治的病理状态,从而出现髓系细胞发育异常、无效造血、血细胞减少等临床表现。玄府不通是MDS发病的内在机制,开通玄府可行气血、调阴阳、养五脏。针对MDS正虚邪实的总体病机,开玄法既包括祛邪,又包括扶正。在疾病不同分期,玄府郁闭、正虚、邪实的严重程度也有所不同,治疗时应结合患者的具体情况而定。Xuanfu maintains the flow of Qi,blood,Fluid and other subtle substances in the body and is closely related to the pathogenesis,diagnosis and treatment of myelodysplastic syndrome(MDS),which is caused by long-term exposure to external evil factors and outside Toxin,which damages the structure of the Xuanfu and causes the obstruction of the Xuanfu.In addition,patients′deficiency of Zheng Qi and loss of nourishment of the Xuanfu cause the inability to open and close the Xuanfu,which further aggravate the Qi stagnation,blood stasis as well as Phlegm stagnation.Blood stasis and Phlegm stagnation are further aggravated by the stagnation of Qi and Phlegm.The accumulation of them exists for a long period of time,with the combination of internal and external evil factors,resulting in medullary toxins,further destroying and blocking the Xuanfu,preventing the circulation of Qi,blood and Fluid to generate stagnation of stasis and Toxin and depleting the Zheng Qi.The Zheng Qi deficiency is incapable of resisting internal and external Toxin and evil factors,thus encouraging the activity of the evil factors.The interaction between the two,over time,forms the pathological state of Zheng Qi deficiency and evil factors excess,which is difficult to be cured,thus resulting in the abnormal development of medullary cells,ineffective hematopoiesis,and reduction of hematopoietic cells,and other clinical manifestations.The obstruction of Xuanfu is the intrinsic mechanism of the pathogenesis of MDS,and opening Xuanfu can move Qi and blood,regulate Yin and Yang,and nourish the Five Zang.In view of the overall pathogenesis of MDS,the method of opening Xuanfu includes both dispelling the evil factors and supporting the Zheng Qi.In different stages of the disease,the severity of Xuanfu depression and closure,Zheng Qi deficiency,and evil factors excess varies,and the treatment should be based on the specific conditions of the patients.

关 键 词：骨髓增生异常综合征 玄府 毒 瘀 虚 扶正 祛邪 通玄府 

分 类 号：R255.7[医药卫生—中医内科学]