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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