Immunohistochemistry is a mandatory examination for the diagnosis of lymphoma.

, abnormalities in cellular immune function and abnormal anti-hematopoietic cell antibodies. The use of specific monoclonal antibodies for immunophenotyping has become one of the diagnostic criteria for acute leukemia. Immunohistochemistry is a mandatory examination for the diagnosis of lymphoma. (7) Histopathological examination: such as biopsy of lymph nodes or infiltrative masses, splenic biopsy, and cytological pathological examination of body fluids. Lymph node biopsy is meaningful for diagnosing lymphoma and differentiating it from other lymphadenitis and metastatic cancer; splenic biopsy is mainly used for diseases with significant splenomegaly; Cytological examination of body fluids includes the detection of tumor cells (or leukemia cells) in pleural effusion, ascitic fluid, and cerebrospinal fluid, which is valuable for diagnosis, treatment, and prognosis assessment. (8) Culture and testing techniques for hematopoietic cells. (9) Instrumental examinations: such as ultrasound, CT, magnetic resonance imaging (MRI), PET-CT, and PET/MRI, which are of great help in the diagnosis of hematological diseases. (10) Radioisotopes: used for determining red blood cell lifespan or sites of red blood cell destruction, bone marrow imaging, lymphoma imaging, etc. (11) Cytogenetic and molecular biological examinations: such as chromosome analysis and gene diagnosis. There are numerous laboratory tests for hematological diseases; how to select the appropriate tests to achieve a definitive diagnosis requires comprehensive analysis and consideration. IV. Treatment of Hematological Diseases (---) General treatment includes diet and nutrition as well as mental and psychological therapy. (2) Eliminate the etiology to remove the patient from the influence of pathogenic factors. (3) Maintain normal blood components and their functions 1. Supplement nutrients required for hematopoiesis: in megaloblastic anemia, supplement folic acid and/or vitamin B12; in iron-deficiency anemia, supplement iron preparations. 2. Stimulate hematopoiesis: for example, in chronic aplastic anemia, use androgens to stimulate hematopoiesis; when granulocyte counts are low, use granulocyte colony-stimulating factor to promote neutrophil release, etc. 3. Splenectomy: removing the spleen reduces the destruction and retention of blood cells, thereby prolonging their lifespan. Splenectomy is particularly effective for hemolytic anemia caused by hereditary spherocytosis. 4. Adoptive immunotherapy: such as administering interferon or donor lymphocyte infusion (DLI) after allogeneic hematopoietic stem cell transplantation. 5. Component transfusion and antibiotic use: transfuse red blood cells in cases of severe anemia or blood loss; supplement platelets when platelet counts are low and there is a risk of bleeding; administer effective anti-infective drugs when white blood cell counts are low and infection is present. (4) Remove abnormal blood components and suppress abnormal functions 1. Chemotherapy: combining chemotherapy drugs that act on different phases can kill diseased cells. 2. Radiotherapy: X-rays and other ionizing radiation can kill leukemia or lymphoma cells. 3. Differentiation induction: Chinese scientists have discovered that all-trans retinoic acid and arsenic trioxide, through differentiation induction, can accelerate the apoptosis of abnormal promyelocytes or induce them to differentiate into normal mature granulocytes, representing a new specific approach to eliminating leukemia cells. 4. Therapeutic apheresis: using a blood cell separator to selectively remove a specific component from the blood, which can be used to treat myeloproliferative neoplasms, leukemia, etc. Plasma exchange can treat macroglobulinemia, certain autoimmune diseases, alloimmune diseases, and thrombotic thrombocytopenic purpura, among others. 5. Immunosuppression: using glucocorticoids, cyclosporine, and anti-lymphocyte/anti-thymocyte globulin to reduce the number of lymphocytes and suppress their abnormal functions, thereby treating autoimmune hemolytic anemia, aplastic anemia, and graft-versus-host disease occurring after allogeneic hematopoietic stem cell transplantation, etc. 6. Anticoagulation and thrombolysis: in cases of disseminated intravascular coagulation, heparin is used to prevent further consumption of coagulation factors. When platelet counts are excessively high, drugs like dipyridamole can be used to prevent abnormal platelet aggregation. Once a thrombus forms, urokinase and other thrombolytic agents can be used to restore smooth blood flow. (5) Targeted therapy: such as tyrosine kinase inhibitors for chronic myeloid leukemia. (6) Other treatments include hematopoietic stem cell transplantation, cellular immunotherapy, epigenetic inhibition, etc., which are currently being used in clinical practice, but their clinical benefits still need further exploration. V. Research Progress and Prospects in Hematology Over the past 10 years, malignant hematological tumors have been one of the most closely watched research topics in the world of medicine today. Since the discovery of blood cells in the 17th century, nearly 200 years of integration between basic and clinical research have ushered in a new era for hematological disease research; since the discovery of leukemia in the 19th century, by the 21st century, children with acute lymphoblastic leukemia (ALL) and adults with acute promyelocytic leukemia (APL) have achieved a clinical cure rate of 75%; The diagnosis of malignant hematological tumors has evolved from morphology to high-level stages of molecular biology and genetics; treatment has progressed from traditional chemotherapy to differentiation induction, gene therapy, hematopoietic stem cell transplantation, and cellular immunotherapy, becoming a new paradigm for treating malignant tumors. The future direction of hematology research is to explore new therapeutic targets, bioeffect therapies, gene therapies, and other fields, which will drive the development of other medical disciplines. VI. Traditional Chinese Medicine's Understanding of Hematological Diseases The main manifestations of hematological diseases include fatigue, dizziness, palpitations, bleeding, hepatosplenomegaly, and lymphadenopathy, or accompanied by symptoms of susceptibility to external pathogens, which fall under the categories of “xu lao,” “xu sun,” “xue zheng,” “wang xue,” “xue ku,” “ji lao,” “re lao,” “wen bing,” “zheng ji,” and “ji lao” in Traditional Chinese Medicine. Ancient TCM literature considers “blood” and “fluid” as two distinct entities. For example, in “Ling Shu · Jue Qi,” it is stated: “When food enters the body and qi fills up, the essence seeps into the bones, the bones flex and extend, the essence nourishes the brain and marrow, the skin becomes moist and radiant—this is called fluid.” “The middle burner receives qi and extracts juice, which transforms into red—this is called blood,” using “blood” to refer to blood itself. Pathological changes in blood are termed “blood diseases,” as mentioned in “Su Wen · San Bu Jiu Hou Lun”: “If the body suffers pain due to blood disease, treat its meridians.” Moreover, “blood” is closely related to “ying” and “wei”—as stated in “Ling Shu · Xie Ke”: “Ying qi secretes its essence and infuses it into the vessels, transforming it into blood”; and in “Ling Shu · Ying Wei Sheng Hui”: “... Ying resides within the vessels, while wei resides outside the vessels, Ying circulates ceaselessly, returning every fifty days to gather again.” The smooth flow of blood depends on the strength of the bone marrow, as described in “Su Wen · Sheng Qi Tong Tian Lun”: “When the bone marrow is strong, both qi and blood flow freely.” Thus, the ancient concept of blood emphasizes the close relationship between “blood,” “ying,” and “wei.” Blood exists in the bones and flows through the vessels. Later generations also referred to various bleeding syndromes as “blood syndromes.” During the Qing Dynasty, Tang Rongchuan’s “Blood Syndrome Theory” was an important specialized work in TCM hematology, widely circulated in the late Qing period and one of the most influential medical texts. Even during the Republic of China era, the “Chinese Medical Dictionary” listed only “blood” and did not include the term “blood liquid.” In 1926, Xie Liheng introduced modern theories, first asserting that “blood” and “blood liquid” are the same concept. He pointed out that “blood is one of the body’s fluids, circulating through the meridians to nourish all parts of the body and excrete waste; its color is bright red or dark red, denser than water, with a pungent odor, salty taste, and tendency to coagulate. It flows throughout the body via blood vessels and the heart, constituting blood circulation, composed of red blood cells, white blood cells, and plasma.” (---) Etiology According to TCM, the Six Evils (wind, cold, summer heat, dampness, dryness, fire) and the Seven Emotions (joy, anger, worry, contemplation, sadness, fear, fright), irregular diet, excessive sexual activity, and pathogenic factors all harm qi and blood, especially affecting the liver, spleen, kidneys, and bone marrow, leading to blood deficiency and deficiency-related conditions. For example, wind-cold can directly invade the Three Yin channels—the Taiyin Spleen Meridian, Shaoyin Kidney Meridian, and Jueyin Liver Meridian—damaging the three organs of the liver, spleen, and kidneys; excessive emotional agitation, such as intense anger, harms the liver; overthinking damages the heart and spleen; irregular diet harms the stomach and spleen; excessive sexual activity harms the kidneys, causing imbalance of yin and yang in the kidneys; pathogenic factors (including chemical and biological harmful substances) entering the blood damage the marrow. When these pathogenic factors affect the aforementioned organs and hematopoietic function, not only do organ-specific symptoms appear, but also blood deficiency symptoms. The “Huangdi Neijing” states: “When vital energy is depleted internally, deficiency accumulates and turns into damage; accumulated damage turns into exhaustion,” indicating that such deficiency diseases are caused by depletion of vital energy and are closely related to the spleen and kidneys. Vital energy is the main component of the body’s righteous qi, as recorded in the “Huangdi Neijing”: “Where evil gathers, qi must be deficient”; “Righteous qi resides within, evil cannot penetrate.” Therefore, patients with blood diseases are prone to infections and fever, qi deficiency makes it difficult to control blood, yin deficiency generates internal heat, and external fevers, heat damaging blood vessels or forcing blood to flow abnormally, can all lead to bleeding. These are the main causes of blood deficiency, fever, and bleeding. (2) Pathogenesis According to TCM, the spleen and stomach are the source of qi and blood production, blood is produced in the spleen, while the kidneys govern bone marrow production, and kidney essence can also transform into blood, so the root lies in the kidneys. In addition, the heart governs blood, and the liver stores blood, thus forming a relatively complete hematopoietic system. Among them, the spleen and kidneys are the most important: spleen deficiency makes it difficult to transform food into qi and blood, resulting in insufficient blood production; kidney essence deficiency leaves the marrow empty, causing a lack of blood sources, both of which can lead to blood diseases. If kidney yang is weak, the spleen lacks warming, fire does not generate earth, chronic anemia is common; if kidney yin is deficient and yang is overly strong, it burns the blood vessels, forces blood to flow abnormally, often causing bleeding. In severe cases, both yin and yang are deficient, and yin deficiency leads to yang deficiency, resulting in dual deficiency of yin and yang. Furthermore, the heart, liver, and spleen are closely related, qi and blood depend on each other. Insufficient heart blood leads to anemia; spleen qi deficiency makes it difficult to control blood and often results in bleeding; liver failure to discharge qi often causes qi stagnation and blood stasis. Clinically observed blood diseases often involve both heart and spleen deficiency, as well as disharmony between the liver and spleen. Therefore, anemia, bleeding, and blood stasis often occur simultaneously. Moreover, because blood diseases weaken righteous qi, making it easier to contract external pathogens, infections often occur concurrently. Most deaths from blood diseases occur in the Ying and Blood divisions, with two direct causes of death: one is external pathogenic factors, where toxins intensify and turn into fire, burning blood vessels and forcing blood to flow abnormally; the other is late-stage yin deficiency, with internal heat and dryness, blood sea unrest, internal and external invasion, and both qi and blood reaching a state of dual exhaustion. (3) Treatment Methods Blood diseases involve the heart, liver, spleen, and kidneys, intricately intertwined, with both deficiency and excess, closely related to qi and blood obstruction. Therefore, the most important aspect of treating blood diseases is to unblock qi and activate blood, as Wang Qingren said: “If qi flows and blood is activated, what disease cannot be eliminated?” “Su Wen · Zhi Zhen Yao Da Lun” states: “Strictly adhere to the pathogenesis, each fulfilling its own role… …Unblock qi and blood, allow them to flow smoothly, and achieve peace.” This should be the guiding principle for treating blood diseases. However, in the specific process of syndrome differentiation, it must vary according to different stages. TCM has extensive discussions on hematological diseases and rich clinical experience. Through continuous exploration of the vast treasure trove of historical TCM and integrated TCM-Western medicine works concerning similar hematological diseases and treatment methods, combining macro and micro perspectives, and integrating syndrome differentiation with disease differentiation, new prospects have been opened for the treatment of hematological diseases. VII. Professor Pei Zhengxue’s Clinical Experience in Diagnosing and Treating Hematological Diseases According to Professor Pei Zhengxue’s experience, the formation of hematological diseases is due to inherent deficiency of righteous qi, dietary imbalances, postnatal nutritional imbalance, emotional depression, spleen and stomach weakness, and other factors that lead to deficiency of essence and blood, weakening of righteous qi, coupled with exposure to physical and biological external pathogens. All these factors result in insufficient production of qi and blood, inability to nourish the five zang organs internally, and inability to resist external pathogens and protect the surface externally, ultimately leading to deficiency of qi and blood and various blood diseases. Traditional treatment methods are limited to “supporting righteous qi” and “eliminating evil,” as stated in the “Huangdi Neijing”: “Where evil gathers, qi must be deficient; righteous qi resides within, evil cannot penetrate.” This is the fundamental view of the relationship between righteousness and evil in TCM. Therefore, the process of the rise and fall of righteousness and evil is usually the course of disease progression. Consequently, treatment of hematological diseases can be tailored based on diagnosis, balancing surplus and deficiency, exuberance and decline, combined with various indicators from modern laboratory tests, such as the number of blood cells, whether bone marrow proliferation is active or sluggish, and biochemical indicators being high or low, all integrated with TCM syndrome differentiation, naturally achieving a balance between “attacking” and “supplementing.” Professor Pei Zhengxue divides hematological diseases into three major categories based on clinical manifestations and laboratory tests: benign anemia, malignant anemia, and leukemia. According to Professor Pei Zhengxue’s clinical experience, all blood diseases, including leukemia, aplastic anemia, myelodysplastic syndromes, and purpura, share the same pathogenesis in TCM—deficiency as the root, excess as the manifestation—and the treatment strategy is to address the manifestation first and then the root, adapting to the situation and treating both the symptom and the cause, without neglecting either. “Supporting righteous qi” is like arming oneself, while “eliminating evil” is like attacking the enemy; only by arming oneself can one maximize the effectiveness of attacking the enemy; similarly, only by maximizing the effectiveness of attacking the enemy can one better arm oneself. Treatment of blood diseases requires clarifying the severity and urgency of the condition based on the patient’s disease progression. Acute attacks are characterized by high fever and bleeding, which can worsen the condition and even lead to death. Therefore, early and effective prevention of high fever and stopping bleeding are key to the success of blood disease treatment. Whenever a patient’s pulse shifts from fine and slow to rapid and forceful, with string-like and slippery pulses, accompanied by restlessness, headache, or extreme fatigue, it is often a precursor to an acute attack. At this point, even if the blood picture has not yet changed, early combination of TCM and Western medicine should be used to control the condition and prevent bleeding, so as not to let the disease spread. If high fever and inflammation have already fully manifested and the blood picture has clearly changed, the effect may be halved. At the same time, because the high fever and bleeding associated with blood diseases are not ordinary, the choice of medication regimen and dosage must fully reflect individual differences. During the remission phase, the fundamental principle is to use tonifying methods, with the key being to strengthen the spleen and kidneys. The spleen is the foundation of postnatal life, while the kidneys are the foundation of innate life; strengthening both spleen and kidneys means both tonifying qi and blood and harmonizing yin and yang. After controlling the blood disease, once the condition improves, treatment should focus on balancing the spleen and kidneys. Only when the spleen and kidneys are strong and qi and blood are abundant can we truly address the root cause of the blood disease. Since the origin of blood production lies in the kidneys and transformation occurs in the spleen, diet must rely on the spleen and stomach to transport and transform food into refined essence, which then gives rise to blood. As Shen Jin’ao of the Qing Dynasty said: “The spleen governs four organs; if the spleen is ill, all four organs will be affected; if any of the four organs is ill, the spleen must also be nourished.” Because the innate is sustained by the postnatal, and the postnatal originates from the innate, this highlights the importance of the spleen and kidneys. In the treatment of strengthening the spleen and kidneys, it is advisable to use Liu Wei Di Huang Wan combined with Sheng Mai Yin, Gui Pi Wan, “Si Shen” or “Lanzhou Formula Core.” The “Lanzhou Formula” is one of the effective prescriptions summarized by Professor Pei Zhengxue after 50 years of clinical practice in treating blood diseases. This formula became famous after curing Ma Changsheng, a patient with acute monoblastic leukemia (Leukemia M5). In 1972, at the Suzhou Conference on Blood Diseases, after a professional evaluation of Ma Changsheng’s cure for Leukemia M5, this formula was officially named the “Lanzhou Formula.” The basic composition of this formula is primarily tonifying and consolidating medicines, with Liu Wei Di Huang Tang, Sheng Mai Yin, and Gui Zhi Tang as the core, reflecting Professor Pei Zhengxue’s academic thought. After 50 years of clinical verification, this formula is considered not only an effective remedy for acute leukemia, but also has clear efficacy for aplastic anemia, myelodysplastic syndromes, purpura, bone marrow fibrosis, and other conditions. Secondly, during treatment, patients often experience disharmony between Ying and Wei due to damage to Wei qi or Wei qi sinking inward, manifesting as exterior syndromes such as solar wind or cold damage. In such cases, it is necessary to combine the patient’s current symptoms with Ma Huang Tang or “Ma Gui Compound” to harmonize Ying and Wei and expel evil to reach the surface. In addition, in the treatment of blood diseases, attacking and tonifying methods are equally important. Attacking methods include clearing heat and detoxifying, activating blood and removing stasis, drying dampness and eliminating phlegm, etc. Among them, activating blood and removing stasis is particularly important, as it promotes hemostasis in cases of bleeding caused by blood stasis, as Miao Zhongchun said: “It is better to move blood than to stop it.” Moreover, since blood diseases often involve both deficiency and excess, intricately intertwined, treatment is often carried out according to the specific symptoms. Common treatment principles include activating blood to generate blood and activating blood to stop bleeding. Iron-deficiency anemia (IDA) is the most common type of anemia, referring to a situation where the body’s demand for iron and supply are imbalanced, leading to depletion of iron stores in the body, followed by iron deficiency in red blood cells, ultimately causing iron-deficiency anemia. Iron-deficiency anemia manifests as small-cell, hypochromic anemia caused by iron deficiency and other abnormalities. Causes and Pathogenesis Iron-deficiency anemia has a very high incidence among pregnant and lactating women and infants. At the same time, long-term hemorrhage from hemorrhoids, gastric ulcers, inflammatory bowel disease, gastrointestinal tumors, and other conditions are often accompanied by iron-deficiency anemia. Among women, prolonged heavy menstrual bleeding combined with chronic iron loss that is not corrected easily leads to IDA. II. Clinical Manifestations This disease is generally mild, with no obvious subjective symptoms; in severe cases, patients may experience palpitations, shortness of breath, tachycardia, and in serious cases, heart failure. It is a common and frequently occurring disease both domestically and internationally, so prevention and control are of great significance.