Western diagnosis: Bone marrow smear confirmed aplastic anemia.

Western diagnosis: Bone marrow smear confirmed aplastic anemia. TCM differentiation: Spleen-stomach qi deficiency. Treatment principle: Benefit qi and strengthen the spleen. Prescription: Modify Guipi Tang. Use huang qi 30 g, dang gui 10 g, dang shen 10 g, bai shu 10 g, fu ling 12 g, gan cao 6 g, mu xiang 3 g, long yan rou 20 g, fuzi 6 g, cinnamon 3 g, jixueteng 15 g, buguozhi 15 g, decocted once daily. After 20 doses, his spirit and appetite improved, bowel movements became regular. However, he still felt cold, had lower back pain, tinnitus, and nocturnal emissions. Tongue and pulse remained unchanged. Lab results: Hemoglobin 70 g/L, platelets 60 × 10^9/L, red blood cells 2.4 × 10^9/L, white blood cells 2.4 × 10^9/L, so the prescription was further adjusted to Yougui Wan with added ingredients. Prescription: Shanyao 15 g, deer antler glue 15 g, gou qi zi 15 g, du zhong 10 g, shan yu rou 30 g, dang gui 10 g, tu si zi 15 g, fuzi 6 g, cinnamon 3 g, sheng di 15 g, dan shen 10 g, mu xiang 3 g, cao dou 3 g, decocted once daily. After more than 20 doses, symptoms of coldness and lower back pain significantly improved. Follow-up blood routine: Hemoglobin 84 g/L, platelets 64 × 10^9/L, red blood cells 2.4 × 10^9/L, white blood cells 2.4 × 10^9/L, so the prescription was further adjusted to Yougui Wan with added ingredients. Prescriptions: Shanyao 15 g, deer antler glue 15 g, gou qi zi 15 g, du zhong 10 g, shan yu rou 30 g, dang gui 10 g, tu si zi 15 g, fuzi 6 g, cinnamon 3 g, sheng di 15 g, dan shen 10 g, mu xiang 3 g, cao dou 3 g, decocted once daily. After more than 20 doses, symptoms of coldness and lower back pain significantly improved. Follow-up blood routine: Hemoglobin 84 g/L, platelets 64 × 10^9/L, red blood cells 2.4 × 10^9/L, white blood cells 2.4 × 10^9/L, so the prescription was further adjusted to Yougui Wan with added ingredients. Prescriptions: Shanyao 15 g, deer antler glue 15 g, gou qi zi 15 g, du zhong 10 g, shan yu rou 30 g, dang gui 10 g, tu si zi 15 g, fuzi 6 g, cinnamon 3 g, sheng di 15 g, dan shen 10 g, mu xiang 3 g, cao dou 3 g, decocted once daily. After more than 20 doses, symptoms of coldness and lower back pain significantly improved. Follow-up blood routine: Hemoglobin 84 g/L, platelets 64 × 10^9/L, red blood cells 2.4 × 10^9/L, white blood cells 2.4 × 10^9/L, so the prescription was further adjusted to Yougui Wan with added ingredients. Prescriptions: Shanyao 15 g, deer antler glue 15 g, gou qi zi 15 g, du zhong 10 g, shan yu rou 30 g, dang gui 10 g, tu si zi 15 g, fuzi 6 g, cinnamon 3 g, sheng di 15 g, dan shen 10 g, mu xiang 3 g, cao dou 3 g, decocted once daily. After more than 20 doses, symptoms of coldness and lower back pain significantly improved. Follow-up blood routine: Hemoglobin 84 g/L, platelets 64 × 10^9/L, red blood cells 2.4 × 10^9/L, white blood cells 2.4 × 10^9/L, so the prescription was further adjusted to Yougui Wan with added ingredients. Prescriptions: Shanyao 15 g, deer antler glue 15 g, gou qi zi 15 g, du zhong 10 g, shan yu rou 30 g, dang gui 10 g, tu si zi 15 g, fuzi 6 g, cinnamon 3 g, sheng di 15 g, dan shen 10 g, mu xiang 3 g, cao dou 3 g, decocted once daily. After more than 20 doses, symptoms of coldness and lower back pain significantly improved. Follow-up blood routine: Hemoglobin 84 g/L, platelets 64 × 10^9/L, red blood cells 2.4 × 10^9/L, white blood cells 2.4 × 10^9/L, so the prescription was further adjusted to Yougui Wan with added ingredients. Prescriptions: Shanyao 15 g, deer antler glue 15 g, gou qi zi 15 g, du zhong 10 g, shan yu rou 30 g, dang gui 10 g, tu si zi 15 g, fuzi 6 g, cinnamon 3 g, sheng di 15 g, dan shen 10 g, mu xiang 3 g, cao dou 3 g, decocted once daily. After more than 20 doses, symptoms of coldness and lower back pain significantly improved. Follow-up blood routine: Hemoglobin 84 g/L, platelets 64 × 10^9/L, red blood cells 2.4 × 10^9/L, white blood cells 2.4 × 10^9/L, so the prescription was further adjusted to Yougui Wan with added ingredients. Prescriptions: Shanyao 15 g, deer antler glue 15 g, gou qi zi 15 g, du zhong 10 g, shan yu rou 30 g, dang gui 10 g, tu si zi 15 g, fuzi 6 g, cinnamon 3 g, sheng di 15 g, dan shen 10 g, mu xiang 3 g, cao dou 3 g, decocted once daily. After more than 20 doses, symptoms of coldness and lower back pain significantly improved. Follow-up blood routine: Hemoglobin 84 g/L, platelets 64 × 10^9/L, red blood cells 2.4 × 10^9/L, white blood cells 2.4 × 10^9/L, so the prescription was......The condition is often acute, with most cases presenting as a pattern of intense internal heat and excessive fire that drives blood to flow abnormally. (A very small number of cases involve qi deficiency that fails to control the blood.) In such situations, Professor Pei Zhengxue advocates clearing heat, draining fire, and cooling the blood. He highly appreciates Tang Rongchuan’s view that “the heart is the sovereign fire, which generates blood; blood is the essence of fire, and fire is the soul of blood. When fire rises, blood rises; when fire descends, blood descends.” Understanding that blood is born from fire and that fire resides in the heart, he believes that draining the heart is equivalent to draining fire, and draining fire is equivalent to stopping bleeding. For acute hemorrhage and infection in aplastic anemia, he often chooses Sanhuang Xiexin Tang, considering it the first-choice formula for draining fire and stopping bleeding in aplastic anemia. This formula is predominantly bitter and cold, directly attacking excess fire while incorporating hemostasis into the process of fire drainage. Adding 20 grams of Shengdi Huang aims to cool the blood, thereby enhancing its hemostatic effect; adding 30–60 grams of Shengshigao further strengthens its fire-draining power, with the rationale: “Shengshigao has a mild taste and a heavy nature—its mildness allows it to enter the qi, while its heaviness enables it to reach the blood. For fevers associated with blood disorders, this herb is indispensable for clearing them.” Through long-term clinical observation, he has developed the principle: “For chronic conditions, tonify the spleen and kidney; for acute conditions, drain fire and cool the blood.”

4. Strengthen Yang to elevate “white,” nourish Yin to elevate “platelets,” and tonify Qi and blood to elevate “red.” In his long clinical practice, Professor Pei Zhengxue proposed the concepts of strengthening Yang to elevate “white,” nourishing Yin to elevate “platelets,” and tonifying Qi and blood to elevate “red.” Although these are merely empirical observations, they embody the essence of clinical practice. The Suwen states: “Yang transforms into qi, while Yin forms substance.” Zhang Jingyue added: “Yang moves and disperses, thus transforming into qi; Yin remains still and condenses, thus forming substance.” From the functional attributes of white blood cells and platelets, white blood cells seem to belong to Yang, platelets to Yin, and red blood cells can be regarded as tangible blood; therefore, methods to elevate them should focus on tonifying Qi and blood.

Below are some commonly used herbs by Professor Pei Zhengxue: To elevate white blood cells, he mainly uses cinnamon, Aconite, Sophora, Codonopsis, Psoralea, Millettia, Astragalus, American ginseng, star anise, and fennel; to elevate platelets, he mainly uses Polygonatum, Polygonum, jujube, Rehmannia, donkey-hide gelatin,