1.2.1 Classification and Treatment

1.2.1 Classification and Treatment

1.2.1.1 Kidney Generates Marrow Method [16]

1.2.1.1.1 Nourish Yin and Tonify the Kidneys

When patients with aplastic anemia present with kidney yin deficiency symptoms, in addition to the aforementioned qi and blood deficiency symptoms, they may also exhibit low-grade fever, heat in the palms and soles, night sweats, bleeding of the skin and mucous membranes, and even retinal and visceral bleeding. This method is often used in combination with qi-replenishing and blood-nourishing herbs such as Danggui Buxue Tang.

Representative formulas: Nourish Yin and Tonify the Kidneys Formula; Gui Shao Di Huang Tang; Zuo Gui Yin; Zhi Gan Cao Tang.

1.2.1.1.2 Warm Yang and Tonify the Kidneys

When patients with aplastic anemia present with kidney yang deficiency symptoms, in addition to the aforementioned qi and blood deficiency symptoms, they may also exhibit cold intolerance, cold limbs, lower back pain, frequent urination, nocturia, impotence, and other yang deficiency signs.

Representative formulas: Tonify the Kidneys and Assist Yang Formula; You Gui Yin.

1.2.1.1.3 Both Yin and Yang Tonification

Patients with aplastic anemia may experience low-grade fever, heat in the palms and soles, dry mouth, night sweats, and other yin deficiency symptoms, as well as lower back pain, leg weakness, frequent urination, cold intolerance, nocturia, and edema—symptoms of yang deficiency.

Representative formulas: Both Yin and Yang Tonification Formula; Gui Fu Di Huang Tang.

1.2.1.2 Warmly Tonify Spleen and Kidneys

Patients present with spleen and kidney yang deficiency symptoms such as abdominal distension, loose stools, cold intolerance, lower back pain, leg weakness, and impotence.

Representative formulas: Fourteen-Ingredient Jianzhong Tang; Warmly Tonify Spleen and Kidneys Formula.

1.2.1.3 Replenish Heart and Spleen

This method is suitable for all types of aplastic anemia presenting with heart and spleen deficiency symptoms, such as palpitations, shortness of breath, fatigue, insomnia, loose stools, and poor appetite. When used alone, it is mostly applied to mild cases; more often, it is combined with kidney-tonifying methods for treating aplastic anemia.

Representative formulas: Gui Pi Tang; Ren Shen Yang Rong Tang; Shen Qi Si Wu Tang.

1.2.1.4 Activate Blood Circulation and Remove Stasis

Patients with aplastic anemia may exhibit a dull, lusterless complexion and body pain—symptoms of blood stasis.

Representative formulas: Tao Hong Si Wu Tang; Activate Blood Circulation and Remove Stasis Formula.

Activating blood circulation and removing stasis is rarely used alone in the treatment of aplastic anemia; it is usually combined with kidney-tonifying methods, forming what is known as "kidney-tonifying and blood-activating" or "kidney-tonifying and stasis-removing" therapies. Most commonly, Danshen, Jixueteng, Danggui, Chishao, and Chuanxiong are used, while Taoren and Honghua are used less frequently.

1.2.1.5 Clear Heat and Detoxify

Acute aplastic anemia patients often experience infection-related fever, or aplastic anemia associated with hepatitis, or aplastic anemia complicated by jaundice-type hepatitis; in such cases, this method can be employed, and once the fever and jaundice subside, treatment can transition to kidney-tonifying methods.

Representative formulas: Clear Heat and Detoxify Formula; Yin Chen Hao Tang.

Since the 1990s, based on syndrome differentiation and classification, treatment has been further refined according to the severity of the condition, thereby enriching the content of syndrome differentiation and treatment for aplastic anemia. First is the progressive stage (also known as the critical stage): the condition progressively worsens, with declines in all three blood cell lines, frequent blood transfusions, often accompanied by fever and bleeding, commonly seen in acute aplastic anemia, or in newly diagnosed chronic cases, as well as the aforementioned yin deficiency type. Treatment emphasizes the integration of traditional Chinese and Western medicine.

Research on Pei Zhengxue’s Series of Formulas and Medications

A comprehensive treatment combining multiple drugs with blood transfusions. TCM treatment methods: nourish yin and tonify the kidneys, cool the blood and detoxify, treat both the root and the symptoms; for severe fever and bleeding, symptomatic treatment may also be prioritized. Prescription: Based on the aforementioned nourish yin and tonify the kidneys formula, add or increase the dosage of clear heat, detoxify, cool the blood, and stop bleeding herbs, such as Yinhua, Lianqiao, Zhizi, Pugongying, Banlangen, Lingyangjiao, Shengdi, Danpi, Bai Maogen, Shengdi Yu, Ou Jie, and others.

Second is the improvement stage (also known as the stable stage): the condition tends to stabilize, with no obvious bleeding or fever, stable or slightly improving blood counts, significantly extended intervals between blood transfusions, or even complete cessation of transfusions. During this stage, treatment focuses on addressing the root cause, often following the aforementioned treatment for both yin and yang deficiency of the kidneys.

Third is the recovery stage (also known as the remission stage): blood counts have risen markedly, hemoglobin and red blood cells have reached or are close to normal levels, white blood cells and platelets have also increased to some extent, complete cessation of blood transfusions for more than three months, with no bleeding or fever. At this stage, yin and yang deficiency symptoms are no longer obvious, but treatment still primarily focuses on tonifying the kidneys, often using both yin and yang tonification formulas. Elderly patients often use kidney-tonifying and yang-assisting formulas, or alternate between the two regularly. This stage requires a relatively long treatment period—at least one year or more—with gradual reduction and tapering of medication to maintain stability for an extended period.