基于“脾肾相赞”理论探讨针刺治疗慢性原发性免疫性血小板减少症的诊疗思路

Exploration of Acupuncture Treatment for Chronic Primary Immune Thrombocytopenia Based on the Theory of “Spleen-Kidney Mutual Support”: A Diagnostic and Therapeutic Approach

摘要: 原发性免疫性血小板减少症(ITP)是一种以血小板数量显著减少及凝血功能障碍为主要特征的自身免疫性疾病，归属于中医学的“紫斑”、“虚劳”范畴。文章提出慢性ITP病程日久则气与阴血双亏，其病理机制可概括为气阴两虚。运用“脾肾相赞”理论，结合脾运化先天，化生气血及统摄血液、肾封藏后天，生髓化血及调控气血转化的生理特点，通过经络系统运行气血、联络脏腑，提出针刺“三阴交、血海、天枢、足三里、章门、中脘、脾俞、胃俞、膈俞”以益气补血、理气化瘀，并联合针刺“太溪、肾俞、关元、气海、照海、水泉”以滋阴降火、宁血止血的治疗方案，并举隅临床案例，以期为慢性ITP的临床治疗提供诊疗思路和方法。

Abstract: Primary immune thrombocytopenia (ITP) is an autoimmune disorder characterized by a significant reduction in platelet count and coagulation dysfunction, which falls under the categories of “purpura” and “consumptive disease” in traditional Chinese medicine (TCM). This article proposes that chronic ITP, over time, leads to a dual deficiency of qi and yin-blood, with its pathological mechanism summarized as qi-yin deficiency. Based on the theory of “Spleen-Kidney Mutual Support,” and considering the physiological characteristics of the spleen in transforming and transporting innate essence, generating Qi and blood, and governing blood, as well as the kidney’s role in storing acquired essence, producing marrow and blood, and regulating Qi-blood transformation, this study utilizes the meridian system to promote qi and blood circulation and connect internal organs. A therapeutic acupuncture protocol is proposed, targeting the acupoints Sanyinjiao (SP6), Xuehai (SP10), Tianshu (ST25), Zusanli (ST36), Zhangmen (LR13), Zhongwan (CV12), Pishu (BL20), Weishu (BL21), and Geshu (BL17) to tonify Qi and blood, regulate Qi, and resolve stasis. Additionally, the acupoints Taixi (KI3), Shenshu (BL23), Guanyuan (CV4), Qihai (CV6), Zhaohai (KI6), and Shuiquan (KI5) are combined to nourish yin, reduce fire, calm blood, and stop bleeding. Clinical cases are presented to illustrate the efficacy of this approach, aiming to provide diagnostic and therapeutic insights for the clinical management of chronic ITP.