邸海侠教授从“髓–血–络”辨治骨髓增殖性肿瘤经验

Professor Di Haixia’s Experience in Treating Myeloproliferative Neoplasms from the Perspective of “Marrow-Blood-Collaterals”

摘要: 邸海侠教授长期从事骨髓增殖性肿瘤(MPN)的中西医结合诊疗。在既往针对真性红细胞增多症(PV)提出的“瘀毒虚”分期辨治经验基础上，她结合PV与原发性血小板增多症(ET)的共性病机及临床差异，进一步构建了“病起于髓、变见于血、病及于络”的“髓–血–络”辨治新框架：髓毒内伏为本，瘀血阻络为主要病理变化，瘀毒互结贯穿病程，久病则正虚渐显。治疗以活血解毒为核心，兼调气通络、凉血养阴、消癥扶正；PV偏重凉血化瘀，ET偏重活血通络，并随邪正消长调整攻补尺度。两则典型验案显示，邸教授不执一方一法，而重视血象、症状、血栓出血风险及正邪变化的综合判断。现代医学关于慢性炎症、内皮损伤与血栓炎症的认识，可为“髓–血–络”病机提供一定病理参照。

Abstract: Professor Di Haixia has long been engaged in the integrated traditional Chinese and Western medicine diagnosis and treatment of myeloproliferative neoplasms (MPN). Building on his previous experience in staged syndrome differentiation and treatment of polycythemia vera (PV) as a single disease based on the “blood stasis-toxin-deficiency” framework, and combining the shared pathogenesis and clinical differences between PV and essential thrombocythemia (ET), he further proposed the “marrow-blood-collaterals” syndrome differentiation and treatment framework, characterized by “disease originating in the marrow, manifesting in the blood, and involving the collaterals”: Latent marrow toxin constitutes the root, blood stasis and collateral obstruction represent major pathological changes, and stasis-toxin interaction persists throughout the disease course; prolonged illness may lead to deficiency of healthy qi. Treatment centers on activating blood and resolving stasis together with clearing heat and removing toxins, while regulating qi, freeing the collaterals, cooling and nourishing the blood, resolving masses, and supporting healthy qi as indicated. PV treatment emphasizes cooling blood and resolving stasis, whereas ET treatment emphasizes activating blood circulation and dredging collaterals, with the balance between attacking and tonifying adjusted according to the waxing and waning of pathogenic and healthy qi. Two representative cases show that Professor Di does not adhere to a single formula or method, but instead values comprehensive judgment based on blood counts, symptoms, risks of thrombosis and bleeding, and changes in healthy and pathogenic qi. Modern medical understanding of chronic inflammation, endothelial injury, and thrombo-inflammation may provide a certain pathological reference for the “marrow-blood-collaterals” pathogenesis.