中西医结合治疗不明原因多发血栓伴消化道出血个案报道

A Case Report on the Integrated Chinese and Western Medicine Treatment of Unexplained Multiple Thrombosis with Gastrointestinal Bleeding

摘要: 文章报道1例全身多发动静脉血栓伴反复消化道出血的病例。患者病史长达3年，既往针对血栓行抗凝治疗疗效不佳且出现反复消化道出血，最终致重度贫血难以纠正。外院检查均未明确诊断，属于难诊断、难治疗的复杂病例，西医治疗在止血、抗凝之间存在显著矛盾，常规抗凝治疗因存在活动性出血、高出血风险而无法实施。中医药分阶段干预：急性期先以甘草人参白芨汤益气固脱、止血；出血控制后改予参芪四物汤合凉血四物汤加减，益气养血、凉血散瘀、活血止血双向调节。治疗后患者出血停止，血红蛋白逐步回升，D-二聚体下降，病情显著改善。通过该案例，文章探讨了血栓与出血并存状态下的中西医结合治疗策略，突出中医药在“益气养血、祛瘀生新、双向调节”方面的独特优势，为类似疑难危重症提供了治疗思路与参考。

Abstract: A case report of systemic multiple arterial and venous thrombosis complicated by recurrent gastrointestinal bleeding is presented. The patient had a three-year history, with previous anticoagulant therapy for thrombosis proving ineffective and resulting in repeated episodes of gastrointestinal bleeding, ultimately leading to severe anemia that was difficult to correct. Despite extensive investigations at other hospitals, no definitive diagnosis was reached, making this a complex, challenging case involving both diagnostic and therapeutic difficulties. Conventional Western medicine faced significant contradictions between hemostasis and anticoagulation; standard anticoagulant treatment could not be administered due to active bleeding and high bleeding risk. A phased integrative approach using traditional Chinese medicine (TCM) was adopted: during the acute phase, Gancao Ren Shen Baiji Decoction was used to tonify qi, stabilize vital energy, and stop bleeding; after bleeding control, the treatment was switched to modified Shenqi Siwu Decoction combined with Liangxue Siwu Decoction to regulate qi and blood, cool the blood, resolve stasis, and promote circulation while controlling hemorrhage—achieving dual regulation. Following treatment, the patient’s bleeding ceased, hemoglobin levels gradually increased, D-dimer decreased, and the clinical condition significantly improved. This case illustrates an integrated TCM-Western medical strategy for managing coexisting thrombosis and bleeding, highlighting the unique advantages of TCM in tonifying qi and blood, resolving stasis, promoting regeneration, and achieving bidirectional regulation. It offers valuable insights and reference for treating similar complex and critical conditions.