Chinese medicine believes that the occurrence of this disease is closely related to the spleen and kidney, and falls under the categories of "jaundice," "shallow yellow," and "deficiency fatigue" in Chinese medicine. The disease's cause and mechanism are mainly due to congenital deficiency, compounded by external dampness-heat pathogens, or damage from spleen and stomach deficiency, leading to internal dampness turbidity, which stagnates and transforms into heat. The dampness-heat then accumulates and steams, damaging qi and blood. Over time, this results in qi stagnation and blood stasis, affecting the functions of the zang-fu organs, leading to symptoms such as anemia and jaundice.

bubble_chart Modern Research

Autoimmune hemolytic anemia is an acquired hemolytic disorder. The main clinical symptoms include pale complexion, lack of strength, reduced appetite, irregular fever, back pain, significant jaundice, and hematuria. This disease is more common in young and middle-aged women, and infants are also susceptible. The onset is generally slow, the course is long, and it is prone to recurrence.

This disease is caused by the disorder of the body's immune function, which produces autoantibodies that attach to the red blood cell membrane, accelerating the destruction of red blood cells and leading to hemolytic anemia. It can be caused by warm-reactive antibodies or cold-reactive antibodies, and can also be induced by secondary infections, malignant proliferation of the lymphatic system, drug allergies, connective tissue diseases, etc. Clinically, it is classified into primary and secondary types based on the cause of onset.

[Diagnosis]

1. Acute cases have a sudden onset, presenting with anemia, jaundice, and may include fever, shivering, headache, back and limb pain, nausea, vomiting, and other symptoms. The presence of hemoglobinuria indicates hemolysis.
2. Chronic cases have a slow onset and a long course, with alternating acute episodes and remissions. There is a long history of anemia, with mild or no jaundice.

Jaundice is present during episodes, and the liver and spleen are often enlarged, with the degree of splenomegaly varying and rarely reaching the level of the umbilicus. Cardiac enlargement and systolic murmurs in the precordial area may occur. Some cases are accompanied by subcutaneous purpura.

Laboratory and other examinations

1. Increased red blood cell destruction rate: (1) Increased free hemoglobin in the blood. (2) Decreased or absent serum haptoglobin. (3) Hemoglobinuria. (4) Hemosiderinuria. (5) Hyperbilirubinemia. (6) Increased fecal urobilinogen excretion. (7) Increased urinary urobilinogen excretion or 1/20 positive. In chronic hemolysis, the increase is not significant. (8) Isotope labeling can detect shortened red blood cell lifespan.
2. Red blood cell compensatory hyperplasia: (1) Increased reticulocytes. (2) Presence of young red blood cells, polychromatic cells, stippled cells, and red cell fragments in the peripheral blood. Abnormal morphology of mature red blood cells, with Cabot rings and Howell-Jolly bodies visible. (3) Markedly active bone marrow hyperplasia, mainly in the red blood cell system, with increased red blood cells at all stages, especially intermediate and late erythroblasts, occasionally showing megaloblastic changes, decreased or inverted granulocyte-to-erythrocyte ratio, and mature red blood cell morphology similar to that seen in peripheral blood. Additionally, there may be an increase in sideroblasts.
3. During acute episodes, white blood cells may increase, and intermediate or late white blood cells may appear in the peripheral blood. They may also decrease.
4. Positive Coombs test: (1) Direct test to determine the presence of incomplete antibodies attached to red blood cells in the blood. (2) Indirect test to determine the presence of free incomplete antibodies in the serum.

bubble_chart Pattern Analysis

1. Dampness-heat︰Jaundice appears rapidly, accompanied by fever, thirst without desire to drink; nausea, vomiting, soreness and pain in the lower back, gastric stuffiness, abdominal distension and fullness, constipation or sticky and uncomfortable stools, scanty and dark yellow urine. The tongue is red with a yellow and greasy coating, and the pulse is soggy and rapid. Clear and drain damp-heat, fortify the spleen and resolve jaundice. Modified Capillaris and Five Ingredients with Poria Powder: Virgate Wormwood 20g, Poria 15g, Alisma 10g, Polyporus 15g, White Atractylodes Rhizome 10g, Rhubarb Rhizoma 10g, Forsythia 10g, Salvia 15g. If the body and eyes show shallow yellow and dull discoloration, use modified Virgate Wormwood Cold-Extremities Decoction: Virgate Wormwood 15g, Dried Ginger 10g, Prepared Aconite Lateral Root 10g, Tangshen 15g, Astragalus Root 15g, White Atractylodes Rhizome 10g, Liquorice Root 6g. For severe vomiting, add Bamboo Shavings 10g and Coptis Rhizome 5g. For intense heat and thirst, add Reed Rhizome 20g and Dendrobium 20g.
2. Deficiency of Both Qi and Blood︰Dizziness, shortness of breath, lack of strength, dull complexion, palpitation, flusteredness, spontaneous sweating, reluctance to speak, and fatigue. Pale tongue with thin white coating, weak and thready pulse. Tonifying qi, nourishing blood, and replenishing the heart and spleen. Modified Returning to Spleen Decoction: Codonopsis Root 10g, Astragalus Root 15g, White Atractylodes Rhizome 10g, Chinese Angelica 10g, Poria 10g, Prepared Rehmannia Root 15g, Villous Amomum Fruit 3g, Barbary Wolfberry Fruit 10g, Donkey-hide Gelatin (melting) 10g, Liquorice Root 6g. For poor appetite, abdominal distension and fullness, and loose stools, remove Prepared Rehmannia Root, Chinese Angelica, and Donkey-hide Gelatin, and add Aucklandia Root 10g, Dried Tangerine Peel 10g, Blast-Fried Ginger 10g. For bleeding, add Hairyvein Agrimonia Herb 15g, Sophora Flower 10g, Lotus Rhizome Node 15g. For jaundice, add Virgate Wormwood 15g, Alisma 10g.
3. Spleen-kidney Qi Deficiency︰Dizziness, tinnitus, sore waist and weak legs, poor appetite and chest tightness, cold body and limbs, loose stools. Pale tongue with thin white coating, thin and weak pulse. Warm and tonify the spleen and kidney, tonify qi and nourish blood. Modified Right-Restoring Pill. Codonopsis Root 15g, Astragalus Root 15g, Chinese Angelica 10g, Prepared Rehmannia Root 15g, Deer Horn Slices 10g, Psoralea 10g, Morinda 10g, Epimedium Herb 10g, Dodder Seed 10g. For severe yang deficiency and obvious cold limbs, add Aconite Lateral Root 10g; for bleeding, add Blast-Fried Ginger Charcoal, Hairyvein Agrimonia Herb, Calcined Fossil Bone, and Oyster Shell 15g each. If there are flushed cheeks, low-grade fever, irritability, feverish sensation in palms and soles, night sweats, and brittle nails, use modified Six-Ingredient Rehmannia Decoction: Prepared Rehmannia Root 15g, Chinese Yam 10g, Cornus Fruit 10g, Barbary Wolfberry Fruit 10g, Moutan Bark 10g, Alisma 10g, Poria 15g, Astragalus Root 15g.
4. Qi Stagnation and Blood Stasis︰Yellowing of the body and eyes, dull and lusterless complexion, hypochondriac masses, abdominal distension, mental fatigue, anorexia, vomiting after eating, grayish-white stools, scanty yellow urine, or skin ecchymosis; static blood, dark lips. Tongue with ecchymosis and yellow coating. Thin and choppy pulse. Activate blood to resolve phlegm, regulate qi to relieve jaundice. Modified Blood House Stasis-Expelling Decoction: Bupleurum 10g, Submature Bitter Orange 10g, Chinese Angelica 10g, Red Peony Root 10g, Chuanxiong 10g, Peach Kernel 10g, Carthamus 10g, Cyperus 10g, Zedoary Rhizome 10g, Turtle Carapace 15g. For prominent hypochondriac masses, additionally take Turtle Carapace Decocted Pill and Huazheng Huisheng Dan. For significant bleeding, add Hairyvein Agrimonia Herb 15g, Unprocessed Rehmannia Root 10g, and Cyperus 10g.