血液含有白血球、红血球、血小板等血细胞。白细胞为无色有核细胞，按白细胞形态可分为粒细胞、淋巴细胞及单核细胞三类。粒细胞因细胞质中所含颗粒性质不同，又分为嗜中性、嗜酸性及嗜碱性粒细胞。

Blood contains blood cells such as white blood cells, red blood cells, and platelets. White blood cells are colorless nucleated cells. According to the shape of white blood cells, they can be divided into three categories: granulocytes, lymphocytes and monocytes. Granulocytes are divided into neutrophils, eosinophils and basophils due to the different properties of the granules contained in their cytoplasm.

白细胞减少症（leukopenia）是一种常见血液病。当各种原因导致外周血白细胞数持续低于3.5×109/L，称为白细胞减少症。外周血中性粒细胞绝对值在成人低于2×109/L，称为中性粒细胞减少症(neutropenia),当中性粒细胞低于0.5×109/L，称为粒细胞缺乏（agranulocytosis）。Leukopenia is a common blood disease. When the number of peripheral blood white blood cells continues to be lower than 3.5×109/L due to various reasons, it is called leukopenia. The absolute value of peripheral blood neutrophils is less than 2×109/L in adults, which is called neutropenia, and the absolute value of neutrophils in peripheral blood is less than 0.5×109/L, which is called agranulocytosis. 

在英国，据报道白细胞减少症的患病率为 22−41.8%；在一年的随访期间，Dias 等人, 报道持续性白细胞减少症（定义为至少 75% 的评估中存在）的比例为 12.9%。

In the UK , prevalence of leukopenia is reported in 22−41.8% of cases; during 1 year of follow-up, Dias et al. [11] reported persistent leukopenia (defined as present in at least 75% of the evaluation) in 12.9%.

经吉姆萨染液染色的血液样本，图中四个具多核的大型细胞即为嗜中性球。样本中亦可见零星的血小板与为数众多的红血球

A blood sample stained with Giemsa stain. The four large multinucleated cells in the picture are neutrophils. Scattered platelets and numerous red blood cells were also seen in the sample.

中性粒细胞（Neutrophil 或 Neutrocyte）亦称嗜中性粒细胞、嗜中性细胞或嗜中性多核球（Neutrophilic Granulocyte），是血液白细胞的一种，也是哺乳动物血液中最主要的一种白细胞。中性粒细胞在非特异性免疫系统中有着非常重要的作用。Neutrophils (Neutrophil or Neutrocyte), also known as neutrophils, neutrophils or neutrophilic granulocytes, are a type of blood white blood cells and the most important type of white blood cells in mammalian blood. . Neutrophils play a very important role in the non-specific immune system.

白细胞减少症、粒细胞减少症多发生于女性患者，所占比例远高于男性患者，这与女性较男性易发生免疫系统疾病有关，免疫系统疾病能够破坏白细胞，致使白细胞计数低于正常值。Leukopenia and granulocytopenia mostly occur in female patients, and the proportion is much higher than that in male patients. This is related to the fact that women are more susceptible to immune system diseases than men. Immune system diseases can destroy white blood cells, causing the white blood cell count to be lower than normal.

白细胞减少症属中医“虚劳”、“血虚”、“血证”或“眩晕”等病证范畴。古代无相似的病名，也无专门论述，但有一些症状记载与本症相似。如《灵枢·海论》所述：“髓海不足，则脑转耳鸣，胫酸眩冒，目无所见，懈怠安卧。”《理虚元鉴》提到：“腿酸脚软，蒸蒸内热，胸中邪气隔紧，食不易饥。”中医治疗本症可从中得到启发和借鉴。

Leukopenia belongs to the syndrome categories of “consumption”, “blood deficiency”, “bleeding syndrome” or “dizziness” in traditional Chinese medicine. There was no similar name for the disease in ancient times, and there was no special discussion, but there are some symptoms recorded that are similar to this disease. As stated in “Lingshu·Hai Lun”: “Insufficient marrow sea will lead to dizziness in the head, tinnitus, soreness in the shins, blurred vision, and laziness in sleeping.” “Lixu Yuanjian” mentions: “Sore legs and soft feet , the internal heat is steaming, the pathogenic qi in the chest is tightly separated, and it is difficult to feel hungry after eating. “TCM can be inspired and used for reference in treating this disease.

病因

1.细菌、病毒感染，药物因素（如化疗药物及丙硫氧嘧啶等抗甲状腺药物），结缔组织病（系统性红斑狼疮、类风湿性关节炎、干燥综合征等），消化系统疾病（肝硬化、脾功能亢进、肝炎等），以及血液系统疾病（恶性血液病、再生障碍性贫血、巨幼细胞性贫血、阵发性睡眠性血红蛋白尿症等）。近年来，大气及水质等污染加重，白细胞减少症的发病率逐步升高。

Cause

1. Bacterial and viral infections, drug factors (such as chemotherapy drugs and antithyroid drugs such as propylthiouracil), connective tissue diseases (systemic lupus erythematosus, rheumatoid arthritis, Sjogren’s syndrome, etc.), digestive system diseases (liver Sclerosis, hypersplenism, hepatitis, etc.), and hematological diseases (malignant hematological diseases, aplastic anemia, megaloblastic anemia, paroxysmal nocturnal hemoglobinuria, etc.). In recent years, air and water pollution have worsened, and the incidence of leukopenia has gradually increased.

2.白细胞减少症在肿瘤化疗过程中尤为常见，其主要发病机制是由于抗肿瘤药物缺乏特异性，在杀伤肿瘤细胞的同时，也对正常细胞尤其是增殖旺盛的骨髓造血细胞造成严重损伤，导致血细胞下降。

2. Leukopenia is particularly common during tumor chemotherapy. Its main pathogenesis is due to the lack of specificity of anti-tumor drugs. While killing tumor cells, it also causes serious damage to normal cells, especially the vigorously proliferating bone marrow hematopoietic cells, resulting in Blood cells drop.

3.有研究显示，引起白细胞减少的疾病中，血液系统疾病占主要位置，包括各类良性血液病（如巨幼细胞性贫血、阵发性睡眠性血红蛋白尿症等）以及恶性血液病（如白血病、淋巴瘤、骨髓增生异常综合征、骨髓增殖性疾病等）。

3. Studies have shown that among diseases that cause leukopenia, hematological diseases account for the majority, including various benign hematological diseases (such as megaloblastic anemia, paroxysmal nocturnal hemoglobinuria, etc.) and malignant hematological diseases (such as Leukemia, lymphoma, myelodysplastic syndrome, myeloproliferative diseases, etc.).

症状

1.引起白细胞减少的的原发疾病的表现，如再生障碍性贫血会表现为贫血、出血、反复感染等。

2.容易发生呼吸道或消化道等部位的感染，如咳嗽、咳痰、腹痛、腹泻、口腔炎、发热等，

3.疲乏无力、困倦等。

Symptom

1. Manifestations of primary diseases that cause leukopenia, such as aplastic anemia, which may manifest as anemia, bleeding, repeated infections, etc.

2. Infections in the respiratory tract or digestive tract are prone to occur, such as cough, sputum, abdominal pain, diarrhea, stomatitis, fever, etc.

3. Fatigue, drowsiness, etc.

诊断

符合《血液病诊断及疗效标准》中的白细胞减少症、粒细胞减少症、粒细胞缺乏症的诊断标准。白细胞减少症：白细胞计数小于4×109/L；粒细胞减少症：中性粒细胞计数小于2×109/L；粒细胞缺乏症：中性粒细胞计数小于0.5×109/L。

Diagnosis

It complies with the diagnostic standards for leukopenia, granulocytopenia and agranulocytosis in the “Diagnosis and Treatment Standards for Hematological Diseases”. Leukopenia: white blood cell count less than 4×109/L; granulocytopenia: neutrophil count less than 2×109/L; agranulocytosis: neutrophil count less than 0.5×109/L.

西医治疗

1.维生素B4核酸的活性部分是白细胞代谢的必需成分，它对细胞的生长，特别是细胞的增生有促进作用。维生素B6参与氨基酸和脂肪代谢，刺激白细胞的生成，故可用于治疗白细胞减少症。

2.利血生可促进细胞氧化还原，较早即被用于升高白细胞的治疗，用于预防和治疗各种原因所致的白细胞减少。但有学者认为单独应用利血生治疗白细胞减少起效慢，升高白细胞幅度小，缺乏肯定的疗效。

Western medicine treatment

1. The active part of vitamin B4 nucleic acid is an essential component of leukocyte metabolism. It promotes cell growth, especially cell proliferation. Vitamin B6 participates in amino acid and fat metabolism and stimulates the production of white blood cells, so it can be used to treat leukopenia.

2. Lixue Sheng can promote cell redox and has been used for the treatment of elevated white blood cells for a long time. It is used to prevent and treat leukopenia caused by various reasons. However, some scholars believe that using rexesheng alone to treat leukopenia has a slow onset of effect, a small increase in white blood cells, and lacks definite efficacy.

3.细胞因子治疗在伴有反复感染，难以控制的情况下，可在抗感染的基础上加用粒细胞集落刺激因子（G-CSF）皮下注射，或粒/巨噬细胞集落刺激因子（GM-CSF）皮下注射。以上用药至白细胞和粒细胞正常后逐渐减量至停用，有升高白细胞作用，但此药有明显局限性：①价格昂贵，未能在临床上广泛使用；②效果不稳定，且常伴有发热、过敏等不良反应；③部分患者效果不佳。

3. Cytokine therapy: When recurrent infections are difficult to control, subcutaneous injection of granulocyte colony-stimulating factor (G-CSF) or granulocyte/macrophage colony-stimulating factor (GM) can be added to the anti-infection. -CSF) subcutaneous injection. The above medicines are gradually reduced to discontinuation after the white blood cells and granulocytes are normal. They have the effect of increasing white blood cells. However, this medicine has obvious limitations: ① It is expensive and cannot be widely used in clinical practice; ② The effect is unstable and often accompanied by There are adverse reactions such as fever and allergies; ③ Some patients have poor results.

中医治疗

常用的中药：

1. 太子参：具有益气养阴、生津止渴的功效，适用于气阴两虚型白细胞减少症。

2. 黄芪：具有补气固表、利水消肿的功效，适用于气虚型白细胞减少症。

3. 山药：具有健脾益胃、补精益髓的功效，适用于型白细胞减少症。

4. 白术：具有健脾益气、燥湿利水的功效，适用于脾虚湿盛型白细胞减少症。

5. 熟地：具有滋阴补血、益精髓的功效，适用于阴虚血虚型白细胞减少症。

6. 白花蛇舌草：具有清热解毒、利湿消肿的功效，适用于湿热型白细胞减少症。

Traditional Chinese Medicine Treatment

Commonly used Chinese medicines:

1. Radix Pseudostellariae: It has the effects of replenishing qi and nourishing yin, producing body fluid and quenching thirst. It is suitable for leukopenia due to deficiency of both qi and yin.

2. Astragalus: It has the effects of replenishing qi and strengthening the surface, diuresis and reducing swelling. It is suitable for leukopenia due to qi deficiency.

3. Yam: It has the effect of strengthening the spleen and stomach, replenishing the marrow, and is suitable for leukopenia.

4. Atractylodes macrocephala: It has the effects of strengthening the spleen and replenishing qi, removing dampness and diuresis, and is suitable for leukopenia caused by spleen deficiency and excess dampness.

5. Rehmannia glutinosa: It has the effect of nourishing yin and blood and replenishing essence. It is suitable for leukopenia due to yin deficiency and blood deficiency.

6. Hedyotis diffusa: It has the effects of clearing heat, detoxifying, diuresis and reducing swelling, and is suitable for damp-heat leukopenia.

分型与方药

1. 气阴两虚型：益气养阴汤。药用半枝莲、太子参、白花蛇舌草等。

2. 心脾两虚型：归脾汤。药用黄芪、党参、白术、白芍、山药等健脾养血的中药材。

3. 肝肾阴虚型：左归丸。药用熟地、杭芍、元参、沙参、麦冬等。

4. 脾肾阳虚型：右归丸。人参、黄芪、白术、茯苓、山药等。

Classification and prescription

1. Qi and Yin deficiency type: Yiqi and Yangyin Decoction. Herbal remedies: Scutellaria barbata, Radix Pseudostellariae, Hedyotis diffusa, etc.

2. Heart and spleen deficiency type: Guipi Decoction. Medicinal herbs such as astragalus, dangshen, atractylodes, white peony root, yam, etc. are used to strengthen the spleen and nourish blood.

3. Liver and kidney yin deficiency type: Zuogui Pills. Medicinal herbs: Rehmannia glutinosa, peony root, Radix ginseng, Adenophora adenophora, Ophiopogon japonicus, etc.

4. Spleen and kidney yang deficiency type: Yougui Pill. Herbal medicines: Ginseng, astragalus, atractylodes, poria, yam, etc.

预防与护理

在日常生活中，患者应保持良好的作息习惯，避免过度劳累，适当进行体育锻炼。同时，注意饮食调理，多吃富含蛋白质、维生素的食物，如瘦肉、鸡蛋、牛奶、新鲜蔬菜和水果等。

若出现白细胞减少症状，应及时就医，遵医嘱进行治疗。在治疗过程中，患者应保持乐观的心态，积极配合医生的治疗。

Prevention and care

In daily life, patients should maintain good work and rest habits, avoid overexertion, and engage in appropriate physical exercise. At the same time, pay attention to diet and eat more foods rich in protein and vitamins, such as lean meat, eggs, milk, fresh vegetables and fruits, etc.

If symptoms of leukopenia occur, you should seek medical treatment promptly and follow the doctor’s instructions for treatment. During the treatment process, patients should maintain an optimistic attitude and actively cooperate with the doctor’s treatment.

（作者简介： 张恩勤教授，英国中医学院院长，英国皇家医学会和英国中医药学会资深会员）