Treatment of Acute Leukemia Based on Syndrome Diff...
Abstract
According to the syndromes & signs and features of acute leukemia，this paper holds the idea that the disease should be named from the aspect of"acute disease"in TCM"consumptive disease".The causes of the disease involve congenital aspect，postnatal aspect and aspects of small-pox eruption and after the disease，external infection，circumstances and medicines，etc；the pathogenesis features include six aspects，i.e.the pathological factor is pathogenic toxin，the disease is located in bone marrow，the nature of disease is intermingled deficiency and excessiveness，the pathogenesis changes depending on healthy energy and pathogenic factors，the disease is in rapid and quick progress，the pathological products are stasis and phlegm；the clinical syndrome differentiation is divided into three types，i.e.exuberance of pathogenic toxin and intermingled phlegm and blood stasis，lysis of pathogenic toxin and deficiency of both qi and yin，deficiency of qi &blood and yin & yang.On the basis of folk and empirical prescription，the Chinese Medicine Hui-Sheng-Tang Decoction Series is prepared with the local Chinese herbal medicine medicago lupulina and diversifolious patrinia root，the anticancer Chinese medicine nightshade and the tonic Chinese medicine human placenta as basic prescription.It has such efficiencies as clearing away heat and toxic materials，nourishing blood and eliminating blood stasis，tonifying the kidney and enriching marrow.
Key words
Hui-Sheng-Tang Decoction Series；treatment based on syndrome differentiation；acute leukemia
1 General
Acute leukemia is the primary disease of hemopoietic tissue.It is characterized by the extensive abnormal hyperplasia of certain leukemia cell in bone marrow and other hemopoietic tissues and the leukemia cell can infiltrate various tissues and internal organs of the body，leading to the quantitative and qualitative changes of blood cells in peripheral blood，as a result a series of syndromes like fever，anemia，hemorrhage，enlargement of the liver，spleen and lymph，and pain in bone.The name of leukemia does not exist in Traditional Chinese Medicine，but it should be named from the aspect of"acute disease"in TCM"consumptive disease"according to the syndromes & signs and features of acute leukemia.Based on our over 30 years of clinical experience，we hold the idea that the causes of the disease mainly include congenital reason，postnatal reason and reasons of small-pox eruption and after the disease，external infection，circumstances and medicines，etc.
2 Pathogenesis features
2.1 The pathological factor is pathogenic toxin
The main cause of acute disease is pathogenic toxin，resulting from the internal latency of warm pathogenic toxin or fetal toxin which damages marrow，flows into blood and attacks from inside to outside，then spreads to the whole body.In clinical treatment，if the pathogenic toxin is controlled，the syndromes and state of illness will be alleviated；otherwise，syndromes will be aggravated and disease will relapse or become more serious.So，pathogenic toxin is the basic pathological factor.
2.2 The disease is located in bone marrow
The onset and progression of acute disease involve the internal organs of the body and all the limbs and bones，but the disease is mainly located in bone marrow.Marrow is the blood source and is deeper than the location of the blood tier.External and internal factors lead to the emptiness of marrow and deep latency of pathogenic toxin in bone marrow，which start from the blood tier，so the syndromes of consuming energy and moving blood appear.After the onset of the disease，it has the progress tendency from bone marrow-blood tier-nutrient tier-qi tier-defense tier，even all the marrow，blood，nutrient，qi and defense become ill after the onset of the disease and it spreads to the whole body quickly and endangers life.So，the disease is mainly located in bone marrow.
2.3 The nature of disease is intermingled deficiency and excessiveness
The syndrome of acute disease is complicated.Its general disease nature is deficiency，but a series of excess syndromes such as toxin concentration，blood stasis and sluggishness and muddy phlegm may appear.The main deficiency syndrome is deficiency of qi & blood which influences yin & yang and eventually results in the deficiency of qi &blood and yin & yang.While excess syndrome is the pathology transfer based on the occurrence of deficiency syndrome.It is caused by that the exogenous toxin is excessive and the healthy energy is unable to defect the pathogenic factor，or that the deficiency syndrome and excess syndrome are intertwined and deficiency，toxin，stasis and phlegm are combined to invade bone marrow and block channels，so as to affect internal organs and yin & yang and qi & blood.So，acute disease often appears as the clinical syndrome features of deficiency in origin and excess in superficiality，deficiency complicated with excess and intermingled deficiency and excess.
2.4 The pathology changed depending on healthy energy and pathogenic factors
The acute disease is urgent suddenly and mainly excessive pathogen in preliminary stage followed by the badly weakening of healthy qi due to the failure to dispel toxin，and then turns into the syndrome of healthy factor deficiency while pathogenic factor prevailing；if healthy factor cannot defeat pathogenic factor，qi and blood will be damaged badly and yin & yang will wear away；after effective treatment，it appears as a state pathogenic factor removal and weakened body resistance.So，the state of illness changes depending on the growth and decline of body resistance and pathogenic factor in their conflict.
2.5 The disease is in rapid and quick progress
Acute disease is characterized by acute onset，high risk，short course and fast progress，especially it is particularly obvious in children whose internal organs are tender and physical appearance and qi are not perfect.It is mostly caused by the internal latency of fetal toxin，internal unbalance of organs，further contraction of external evil or herbal toxicity，pathogenic toxin into marrow and gas consumption and disorder of blood.If the treatment is timely and effective，the state of illness may tend to long term mitigation，otherwise，a grave danger state will appear immediately.
2.6 The pathological products are stasis and phlegm
The person with acute disease has internal accumulation of pathogenic toxin and weak healthy qi，or the internal fetal toxin combine with the external toxin to invade organs and discharge into channels and collaterals，or abnormal flow of the blood entering collaterals blocks the running of qi and blood and leads to blood stasis with the passing of time.Pathogenic toxin is transformed into heat and fire，heat fire makes phlegm cohere accompanied by the injury of seven emotions，the syndrome of stagnant qi and phlegm cohere appear or blood stagnated as phlegm and toxin，so stasis and phlegm often coexist.After the formation of stasis and phlegm，qi movement blockage is aggravated，which further makes the qi & blood and yin & yang in internal organs go out of order.So the interaction as both cause and effect promotes various deficiencies caused by stasis or intermingled phlegm and blood stasis，the passing out of marrow will be further aggravated，which will make the disease become protracted.So stasis and phlegm are main pathological products of acute disease，which may appear either separately or in intertwined state and runs through the disease.
3 Treatment based on syndrome differentiation
Basic prescription of Hui-Sheng-Tang Decoction Serial：30～60g of medicago lupulina，15～30g of diversifolious patrinia root，10～20g of nightshade and 1～3g of human placenta powder（take with water by filling into empty capsule）.
In the prescription，the medicago lupulina has functions of clearing away heat and promoting diuresis，removing heat from the blood to stop bleeding；diversifolious patrinia root has the functions of reducing fever and eliminating dampness，arresting bleeding and eliminating blood stasis；nightshade has the function of clearing away heat and toxic material，promoting blood circulation and decreasing swelling；human placenta has the function of invigorating qi and nourishing the blood，replenishing essence and supplementing marrow.By using the four medicines together，such efficiencies as clearing away heat and toxic materials，nourishing blood and eliminating blood stasis，and tonifying the kidney and supplementing marrow will appear；and eliminating the pathogenic factors has no effect on body resistance，strengthening the body resistance does no harm on pathogenic factors and arresting bleeding will not leave stasis.
3.1 Flourishing pathogenic toxin，intermingled phlegm and blood stasis(https://www.daowen.com)
It is equivalent to the preliminary stage of disease，stage before chemotherapy or chemotherapy induced stage.The state of illness is characterized by flourishing excessive pathogen or inapparently weakened body resistance with the former as the primary one.
Symptoms：acute onset in most cases with sthenic fever and extreme thirst，headache，parched lips，epistaxis or hematuria and hemafecia，petechia and ecchymosis on the skin，dark urine，constipation，scrofula and subcutaneous nodule，fullness and hardness in hypochondrium，chest distress and bone pain，and even coma and delirium，or sore in mouth and tongue，swelling and pain in throat，swollen gums and cough that produces yellowish sputum，or swelling and pain in anus and crimson tongue or ecchymosis，yellow greasy furred tongue and weak pulse.
Analysis of pathogenesis：the pathogenic toxin has been flourishing while the healthy qi is not weakened yet；due to healthy energypathogenic factor struggle，the body fluids are damaged by exuberant heat and the nutrient-blood disordered，which makes the blood move frenetically，or even the heart spirit confused by pathogenic toxin.The heat toxin converts the body fluids into phlegm，stagnating in the bone marrow and blocking the collaterals，which leads to obstruction in qi and blood circulation and phlegm-blood accumulation in hypochondrium，at the neck，under the armpit or in the abdomen，etc.；this is most dangerous in this case.
Treatment method：mainly by eliminating the pathogenic factors，by means of clearing away heat and counteracting the toxin，promoting blood circulation by removing blood stasis and reducing phlegm and resolving masses.
Prescription：No.Ⅰ Hui-Sheng-Tang Decoction.Respectively add 20～40g of scutellaria barbata and oldenlandia diffusa，15～30g of selfheal，hairyvein agrimony and cogongrass rhizome，10～20g of polygonum cuspidatum，radix sophorae tonkinensis，peony and turtle shell（to be decocted first）as well as 3～6g of indigo naturalis（taking with water）into the basic prescription.
Analysis of prescription：here the scutellaria barbata，oldenlandia diffusa，polygonum cuspidatum，radix sophorae tonkinensis and indigo naturalis are able to clear away heat and toxic materials；the hairyvein agrimony and cogongrass rhizome to dispel heat from blood to stop bleeding；the peony to remove heat from blood and promote blood circulation；the selfheal and turtle shell to resolve phlegm，soften hard masses and remove stasis.
3.2 Gradually weakened pathogenic toxin and qi & yang deficiency
It is equivalent to the intermediate stage of disease or the stage of post-remission consolidation and intensive treatment.The state of illness is characterized by weakened body resistance and pathogenic toxin as well as illness in both symptoms and root cause.
Symptoms：persistent mild fever，tidal fever in the afternoon，dysphoria in chestpalms-soles，dizziness and tinnitus，sweating and weakness，anorexia and feeling of fullness，or nausea and vomiting，soreness and weakness of waist and knees，subcutaneous petechia and ecchymosis，bleeding from nose and teeth，dryness of oral pharynx，pain in body and bones，reduction or disappearance of masses in hypochondrium，red or pink tongue with less moss and rapid pulse or weak pulse.
Analysis of pathogenesis：although the pathogenic toxin is weakened gradually，the healthy qi has been damaged and the heat toxin accumulated in the body for a long time，which will certainly consume qi and injure yin；the blood and yin of the liver and the kidney is deficient as water failing to nourish wood；the blood is not flourishing due to deficiency of the healthy energy of heart and weakness of heart beating；yin and blood are deficient，deficiency fire breeding，internal heat fumigating，wet heat accumulated inside，spleen and stomach damaged，transportation and transformation disordered as well as reversed flow of qi non-decreasing.In this case，the patient's condition is still serious with illness in both symptoms and root cause，and high sensitivity to exogenous pathogenic factors.
Treatment method：by strengthening the body resistance to eliminate pathogenic factors and treating both cause and symptoms by means of disintoxicating to removing blood stasis and strengthening the spleen and stomach.
Prescription：No.Ⅱ Hui-Sheng-Tang Decoction.Respectively add 15～30g of radix pseudostellariae，radix astragali，ligustrum lucidum ait，eclipta alba，radix rehmanniae，scutellaria barbata and oldenlandia diffusa，as well as 10～20g of poria cocos and bighead atractylodes rhizome into the basic prescription.
Analysis of prescription：here the radix astragali is able to nourish qi and blood，the radix pseudostellariae to supplement qi and nourish yin；the ligustrum lucidum ait，eclipta alba and radix rehmanniae to nourish yin of the liver and the kidney；the scutellaria barbata and oldenlandia diffusa to clear away heat and toxic materials；the poria cocos and bighead atractylodes rhizome to strengthen the spleen & stomach and replenish qi.
3.3 Deficiency of qi & blood and yin & yang
It is equivalent to the late stage of disease or the stage of post-remission maintenance treatment.The state of illness is characterized by pathogenic factor retreating with weak healthy qi，prevailing by weakened body resistance.
Symptoms：sallow，pale or lusterless complexion，accidie and acratia，palpitation and shortness of breath that are even worse once moving，sweating，cold limbs，light-colored lips and nails，anorexia or dysphoria，or presence of petechia and ecchymosis，light and fat tongue body with thin and pale moss or tooth mark，rapid and weak or soft and floating pulse.
Analysis of pathogenesis：although more than half pathogenic toxin is eliminated，the qi and blood are correspondingly weakened；the generation and transformation of qi and blood are short of sources due to weakness of the spleen and the stomach，leading to incapability of nourishing the internal organs and all the limbs and bones；the healthy energy of lung is weaker due to long illness；lack of spirit preservation and weakness of heart beating due to deficiency of qi and blood；bone marrow depletion due to lack of spirit and qi nourishment；the healthy essence cannot transform to blood due to yin deficiency of liver and kidney，which may damage yang resulting from deficiency of yin，leading to damages to both healthy essence and qi.In this case，the healthy qi is not restored and residual pathogenic factors are not eliminated，so the disease recurs easily.
Treatment method：mainly by strengthening the body resistance，supported by eliminating residual pathogenic factors by means of nourishing qi and blood，tonifying the kidney，supplementing the marrow，strengthening the body resistance and counteracting the toxin.
Prescription：No.Ⅲ Hui-Sheng-Tang Decoction.Respectively add 20～40g of radix astragali，15～30g of codonopsis pilosula，angelica sinensis and prepared rehmannia root，10～20g of psoralea corylifolia，caulis spatholobi，dodder and glabrous greenbrier rhizome，as well as 10～15g of colla corii asini（melting by heat）into the basic prescription.
Analysis of prescription：here the radix astragali and codonopsis pilosula are able to nourish qi and generate blood；the angelica sinensis and colla corii asini to nourish yin and blood；the prepared rehmannia root and dogwood to replenish the vital essence and marrow；the psoralea corylifolia and dodder to tonify the kidney and marrow；the caulis spatholobi to enrich the blood and promote blood circulation；the glabrous greenbrier rhizome to counteract the toxin and remove dampness through diuresis.
The above-mentioned three types are classified according to the characteristics of syndrome differentiation of acute leukemia at different stages without any specific boundary between each other and it is impossible that every patient only appears as one type all the way.Therefore，when taking medicine by the prescription，the therapeutic principle and prescription must be adjusted at any time according to the changes of clinical syndrome and pathogenic factors & body resistance，by distinguishing the syndrome，seizing the key points，solving the primary contradiction and flexibly mastering the therapeutic principles such as"strengthening the body resistance to eliminate pathogenic factors"，"treating secondary symptoms for emergency"and"treating both cause and symptoms"，etc.Only in this way，the therapeutic effect may be improved.
（2016年4月在美国旧金山·国际中医药学术交流研讨会议上大会交流，夏小军、段赟 作）