Two TCM Cases of Chronic Myeloid Leukemia Treated by Professor Huang Zhenqiao

Professor Huang Zhenqiao is a chief physician at the Affiliated Hospital of Shanghai University of Traditional Chinese Medicine. He specializes in treating major diseases such as malignant tumors and chronic illnesses using Chinese medicine and integrated Chinese-Western medicine, and has profound expertise in hematology. This article presents two of his cases of chronic myeloid leukemia, to study the thinking and methods he uses to treat such diseases.

Case 1: Treating chronic lymphocytic leukemia with spleen-strengthening, yin-nourishing, toxin-resolving, and dampness-transforming methods

Patient: Wu, male, 45 years old, married.

First visit: July 30, 2002.

Chief complaint and history: In 1998, while hospitalized for trauma, he was found to have an elevated peripheral white blood cell count of about 20×10⁹/L, which he did not take seriously. Over the next four years, repeated blood tests showed WBC counts of (17–32)×10⁹/L with lymphocyte percentages of 64%–83%. A bone marrow smear at another hospital showed a total lymphocyte percentage of 31.5% and a 1% prolymphocyte percentage, leading to a diagnosis of chronic lymphocytic leukemia. He usually felt fatigued, had loose stools, slept poorly, and had an acceptable appetite.

Examination: No superficial lymph nodes palpable; no hepatosplenomegaly. Tongage: red tongue with thin coating; pulse: fine. CBC: WBC 23.2×10⁹/L, lymphocytes 81%, lymphocyte count 18.8×10⁹/L, hemoglobin 147 g/L, platelets 141×10⁹/L. Peripheral blood differential: lymphocytes 81%, neutrophils 16%, monocytes 2%, eosinophils 1%.

Pattern differentiation: Spleen deficiency generating dampness, with phlegm and stasis binding internally.

Treatment method: Fortify the spleen and transform dampness, dissipate phlegm and resolve toxin.

Prescription: stir-fried Baizhu (Atractylodis Macrocephalae Rhizoma) 15g, Fuling (Poria) 15g, Chenpi (Citri Reticulatae Pericarpium) 10g, honey-fried Gancao (Glycyrrhizae Radix) 10g, raw Yiyiren (Coicis Semen) 30g, Huogeng (Agastaches Stem) 15g, Huanglian (Coptidis Rhizoma) 5g, processed Banxia (Pinelliae Rhizoma) 10g, raw Gegen (Puerariae Radix) 30g, stir-fried Huangqin (Scutellariae Radix) 15g, Guangmuxiang (Aucklandiae Radix) 5g.

The above was taken as 7 doses, together with 10 tablets of Jiedu Kang'ai Pian (Antitoxin Anticancer Tablets), three times daily. After the medication, loose stools persisted, so Tubie (Smilacis Glabrae Rhizoma) 30g was added and 14 doses taken. Repeat CBC: WBC 22.6×10⁹/L, lymphocytes 80%, lymphocyte count 18.1×10⁹/L. Peripheral differential: lymphocytes 80%, neutrophils 14%, monocytes 3%, eosinophils 1%, prolymphocytes 2%. On August 20, fever due to acute tonsillitis occurred; Yinqiao San combined with Erchen Tang was given to clear heat and resolve toxin, dissipate phlegm and soothe the throat, for 7 doses.

Second visit: August 27, 2002. Sore throat and fever had resolved; stools were formed; no obvious dizziness or fatigue; sleep at night was peaceful. Tongue: red with thin coating; pulse: rapid.

Pattern differentiation: Qi and yin both deficient, with phlegm, stasis, and toxin binding.

Treatment method: Nourish yin and harmonize the spleen, resolve toxin and dissipate phlegm.

Prescription: Xuanshen (Scrophulariae Radix) 10g, Maidong (Ophiopogonis Radix) 12g, raw and honey-fried Gancao 10g each, raw Yiyiren 15g, Chuanbeimu-like Zhejiang Beimu (Fritillariae Bulbus) 15g, Baihuasheshecao (Hedyotidis Diffusae Herba) 30g, Banzhilian (Scutellariae Barbatae Herba) 30g, Chenpi 5g, Tubie 15g, Sanleng (Sparganii Rhizoma) 15g, Bingqiuzi (i.e., Shancigu, Cremastrae Pleionis Pseudobulbus) 30g, Huogeng 10g.

The above was taken for 14 doses, together with 10 tablets of Jiedu Kang'ai Pian three times daily. Afterward the patient reported easy sweating and poor sleep; the prior formula was modified by adding Duan Muli (calcined Ostreae Concha) 30g, stir-fried Zaoren (Ziziphi Spinosae Semen) 15g, Zibeichi (Arcae Concha) 15g, and Caoheche (Paris seu Polygoni Cuspidati Rhizoma) 30g, for 28 doses. Symptoms improved; Taizishen (Pseudostellariae Radix) 15g and raw Huangqi (Astragali Radix) 10g were added and continued. Repeat peripheral WBC: 12.3×10⁹/L, lymphocytes 66.7%, lymphocyte count 8.2×10⁹/L.

This case is a typical TCM anticancer case combining pattern-based treatment with disease-based treatment. At the first visit, the patient showed spleen-deficiency loose stools, so modified Sijunzi Tang (Four Gentlemen Decoction) was used to fortify the spleen and drain dampness. At the second visit, these symptoms had improved, and the red tongue and rapid pulse indicated internal heat; so modified Zengye Tang (Fluid-Enhancing Decoction) was used, adding anticancer herbs that clear heat and resolve toxin, soften hard masses, and activate blood and resolve stasis. Throughout, the patient also took Jiedu Kang'ai Pian (an in-house preparation of unknown composition) specifically to fight cancer. The two approaches together eliminated the patient's symptoms and lowered the markers associated with chronic myeloid leukemia, with marked efficacy.

Case 2: Treating chronic myeloid leukemia with deficiency-excess and constrained fire, focusing on kidney-tonifying and liver-draining methods

Patient: Wang, female, 39 years old, married.

First visit: March 20, 2001.

Chief complaint and history: Since January 2001 she had felt fatigue and lassitude, with swollen painful gums, cough, and sore throat. A blood test at another hospital showed WBC 40×10⁹/L and platelets 560×10⁹/L; peripheral smear showed immature granulocytes, and a bone marrow smear indicated chronic myeloid leukemia. She had been treated with hydroxyurea combined with alpha-interferon. She often had headaches and had repeatedly taken painkillers. At the visit she reported fatigue, sore throat, and poor sleep. Examination: no superficial lymph nodes palpable; no hepatosplenomegaly. Pattern: liver depression smoldering toxin, kidney yin deficiency. Treatment: Soothe the liver and resolve depression, clear heat and resolve toxin. Modified Danzhi Xiaoyao San was planned.

First-visit prescription: stir-fried Baizhu 15g, Fuling 15g, raw Shanzhi (Gardeniae Fructus) 5g, stir-fried Baishao (Paeoniae Alba Radix) 15g, raw Muli (Ostreae Concha) 30g, Chenpi 10g, Pugongying (Taraxaci Herba) 30g, Chaihu (Bupleuri Radix) 10g, Bohe (Menthae Herba) 3g (added later), Banzhilian 30g, stir-fried Danpi (Moutan Cortex) 10g, processed Banxia 10g, raw and honey-fried Gancao 5g each, Guangmuxiang 5g, stir-fried Zhiqiao (Aurantii Fructus) 10g, raw Huangqin 12g, Zhenzhumu (Margaritifera Concha) 30g, Dafupi (Arecae Pericarpium) 12g.

The above was taken for 7 doses, together with 10 tablets of Jiedu Kang'ai Pian three times daily. Afterward, because of cough, sputum, sore throat, and poor sleep, the formula was changed to herbs that dissipate phlegm and diffuse the lung, clear heat and resolve toxin. On the basis of the original formula, Xingren (Armeniacae Semen) 10g, Xiangbei (Fritillariae Bulbus) 15g, Qianhu (Peucedani Radix) 15g, Jiegeng (Platycodi Radix) 10g, processed Banxia 10g, Yinhua (Lonicerae Flos) 30g, Pugongying 30g, Hongteng (Sargentodoxae Caulis) 30g, and Baijiangcao (Patriniae Herba) 30g were added; Amoxil and Huatanling were given for symptomatic treatment for over two months, after which the cough improved. On June 5, repeat CBC: WBC 4.1×10⁹/L, hemoglobin 138 g/L, platelets 243×10⁹/L. Peripheral smear: neutrophils 67%, lymphocytes 28%, monocytes 3%, basophils 1%, eosinophils 1%.

Second visit: June 5, 2001. Cough had stopped; she still had sputum, occasional dizziness, poor sleep with many dreams, painful finger joints, and lower back soreness. Tongue: pale red with yellow greasy coating; pulse: wiry. Pattern: spleen-kidney deficiency with liver fire and pathogenic toxin. Treatment: Tonify the kidney and fortify the spleen, boost qi and clear heat. Sancai Fengsui Dan was chosen as the main formula.

Prescription: raw Huangqi 30g, Taizishen 15g, raw Baizhu 10g, Fuling 15g, Maidong 15g, stir-fried Huangbo (Phellodendri Cortex) 15g, Sharen (Amomi Fructus, added later) 3g, Shemei (Duchesnae Herba) 60g, Pugongying 30g, Ezhu (Curcumae Rhizoma) 30g, raw and honey-fried Gancao 15g each, Chenpi 15g.

The above was taken for 7 doses, together with 4 tablets of Jiedu Kang'ai Pian three times daily. Night sleep gradually improved and finger-joint pain lessened, but cough recurred at times. Following the prior method with modifications, cough and sputum lessened, and treatment continued for over two months. On September 17, repeat CBC: WBC 4.3×10⁹/L, hemoglobin 125 g/L, platelets 254×10⁹/L. Peripheral smear: neutrophils 72%, lymphocytes 24%, monocytes 4%.

Third visit: September 18, 2001. Dizziness, profuse sweating, poor sleep, oral ulcers, and swollen painful gums. Tongue: pale red with thin yellow greasy coating; pulse: fine. Pattern: spleen-kidney yin deficiency with liver fire and pathogenic toxin. Treatment: Nourish yin and clear heat, drain fire and resolve toxin.

Prescription: Shengdi (Rehmanniae Radix) 12g, Beishashen (Glehniae Radix) 15g, stir-fried Huangbo 15g, Tubie 30g, stir-fried Zhiqiao 5g, Chenpi 5g, Huanglian 5g, Baihuasheshecao 30g, Shemei 30g, raw and honey-fried Gancao 10g each, Zhe Beimu 15g, Banlangen (Isatidis Radix) 30g.

The above was taken for 7 doses, together with 4 tablets of Jiedu Kang'ai Pian three times daily on alternate days. Symptoms eased somewhat, but over the next few weeks recurrent cough, sore throat, yellow sticky phlegm in the throat, and recurring oral ulcers persisted. The original formula was adjusted by adding herbs to clear phlegm-heat and regulate qi; symptoms gradually settled, and outpatient treatment continued. One year after treatment (March 2002), repeat CBC: WBC 6.2×10⁹/L, hemoglobin 124 g/L, platelets 252×10⁹/L. Peripheral smear: neutrophils 73%, lymphocytes 24%, monocytes 3%; no immature granulocytes seen.

This case, like the previous one, is a typical example combining pattern-based and disease-based treatment. Although the patients' clinical symptoms differed and the formulas used for pattern differentiation differed, the anticancer herbs used were largely the same. These two cases illustrate both treating the same disease differently and treating different diseases by the same method. Both patients had chronic myeloid leukemia, yet the treatment strategies were not identical, because their symptoms differed. But although the herbs differed, the key anticancer drugs were consistent—this is seeking common ground within difference.