Using the Strategy of Nourishing Yin and Cooling Blood to Improve the Blood Picture in Leukemia Patients

Some leukemia patients have a low white blood cell count, which falls even lower after chemotherapy. In practice I have found that, for such patients, simply fortifying the spleen and kidney and supplementing qi and blood not only fails to raise the white cells, but actually lowers the white cells, red cells, and platelets.

A leukemia patient I am currently treating developed exactly this problem in the course of treatment. Her white cells, red cells, and platelets were all low. I had previously treated her, following the TCM strategy of supplementing qi and blood, with Bazhen Tang, Renshen Yangrong Tang, and Shengyu Tang, but her white cells, red cells, and platelets kept falling. However, on carefully reviewing her earlier prescriptions treated by me, I found that when I used the strategy of nourishing yin and cooling blood, her blood picture improved rapidly.

On June 6, 2020, the patient had itching at the ankle with small blood spots, tinnitus and deafness, and Western medicine suspected interstitial pneumonia in her lungs. I judged this as TCM "blood heat causing reckless movement," so I planned treatment on the strategy of clearing heat and cooling blood together with nourishing yin and clearing heat.

Prescription: Shengdi 12g, Chishao 12g, Mudanpi 12g, Zicao (Arnebiae Radix) 12g, Chantui (Cicadae Periostracum) 10g, Xianhecao 30g, Sheng Huaimi (Sophorae Flos) 15g, Sheng Diyu (Sanguisorbae Radix) 15g, Hanliancao (Ecliptae Herba) 15g, Nüzhenzi 15g, Cheqiancao (Plantaginis Herba) 15g, Digupi 15g, Shihu (Dendrobii Caulis) 15g, Yuzhu (Polygonati Odorati Rhizoma) 15g, Huangjing 15g, Baiwei 10g, Fuping (Spiraeae Herba) 15g, Peilan (Eupatorii Herba) 10g, Shichangpu (Acori Tatarinowii Rhizoma) 10g, Zhuye (Phyllostachydis Folium) 6g, Taizishen (Pseudostellariae Radix) 30g, Maidong 10g, Wuweizi (Schisandrae Fructus) 10g, Chao Maiya (fried Hordei Fructus) 30g, Jiao Shanzha (charred Crataegi Fructus) 10g.

At the same time I used the patent medicine Qiju Dihuang Wan to improve the tinnitus and deafness, for a one-week trial. Externally, MEBO moist burn ointment plus zinc oxide ointment was to be applied to the itchy ankle.

After taking the oral medicine, her problems resolved, so the external medicine was not used. On June 14, the patient's family reported that the ankle was no longer itchy, the small blood spots were gone, the white cells had risen, the red cells were not high, there was slight dry mouth, sweating over the body had lessened (though the head still sweated a lot), and she felt no discomfort from the above formula.

I then adjusted the prescription as follows: Sheng Huangqi 30g, Danggui 10g, Shengdi 12g, Chishao 12g, Mudanpi 12g, Zicao 12g, Chantui 10g, Xianhecao 30g, Sheng Huaimi 15g, Sheng Diyu 15g, Hanliancao 30g, Nüzhenzi 30g, Cheqiancao 15g, Digupi 15g, Shihu 15g, Yuzhu 15g, Huangjing 15g, Baiwei 10g, Cebaiye (Platycladi Cacumen) 30g, Gouqi 15g, Shayuanzi (Astragali Complanati Semen) 10g, Tusizi 10g, Peilan 10g, Fuxiaomai (Fructus Tritici Levis) 30g, Zhuye 6g, Taizishen 30g, Maidong 10g, Wuweizi 10g, Chao Maiya 30g, Jiao Shanzha 10g, Yejuhua (Chrysanthemi Indici Flos) 10g, Sheng Cishi (Magnetitum) 6g (crushed, wrapped for decoction), fresh Jiang (Zingiberis Rhizoma) 5 slices, Dazao 7 pieces.

On June 17, the red cells had risen to normal, with no marked discomfort, so I instructed the patient to add 15g of Daqingye (Isatidis Folium) to the formula (starting at 15g, gradually increasing to 30g). After taking it she felt comfortable and her blood picture was good. Later, due to chemotherapy, the white and red cells fell markedly again; her daughter reused these two prescriptions, and the blood picture once more returned to normal.

This shows that in clinical practice, prescribing according to Western lab reports can actually yield worse results than prescribing according to TCM pattern differentiation. Every TCM formula has its indications; in treating disease, the TCM physician should not abandon the principle of pattern differentiation merely because of modern instrumental lab results and modern pharmacological knowledge.

According to modern pharmacology, Shengdi, Chishao, Mudanpi, and the like all have a blood-activating, stasis-resolving action and should not be used in severe anemia, where they would have an adverse effect. But according to TCM pattern differentiation, this patient had red spots and purpura on the skin—purpura due to blood heat causing reckless movement—so cooling blood with Shengdi, Chishao, Mudanpi, and Zicao was required. After use, her blood picture rose rather than fell, showing that modern pharmacology's study of Chinese medicine has its shortcomings. TCM should not, merely to align with science, abandon the pattern-differentiation thought formed over a thousand years.