"Qingre Liangxue Decoction" for Thrombocytopenia in Cancer Patients
Qingre Liangxue Decoction (Heat-Clearing, Blood-Cooling Decoction) is an experienced formula summed up by contemporary TCM practitioners for childhood purpura and epistaxis. It is composed of Shengdi (Rehmanniae Radix), Xuanshen (Scrophulariae Radix), Maidong (Ophiopogonis Radix), Zicaorong (Arnebiae Radix), Mudanpi (Moutan Cortex), Chishao (Paeoniae Rubra Radix), Baishao (Paeoniae Alba Radix), Zhizi (Gardeniae Fructus), Hongzao (Jujubae Fructus), Daqingye (Isatidis Folium), Baimaogen (Imperatae Rhizoma), and others.
According to traditional TCM theory, this formula cools blood and stops bleeding while clearing heat and nourishing yin. It is used for purpura and various bleeding conditions due to yin deficiency with internal heat and reckless movement of hot blood. Symptoms include recurrent purpura, epistaxis and gingival bleeding with bright red blood, low fever and night sweats, vexation and insomnia, dry stool, yellow-red urine, a glossy red tongue with scant coating, and a fine rapid pulse. Modern research confirms this formula has a good effect in raising the patient's platelets.
If this formula is combined with Huanglian Ejiao Tang and Erzhi Pill, it can raise not only platelets but also red and white blood cells. But note it must match the above indications. Many pediatric tumor patients—such as children with leukemia or neuroblastoma—develop constipation, low fever, night sweats, thrombocytopenia and skin purpura; this formula is well suited to raising their platelets.
The usual dose is: Shengdi 15 g, Maidong 15 g, Xuanshen 15 g, Zicaorong 9 g, Mudanpi 9 g, Chishao 9 g, Baishao 9 g, Zhizi 9 g, Hongzao 7 pieces, Daqingye 30 g, Baimaogen 30 g. This is a pediatric dose; adults may use the same dose or double it. Those with weak spleen and stomach should reduce the amount.
This formula can serve as the main pattern-differentiation formula for secondary leukemia after chemotherapy for childhood leukemia or various tumors. When used clinically against cancer, one should add Chinese herbs or patent medicines with anti-tumor action according to the patient's condition.
The combination of Shengdi, Maidong and Xuanshen is the famous warm-disease formula Zengye Tang (Fluid-Increasing Decoction), suited to patients with depleted yin fluids. Zicaorong, Mudanpi, Chishao and Baishao all cool blood; Zhizi, Daqingye and Baimaogen clear heat and stop bleeding. Together they nourish the depleted yin fluids and clear heat and cool blood, hence resolving purpura and stopping bleeding. Hongzao in the formula nourishes blood; if bleeding is heavy and the body weak, Hongzao may be increased to 10–30 pieces.
TCM mostly considers bleeding disorders as due to reckless movement of hot blood or the spleen failing to govern blood. This formula suits bleeding from reckless hot-blood movement. If the spleen is deficient and cannot govern blood, one should use warm supplementation instead, with Guipi Tang (Spleen-Restoring Decoction) as the representative formula. Patients whose spleen fails to govern blood show a picture of deficiency: fatigue and lassitude, shortness of breath and low voice, a pale sallow complexion, a pale tongue—very different from reckless hot-blood movement, and this formula must not be used indiscriminately.
Thrombocytopenia and purpura in adult cancer patients can also be addressed with this formula, but adult treatment is generally more complex than in children, and adult response is usually not as rapid as in children. So when using this formula in adults, the physician should judiciously add or remove herbs according to the patient's condition to achieve better results.