A Case of Remote Diagnosis and Treatment of Chronic Lymphocytic Leukemia

The patient, Lei, male, 52 years old, from Wangjiaqiao Town, Songzi, Jingzhou, Hubei Province. In mid-December 2021 he was diagnosed at Jingzhou Central Hospital (inpatient No. 21846890) with non-Hodgkin B-cell lymphoma, consistent with the features of chronic lymphocytic leukemia/small lymphocytic lymphoma. Imaging showed enlarged bilateral cervical lymph nodes, bilateral supraclavicular lymph nodes, bilateral axillary lymph nodes, and bilateral inguinal lymph nodes; a nodule in the right lower lung (considered a proliferative focus or intrapulmonary lymph node); bilateral pulmonary emphysema; and multiple hepatic cysts.

Western medicine held that there was currently no good treatment for this patient, so he was left untreated for the time being, with measures to be taken only when the condition worsened. While receiving treatment for other ailments from a physician surnamed Zheng in his town, the patient mentioned his lymphoma and leukemia. Dr. Zheng knew of the author's reputation and had already referred several local patients to him, all of whom had achieved some therapeutic effect, so he persuaded this patient to give the author a try.

Because of the pandemic, the author had suspended all in-person consultations, so the patient could only be seen via remote video consultation. At the first video consultation on February 23, 2022, it was learned that in previous years the patient had regularly accompanied others in gambling through the night, smoked and drank, and had an extremely irregular routine, which had greatly damaged his health. In recent years he caught colds easily, suffered severe night sweats, and now, because of the leukemia, frequently developed blood blisters in the mouth and bleeding gums when brushing his teeth, with dizziness and fatigue. He had previously sought out a local Chinese medicine physician, who also had no good solution and merely suggested he buy cordyceps (dongchong xiacao) on his own to boost his immunity.

Although referred by Dr. Zheng, the patient's attending Western physician had told him that Chinese medicine would not work and advised against seeking a TCM physician. The patient therefore hesitated and had little confidence in remote diagnosis. But since the illness had reached this point and there was no other option, he finally decided to give it a try and take Chinese medicine for a period of time.

Based on the patient's past lifestyle, the author judged his condition to be a consumptive deficiency disease caused by chronic irregular living, accompanied by the TCM pattern of scrofula (luoli). Accordingly, the main treatment for the leukemia and lymphoma was a modified Herba-and-Radix-Scattering-Hardness Pill (Heruo Sanjian Wan) by Chen Shigong of the Ming Dynasty and a modified Scrofula-Resolving Decoction (Xiaoluo Tang) by Cheng Zhongling of the Qing Dynasty; night sweats were treated with Lily Bulb Metal-Securing Pill (Baihe Gujin Wan) by Zhou Shenzhai of the Ming Dynasty; and dizziness was treated with the patent medicine Shengmai Yin oral liquid. These medicines were combined into a single coherent strategy to treat both the root and the manifestation. This regimen was also economical, costing only two to three thousand yuan per month—far more affordable than using expensive products such as Xihuang Wan.

By March 5, 2022, the patient no longer had night sweats, his gums no longer bled, he no longer developed large blood blisters in the mouth, his dizziness had disappeared, his stamina had markedly improved, and his confidence had grown. He contacted the author joyfully, saying the effect had been a great surprise and had changed his view of Chinese medicine.

The patient is still undergoing further treatment, and whether even better outcomes can be achieved remains to be seen. But through communication, the author learned that the patient has now adjusted his routine well, no longer stays up gambling, and walks and exercises in the village every day; everything is turning for the better, so there is still hope of a better outcome.

When Chinese medicine treats stubborn diseases such as cancer and leukemia, one must understand the patient's overall situation and comprehensively judge the cause based on family genetic factors, years of lifestyle, work habits, and stress levels, and then prescribe symptom-targeted treatment.

Symptom-targeted supportive treatment is the greatest feature of Chinese medicine and where its clinical efficacy is strongest. The formula-pattern school of Chinese medicine has always attached the greatest importance to the patient's various symptoms rather than to unreliable factors too tied to the physician's subjective awareness, such as the pulse. The representative of the formula-pattern school, Professor Hu Xishu, said that formula-pattern correspondence is the highest and most difficult realm of TCM pattern differentiation and treatment. Clinical inquiry in Chinese medicine must be detailed; only by clearly tracing the whole course of the illness can one make a correct judgment and select the appropriate formula. When the correspondence between formula and pattern is correctly identified, the prescribed medicine can produce unexpectedly good results. Those who study Chinese medicine should therefore devote effort in ordinary times to memorizing formula-pattern correspondences. A given category of illness has many formulas that can be shared; if we memorize the indications of these formulas, we will not be at a loss clinically.

In addition, young TCM physicians must patiently read and study medicine. As long as we produce real clinical results, patients will naturally accumulate through word of mouth. In recent years, more than 90% of the patients the author has received have been referred by patients he has treated or by people close to them. New patients referred by patients treated with real results usually already have a basis of trust in the physician; compared with patients who seek doctors through other channels, these patients have higher trust and adherence.

Professor Fang Yaozhong once said that when he was young, he treated patients earnestly when there were many, and read more when there were few; over time, his reputation among patients grew, his reading increased, his level rose, and more and more people came to seek his care. What Professor Fang described is the general rule of intellectual growth and career development for most TCM physicians who love and diligently study Chinese medicine. Having chosen Chinese medicine as our profession, we should accept this rule with a calm mind, persevere over the long term, and gradually improve our learning and develop our career.

The author has seen many young TCM physicians who are restless, caught up in various debates rather than settling down to read and treat patients, which is often regrettable. But he also understands that young people newly entering society can hardly settle down because of objective reality. Even so, he hopes that the cause of Chinese medicine will have successors, and hopes that rising talents reading his articles will learn from Professor Fang's spirit: be down-to-earth, see patients patiently, read diligently, be neither impatient nor impetuous, and through steady accumulation achieve great results. When the time is ripe, the career will naturally develop and the academic level will rise. Chinese medicine is a fine empirical medicine with strong practical value; as we study and apply it, we ourselves must have confidence and patience in it.