A TCM Case Record: Treating a Patient with Leukemia

Patient Feng, female, 71, from Xi'an, Shaanxi Province. Acute myeloid leukemia, AML-M4E0. First visit January 1, 2020. White blood cells, platelets and red blood cells were all low; C-reactive protein was high. Erythrocyte sedimentation rate: 31 (reference range 0–20).

Pulse was deep, fine, soft and forceless; after bathing, petechiae, maculopapular rashes and itching easily appeared on the hands and feet.

Dry mouth and throat, worse at night; throat was dry day and night. Low fever. There were stasis spots under the tongue; the tongue was enlarged and dry with a yellow greasy coating. Heat-intolerant, especially hot at night, and in the early hours felt unbearably hot. Much phlegm, white and frothy. Urine slightly yellow, clear when drinking much water. No constipation previously, but constipation after hospitalization. Stools were formed. Chronic cough.

The patient had been discharged on December 31, 2019 from Ward 1, Department of Hematology, First Affiliated Hospital of Xi'an Jiaotong University (hospital no. 0001626203). Discharge diagnosis: acute non-lymphocytic leukemia M4, pulmonary infection. The chest always had a dull ache; since 2011 there had been needle-like pain in the chest. Hearing was poor. Easily fatigued, with shortness of breath after walking a lot.

The subcutaneous fat on the medial side of the left calf was thickened and edematous, considered inflammatory change.

Decoction:

Sheng Huangqi (Astragali Radix) 30 g, Dangshen (Codonopsis Radix) 30 g, Maidong (Ophiopogonis Radix) 10 g, Wuweizi (Schisandrae Fructus) 10 g, Shuiniujiao (Bubali Cornu) 30 g, Shengdi (Rehmanniae Radix) 24 g, Mudanpi (Moutan Cortex) 12 g, Chishao (Paeoniae Rubra Radix) 12 g, Digupi (Lycii Cortex) 12 g, Huanglian (Coptidis Rhizoma) 6 g, Huangbai (Phellodendri Cortex) 6 g, Huangqin (Scutellariae Radix) 10 g, Chao Zhizi (Gardeniae Fructus) 10 g, Hanfangji (Stephaniae Tetrandrae Radix) 30 g, Fuling (Poria) 15 g, Zhuling (Polyporus) 15 g, Huainiuxi (Achyranthis Bidentatae Radix) 10 g, Cheqianzi (Plantaginis Semen) 10 g (wrapped), Zicaogen (Arnebiae Radix) 15 g, Qiancaogen (Rubiae Radix) 15 g, Mohanlian (Ecliptae Herba) 20 g, Nüzhenzi (Ligustri Lucidi Fructus) 20 g, Xiaoji (Cirsii Herba) 20 g, Zhuru (Bambusae Caulis in Taeniam) 6 g, Jupi (Citri Reticulatae Pericarpium) 6 g, Shayuanzi (Astragali Complanati Semen) 10 g, Tusizi (Cuscutae Semen) 10 g, Huangjing (Polygonati Rhizoma) 15 g, Sheng Shigao (Gypsum Fibrosum) 30 g (decoct first), Zhimu (Anemarrhenae Rhizoma) 6 g, Lianqiao (Forsythiae Fructus) 10 g, Jiao Maiya (Hordei Fructus Germinatus) 30 g, Xianhecao (Agrimoniae Herba) 30 g, Fengweicao (Pteris Herba) 30 g, Jixueteng (Spatholobi Caulis) 30 g, Baihuasheshecao (Hedyotidis Herba) 20 g, Banzhilian (Scutellariae Barbatae Herba) 20 g, Yiyiren (Coicis Semen) 30 g.

One decoction per day, taken after breakfast, lunch and dinner. Also given Angong Niuhuang Pills, Compound Qingdai Capsules, and powders/pills made from Chan'su (Bufonis Venenum), Shexiang (Moschus) and others, taken together with the decoction. When fever subsided, Liushen Pills were used instead of Angong Niuhuang Pills. External plaster: MEBO plus alumina ointment, or calamine plus zicao ointment, applied to itchy areas.

Dietary prohibitions: seafood, river crabs, river shrimp, shellfish, pickled vegetables, barbecue, hotpot, fried foods, citrus, spicy and greasy, scallion ginger garlic, beef and lamb, carp.

The patient's fever subsided; on the first day after taking Liushen Pills, the skin symptoms improved markedly.

January 9, 2020: remote feedback from family.

The patient went to Lanzhou to recuperate and had taken 8 doses of the Chinese medicine. She felt frequently fatigued, with a dry throat and nocturnal heat; the daytime heat had diminished. Appetite was poor, intake small; stools turned black and slightly loose. A pre-New Year examination in Xi'an had shown a high-density nodular shadow in the anterior segment of the right upper lobe, with multiple small mediastinal lymph nodes. Recent examination showed no hepatosplenomegaly.

The patient's daughter recalled that nodules had been present in the patient's lungs for several years, accompanied by cough, but these had never been taken seriously and were observed per the local doctor's advice. By 2017 the nodule was fairly obvious but remained untreated. The patient had a history of second-hand smoke exposure; the home had been newly renovated in 2012.

Decoction 1: Qinghao Biejia Tang (Artemisia-Shell Decoction)

Qinghao (Artemisiae Annuae Herba) 6 g (add near the end), Zhimu (Anemarrhenae Rhizoma) 6 g, Zhibiejia (Trionycis Carapax Praeparata) 15 g (decoct first), Shengdihuang (Rehmanniae Radix) 12 g, Mudanpi (Moutan Cortex) 12 g.

One dose each morning and evening, drinking only the first decoction.

Decocting method: decoct the biejia alone first for 15 minutes, then together with Zhimu, Shengdihuang and Mudanpi for half an hour; add Qinghao, decoct another 5 minutes, pour out and take in one portion. The herbs are few, so do not add too much water, lest too much fluid be hard to drink. Take after meals. Report back after three days. Take once morning and evening, observing whether nocturnal body heat improves after taking it.

Decoction 2: Modified Huangqi Buxue Tang (Astragalus Blood-Building Decoction)

Sheng Huangqi 60 g, Danggui 12 g, Sanleng (Sparganii Rhizoma) 6 g, Xianhecao 50 g, Beidougen (Menispermi Rhizoma) 20 g.

One dose per day; after decocting, take it all at once after lunch.

Patent medicines: Liushen Pills three times daily—10 pills the first time, 15 the second, 20 the third. If 20 pills cause no obvious side effects, the next day increase to 25–30 pills each time, about 90 pills total per day. On the third day may increase to 40 pills each time, about 120 pills per day. Watch closely for side effects; if obvious, reduce promptly. Also prescribed Xihuang Pills, Compound Qingdai Capsules and other patent medicines. If appetite worsens, reduce the Qingdai Capsules. Qingdai Capsules darken stool color—do not worry. If temperature exceeds 38°C, add Angong Niuhuang Pills; stop when fever subsides. If stool becomes black like after eating pig blood, consider occult bleeding and add Yunnan Baiyao Capsules.

Thereafter, due to the pandemic, the patient found it very difficult to seek care. During a bout of cough and fever, she was advised to brew Gouteng (Uncariae Ramulus) and Bohe (Menthae Herba) as tea, with remarkable effect. Later, troubled by dry mouth and tongue, she was advised to infuse Shihu (Dendrobii Caulis) powder, which brought clear improvement. The family sought Western medical advice; the oncologist recommended chemotherapy, so the patient underwent chemotherapy for several months. During chemotherapy, she used the author's self-formulated Jianwei Shengxue Tang (Stomach-Strengthening, Blood-Generating Decoction; formula in the linked article) to reduce side effects.

June 6, 2020: remote online consultation.

Chemotherapy ended two weeks ago. The patient has lost a lot of weight—over 10 jin—and now weighs 90 jin, at 162 cm. After returning home she took Chinese medicine to reduce side effects, and her weight had rebounded. But both ankles were very itchy (there had previously been lumps there that resolved after the first prescription).

Nausea began about five days after chemotherapy and has now basically disappeared. Hearing was greatly damaged by chemotherapy—tinnitus and deafness; these had already lasted over a year and recently worsened. The tongue always feels coated; tongue pale with a greasy white coating. Lips still often feel dry; there is always sticky phlegm from time to time. Nights are still hot but better than before; in the hospital the nocturnal heat made sleep impossible. She sweats easily, sweating on the head, and hair is falling out. Sweating heavily with every drink and meal. After bathing the ankle itching worsens. Appetite poor. Recently there has been sticky phlegm and coughing. Urine and stool normal. Recent CT showed pulmonary inflammation and a hepatic cyst. Because the chemotherapy side effects were too severe and red and white cells dropped too far, the family hopes to rely mainly on TCM going forward.

Decoction: Shengdi 12 g, Chishao 12 g, Mudanpi 12 g, Zicao 12 g, Chanyi (Cicadae Periostracum) 10 g, Xianhecao 30 g, Sheng Huaimi 15 g, Shengdiyu 15 g, Hanliancao 15 g, Nüzhenzi 15 g, Cheqiancao (Plantaginis Herba) 15 g, Digupi 15 g, Shihu 15 g, Yuzhu (Polygonati Odorati Rhizoma) 15 g, Huangjing 15 g, Baiwei (Cynanchi Atrati Radix) 10 g, Fuping (Spirodelae Herba) 15 g, Peilan (Eupatorii Herba) 10 g, Shichangpu (Acori Tatarinowii Rhizoma) 10 g, Zhuye (Phyllostachdis Folium) 6 g, Taizishen 30 g, Maidong 10 g, Wuweizi 10 g, Chao Maiya 30 g, Jiao Shanzha (Crataegi Fructus) 10 g.

Patent medicines basically as before, but without Angong Niuhuang Pills and Xihuang Pills.

Feedback June 14, 2020:

After one dose of the above, skin itching improved markedly; after three doses, itching stopped. Weight rebounded by 5 jin; white blood cells returned to normal, but red blood cells remained low. Stools changed from once to twice a day. Head sweating was considerable, occasional dry mouth, body sweating much reduced, and edema resolved. Deafness and tinnitus, however, showed no clear improvement. The decoction was adjusted as follows:

Sheng Huangqi 30 g, Danggui 10 g, Shengdi 12 g, Chishao 12 g, Mudanpi 12 g, Zicao 12 g, Chanyi 10 g, Xianhecao 30 g, Sheng Huaimi 15 g, Shengdiyu 15 g, Hanliancao 30 g, Nüzhenzi 30 g, Cheqiancao 15 g, Digupi 15 g, Shihu 15 g, Yuzhu 15 g, Huangjing 15 g, Baiwei 10 g, Ceboye 30 g, Gouqizi (Lycii Fructus) 15 g, Shayuanzi 10 g, Tusizi 10 g, Peilan 10 g, Fuxiaomai (Tritici Fructus Levis) 30 g, Zhuye 6 g, Taizishen 30 g, Maidong 10 g, Wuweizi 10 g, Chao Maiya 30 g, Jiao Shanzha 10 g, Yejuhua 10 g, Sheng Cishi (Magnetitum) 6 g (crushed and wrapped), fresh ginger 5 slices, Chinese dates 7.

June 17, 2020:

After taking the above, red blood cells rose, white blood cells rose, weight continued to rebound, and overall condition improved greatly. The patient was advised to gradually add Daqingye (Isatidis Folium) 15–30 g to enhance the anti-leukemia effect. The patient and family were reluctant to risk further Western follow-up treatment; they were advised to have regular check-ups and observe the ongoing effect.

This patient's response was fairly striking: basically every formula worked immediately, with visible improvement after even one extra day. Such cases are uncommon and show that the patient was very sensitive to Chinese medicine. Moreover, her symptoms were very typical—TCM viewed this as heat entering the ying and blood, making it easy to find a targeted treatment. The more pronounced the symptoms, the more TCM can exert the advantages of pattern differentiation; conversely, patients with no symptoms respond less well, because without clear indications it is hard to find a good prescribing approach.

In addition, this patient's husband had lung cancer; after standard modern medical treatment, his survival was very poor, and the family sought palliative end-of-life care from the author. Only months after the husband's death, this patient was diagnosed with leukemia. Because the family had already been through cancer treatment once, they were more rational, and a very strong trust had been built with the author; throughout treatment, doctor and patient trusted each other, which was key to the good outcome. Subsequent care was all conducted online, but this did not affect efficacy.

The long-term outcome in this patient remains to be seen, but that TCM can treat leukemia and improve a patient's various indices and quality of life is beyond doubt.