Appreciation of a Case: Yan Dexin Treating Polycythemia Vera
Polycythemia refers to a state in which the number of red blood cells, the hemoglobin concentration, and the hematocrit (the volume percentage of red cells in whole blood) in the blood are abnormally elevated. This condition makes the blood "thick," slows blood flow, and thereby increases the risk of thrombosis, giving rise to a series of health problems.
Polycythemia is mainly divided into two broad categories, which differ markedly in cause and nature. One is polycythemia vera (PV), and the other is secondary polycythemia. The former is a chronic myeloproliferative neoplasm, a type of blood cancer whose root cause lies in the hematopoietic stem cells of the bone marrow.
More than 95% of patients with polycythemia vera (PV) carry a JAK2 gene mutation. This mutation causes the bone marrow to overproduce red blood cells without normal regulation; usually the white blood cells and platelets are also elevated at the same time. Secondary polycythemia is not cancer and has a better prognosis than PV. Polycythemia vera is an incurable disease in modern medicine; currently medicine can only control blood cell counts, prevent thrombotic and hemorrhagic complications, and relieve symptoms. There are relatively few TCM case records on treating this kind of disease.
Professor Yan Dexin once treated a patient with polycythemia vera. The patient, Zhou, was 73 years old. At the visit the chief complaint was recurrent dizziness, headache, and tinnitus that had worsened progressively over three years. There was a flushed face, skin hyperpigmentation, slow thinking, listless spirit, and edema of the lower limbs. Examination showed red blood cells above the normal range, and bone-marrow aspiration confirmed polycythemia vera.
Professor Yan Dexin's pattern differentiation judged this patient to have the TCM blood-stasis pattern, and he planned to treat it by the method of activating blood and resolving stasis.
First visit prescription: Sanleng (burreed rhizome) 9 g, Ezhu (curcuma) 9 g, Sumu (sappwood) 9 g, Jiangxiang (dalbergia) 4.5 g, Honghua (safflower) 9 g, Taoren (peach kernel) 9 g, Chishao (red peony) 9 g, raw Puhuang (typha pollen, wrapped) 15 g, Wulingzhi (trogopterus dung) 9 g, Chuanxiong (Sichuan lovage) 9 g, Shui zhi (leech) 4.5 g, Chuanniuxi (Cyathula) 9 g, Fangfeng (Saposhnikovia) 9 g. Twenty-eight doses, decocted in water, one dose daily, taken in two divided doses.
After taking the above formula, the patient's dizziness lessened, the spirit improved, and the lower limbs were no longer edematous, but the blood picture had not improved. Professor Yan judged that the pattern differentiation was correct and the treatment had a certain effect, so the original approach should be maintained with slight adjustments and treatment continued.
Second visit prescription: Sanleng 9 g, Ezhu 9 g, Sumu 9 g, Jiangxiang 4.5 g, Honghua 9 g, Taoren 9 g, Chishao 9 g, raw Puhuang (wrapped) 15 g, Wulingzhi 9 g, Chuanxiong 9 g, Shuizhi 4.5 g, Chuanniuxi 9 g, raw Shanzha (hawthorn) 15 g, Huzhang (Polygonum cuspidatum) 15 g, Juemingzi (cassia seed) 30 g. Twenty-eight doses, decocted in water, one dose daily, taken in two divided doses.
At the third visit the blood picture had begun to improve. Following the ancient maxim that when a treatment is effective one should not change the method, he continued along this approach with slight modifications and treated for another two months; on re-examination the blood picture had returned to normal.
Professor Yan's prescription was based mainly on blood-activating and stasis-resolving herbs, appropriately assisted by qi-moving herbs (such as Jiangxiang) and symptom-targeted drugs (such as Juemingzi for dizziness). The prescribing approach was steady and prudent, seeking not quick results but gradual regulation. In Western medicine there is also no specific drug for this disease; the common treatment is likewise mainly the blood-activating aspirin to control symptoms, whose therapeutic rationale is consistent with Professor Yan's prescribing approach.
The diagnosis in this case borrowed from the Western diagnosis. The disease mechanism of polycythemia vera is clear, and the condition belongs to the typical TCM "blood-stasis pattern," so the treatment principle should emphasize activating blood and resolving stasis. Appropriately using qi-moving herbs can enhance the effect of the blood-activating herbs, and using some targeted symptom-relieving drugs can improve the patient's clinical symptoms, raising the patient's trust in and compliance with the doctor during treatment—all of which lays a good foundation for ultimately curing the patient.
Western diagnosis with TCM treatment is also a currently popular integrated Chinese-Western approach to treating disease, and this approach has its merits. When applied properly, it can improve the precision of TCM treatment. Combining this disease-differentiating integrated approach with the traditional TCM pattern-differentiation approach yields even better outcomes.