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Journal of Acuherb in Medicine


Acute Leukemia

J. of Acuherb in Medicine By: | 2011.12.26
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 Acute Leukemia

 

Acute leukemia is a malignant proliferative disease that originates from blood producing tissues in the body. It is characterized by symptoms that include anemia, bleeding, fever and infiltration symptoms such as enlargement of the spleen liver and lymph nodes.

Acute leukemia, also referred to by its common subtypes of acute lymphocytic leukemia (ALL) or acute myelogenous leukemia (AML), is a modern medical term that cannot be found in the ancient Chinese medical classics. However, its symptoms are similar to some TCM diseases. Acute leukemia symptoms fall under Traditional Chinese Medicine (TCM) disease categories of “pulmonary tuberculosis”, “hectic fever due to yin-deficiency”, “acute febrile diseases due to insidious pathogens “, “blood disorders”, “saber”, “subcutaneous nodules” and ” abdominal masses”.

Pulmonary Tuberculosis: This disease causes the same kind of fever and anemia symptoms as in acute leukemia, and is mentioned in the famous medical classic “Sheng Ji Zong Lu” written in 1118 A.D. The title means a collection of medical records.
Hectic fever due to Yin-deficiency: This is a low-grade fever similar to those experienced in leukemia. It results from a yin deficiency and is mentioned in the medical classic “Treatise on the Causes and Symptoms of Diseases” written in 610 A.D.
Acute febrile diseases due to insidious pathogens: These diseases cause similar high fever symptoms as in acute leukemia associated infections.
Blood disorders: These conditions produce the same bleeding symptoms such as nose bleeds, gum bleeding and blood in the stool.
Saber: Named after its shape, this is the inflammation of the axillary (armpit) and neck lymph nodes caused by tuberculosis bacteria.
Subcutaneous nodules or abdominal masses: This TCM condition presents as infiltration symptoms such as enlargement of the lymph nodes, liver and spleen.

Causes

The major cause of leukemia is a qi deficiency and pathogen invasion that disturbs the harmony and balance of the body. The ways in which these conditions lead to leukemia symptoms are described below:

 

1. When the vital qi (vital energy) is deficient, pathogens can more easily invade the body and affect the normal functions of the heart,liver, nutrient qi and blood. When this happens, TCM febrile disease symptoms such as high fever, bleeding, coma and convulsion can occur.
2. If the body’s internal organs, especially the spleen and kidney,yin and yang, qi and blood, become exhausted after a long period of months or years, the production of qi, blood, essence and bone marrow decline. This leads to leukemia related symptoms such as anemia and fatigue.
3. A vital qi deficiency and pathogen invasion also affect qi and blood movement and the distribution of body fluid inside the body. Abnormal disturbances of these substances can cause blood and body fluids to leak out from the Taiyin (lung and spleen), Shaoyin (heart and kidney) and Jueyin (pericardium and liver) meridians, or the disturbance can cause them to accumulate and mix together. When this happens, they transform into a mass or nodule inside the body leading to infiltration symptoms such as liver, spleen or lymph node enlargement.

Symptoms

TCM practitioners will examine the individual, and categorize the symptoms under special syndrome groups known as “disharmony patterns.” Certain disharmony patterns are present during the different stages of the disease. Acute leukemia can be classified into following types:

I. Acute Attack Stage: This first phase of the disease is when abnormal white blood cells crowd the bone marrow and blood so that normal blood cells such as red blood cells, normal white blood cells, and platelets cannot be made in their normal amounts. There are four disharmony patterns under this stage. 

1. Damp and Heat Type
  Individuals have symptoms like a fever that cannot be relieved after sweating, and do not experience an aversion to cold temperatures. Dizziness, fatigue, a full feeling in the stomach and abdominal areas, and diarrhea are common. The urine appears dark yellow and comes in scanty amounts. In serious conditions, individuals will additionally suffer from severe joint pain.
2. Noxious Heat Type
  Individuals suffer from a high fever, heavy sweating, and a pounding, throbbing pain in the head. Abnormal blood circulation symptoms such as bleeding from the nose, gums, or blood in the stool or urine can be present. The skin may also have a bruised appearance or have petechiae. The blood coagulation problems may cause life threatening symptoms in severe cases such as unconsciousness and bleeding into the brain.
3. Accumulated Mass Type
  Masses or nodules appear beneath the skin of both sides of the neck, axilla (armpits) and inguinal regions (groin area). Individuals may experience severe and persistent bone pain, accompanied with restlessness and fever.
4. Interior Liver-Wind Stir- Up Type
  Symptoms include severe pounding, throbbing pain in the head, impulsive vomiting, and a stiff neck. These can progress to more serious symptoms such as convulsions, spasms, and even paralysis of the face. In the most severe cases individuals experience an irregular and intermittent pulse, which leads to coma and finally death. The most severe cases occur when the leukemic cells enter the brain and impair its functioning.

II Remission Stage: The remission stage is when individuals are recovering from leukemia or are cured from it. This phase begins when the symptoms and signs of leukemia disappear, and the number of white blood cells and other blood cells in the blood or bone marrow return to normal. There are two disharmony patterns grouped under this stage. 

1. Deficiency of Qi and Yin Type
  Individuals have symptoms like heart palpitations, and shortness of breath. The complexion appears wan and sallow, and the body’s skin itself appears withered and pale. Additional symptoms that may be present include fatigue, poor appetite, chapped lips, dryness of the mouth and throat, restlessness, fever, spontaneous sweating or night sweats.
2. Deficiency of Qi and Blood Type
  Individuals have pale lips, nails and a pale complexion. The skin may appear bruised in certain areas and the mucous membranes inside of the mouth can have petechiae. Dizziness, vertigo, distension and fullness in the abdomen, poor appetite, and heart palpitations that worsen with activity may also be present.

Diagnosis

Determining the circumstances and manifestations of a disease through inquiry, and by observing the individual’s symptoms are important in TCM. Diagnosis is based on the following four examination techniques. 

Through these four techniques a variety of symptoms and signs will be used to identify the individual’s disharmony pattern. This is crucial because at the various stages of a disease, a variety of disharmony patterns are present which require different types of therapy. This is why individuals with the same disease are often treated very differently by their TCM practitioner. 

A TCM practitioner will not diagnose an individual with acute leukemia. Instead, he or she will diagnose the individual with a disharmony pattern. Particular attention is paid to the following points for differentiation of the various disharmony patterns.

1. Distinguishing the locations of the illness to find out which organs or systems are involved.
2. Distinguishing the nature of illness to decide whether the syndrome is yin, yang, excess or deficiency type.
3. Distinguishing the stage of illness to classify the disease in its acute or remission stages.

Acute leukemia commonly has the disharmony patterns described below:
I Acute Stage of Acute Leukemia 

1. Damp and Heat Type
  This often occurs in the early stage of leukemia, and is mainly caused by a mild deficiency of qi, and extreme excess of pathogenic heat. Dampness is produced when the stomach and spleen cannot function properly to transform and transport nutrients. As the dampness accumulates over time, it turns into a heat evil which can inflict damage to the body. Upon examination, the tongue is red and covered with yellow, greasy fur. The pulse is rapid.
2. Noxious Heat Type
  This usually occurs at the time when normal blood cell production of white blood cells, red blood cells and platelets is exhausted due to the overproduction of leukemic cells in the bone marrow and blood. At this stage, noxious heat is extremely excessive, and the remaining vital qi is sparse. Noxious heat and other toxic waste products are produced when the organs hyperfunction and an increase in metabolism is created that results in material consumption of substances such as nutrients and body fluids. As a result, the noxious heat damages the meridians and blood and causes bleeding symptoms. Upon examination, the tongue is red and dry and covered with yellow, dry fur. The pulse feels rolling and rapid.
3. Accumulated Mass Type
  Noxious heat and phlegm evils transform into masses when they stagnate, and block the collaterals (part of the meridian system) in the course of leukemia. Upon examination, the lips and tongue appear pale, and the tip and the margin of the tongue exhibits petechiae. The pulse feels deep and fluttery.
4. Interior Liver-Wind Stir-Up Type
  This usually occurs at the terminal stage of acute leukemia, and develops from the stirring up of interior wind evils. In this stage, the body accumulates excessive noxious heat, which consumes body fluids and damages the blood and meridians. This triggers endogenous pathogenic wind that seriously disturbs the movement of qi and blood. Wind evils affect the liver, which is responsible for helping with the flow of qi and blood. The wind evils are the result of yin deficiency, hyperactivity of liver-yang or excess heat evils. This type can also be caused by phlegm evils blocking the clear orifices such as the mouth. Upon examination, the tongue appears red and dry is coated with little or no fur. The pulse is stringy and rapid.

II Remission Stage of Acute Leukemia 

1. Deficiency if Qi and Yin Type
  This occurs in a late stage of leukemia when the body is trying to recover from the damage the disease has inflicted. Qi and yin have been exhausted for a long period and the heart, spleen and body fluid distribution are no longer functioning normally. Upon examination, the tongue appears red and is covered with scanty or scaled fur. The pulse feels deep, thready and rapid.
2. Deficiency of Qi and Blood Type
  This also occurs at the late stage of leukemia where the body is starting to recover. During this stage, vital qi begins to convalesce, and the heat, wind or damp evils start to disperse. The body is getting better from the illness, but the impaired organs, qi and blood are still very weak. Upon examination, the tongue is pale and swollen with indented margins, and covered with a thin, white fur. The pulse sign is deficient and heavy or soft and thready.


III Differentiating acute leukemia from other illnesses

In the clinical diagnosis of TCM, acute leukemia should be differentiated from other similar diseases. 

1. Consumptive Disease
  This is a disease caused by insufficiency of vital qi and blood, or organ deficiency. When the individual experiences fever and anemia, it should be distinguished from aplastic anemia, which comes under the category of consumptive disease. In the whole course of this type of disease, there are no nodules or abdominal mass, so it is easy to differentiate.
2. Blood Disorders
  Blood disorders involve spontaneous bleeding diseases such as thrombocytopenia (not enough platelets to clot the blood), abnormal blood vessels and blood coagulation factor deficiencies. These specific blood disorders can be detected in leukemia patients through blood tests.
3. Fever Caused by Exogenous (external) evils
  This type of fever is usually induced by seasonal pathogens. It usually presents with persistent high fever and excessive interior heat. Interior heat is produced when there is a pathological disturbance in the physiological functions of the qi, blood, body fluids and organs. With this type of fever, the individual’s blood parameters are normal, and it is easy to recover from the fever. However, leukemia sufferers usually have a persistent low-grade fever, but when it is complicated by infections, the temperature will be high.

Treatment

In TCM, the treatment of acute leukemia is based on the type of disharmony pattern.

ACUTE  STAGE:

1. Damp and Heat Type:


Therapeutic aim: Due to an accumulation of damp-heat and toxic pathogens in the whole body, treatment focuses on clearing away heat and dampness evils, eliminating pathogens, and removing toxic substances.

Example of Prescription: Chaiqin Chenling decoction with modification 

chai hu chinese torowax root
huang qin baical skullcap root
long dab cao chinese gentian
zhi zi cape jasmine fruit
chen pi dried tangerine peel
fu ling Indian bread
ban xia pinellia tuber
ze xie oriental water plantain rooti
zhu ling chuling
bai zhi large head atractylodes rhizome
lu gen reed rhizome
she she cao herba hedyotis diffusa
qing dai natural indigo

 

2. Noxious Heat type


Therapeutic aim: This is caused by excessive noxious heat in the interior, and the disturbance of nutrient qi and blood. Treatment includes clearing away heat evils, removing toxic substances, and clamping down on blood circulation to stop bleeding. 
Example of Prescription: Shuiniujiao Dihuang decoction with modification 

shui niu jiao buffalo horn
sheng di dried rehmannia root
dan pi tree peony bark
chis hao red peony root
yin hua honeysuckle flower
lian qiao weeping forsythia capsule
zhi zi cape jasmine fruit
sheng shi gao gypsum
bai hua she she cao herba hedyotis diffusae

For delirium caused by intensive heat, Zixue pill, Zhibao pill or Angong Niuhuang pellet is helpful. 

3. Accumulated Mass type

Therapeutic aim: This is caused by stagnant phlegm lingering in the interior and blocking the collaterals (meridians). Therefore, treatment includes promoting blood circulation, removing obstruction in meridians, and softening and resolving hard masses. 

Example of Prescription: Taohong Siwu decoction with modification 

tao ren peach kernel
hong hua safflower
chuan xiong szechwan lovage root
dang gui chinese angelica
di huang rehmannia root
chis hao red peony root
hai zao seaweed
bie jia turtle shell
sheng mu li fresh oyster shell
zhe bei thunberg fritillary bulb
xia ku cao spike of prunella

 

4. Internal Liver-Wind Stir Up Type

Therapeutic aim: Individuals with this type are in the most critical condition. Emergency treatment includes using aromatic drugs for resuscitation, and suppressing the hyperactive liver to relieve the wind syndrome. 

Example of Prescription: Zhengan Xifeng decoction

huai niu xi achyranthes root
sheng long ku unprocessed fossil fragment
sheng bai shao white peony root
tian dong asparagus root
sheng mai ya fresh germinated barley
dai zhe shi ochre
sheng mu li fresh oyster shell
xuan shen figwort root
chuan lian zi szechwan chinaberry fruit
yin chen hao virgate wormwood herb
gui ban tortoise shell
gan cao liquorice root

Additionally, Zixue pill and Angong Niuhuang pellet can be taken with water.

REMISSION STAGE:

1. Deficiency of Qi and Yin Type

Therapeutic aim: The toxins and heat evils impair heart-qi, and burn primordial yin. As a result, treatment benefits the qi, nourishes the heart, aids the yin and invigorates the kidney. 

Example of Prescription: Shenmai, Erzhi plus Dihuang decoction with modification

bei sha shen coastal glehnia root
mai dong dwarf lilyturf tuber
wu wi zi chinese magnoliavine fruit
nu zhen zi glossy privet fruit
han lian cao ecliptai
gou qi chi barbary wolfberry fruit
sheng di dried rehmannia root
dan pi tree peony bark
fu ling indian bread
yi yi ren coix seed
bai ji li puncturevine caltrop fruit
gui ban tortoise shell

For individuals with residual toxic substances: 

she she cao herba hedyotis diffusae
ban zhi lian chinese lobelia herb

 

2. Deficiency of Qi and Blood Type

 

 

Therapeutic aim: This type is caused by the deficiency of both qi and blood. In TCM, the  spleen  is responsible for the production of blood and qi. The kidney is responsible for storing the essence, which is the source for blood and qi. Therefore, treatment includes replenishing the qi, nourishing the blood, and invigorating the spleen and kidney.

Example of Prescription: Danggui Buxie decoction plus Sijun, Bazhen decoction with modification

huang qi milkvetch root
dang shen pilose asiabell root
dang gui chinese angelica
bai zhi large head atractylodes rhizome
fu ling indian bread
shu di processed rehmannia root
qi zi barbary wolfberry fruit
nu zhen zi glossy privet fruit
e jiao donkey-hide gelatin

For individuals with residual toxic substances and hyperactivity of minute collaterals (meridians):

she she cao herba hedyotis diffusae
xiao ji field thistle herb

Prevention

From TCM’s viewpoint, prevention includes two aspects:

1. Preventing the onset of disease
2. Preventing the progression of disease

 

Prevention of Disease Onset:
  Stay away from evils such as wind and heat that invade the body and cause disease is important. Eat a proper diet, exercis regularly, maintain peace of mind by having an optimistic outlook on life. Get enough rest, and maintain a balanced lifestyle.
   
Prevention of Disease Progression:
  Individuals who suffer from acute leukemia should maintain an optimistic attitude, and actively participate with doctors in deciding treatment options. Keeping up good personal hygiene, eating a moderate diet, avoiding smoking and alcohol and avoiding overstrain or mental excitement are also important ways to prevent disease progression.
Special attention should be paid to following conditions: 

When bleeding symptoms like the appearance of large body bruises, nose bleeding and gum bleeding occur, strict bed rest is recommended.
Leukemia sufferers are more susceptible to exogenous (external) pathogens, so they should be kept in a warm, clean and ventilated room, which should be sterilized regularly to prevent infection.
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