用中医阴阳理论治疗白血病 Treating Chronic Lymphocytic Leukemia Through Yin and Yang Theory

Cathay Toronto Acupuncture & Herbs Clinic

500 Sheppard Ave. E. Unit 302, Tonronto. 416-733-9888

女性，49岁，初诊日期2021-08-17

主诉：患慢性淋巴细胞白血病9年多，头几年没有症状，近2年经常咳嗽，哮喘，尿道感染。诉自从完全接种covid 疫苗后，从2021年3月中开始出现全身关节痛，髋部为主，行走困难，午后低热（37.5-37.8°C），体重减。服用类固醇后，咳嗽哮喘好转。

现每天下午低热，右肺有5cm结节,少许咳，白痰，夜重日轻，遇冷加重，咽痒即咳，疲倦乏力。经期准，经前乳胀，经期头晕头痛。

舌像：舌红，少苔，裂纹舌，舌体厚大，舌下络脉中度粗紫

脉象：左沉细滑稍数；右沉滑稍数

分析：阴虚，稍有火，是其白血病之本，但现在外感症状仍存在，外感是标，先治疗标病，标病解除再治本。

处方：射干麻黄汤合千金苇茎汤

二诊：2021-08-20

主诉：药后咳嗽减，哮喘减，痰稍增多，色白

舌像：如一诊

脉象：沉细滑

处方：一诊方+滋阴药（麦冬，沙参，女贞子，墨旱莲）

几次治疗后外感除，转而专门治疗其慢性白血病，根据其发热特点：午睡即发热，睡醒而热退，不午睡则没有出现下午发热，夜睡不发热但脚热。得出其为阴虚发热的结论，所以治疗主要以滋阴为主，主要是六味地黄汤系列和大补阴丸等滋阴药方，或加味或原方，5个月后病情稳定，午睡不再发热，夜间睡觉足部也不会发热，尿路感染基本消除。从初诊至今已超过2年，其慢性白血病病情稳定，淋巴细胞从最高时的21 降低到现在的11左右。

从阴阳理论分析此案：午睡发热，不午睡即下午不发热来看，她的情况不属于午后发热，根据“阳入阴则寐”的理论，睡觉时阳气入阴，由于其本身阴虚，阳气入阴而令到阴的相对量更少而阳气更多，阳盛则热，所以她午睡时发热，醒后由于阳出阴，不在阴中，所以热退。那为什么要夜晚入睡不发热？那是因为夜晚属阴，她入睡时阳气是入阴了，但因为有夜晚阴的支持，令到阴阳几乎平衡，所以夜睡不发热，但足底仍发热，也就是还有一点阳胜之意。明白病的根源后，无论用药或针灸，都遵循滋阴为主，偶尔滋阴加清热的原则，这一慢性白血病的治疗就取得了不错的效果。

这就是中医阴阳理论指导下进行用方遣药，或针刺或针灸的治疗法则的来源。

Patient: female, 49 years old

Initial visit: August 17, 2021

 Patient History

Patient has been suffering from chronic lymphocytic leukemia for more than 9 years. She did not show any symptoms in the first few years, but has been experiencing frequent coughing, asthma, and urinary tract infections in the past 2 years. After receiving the second dose of COVID-19 vaccine, in March 2021, she started experiencing joint pain all over the body especially in her hips which affected her walking, low-grade fevers in the afternoon (37.5-37.8°C), and weight loss. After taking steroids, her cough and asthma improved.

 Current Symptoms

Patient still complains of low-grade afternoon fevers, low energy, slight cough with white sputum that worsens at night, with the cold, and can be triggered by itchiness in her throat. She also has a 5cm nodule in her right lung. Her period cycle is regular, but experiences swelling of the breasts before her period, dizziness, and headaches during her period.

 Tongue

Red and swollen with little coating, cracks all over the tongue body with a deep vertical crack in the middle, moderately thick sublingual veins.

 Pulse

Left: deep, slippery, slightly rapid.

Right: deep, thin, slippery, slightly rapid.

 Diagnosis and Analysis

The primary root cause (the “ben”) of leukemia is yin deficiency . However, the patient is also presenting with external pathogenic invasion symptoms (the “biao”). Therefore, the treatment principle is to first treat the external pathogen followed by treating the root.

 Herbal Formula

She Gan Ma Huang Tang + Qian Jin Wei Jing Tang

Second visit: August 20, 2021

 Chief Complaint

After taking the herbs, patient reports improvement in coughing and asthma. There was also a slight increase in the amount of white sputum.

 Tongue

Same as first visit.

 Pulse

Deep, thin, slippery.

 Herbal Formula

She Gan Ma Huang Tang+ Qian Jin Wei Jing Tang + Mai Dong, Sha Shen, Nu Zhen Zi, Mo Han Lian

 Treatment of Leukemia

Following the recovery from external pathogenic symptoms after a few more treatments, the treatment plan switched to treating the root cause of the symptoms of leukemia. The patient presented with low-grade fever only during her afternoon naps that subsided once she woke up. During nighttime sleep, only her feet felt hot. These symptoms led to the diagnosis of yin deficiency, and the main treatment principle was to nourish yin. Her symptoms showed improvement after five months of treatment using the Liu Wei Di Huang Tang series, Da Bu Yin Wan and other yin-nourishing formulas. She no longer had low-grade fevers during her afternoon naps nor did her feet feel hot in the nighttime. The frequent urinary tract infections also subsided. After two years of continuous care, the symptoms from leukemia are stabilized and the patient’s peripheral blood absolute lymphocyte count has dropped from the highest of 21 x E9/L to the lowest of 9 x E9/L. Her  current lymphocyte count stays between 9 and 12 x E9/L.

Analysis Through Yin and Yang

This chronic lymphocytic leukemia patient presenting with low-grade fevers only during naps does not classify as having afternoon fevers, but rather, indicates a yin deficiency in the body.

 In the concept of yin and yang, sleep is the result of the body’s yang energy moving back to the core to be nurtured by its yin energy. When yin and yang are in balance, the patient will have no problem sleeping. However, when yin is deficient, it causes the relative amount of yang energy to be greater than yin. This is when yin is unable to contain yang, thus creating heat during her naps. Once she awakes, yang is no longer in the core and the relative difference between yin and yang is reduced. Therefore, heat symptoms dissipate.

 Yin and yang can also be understood as night and day respectively. When nighttime comes, yin energy is strong. Rather than the whole body, the patient only feels hot in her feet during nighttime sleep as there is environmental yin at night to support her constitutional yin. Despite the help from nighttime’s yin energy, it is still insufficient to control the yang entirely. Therefore, heat is still experienced in the patient’s feet. Acupuncture and herbal medicine were administered to mainly nourish yin, and occasionally clear heat as required. This chronic lymphocytic leukemia case has demonstrated the importance of understanding the root cause of a disease in creating an effective treatment plan and thus yielding good results for the patient.

 This has showcased the origins of the treatment principles of using herbal medicine and acupuncture under the guidance of the yin and yang theory of Traditional Chinese Medicine.