Case 2

Case 2

Mr. Wang, a 48-year-old man, came for treatment in October 1995 due to “pain in the liver area accompanied by abdominal distension.” Physical examination revealed no jaundice of the skin or mucous membranes, normal cardiac and pulmonary function, a liver size of 5 cm below the xiphoid process, firm texture, no ascites, no palpable spleen, a purple-dark tongue with bruising spots, a thin yellow coating, and a tense pulse. CT scan showed a 6.0 cm × 5.0 cm mass in the left lobe of the liver, suspected to be liver cancer. Liver function tests revealed total bilirubin levels of 15 μmol/L, a turbid reaction to cresol of 4 u, alanine aminotransferase levels of 82 u, and alpha-fetoprotein levels exceeding 400 ng/L. Western medical diagnosis: primary liver cancer. TCM syndrome differentiation: liver qi stagnation, blood stasis obstructing the liver, treatment focused on soothing the liver, regulating qi flow, and promoting blood circulation and resolving stasis. The formula used was Chaihu Shu Gan San with modifications: 10g of chaihu, 10g of white peony, 15g of citrus aurantium, 6g of licorice, 6g of fragrant ligusticum, 6g of chuanxiong, 10g of sanleng, 10g of oshiro, 10g of sea lettuce, 3g of prepared milk vetch, 30g of salvia miltiorrhiza, 30g of astragalus, 10g of turtle shell, 6g of turtle shell, 10g of chicken gallbladder, all brewed in water and taken daily, divided into doses. After 20 doses, his abdominal distension lessened, his liver pain improved slightly, and upon examination, the liver size was comparable to before. The formula was modified to incorporate Lanzhou formulas with additions. The new formula was: 12g of rehmannia root, 10g of Chinese yam, 10g of cornelian cherry, 12g of poria, 10g of alisma, 10g of peony root, 15g of ginseng roots, 15g of太子参, 15g of northern sandwort, 15g of codonopsis, 10g of wheatgrass, 3g of five-flavor berry, 30g of salvia miltiorrhiza, 30g of astragalus, 10g of angelica sinensis, 10g of white peony—all brewed in water and taken in two doses, combined with Western medicine 5-Fu, 500 mg administered intravenously once daily, for 5 days, followed by 9 days off before repeating for another 5 days—totaling 5 g, with 200 ml of saline plus 3 g of Vanguard V, administered intravenously once daily, and 500 ml of 10% glucose solution with 200 mg of vitamin C, 0.2 g of vitamin B6, 10 ml of 10% potassium chloride solution, 8 units of insulin, administered intravenously twice weekly. After 21 days of treatment, his liver pain significantly eased; the liver size was reduced by 2 cm below the xiphoid process, and its texture softened, though he still experienced fatigue and poor appetite. Therefore, the formula was modified again to incorporate Chaihu Shu Gan San with adjustments. The new formula was: 10g of chaihu, 10g of white peony, 10g of citrus aurantium, 6g of licorice, 30g of salvia miltiorrhiza, 30g of astragalus, 3g of wood fragrance, 3g of grass cardamom, 10g of angelica sinensis, 10g of sea lettuce, 10g of kelp, 10g of turtle shell, 10g of chicken gallbladder, 6g of green tangerine peel—all brewed in water and taken daily, divided into doses. After another 20 days of treatment, his appetite and mental state improved, and the CT scan at discharge indicated that the liver mass had shrunk to 2.0 cm × 1.5 cm, and liver function tests returned to normal. He continued to receive TCM treatment afterward, and has survived to this day.

Cure of Acute Monocytic Leukemia

Ma Changsheng, a 17-year-old soldier, hospital number 2346. He reported feeling dizzy and fatigued for three months, with occasional small bleeding spots on his skin. As the bleeding increased, he also experienced nosebleeds and bloody stools. He was admitted to a local hospital on February 1, 1967, with a preliminary diagnosis of “aplastic anemia,” and underwent bone marrow aspiration, which confirmed “acute monocytic leukemia.” He stayed in the hospital for over 50 days, receiving more than 10 blood transfusions totaling 3000 ml, as well as hormone therapy and 6-MP treatment; however, his condition continued to deteriorate, and he was transferred to our hospital on March 15 of the same year.

Past medical history: Good health, previously recovered from “typhoid fever.” No history of radiation exposure or contact with toxic substances. Task output rules: Translate this markdown block from Chinese to English. Preserve markdown markers, links, and formatting. Keep headings and list structure unchanged. Return only the translated block.

Input: 体检：体温38.5℃，脉搏112次/min，血压12.1/6.7kPa(90/50mmHg)。发育尚可，营养欠佳，神志清晰，查体合作。面色苍白，急性病容，全身皮肤黏膜可见散在性大小不等之出血点，压不退色。臀部及小腿外侧可见4cm×6cm及7cm×4cm两处出血斑。巩膜未见黄染。咽部充血，扁桃体不肿大。颈部柔软，未见畸形。胸廓对称胸骨压痛明显，两肺呼吸音粗糙，未闻及干湿啰音。心界不大，心律齐。P₂>A₂，心尖区可闻及Ⅲ级收缩期吹风样杂音。腹胀，中腹部有压痛，肝脾未触及。四肢未见异常。病理反射阴性。

化验检查：血象：红细胞90万/mm³，血色素19.2%，血小板10000/mm³，白细胞1200/mm³，中性18%、淋巴72%、单核10%，网织红细胞0.1%，出血时间5'20"，凝血时间24s。尿、粪常规均正常。骨髓穿刺涂片检查：标本号L-802，骨髓增生明显活跃，粒:红=3.1:1，白:红=27.6:1，白细胞系统显著增生，主要细胞类型为单核细胞，其中原始单核细胞5.0%，幼稚单核细胞69.5%，成熟单核细胞6.0%，共计80.5%。各阶段幼红细胞共计3.5%，成熟红细胞形态基本正常，部分红细胞血红蛋白充填欠佳。未见巨核细胞。诊断意见：急性单核细胞白血病(非白血病型)。

治疗经过：患者于1967年3月15日入院。即予青霉素、链霉素肌注，口服维生素B₁、维生素C、强的松。同时着重采用中医辨证施治，时见壮热烦渴，骨蒸汗出，遍身血斑，吐、衄、便血，舌红少苔，脉细而数。显系气阴两亏，血热妄行之证。法宜益气养阴、清热降火、固表止汗、凉血止血。遂以Ⅰ号方①煎服，每日1剂。8剂后一般情况稍有改善，发热、汗出、口渴均较前减轻，出血症状亦较前好转（其间输血2次，共600ml）。4月5日复诊，证见夜热早凉，骨蒸盗汗，吐、衄、便等全身出血症状较前稍减轻。舌红少苔，脉仍细数。证乃余热未清、气阴两亏。气虚不能统血，阴虚不能制火。法宜大补气阴，清热除蒸，佐以凉血止血，固表止汗之剂。遂用Ⅱ号方②水煎服，每日1剂。共服10剂后，患者体温下降至正常，鼻衄停止，全身血斑及出血点渐呈干涸。一般情况亦逐日好转，并可在床下作轻微活动（其间亦输血2次，计600ml）。4月20复诊，证见颜面苍白，少气乏力，心悸气短，夜寐不安，头晕目眩，骨蒸自汗。舌质红，少苔，脉细数。此系气阴亏损，表里两虚，血不安神，浮阳外越之证，法当大补气阴，重镇安神，佐以固表止汗之剂。方用Ⅲ号方③水煎服，每日1剂。连服40余剂患者一般情况明显好转。出血止、斑疹消，颜面稍稍转红，乏力、自汗、心悸、气短、夜寐不安等症状均有一定程度的减轻（其间输血3次，共计800ml）。1967年6月25日，继续以大补气阴之法改用Ⅳ号方④煎汁收膏，日服2次，每次15.0g，开水冲服，共服3料，历时5月余，至1967年11月，患者体力增加，颜面红润，食欲可，精神佳，发热、骨蒸、口渴、多汗诸证均初步控制，只是偶有头晕、目眩、心悸。患者尚能从事轻微劳动（其间先后输血5次，共计1200ml，西药仅使用维生素及强地松）。血色素持续维持在50%以上。于11月10号作骨髓涂片赴兰州医学院复查，并嘱其在兰期间，每日坚持服Ⅲ号方，1968年1月17日接该院内科张主任函云：“患者之骨髓象属急性单核细胞白血病缓解期变化，除单核细胞各阶段尚有轻微异常外，其他各系统均恢复正常。1968年1月13日患者返家继续服用中药。笔者于1月20日应邀赴患者家中诊视，见患者仍有颜面㿠白，伴乏力自汗，心悸气短，偶有牙龈出血及鼻衄，脉沉细，舌胖淡，给Ⅳ号方配膏1料，白开水冲服（服法同上）。1968年3月9日，患者以感冒2d，胸闷咳嗽之主诉，二次入我院（住院号3102），体温39.2℃，胸闷咳嗽，痰中带少量血丝，前胸后背可见少量出血点，咽微红，扁桃腺不大，两肺呼吸音粗、未闻及啰音。胸骨有压痛，肝脾未触及，四肢未见异常，病理反射阴性。血象：红细胞345万/mm³，血色素52%，白细胞3400/mm³，中性56%、淋巴40%、单核4%。诊断：①急性单核细胞白血病（缓解），②上感。入院后即给青霉素40万单位，链霉素0.5g，维生素B₂0mg，维生素C100mg，强地松20mg，咳必清2片。中医检查：证见壮热无汗，喘息不宁，头疼恶寒，舌红少苔，脉濡细。此系风寒犯表，热蕴肺经，气阴两虚之证。法当解表清里，益气养阴。投以Ⅴ号方⑤水煎服，每日1剂。服4剂后，一般情况好转，体温降至37.5℃，咳嗽止，痰呈泡沫状，未见血丝。3月15日起改用Ⅲ号方服40余剂，患者除时有头晕、心悸外，其他症状完全消失，于1968年5月18日出院。出院后在家继续服Ⅲ号方达60余剂，身体恢复健康，于1968年7月重返工作岗位。

1973年春，笔者随访了患者，时患者在金塔县农建三团任班长，精力充沛。当时（1973年3月24日）血象：红细胞420万/mm³。血色素82%，血小板20万/mm³，白细胞5600/mm，中性65%、淋巴33%、单核2%。当时（1973年3月26日）骨髓象：骨髓增生活跃，白:红=1.96:1，粒细胞系统中幼粒至带状核阶段比例稍低，幼稚单核细胞及单核细胞比较偏高（共17.8%，其中幼稚单核为3.8%），淋巴系统基本正常，红细胞系统基本正常，全片见成熟巨核细胞3个，无血小板形成征象，成熟红细胞形态如常，血红蛋白充填良好。两次住院血象变化情况见表1、表2。

表1

表2

讨论

白血病是骨髓造血功能恶性紊乱之疾患，祖国医学对此病尚无专门命名，此例患者经中西医结合治愈，关于中医中药对本病的作用，笔者有下列体会。

本例患者自始至终具有明显的气虚证候，如面色不华，自汗乏力，少气懒言，头晕眼花等。“气为血帅”、“血为气母”，气虚必然导致血虚，因此在此例病程之中期，出现心悸气急，夜寐不安等血虚证候。《内经》说：“气为阳，血为阴”、“孤阴不生，孤阳不长”，气虚与血虚相互促进，使病程急剧进展，最后发展至阴虚内热，血热妄行，气虚阳脱，不能统血的程度。在这一系列病机的形成中，最早出现的气虚，是一个极为重要的因素。治疗此病必须紧紧抓住补气这一环，才能达到治本的目的。拙拟五个方剂，均以补气为主，选用了大剂量的参须、潞党参、太子参、黄芪等补气药。气是什么？用现代医学观点来看，它可能是机体生理功能和防卫力量等一切正常功能活动的总概念。《内经》说：“邪之所凑，其气必虚”、“正气存内，邪不可干”，可知通过全力补气，机体自身的抗病功能可得到充分的动员；造血系统的生理机能，指望得到进一步提高，这是治愈本病的主要因素。在补气的同时，还必须养阴。祖国医学的养阴，包含有增加血液、水分、营养之意，这些物质是维持机体生理功能的先决条件。补气与养阴相配合，才能相得益彰，功效卓著。在拙拟五个方剂中，均包含有类似六味地黄汤的组成；六味地黄汤系五代钱乙为补阴而专设，有“壮水之主以治阳光”的显著疗效，所谓“壮水之主”指补益肾阴而言，“肾主骨”、“骨藏髓”。六味地黄汤既补肾阴，能否对骨髓造血有所补益，这是一个值得进一步研究的问题。除参类补气，六味益阴，方中尚包含着麦冬、五味子二药，此二药与参类配合，是唐代医家孙思邈所定之生脉散，为益气养阴之名方，用于本病可助参类以补气，助六味以养阴，使益气养阴之力更专。I 号方中加入“白虎”以清热，犀角以凉血；号方中加入青蒿鳖甲以去余热除骨蒸；V 号方中用麻桂以解表散寒，这些都是适当的对证加减。