Task output rules:

例二

卫××，男，11岁，学生，兰州市人。于1974年4月，因发热、疲乏、食欲不振、胸骨隐痛，在甘肃省人民医院住院，确诊为急性淋巴细胞白血病。曾用联合化疗，未能控制病情发展。鉴于白细胞持续下降，于同年6月12日请中医会诊，时面色萎黄、形体瘦弱、发热自汗，胸骨压痛，脉浮无力、两尺更弱。血象：血红蛋白9.2g、红细胞232万/mm³、白细胞1550/mm³、淋巴细胞10%、血小板计数33000/mm³，证系肺肾两虚，方用益气养阴汤。6月26日第二次会诊：服上方12剂后，烧退汗止，自觉症状好转。血

红蛋白11g，红细胞412万/mm³、白细胞5100/mm³，中性76%、淋巴细胞23%、幼稚细胞(单核)1%，血小板计数12万/mm³。仍按原方继续服用。7月1日，突发高烧，吐泻交作，7月7日第三次会诊：体温39℃持续不降，便溏、色黑，神疲、心下痞不思食、口干不思饮，脉沉数，舌质红，苔薄白，证系血证阴虚，内热与温邪交织，仿泻心汤及清骨散意，方用：北沙参9g、白扁豆9g、茯苓9g、苡仁15g、白蔻仁1.5g、黄连2.4g、干姜2.4g、银柴胡9g、青蒿9g、鳖甲9g、焦楂9g、丹皮6g、白薇6g、莱菔子6g、炙甘草3g，水煎服。7月12日第四次会诊：服上方3剂后，体温降至36.4℃，便溏已止，稍能进食，脉沉弱，舌质红、白苔渐退净，尚有指甲大一片稍腻，上午疲倦，下午轻快，不时自汗，改用补中益气汤、益气养阴汤合剂。调理月余，病情、血象又回到7月1日以前的完全缓解状态。此后，中药方面，一剂药作2日分服，每日1次，以益气养阴汤、益气助阳汤交替使用。西药方面，除在发病初期曾用联合化疗外，一年半来仅用中药调理，于今整2年，仍在完全缓解中。

恶性淋巴瘤误诊纠正3例

例一：陈××，女，48岁，病历号：6380。 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: Patient was admitted to our department in September 1992 with a history of “abdominal distension and ascites for more than two years, worsening over the past six months.” The patient reported feeling fatigued, experiencing night sweats, and noticing gradual abdominal distension and swelling. He had been diagnosed with “tuberculous peritonitis” at another hospital and received systematic anti-tuberculosis treatment. Over ten abdominal paracenteses were performed, during which a total of more than 20,000 ml of ascitic fluid was drained. Treatment lasted for six months, but his condition progressively worsened, with rapid increases in ascitic fluid volume and extremely poor general health, leading to his admission to our department. Physical examination revealed: temperature of 36.2°C, pulse rate of 120 beats per minute, blood pressure of 13/8 kPa, extreme weight loss, severe exhaustion, and cachexia. Aside from a bean-sized lymph node palpable in the right neck, no other superficial lymph nodes were detected. Cardiac and pulmonary examinations were negative. Abdomen was markedly distended, with an abdominal circumference of 90 cm, and percussion revealed massive ascitic fluid. Complete blood count showed: hemoglobin level of 100 g/L, white blood cell count of 12.9 × 10⁹/L, with neutrophils accounting for 82% and lymphocytes 18%; platelet count of 60 × 10⁹/L. Urine analysis indicated: bilirubin levels were low, ketone bodies were present at 0.5 mmol/L, protein levels were 0.3 g/L, urine specific gravity was 33 mmol/L, nitrites were positive, white blood cells were present at 12 u/L, and erythrocyte sedimentation rate was 55 mm/h. Ascitic fluid cytology revealed clumps of degenerated cells (malignant tumor possibilities cannot be ruled out). CT scan suggested a suspected malignant tumor in the retroperitoneal space. This massive ascitic fluid may be caused by malignant lymphoma; chemotherapy was administered concurrently with cervical lymph node biopsy. To reduce chemotherapy side effects and enhance the efficacy of chemotherapy drugs, traditional Chinese medicine “Lanzhou Formula” was used—primarily composed of rehmannia root, cornus fruit, and ginseng root—and one dose was prepared by decocting the herbs in water, taken orally in divided doses daily. The chemotherapy regimen was COPP: 600 mg of cyclophosphamide intravenously weekly, 2 mg of vincristine intravenously weekly, 50 mg of prednisolone orally once daily, given in three-week cycles with one week of rest between treatments. A total of three cycles were administered. The patient’s ascitic fluid gradually decreased over time, and by the end of chemotherapy, the ascitic fluid had completely disappeared. His overall condition improved, and he was able to walk around. Complete blood count results showed: hemoglobin level of 130 g/L, white blood cell count of 6.8 × 10⁹/L, with neutrophils accounting for 76% and lymphocytes 24%; erythrocyte sedimentation rate was 6 mm/h. Other tests were normal, and the pathology biopsy report indicated malignant lymphoma (NHL).

Case 2: Dong ××, male, 43 years old, medical record number: 6251.

The patient was admitted to our department in August 1992 with a history of “abdominal distension and ascites for six months.” He reported abdominal distension and subsequent ascitic fluid six months prior, following exertion or exposure to cold. He had been diagnosed with “liver cirrhosis with ascites” at another hospital; despite five months of liver-protecting and diuretic treatment, the condition did not improve, and his condition significantly worsened, leading him to our department. Physical examination revealed: temperature of 36.1°C, pulse rate of 87 beats per minute, blood pressure of 13/9 kPa, poor mental state, chronic wasting appearance, no superficial lymph nodes palpated; cardiac and pulmonary examinations were negative. Abdomen was distended, with visible abdominal veins, though not varicosed; liver and spleen were not palpated below the ribs. Ascitic fluid was abundant, with an abdominal circumference of 98 cm, bowel sounds unremarkable, and no edema in both lower limbs. Complete blood count showed: hemoglobin level of 138 g/L, white blood cell count of 8.2 × 10⁹/L, with neutrophils accounting for 86% and lymphocytes 14%; erythrocyte sedimentation rate was 5 mm/h. Urine analysis indicated: specific gravity greater than 1.030, nitrite was positive, and liver function tests, protein electrophoresis, and three-system tests were all normal. Isotope studies showed: SA 777 μg/ml, B₂-M: 3.08 μg/L, with all other values being negative. Ultrasound imaging suggested possible liver cirrhosis with ascites, with enlargement of the left liver. First, ascitic fluid was collected for laboratory testing, followed by chemotherapy using the COPP regimen, with drug dosages as previously described for the previous case. A total of five cycles were administered, with intervals of three weeks, combined with the use of traditional Chinese medicine “Lanzhou Formula.” The ascitic fluid completely disappeared, and ultrasound imaging showed no abnormalities. Laboratory tests were all normal, and the patient made a clinical recovery and was discharged. Ascitic fluid analysis revealed a large number of lymphocytes; pathology indicated malignant lymphoma (NHL).

Case 3: Huang ××, female, 59 years old, medical record number: 5815.

The patient was admitted to our department in June 1992 with a history of “left cervical lymphadenopathy for four months, accompanied by redness, swelling, heat, and pain for one month.” Four months prior to admission, she developed a left cervical lymph node that grew to the size of a fava bean without any obvious triggering factors, with no other symptoms. She had been diagnosed with “cervical lymph node tuberculosis” at another hospital and had undergone anti-tuberculosis treatment for three months; however, the lymph nodes continued to enlarge, accompanied by redness, swelling, heat, and pain, leading her to our department. Physical examination revealed: temperature of 36.3°C, pulse rate of 74 beats per minute, blood pressure of 12/8 kPa, malnutrition, chronic illness appearance, poor mental state, a 2.3 cm × 2.4 cm enlarged lymph node palpated in the left neck, lobulated with a smooth surface, firm in texture, poorly mobile, accompanied by redness, swelling, heat, and tenderness, with a sensation of throbbing pain. Cardiac and pulmonary examinations were negative; abdomen was soft, with no signs of ascitic fluid; ultrasound and chest X-ray were normal, and the electrocardiogram was also normal. Complete blood count showed: hemoglobin level of 130 g/L, white blood cell count of 8.8 × 10⁹/L, with neutrophils accounting for 84% and lymphocytes 16%; platelet count was 160 × 10⁹/L. Urine analysis indicated: HIT: positive, microscopic white blood cells: 1–7/HP, erythrocyte sedimentation rate: 75 mm/h. Isotope studies showed: DNA-P (+), with all other results being negative. Lymph node biopsy revealed malignant lymphoma (HD). Chemotherapy was then administered using the COPP regimen, with drug dosages as previously described for the previous case, combined with traditional Chinese medicine “Lanzhou Formula.” After four cycles, the lymph node mass in the neck had completely disappeared, the erythrocyte sedimentation rate was 5 mm/h, and all other laboratory tests were normal. The patient made a clinical recovery and was discharged. Follow-up examinations showed no recurrence to date.

Two Cases of Purpura

Case 1: Sun ××, female, 11 years old. Initial visit on February 3, 1997.

After an external infection, purpura appeared on both lower limbs, accompanied by pain in both knee joints, abdominal pain, and dry throat. Hormone therapy administered at a local hospital did not provide significant relief, so she came to our hospital seeking treatment. Cardiac and pulmonary examinations were normal, liver and spleen were not palpated, and clustered or scattered hemorrhagic spots were observed on both lower limbs, most prominently on the medial ankle joint, with colors ranging from bright red to dark purple; when pressed, the color did not return. Tongue was red with a thin yellow coating, and pulse was floating and rapid. Laboratory tests showed a platelet count of 228 × 10⁹/L; Western medical diagnosis: allergic purpura. This condition was attributed to wind-heat entering the interior, causing blood heat to run rampant. Treatment should focus on clearing heat and detoxifying while cooling the blood and dispelling wind. Prescription: 15 g of double flowers, 15 g of Forsythia, 15 g of Flea Grass, 12 g of Rehmannia Root, 10 g of Kudzu Root, 20 g of White Cocklebur, 20 g of White Moss Skin, 10 g of Red Peony, 10 g of Cicada Shell, 10 g of Cortex Phellodendri, 12 g of Ledebouriella, 12 g of Poria, 6 g of Agastache, 6 g of Coptis Chinensis—prepared by decocting in water, one dose per day, divided into several servings. Ten days later, the purpura on both lower limbs had reduced, abdominal pain had disappeared, but pain remained in both knee joints. Tongue was red with a thin yellow coating, pulse was tense; the above formula was adjusted to remove Wood Sage and Coptis Chinensis, adding 6 g of Aconite and 10 g of Bupleurum. After further administration of over 20 doses, all symptoms had resolved.

According to the principle: “When wind and fire are stirred externally, convulsions occur; when wind and fire are stirred internally, blood runs rampant.” Allergic purpura is considered to be caused by wind and fire stirring internally; therefore, treatment must emphasize both “clearing fire” and “dispelling wind,” so that the medication can address the underlying disease. Clearing fire involves using herbs like Double Flowers and Forsythia, while dispelling wind requires cooling the blood and dispersing wind, employing herbs such as Rehmannia Root and Cicada Shell.

Case 2: Wang ××, female, 24 years old. She experienced intermittent purpura throughout her body for two years, accompanied by epistaxis, poor appetite, fatigue, and heavy menstrual bleeding. She visited the clinic in April 1995. Her complexion was pale, and her spleen was enlarged, palpable below the ribs. Tongue was pale with a thin white coating, pulse was slippery and rapid; small, varying-sized dark purple hemorrhagic spots were present under the skin across her body, most prominent on both lower limbs. Laboratory tests showed a platelet count of 40 × 10⁹/L. Western medical diagnosis: thrombocytopenic purpura. This condition was attributed to spleen failure in controlling blood, resulting from excess internal fire. Treatment focused on tonifying the spleen and clearing excess fire. Prescription: 15 g of Astragalus, 15 g of Codonopsis, 10 g of Atractylodes, 3 g of Coptis Chinensis, 10 g of Phellodendron, 20 g of White Cocklebur, 15 g of Rheum Palmatum, 3 g of Frankincense, 3 g of Myrrh, 10 g of Cortex Phellodendri, 10 g of Blood Remains, 6 g of Licorice—prepared by decocting in water, one dose per day, divided into several servings. After administering the formula for over 20 doses, the purpura had reduced, but she still felt fatigued and had poor appetite. Tongue was pale with little coating, pulse was fine and rapid. The above formula was adjusted to remove Blood Remains and Blood Remains, adding 12 g of Yam and 10 g of Dendrobium, and after further administration of over 20 doses, all symptoms had subsided. Laboratory tests showed a platelet count of 80 × 10⁹/L.

Two Cases of Aplastic Anemia

Case 1: Patient Ma Rong, male, 54 years old, visited the clinic in May 1992. He reported dizziness, fatigue, poor appetite, loose stools, chills, and soreness in his lower back and knees. Physical examination revealed a thin physique, no obvious abnormalities in heart or lungs, a flat abdomen, a palpable spleen below the ribs, a pale tongue with a thin white coating, and a deep, slow pulse. Laboratory tests showed: red blood cells at 2.1 × 10¹²/L, hemoglobin level of 63 g/L, platelets at 50 × 10⁹/L, white blood cells at 2.0 × 10⁹/L, and reticulocytes at 1.2%. Western medical diagnosis based on bone marrow aspiration: aplastic anemia. Treatment focused on tonifying qi and strengthening the spleen, using Guipi Tang with modifications. Prescription: 30 g of Astragalus, 10 g of Angelica Sinensis, 10 g of Codonopsis, 10 g of Atractylodes, 12 g of Poria, 6 g of Licorice, 3 g of Agastache, 20 g of Round Meat, 6 g of Aconite, 3 g of Cinnamon, 15 g of Clematis Armandii, 15 g of Shuiguozhi, prepared by decocting in water, one dose per day. After administering the formula for over 20 doses, his mental state and appetite improved, and his stools became formed. However, he still felt cold, had lower back discomfort, tinnitus, and nocturnal emission. Tongue and pulse were similar to before; laboratory tests showed: hemoglobin level of 84 g/L, platelets at 60 × 10⁹/L, red blood cells at 2.8 × 10¹²/L, white blood cells at 2.4 × 10⁹/L. Therefore, the formula was modified to include Yougui Wan with additions: 15 g of Yam, 15 g of Deer Antler Gelatin, 15 g of Goji Berries, 10 g of Eucommia Ulmoides, 30 g of Rehmannia Root, 10 g of Angelica Sinensis, 15 g of Tussah Seed, 6 g of Aconite, 3 g of Cinnamon, 15 g of Rehmannia Root, 10 g of Salvia Miltiorrhiza, 3 g of Agastache, prepared by decocting in water, one dose per day. After administering the formula for over 20 doses, his coldness and lower back discomfort had significantly improved. Repeat blood tests showed: hemoglobin level of 100 g/L, platelets at 64 × 10⁹/L, white blood cells at 3.4 × 10⁹/L, red blood cells at 3.4 × 10⁹/L—close to normal.

Case 2: Patient Zhang, female, 44 years old, had a history of aplastic anemia for over ten years and visited the clinic in April 1995. She experienced dizziness, fatigue, lightheadedness, tinnitus, epistaxis, dry throat, and heavy menstrual bleeding. Physical examination revealed a pale complexion, scattered ecchymoses under both upper limbs. Cardiac and pulmonary examinations were normal, abdomen was flat and soft, and the spleen was palpable below the ribs. Tongue was pale with a thin white coating, pulse was fine and sluggish. Laboratory tests showed: red blood cells at 1.90 × 10¹²/L, hemoglobin level of 60 g/L, platelets at 50 × 10⁹/L, white blood cells at 2.4 × 10⁹/L, with reticulocytes accounting for 1%. Western medical diagnosis based on bone marrow aspiration: aplastic anemia. Traditional Chinese Medicine diagnosis: kidney yin deficiency, blood stasis within the vessels. Treatment focused on nourishing yin, tonifying the kidneys, and promoting blood circulation to resolve stasis. Prescription: 10 g of Angelica Sinensis, 6 g of Chuanxiong, 12 g of Rehmannia Root, 15 g of Herba Leonuri, 15 g of Polygonum Cuspidatum, 15 g of Rheum Palmatum, 15 g of Clematis Armandii, 6 g of Carthamus Tinctorius, 30 g of Black Soybeans, 20 g of Rehmannia Root, 15 g of Longan Fruit, 15 g of Ligustrum Lucidum, 15 g of Goji Berries, 15 g of Myrrh, 10 g of Dendrobium. After administering the formula for over 20 doses, her dizziness and lightheadedness eased, though she still experienced epistaxis and dry throat. Her red blood cell count was 2.4 × 10¹²/L, hemoglobin level was 68 g/L, platelets were 60 × 10⁹/L, white blood cells were 2.8 × 10⁹/L; therefore, the formula was adjusted to remove Goji Berries and add 3 g of Coptis Chinensis and 10 g of Scutellaria Baicalensis. After further administration of over 40 doses, repeat blood tests showed: red blood cells at 3.5 × 10¹²/L, hemoglobin level of 85 g/L, platelets at 60 × 10⁹/L, white blood cells at 3.0 × 10⁹/L. All symptoms had disappeared.

Treatment for aplastic anemia should, on the one hand, inherit the ancient principles of tonifying qi and blood, regulating the spleen and stomach; on the other hand, it is advisable to integrate these approaches with various modern medical findings. Patients with low white blood cell counts often exhibit fatigue, lack of energy, and reluctance to speak; those with low red blood cell counts often experience dizziness, lightheadedness, and pale complexions. In the former case, qi deficiency is common, so herbs like Astragalus, Aconite, and Cinnamon are often used to tonify qi—such as in Case 1. In the latter case, blood deficiency is prevalent, so herbs like Rehmannia Root, Polygonum Cuspidatum, and Ligustrum Lucidum are employed to nourish blood—such as in Case 2. However, “physical blood is difficult to restore quickly; yet, spiritual qi must be replenished urgently.” Therefore, treating aplastic anemia to increase white blood cell counts yields quick results, whereas increasing red blood cell counts requires consistent medication; do not stop treatment merely because improvement is observed, as previous efforts may be wasted. On the basis of strengthening the spleen and kidneys, nourishing qi and blood, consider incorporating herbs that promote blood circulation to resolve stasis. Modern medicine has confirmed that promoting blood circulation to resolve stasis is highly effective in improving microcirculation in the bone marrow. Clinically, most patients benefit from adding a few blood-circulating herbs to their regimen of tonifying the spleen and kidneys—this approach often provides a “finishing touch,” making the treatment more effective.

Four Cases of Arrhythmia