4 Case Analysis

turtle shell glue, deer antler glue, Forsythia, and rhubarb; to elevate red blood cells, he mainly uses Guipi Tang, Renshen Yangrong Tang, Prince Ginseng, ginseng roots, Codonopsis, Astragalus, Polygonum multiflorum, Cornus, longan meat, Millettia, Ligustrum, and Eclipta. (4) Case Analysis Case 1: A 42-year-old female patient, first seen on December 28, 2009. Chief complaint: low back and knee soreness, fatigue for one year. Past medical history: at the end of 2008, scattered purpura appeared on both lower limbs; on December 24, 2009, bone marrow aspiration diagnosed her with aplastic anemia. She had previously received hormone and immunosuppressive therapy (cyclophosphamide) at a local hospital, but the treatment was ineffective, so she sought consultation at Professor Pei Zhengxue’s outpatient clinic. Physical examination: pale complexion, dizziness and tinnitus, low back and knee soreness, fatigue, pale red tongue with thin white coating, and fine, rapid pulse. Blood routine showed: white blood cells 2.3 × 10^9/L, red blood cells 1.55 × 10^12/L, hemoglobin 58 g/L, platelets 21 × 10^9/L. Western medical diagnosis: aplastic anemia. Traditional Chinese Medicine differentiation: deficiency syndrome. The pattern is kidney essence deficiency and dual deficiency of qi and blood; treatment should focus on replenishing essence and marrow, as well as tonifying qi and generating blood. Prescription: 15 grams of ginseng roots, 15 grams of Prince Ginseng, 15 grams of northern ginseng, 15 grams of Codonopsis, 12 grams of angelica root, 6 grams of chuanxiong, 12 grams of Rehmannia, 15 grams of Polygonum multiflorum, 15 grams of centella asiatica, 10 grams of rhubarb, 15 grams of Millettia, 6 grams of safflower, 6 grams of peony bark, 20 grams of salvia miltiorrhiza, 30 grams of cornus, 10 grams of longan meat, 10 grams of fructus psoraleae, 10 grams of cistanche, 1 fried horse chestnut seed, one dose per day, decocted in water and taken in two divided doses; deer antler and leech capsules, each containing half a gram, twice daily. After one month of medication, the patient’s spirits improved markedly, her complexion returned to normal, and symptoms such as dizziness, palpitations, and low back and knee soreness completely disappeared. Repeat blood test: white blood cells 4.34 × 10^9/L, red blood cells 4.36 × 10^12/L, hemoglobin 127 g/L, platelets 109 × 10^9/L. The patient was advised to continue taking Pei’s Hematopoietic Granules for follow-up care. The basic formulation includes Rehmannia, Chinese yam, cornus, peony bark, poria, alisma, ginseng roots, Prince Ginseng, northern ginseng, American ginseng, Lu Dang Shen, ophiopogon, schisandra, cinnamon twig, white peony, ginger, jujube, honey-fried licorice, floating wheat, 15 grams per dose, twice daily; deer antler and leech capsules, each containing half a gram, once daily. Pei’s Hematopoietic Granules are primarily based on Liuwei Dihuang Tang, with deer antler added to replenish essence and marrow; ginseng roots, Prince Ginseng, northern ginseng, and Lu Dang Shen strengthen the spleen and tonify qi; Gui Zhi Tang harmonizes the yin and yang of the internal organs; Shengmai San nourishes qi and yin; Gan Mai Da Zao Tang calms the heart and soothes the spirit; leeches break up blood stasis. This formula integrates kidney-tonifying, spleen-strengthening, and blood-activating effects in one, with a rigorous formulation and rich content. The patient undergoes a monthly check-up, and her condition remains stable. Case 2: Mr. Qiao, a 19-year-old male. He has suffered from aplastic anemia for 14 years and usually receives treatment at the outpatient clinic using a modified version of the Lanzhou Formula, with stable condition. In July 2000, he developed skin purpura due to a cold, accompanied by tooth, nose, dizziness, fatigue, pale complexion, hot hands and feet, thin yellow coating on the tongue, and rapid pulse. Physical examination: body temperature 37.8°C, heart rate 112 beats/min, respiration 22 breaths/min, blood pressure 108/86 mmHg, clear consciousness, severe anemic appearance. Blood routine: white blood cells 2.1 × 10^9/L, red blood cells 1.28 × 10^12/L, hemoglobin 40 g/L, platelets 14 × 10^9/L, reticulocyte count 0.12%. Urine routine: trace blood (++), otherwise normal. Stool routine normal. Biochemical tests: ALT 68 U/L, otherwise normal. Bone marrow smear: hypoproliferation of bone marrow, especially affecting the erythroid lineage, with only two megakaryocytes visible across the entire slide. Traditional Chinese Medicine differentiation: yin deficiency with internal heat, blood not retained, treated with the Lanzhou Formula modified to address both root and branch issues. Prescription: Add 15 grams of rhubarb to the Lanzhou Formula to increase platelets, along with 10 grams of mugwort, 15 grams of ligustrum, 15 grams of eclipta, reduce ginseng roots, Codonopsis, and Gui Zhi Tang, aiming to nourish yin without fueling fire, preventing qi-tonifying from exacerbating heat. During severe bleeding, add 15 grams of peppermint charcoal, 15 grams of cypress charcoal, and 15 grams of madder root charcoal, decocted and taken once daily. Intermittent blood and platelet transfusions. After one month of treatment, gum bleeding and nosebleeds decreased, skin petechiae reduced, but the patient remained pale, weak, prone to colds, with a pale tongue, thin white coating, and a large pulse. Blood transfusions were stopped. Red blood cells 3.2 × 10^12/L, white blood cells 2.4 × 10^9/L, hemoglobin 50 g/L, platelets 81 × 10^9/L, reticulocyte count 0.42%. Prescription: 12 grams of Rehmannia, 20 grams of cornus, 10 grams of Chinese yam, 10 grams of peony bark, 12 grams of poria, 10 grams of alisma, 10 grams of cinnamon twig, 10 grams of white peony, 6 grams of ginger, 4 jujubes, 6 grams of honey-fried licorice, 15 grams of American ginseng, 30 grams of Astragalus, 15 grams of rhubarb, 15 grams of ligustrum, 15 grams of eclipta, 15 grams of cistanche, 15 grams of codonopsis, 10 grams of white atractylodes, 3 grams of leeches (decocted), after three months of medication, the patient’s complexion became rosy, tongue pale red, coating thin white, pulse deep and fine. Red blood cells 2.4 × 10^12/L, white blood cells 4.6 × 10^9/L, hemoglobin 103 g/L, platelets 90 × 10^9/L, reticulocyte count 0.39%. The prescription was adjusted by reducing Forsythia, cistanche, centella, deer antler, and rhubarb, adding 12 grams of windproof herb, 15 grams of ginseng roots, 30 grams of longan meat, 15 grams of Xuan Shen, 15 grams of codonopsis, 10 grams of white atractylodes, 3 grams of leeches (decocted). After three months of medication, the treatment was switched to Pei’s Fuzheng Granules (an in-house preparation based on the Lanzhou Formula), taken for one year, with no recurrence during follow-up. In March 2002, the patient was admitted to the emergency room due to “jaundice, fatigue, and tooth problems for two weeks,” with ALT reaching 246 U/L, diagnosed as acute icteric hepatitis. At that time, blood tests showed pancytopenia, reticulocyte count 0.53%, and bone marrow smear indicated active proliferation, but only two megakaryocytes were visible across the entire slide. Professor Pei Zhengxue diagnosed the case as a combination of new disease and existing illness, treating the new disease first and then the existing one. The differentiation was “root deficiency with branch excess,” following the principle of addressing both root and branch, prescribing Xiao Chaihu Tang combined with Wuwei Xiaodu Yin. Prescription: 10 grams of bupleurum, 10 grams of scutellaria, 6 grams of pinellia, 10 grams of codonopsis, 6 grams of ginger, 6 grams of licorice, 4 jujubes, 15 grams of double flowers, 15 grams of forsythia, 15 grams of dandelion, 15 grams of houttuynia, 15 grams of half-flower lotus, 15 grams of artemisia, 10 grams of gardenia, 10 grams of raw rhubarb, 30 grams of salvia miltiorrhiza, 30 grams of astragalus, 15 grams of ligustrum, 15 grams of eclipta, 10 grams of cistanche, 15 grams of codonopsis, 10 grams of white atractylodes, 3 grams of leeches (decocted). After ten doses, the jaundice completely subsided, liver function returned to normal, and hemoglobin rose to 100 g/L, reticulocyte count normalized, white blood cells reached 5.6 × 10^9/L, platelets 114 × 10^9/L. Suspecting possible errors, a bone marrow biopsy was performed, revealing a normal bone marrow smear. As a result, the aplastic anemia was clinically cured, and the patient was advised to continue taking the Lanzhou Formula regularly. Follow-up for three years showed stable condition. Note: Diseases caused by congenital defects are prone to hepatitis A infection. Professor Pei Zhengxue believes that in traditional Chinese medicine, extreme deficiency corresponds to excess patterns, and extreme excess corresponds to winning patterns. Aplastic anemia is easily infected by hepatitis, and the herbal formula Xiao Chaihu Tang is the first choice for treating aplastic anemia complicated by various types of hepatitis, often with life-saving effects. In this case, the patient’s condition was critical, but treatment reversed the situation almost instantly, highlighting the importance of clinical attention. Moreover, the herbal ingredient leech has hormone-like effects and proves effective. Erzhi Wan tonifies the kidney without causing greasiness or harming the spleen, especially suitable for patients with long-term aplastic anemia who have difficulty regulating yin deficiency. It helps maintain “yin balance and yang concealment,” making aplastic anemia treatable. Case 3: Mr. Bai, a 54-year-old male, visited the clinic in November 2003. He complained of dizziness, fatigue, loss of appetite, constipation, feeling cold and having cold limbs, low back and knee soreness. Physical examination: emaciated physique, anemic appearance, heart and lungs ( ), abdomen flat and soft, spleen palpable about 3 cm below the ribs, pale tongue with little coating, pulse deep and weak. Laboratory tests: red blood cells 2.1 × 10^12/L, hemoglobin 63 g/L, platelets 50 × 10^9/L, white blood cells 2.0 × 10^9/L, reticulocyte count 1.2%. Western medical diagnosis: bone marrow smear confirmed aplastic anemia. Prescription: Treat with qi-tonifying and spleen-strengthening, modifying Guipi Tang. Use 10 grams of Codonopsis, 10 grams of white atractylodes, 30 grams of Astragalus, 10 grams of angelica root, 12 grams of poria, 6 grams of licorice, 3 grams of agarwood, 20 grams of longan meat, 6 grams of Aconite, 3 grams of cinnamon, 15 grams of Millettia, 15 grams of Psoralea. Decocted once daily. After more than 20 doses, the patient’s spirits and appetite improved, bowel movements became regular, but he still felt cold and had lower back pain, tinnitus, and the tongue and pulse remained unchanged. Lab tests: hemoglobin 82 g/L, platelets 61 × 10^9/L, red blood cells 2.85 × 10^12/L, white blood cells 2.6 × 10^9/L. Therefore, the prescription was further adjusted to Yougui Wan with added ingredients: 15 grams of Chinese yam, 10 grams of deer antler glue, 15 grams of goji berries, 10 grams of eucommia, 30 grams of cornus, 10 grams of angelica root, 6 grams of Aconite, 3 grams of cinnamon, 15 grams of dodder, 15 grams of Rehmannia, 10 grams of white atractylodes, 3 grams of agarwood, decocted once daily. After another 30-plus doses, the symptoms of cold and lower back pain significantly improved, and repeat blood tests showed: hemoglobin 103 g/L, platelets 64 × 10^9/L, red blood cells 3.4 × 10^12/L, white blood cells 3.4 × 10^9/L, approaching normal levels. Case 4: Ms. Shen, a 19-year-old female, with a three-year history of aplastic anemia, visited the clinic in February 2004. Symptoms: dizziness, fatigue, vertigo and tinnitus, nosebleeds, gum bleeding, dry throat, heavy menstrual flow. Physical examination: pale complexion, scattered ecchymoses under the skin of both upper limbs. Heart and lungs unremarkable, abdomen flat and soft, spleen not palpable under the ribs, dark red tongue with little coating, pulse tight and rough. Laboratory tests: white blood cells 2.8 × 10^9/L, red blood cells 1.39 × 10^12/L, hemoglobin 58 g/L, reticulocyte count 1%, platelets 27 × 10^9/L. Western medical diagnosis: bone marrow smear confirmed aplastic anemia. Traditional Chinese Medicine differentiation: kidney yin deficiency with blood stasis obstructing circulation. Treatment should focus on nourishing yin and replenishing kidney, as well as activating blood and removing stasis. Prescription: 10 grams of angelica root, 6 grams of chuanxiong, 15 grams of Millettia, 15 grams of salvia miltiorrhiza, 6 grams of safflower, 12 grams of Rehmannia, 15 grams of centella asiatica, 15 grams of Polygonum multiflorum, 30 grams of black soybeans, 20 grams of cornus, 15 grams of longan meat, 15 grams of ligustrum, 15 grams of goji berries, 15 grams of Psoralea, 10 grams of cistanche. After 28 doses of the above prescription, the symptoms of dizziness and vertigo eased, but nasal and throat dryness persisted, with hemoglobin 63 g/L, platelets 39 × 10^9/L, red blood cells 2.54 × 10^12/L, white blood cells 4.4 × 10^9/L. Therefore, the prescription was adjusted by removing Psoralea and adding 3 grams of coptis, 10 grams of Astragalus. After another 40-plus doses, repeat blood tests showed: hemoglobin 85 g/L, platelets 63 × 10^9/L, red blood cells 3.5 × 10^12/L, white blood cells 3.8 × 10^9/L. All symptoms disappeared. Case 5: Mr. Ma, a 54-year-old male. He visited the clinic in May 1992. He complained of dizziness, fatigue, loss of appetite, constipation, feeling cold and having cold limbs, low back and knee weakness. Physical examination: emaciated physique, both lungs unremarkable, abdomen flat and soft, spleen palpable under the ribs, pale tongue with little coating, pulse deep and weak. Lab tests showed: red blood cells 2.1 × 10^9/L, hemoglobin 63 g/L, platelets 50 × 10^9/L, white blood cells 2.0 × 10^9/L, reticulocyte count 1.2%