4 Oncology Treatment

(4) Oncology Treatment Oncological drugs include podophyllotoxin, vincristine, vincristine, bleomycin, alpha-interferon, cyclophosphamide, etc. (Wu Bin) Chapter 21: Infectious Mononucleosis – Overview Infectious mononucleosis is an acute, reticuloendothelial system proliferative infectious disease caused by Epstein-Barr virus (EBV). Its clinical characteristics include fever, lymphadenopathy, pharyngitis, and a significant increase in mononuclear cells in peripheral blood. The disease typically has a self-limiting course with a good prognosis. It is most common in autumn and winter, often affecting children and adolescents, though in the past two to thirty years, young adults aged 16–30 have been found to be particularly prevalent, while individuals over 35 are less commonly affected. EBV is a DNA virus measuring 180–200 nm in size. The virus possesses five major antigens: a membrane shell, a membrane protein, early antigens, complement-binding antigens, and virus-related nuclear antigens. Both carriers and patients serve as sources of infection. Transmission primarily occurs through oral contact and close physical proximity. After entering the mouth, the virus may first replicate in the lymphatic tissues of the throat, then enter the bloodstream, causing viremia, which subsequently affects various tissues and organs of the lymphatic system. White blood cell counts are usually normal or slightly elevated, with mononuclear cells accounting for more than 50% of total white blood cells—a hallmark of the disease. In two-thirds of cases, neutrophils show a mild decrease. A positive heterophile agglutination test indicates the presence of anti-EBV antibodies.

II. Diagnosis (1) Diagnostic Key Points Epidemiological data are highly valuable, and when combined with symptoms such as fever, lymphadenopathy (70%) and hepatosplenomegaly (50%), pharyngeal pain, and abnormal peripheral blood findings—including mononuclear cells exceeding 10% or rising to around 1.0 × 10⁹/L—clinical diagnosis can be made. If the heterophile agglutination test is positive or if anti-EBV IgM antibodies are detected, the diagnosis can be confirmed.

(2) Differential Diagnosis

1. Hepatitis A Patients often experience severe fatigue and loss of appetite, with jaundice appearing in some cases—though “fever subsides, jaundice appears,” and mild lymphocytosis is common in the early stages of jaundice, with liver function abnormalities being relatively frequent, yet the heterophile agglutination test remains negative.
2. Streptococcal Tonsillitis Pharyngeal pain is prominent, with white, pinpoint exudates on the tonsils, accompanied by a significant increase in white blood cells and neutrophils; penicillin G treatment is highly effective.
3. Other conditions also require differential diagnosis with influenza, typhoid fever, lymphatic tuberculosis, and other diseases.

III. Traditional Chinese Medicine’s Understanding and Treatment of Infectious Mononucleosis (1) Historical Medical Views on Similar Conditions Ming Dynasty · Wu Youke’s “Wen Yi Lun” states: “When pathogenic factors invade the interior, they move heat downward to the lower burner; when urine becomes blocked, it leads to jaundice, with the skin turning yellow like gold.” Qing Dynasty · Wu Jutong’s “Wen Bing Tiao Bian” · Upper Burner Chapter: “Warm-toxicity causes swelling in the throat… swelling behind the ears… or the throat does not hurt, but the exterior is swollen… Pu Ji Du Xiu Yin uses Chai Hu and Sheng Ma as primary ingredients…” suggesting that this condition was already recognized. (2) Traditional Chinese Medicine’s Understanding of the Pathogenesis of Infectious Mononucleosis Currently, it is believed that the cause of this disease is warm-toxicity. Warm-toxicity enters through the nose, first multiplying and thriving in the throat, manifesting as symptoms such as chills and fever, pharyngeal pain, cough, and excessive sweating—these are manifestations of the external defense system. Warm-toxicity then travels along the Shaoyang meridian, causing qi stagnation and blood stasis, disrupting the flow of qi and blood, and leading to exposure to pathogenic heat, ultimately resulting in aggregation and enlargement of the lymph nodes, liver, and spleen. When heat-toxicity invades the liver and gallbladder, it causes bile to overflow, leading to jaundice of the skin and eyes. Occasionally, if it affects the heart and liver, symptoms such as high fever, delirium, and limb weakness may occur.

(3) TCM Syndrome Differentiation and Herbal Formulas

1. For the Exterior Defense Syndrome, with fever, chills, red and painful throat, swollen cervical lymph nodes, red tongue, white coating, and floating, rapid pulse: treat with clearing heat and detoxifying, using Yin Qiao San with additions or subtractions: 15g of Honeysuckle, 12g of Forsythia, 6g of Peppermint, 12g of Coptis, 12g of Platycodon, 12g of Gardenia root, 12g of Pinellia, 10g of Red Peony, 12g of Bamboo Leaves, 15g of Indigo Root, 15g of Herba Lysimachiae, 9g of Licorice. Brew and drink once daily.

2. For the Toxicity-Residue Syndrome, with high fever, headache, red and swollen throat, painful swelling on the sides of the neck, painful lumps in the flank area, red tongue with yellow coating, and slippery, rapid pulse: treat with detoxifying and resolving residue, using Pu Ji Du Xiu Yin with additions or subtractions: 20g of Indigo Root, 10g of Scutellaria, 10g of Coptis, 12g of Forsythia, 12g of Radix Rehmanniae, 10g of Horseweed, 10g of Silkworm Moth, 10g of Trichosanthes, 10g of Curcuma, 12g of Burdock Seed, 12g of Motherwort, 15g of Salvia Miltiorrhiza. Brew and drink once daily.

3. For the Liver-Gallbladder Invasion Syndrome, with fever, loss of appetite, abdominal distension and pain in the flanks, jaundice of the skin and eyes, enlarged lymph nodes and liver/spleen, red tongue with greasy yellow coating, and slippery, rapid pulse: treat with detoxifying and promoting bile flow, using Yin Chen Hao Tang with additions or subtractions: 30g of Artemisia, 12g of Gardenia, 12g of Rheum, 15g of Indigo Root, 15g of Dandelion, 10g of Forsythia, 9g of Peppermint, 12g of Red Peony, 15g of Astragalus, 15g of Herba Lysimachiae, 12g of Bamboo Leaves. Brew and drink once daily.

(4) Traditional Chinese Medicine Resources on Syndrome Differentiation and Treatment of This Disease A clinical analysis of 58 cases of infectious mononucleosis reveals that in the early stages, the disease resides in the Wei and Qi divisions; treatment focuses on clearing the Qi, penetrating the Wei, and detoxifying and cooling the heat, using Yu’s Qing Xin Liang Ge San (modified with Forsythia, Scutellaria, Gardenia, Peppermint, Gypsum, Platycodon, Licorice). In the mid-stage, when Qi and Ying are both burned, and heat-toxin is rampant, treatment focuses on clearing heat and detoxifying, promoting blood circulation and resolving stasis, using Liang Ying Qing Qi Tang (with Rhinoceros Horn, Fresh Dendrobium, Roasted Gardenia, Cortex Phellodendri, Fresh Rehmannia, Peppermint Leaves, Forsythia Shell, Reed Root, Golden Juice) with additions or subtractions. In “Ding Gan Ren’s Medical Cases · Summary of Throat Syndrome Treatment,” the late stage involves recovery; formulas like Sha Shen Mai Dong Tang and Yi Wei Tang are used with additions or subtractions. After 12–49 days of treatment, the overall effective rate reached 96.3%. The average time to return to normal body temperature was 5.4 days, and various clinical symptoms, signs, and laboratory indicators showed significant improvement. (Journal of Traditional Chinese Medicine, 1989.11)

It is also reported that basic formulas such as Indigo Root, Cortex Phellodendri, Dandelion, Purple Flowered Groundsel, Saishen, Fresh Rehmannia, Radix Rehmanniae, and Radix Ophiopogonis were used; for fever, add Jingjie, Bai Wei, Zhimu; for enlarged lymph nodes, add Xia Ku Cao, Fresh Oyster, Walang Zi; for enlarged liver and spleen, add Turtle Shell, Turmeric, Hou Po, Zhishi, Dendrobium, Bamboo Leaves; for pharyngitis, add Niu Lao Zi, Fresh Lily, Mountain Gardenia; for elevated white blood cell counts, use Licorice heavily; for low white blood cell counts, add Prince’s Ginseng, Astragalus, Fresh Yam; for rashes, add Cucurbita pepo seeds, White Skin, Cicada Wings; for nosebleeds, add Lotus Root, White Reed Root. A total of 371 cases were treated, with complete efficacy and a cure rate of 95.6%. (Journal of External Heat Diseases in Traditional Chinese Medicine, 1991)

Yang Rongxiu et al. achieved good therapeutic results by combining bitter-cold detoxification methods with Western anti-viral treatment for children with infectious mononucleosis. They selected 113 children diagnosed with infectious mononucleosis and randomly divided them into a group receiving traditional Chinese medicine’s bitter-cold detoxification method combined with basic Western treatment (treatment group) and a group receiving basic Western treatment (control group). The control group received interferon-based antiviral therapy and symptomatic treatment for two weeks, while the treatment group added bitter-cold detoxification herbal remedies orally in addition to basic Western treatment, for a duration of one week. Results showed that the treatment group had an overall effective rate of 91.07%, while the control group had an overall effective rate of 80.70%. The clinical efficacy difference between the two groups was statistically significant (p < 0.05). Furthermore, it was discovered that the treatment group significantly shortened the number of days before the child’s fever subsided, the number of days before pharyngitis resolved, the number of days before lymph nodes shrank, the time it took for liver function to return to normal, and the length of hospital stay (p < 0.05). The basic formula for bitter-cold detoxification was formulated independently: Honeysuckle, Forsythia, Scutellaria, Indigo Root, Big Green Leaf, Radix Rehmanniae, Purple Herb. At the same time, practical pediatric TCM syndrome differentiation was incorporated, with 21 cases identified as having pathogenic factors obstructing the lung and Wei, who were treated with methods to clear wind, cool the heat, and clear the lungs and throat, adding Peppermint, Jingjie, Reed Root, Bamboo Leaves, Platycodon, Horseweed; 16 cases with severe heat-toxin, who were treated with clearing the Qi to cool the heat and detoxify the throat, adding Platycodon, Coptis, Gardenia, Mountain Gardenia, Horseweed, and others; for those with phlegm-heat accumulation, 4 cases were treated with methods to clear heat and detoxify, regulate qi, and remove dampness, adding Talc, Acorus Calamus, and Softened Yellow Grass; for those with damp-heat stagnation, 15 cases were treated with methods to clear heat and detoxify, regulate qi and remove dampness, adding Talc, Acorus Calamus, Softened Yellow Grass, White Cardamom, and Ho Xiang. Throughout the course of treatment, as the condition changed, syndromes were appropriately differentiated and formulas adjusted accordingly. When phlegm-heat invaded the lungs, treatment focused on clearing heat and detoxifying, opening the lungs and dissolving phlegm, adding Ma Xing Shi Gan Tang and Qing Ning San; when the condition shifted to heat-toxin accumulation in the liver and gallbladder, treatment focused on clearing heat and detoxifying, resolving stasis and removing dampness, adding Yin Chen Hao Tang; in the later stages, when the body was deficient and pathogenic factors lingered, treatment focused on replenishing qi and generating fluids, while also clearing residual heat, switching to Zhu Ye Shi Gao Tang. Conclusion: Traditional Chinese medicine’s bitter-cold detoxification treatment for infectious mononucleosis features significantly shorter disease courses, faster symptom relief, and earlier recovery of various observed indicators—making it worthy of further clinical promotion. (Sichuan Journal of Traditional Chinese Medicine, 2007.8)

IV. Western Medical Treatment There are currently no specific treatments for this disease. For patients with hepatitis, bed rest is recommended, and diet should be light yet nutritious. To prevent bacterial infections, penicillin can be used for a course of 7–10 days. Amoxicillin is prone to triggering erythema multiforme (95% of cases), so its use should be avoided. For severe pharyngeal pain, as well as for patients with central nervous system damage, thrombocytopenic purpura, hemolytic anemia, pericarditis, myocarditis, etc., corticosteroids may be considered.

(Qiao Fu Qu, Wu Bin) Chapter 22: Epidemic Encephalitis B – Overview

Epidemic encephalitis B, abbreviated as EEE, is an acute infectious disease caused by the EEE virus, characterized primarily by inflammation of the brain parenchyma. It is prevalent in summer and autumn, often affecting infants and young children. Clinical features include sudden high fever, altered mental status, and convulsions. Severe cases may leave neurological sequelae. This disease falls within the scope of summer heat-related illnesses, heat-induced wind-related conditions, and similar ailments in traditional Chinese medicine.

The EEE virus was first discovered in Japan in 1935, hence the name “Japanese Encephalitis B.” China confirmed the disease in 1940. The EEE virus belongs to Group B, a vector-borne virus, spherical in shape with a diameter of 20–30 mm, containing a single-stranded RNA core, surrounded by a lipid envelope, and bearing hemagglutinin spikes on its surface that can agglutinate chicken, pigeons, and other red blood cells. The EEE virus is easily killed by common disinfectants, but it is resistant to low temperatures. This disease is a naturally occurring zoonotic illness, with poultry and livestock serving as primary hosts; pigs are the main source of infection, while the tri-band mosquito is the primary vector. Humans are generally susceptible, and after infection, long-lasting immunity may develop.

The EEE virus enters the body through mosquito bites, replicates within mononuclear macrophages, then enters the bloodstream, causing viremia. Most cases present as asymptomatic infections, but in those with compromised blood-brain barriers, encephalitis develops, with widespread lesions affecting both the brain and spinal cord—most notably the cerebral cortex, thalamus, and midbrain. Within the small blood vessels, endothelial cells swell and undergo necrosis, with surrounding ring-shaped hemorrhages; nerve cells degenerate and die, glial cells proliferate, and perivascular lymphocytes and large mononuclear cells infiltrate, forming “vascular sheaths.” Focal necrosis of neural tissue may result in softening foci, cavities, or calcifications. Due to varying degrees and distributions of lesion severity, clinical presentations vary widely.

Clinical Manifestations: The incubation period lasts 10–14 days. Mild cases exhibit a temperature of 38–39°C, mild headaches, vomiting, drowsiness, without convulsions, often recovering within about a week. Moderate cases: 39–40°C, headaches, vomiting, marked meningeal irritation, occasional convulsions, shallow coma or deep coma, with a course of approximately 2 weeks. Severe cases present with sudden, high fever—40°C—and the onset of coma, convulsions, vomiting, intense agitation, loss of reflexes; after 3–4 days, respiratory failure and circulatory failure may occur, posing a life-threatening risk. Survivors often suffer severe sequelae. Extremely severe cases (acute onset) present with sudden, extremely high fever—41°C—and recurrent, persistent convulsions, deep coma, rapidly developing brain herniation, central respiratory failure, and circulatory failure—leaving survivors often with severe sequelae. Complications often include pneumonia, followed by urinary tract infections, sepsis, stress ulcers, upper gastrointestinal bleeding, and other conditions. Among severe cases, 5–20% may experience aphasia, paralysis, spasms, or psychiatric disorders as sequelae. Laboratory tests reveal a significant increase in total white blood cell count and neutrophil levels, elevated cerebrospinal fluid pressure, with transparent or slightly turbid appearance; white blood cell counts are mildly elevated, or even normal, with early stages showing a predominance of neutrophils, later becoming predominantly lymphocytes; protein levels are slightly elevated, while glucose levels are normal or slightly elevated, and chloride levels remain normal. If cerebrospinal fluid glutamate dehydrogenase activity increases, it suggests severe brain tissue damage and a poor prognosis. Serum complement binding tests are highly specific, but antibody production occurs late, with no early diagnostic value—positive results are obtained when serum samples are tested four times, with a fourfold increase in antibody titers, or when a single sample shows a titer of 1:4. Antibody detection via the hemagglutination inhibition test occurs relatively early, reaching 60–70% by the second week, offering a simple and convenient method with a fourfold antibody titer as a positive indicator. Specific IgM antibody testing can yield positive results in over 80% of cases starting on the fourth day, making it a useful tool for early diagnosis. The adhesion inhibition test for white blood cells can reach a positivity rate of 69.4%, also serving as an early diagnostic marker. Viruses are often difficult to isolate from blood and cerebrospinal fluid; post-mortem brain tissue isolation can provide a basis for retrospective diagnosis.