4. Leukemia

4. Leukemia

Qin Bowei said: "Overall, leukemia is a deficiency syndrome. Although it may sometimes be infected by external pathogens, it should not be regarded as a typical excess or external pathogen syndrome." Yan Dexin also believed that "this disease is fundamentally a deficiency, although there may sometimes be manifestations of phlegm-heat, damp-heat, or blood stasis, these changes occur very rapidly. In fact, the disease is caused by deficiency, making it a syndrome of deficiency at the root and excess at the manifestation." According to the theory that "the kidneys produce bone marrow," this disease should be related to kidney deficiency; and according to the theory that "the middle jiao transforms qi into essence, which becomes blood," this disease should also be related to spleen deficiency. In recent years, more and more places have been treating this disease using the spleen-strengthening and kidney-tonifying method. Gu et al. used the spleen-strengthening Bu Zhong Yi Qi Tang combined with the kidney-tonifying Jian Bu Hu Qian Wan to treat a case of acute myeloid leukemia with good results①. In 1967, the author treated a case of acute monocytic leukemia (AML, M5), using the spleen-strengthening and kidney-tonifying method, with heavy use of Taizi Shen, Lu Dang Shen, Ren Xu, and Bei Sha Shen to strengthen the spleen, and Liu Wei Di Huang Tang to tonify the kidneys. After taking over 400 doses, the patient achieved complete remission and has remained healthy for 15 years to date②.

## 5. Aplastic Anemia

In recent years, TCM's understanding of this disease has increasingly leaned toward "deficiency at the root, excess at the manifestation." Since the disease is caused by impaired hematopoietic function of the red bone marrow, and given that "the kidneys produce bone marrow," kidney deficiency should be related to this disease. TCM also has the theory that "the middle jiao transforms qi into essence, which becomes blood," so this disease is also linked to spleen deficiency. The Shuguang Hospital of Shanghai University of Traditional Chinese Medicine treated 82 cases of chronic aplastic anemia using the spleen-strengthening and kidney-tonifying method, achieving an effectiveness rate as high as 91.46%, significantly higher than the control group treated with other traditional Chinese medicines or combined traditional and Western medicines. Pei Shen believes that "the kidneys govern bone marrow, while the spleen governs the extremities," emphasizing that tonifying the kidneys can improve bone marrow hematopoiesis, and strengthening the spleen can raise peripheral blood counts. Therefore, he proposed that the kidney-tonifying and spleen-strengthening method is the primary approach to treating aplastic anemia, and the author also follows this method when treating this disease.

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In June 1975, the author treated a patient named Sun, a 20-year-old man with pale complexion, extreme fatigue, loss of appetite, five-point heat, bone-steaming heat, night sweats, dizziness, palpitations, poor sleep, frequent dreams, and scattered petechiae on the gums and throughout the skin. His hemoglobin was 5 g/dL, red blood cells 1.7 million/mm³, platelets 29,000, and white blood cells 1,700/mm³. Bone marrow examination showed a significant reduction in all three cell types, with a relative increase in lymphocytes. Using the spleen-strengthening and kidney-tonifying method, with ingredients such as Codonopsis pilosula, Atractylodes macrocephala, Astragalus membranaceus, Poria cocos, Rehmannia glutinosa, Cornus officinalis, Moutan cortex, Cinnamomum cassia, Polygonatum odoratum, Anemarrhena asphodeloides, Phellodendron amurense, Aconitum carmichaelii, and Millettia reticulata, adjusted up and down as needed, after taking over 100 doses, all symptoms markedly improved, hemoglobin rose to 10 g, white blood cells increased to 4,100/mm³, platelets to 68,000/mm³, and bone marrow examination showed significant improvement, allowing him to return to work③.

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① "Complete Works of Jing Yue (Volume 1)," Shanghai Health Publishing House, 1958, p. 314
② "Complete Works of Jing Yue (Volume 1)," Shanghai Health Publishing House, 1958, p. 397
③ Li Chunyue, "Shanghai Journal of Traditional Chinese Medicine," 1965, (12): 17
④ Internal Medicine Department of the 285th Hospital of the People's Liberation Army, "Tianjin Pharmaceutical," 1975, (4): 192
⑤ Respiratory Group of the Xiyuan Hospital Internal Medicine Department, "Reference Materials for Research on Traditional Chinese Medicine," 1977, (1): 2
⑥ Prevention and Treatment Group for Senile Chronic Bronchitis of the Shaanxi Provincial Institute of Traditional Chinese Medicine, "Shaanxi New Medicine," 1972, (1): 6
⑦ Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, "Journal of Traditional Chinese Medicine," 1974, (11): 14
⑧ Qin Bowei et al., "Chinese Journal of Internal Medicine," 1960, (8): 5
⑨ Yan Dexin et al., "Shanghai Journal of Traditional Chinese Medicine," 1963, (7): 13
⑩ Gu Zaishi et al., "Shanghai Journal of Traditional Chinese Medicine," 1965, (9): 21
⑪ Pei Zhengxue, "Shaanxi New Medicine," 1979, (9): 4
⑫ Shuguang Hospital of Shanghai University of Traditional Chinese Medicine, "Shanghai Journal of Traditional Chinese Medicine," 1981, (2): 13
⑬ Pei Zhengxue, "Zhejiang Journal of Traditional Chinese Medicine," 1983, (3): 123
⑭ Xue Guoli et al., "Compilation of Data on Combined Traditional and Western Medicine," 1978, (2): 39

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## How to Formulate Prescriptions in Clinical Practice—Pei Zhengxue

Formulating prescriptions in clinical practice is a crucial step in TCM treatment, and the quality of the prescription directly affects the therapeutic outcome. So how should one formulate prescriptions in clinical practice? This is a question that every TCM practitioner takes very seriously. China's medical literature on this topic is extremely rich. In recent years, with the vigorous development of integrated traditional and Western medicine, many Western-trained physicians have boldly attempted to combine disease and syndrome differentiation in their clinical prescriptions, injecting new content into this traditional TCM subject. The author, humbly offering his own shallow thoughts, would like to share his views on this issue.

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**Pei Zhengxue's TCM—Discussion on TCM Theory and Clinical Cases**

Published by Hefei Huitian Publishing House

It can also alleviate the side effects of the main medicinal ingredients; make the medicine more suitable for guiding the meridians or harmonizing the other herbs. Among the four components, the chief and assistant herbs are usually the main elements of the theory and method, representing the fundamental aspect of the formula; the auxiliary herbs, on the other hand, are more flexible and often adjusted according to individual patient differences, representing the symptomatic aspect of the formula.

The "Shanghan Lun" records the Guizhi Tang formula, which is revered by physicians as the "king of all formulas" due to its infinite variations and proven efficacy. The main syndrome treated by this formula is wind-cold exterior deficiency and disharmony between nutritive and defensive qi. Guizhi dispels wind-cold and harmonizes defensive qi, so it serves as the chief herb; Shaoyao collects yin and regulates nutritive qi to prevent Guizhi's warming and dispersing effect from damaging yin while regulating nutritive qi, so it serves as the assistant herb. Together, these two herbs effectively dispel wind-cold and harmonize nutritive and defensive qi, embodying the unity of theory, method, formula, and medicine. Under the condition that the main syndrome remains unchanged, if the patient also presents with stiffness in the neck and back, add Gegen; if the pulse is rapid and there is chest fullness, remove Shaoyao; if the limbs are slightly stiff and difficult to bend and stretch, add Fuzi; if there is asthma, add Houpu and Xingren; if there is palpitation and restlessness in the heart, add Yitang and Bai Shaoyao. Adding Gegen, Fuzi, Houpu, Xingren, and Yitang to Guizhi Tang aims to adapt the formula to the specific needs of the condition; these herbs are usually classified as auxiliary or supporting ingredients in the formula, serving the symptomatic aspect and playing an important role in the physician's clinical flexibility.

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## Part One: Academic Thought

In the category of blood stasis in TCM, the Yishen Tang formula therefore selects a large number of herbs that activate blood circulation and dissolve blood stasis; at the same time, the main factor causing aggravation of chronic nephritis is infection, so a large amount of Qingre Jiedu herbs such as Yin Hua and Lian Qiao are added to the blood-activating herbs.

Both the Guanxin II formula and the Yishen Tang formula are the result of applying the concept of combining disease and syndrome in clinical prescription formulation. These two formulas have proven effective in clinical practice and are widely recognized by the domestic medical community, which strongly demonstrates that adopting the concept of combining disease and syndrome in clinical practice is the correct way to improve therapeutic efficacy. Adopting the concept of combining disease and syndrome is currently a prerequisite for integrated traditional and Western medicine clinical prescription formulation. For example, a patient with prostatitis presents with difficulty urinating, lower back pain, and acute congestion in the lower abdomen; he also experiences dizziness, blurred vision, tinnitus, aversion to cold, and spontaneous sweating. From a syndrome-differentiation perspective, this is a patient with kidney-yang deficiency and yang failing to transform into qi, so the Jisheng Shenqi Wan should be the main formula; from a disease-differentiation perspective, chronic prostatitis is mainly characterized by prostate hyperplasia and enlargement, compressing the urinary tract, so it is also appropriate to add herbs that activate blood circulation and dissolve blood stasis, soften hard masses, and disperse nodules, such as Amber, Wang Buliu Xing, Bai Tou Weng, and Liang Tou Jian (often paired with Yin Lian Hua). A formula composed in this way will undoubtedly be much more effective than treatment based solely on syndrome differentiation. When treating aplastic anemia, if one only uses the general principles of syndrome differentiation to address symptoms such as pallor, fatigue, palpitations, sweating, and nosebleeds, the most one can do is conclude that the patient suffers from both spleen and kidney deficiency and qi failing to control blood, then prescribe formulas like Guipi Tang, which only have a general effect in clinical practice.

To further improve the therapeutic efficacy of aplastic anemia, one must apply the concept of combining disease and syndrome to adjust the above formula—for example, adding Po Guo Zhi, Di Gu Pi, and Ji Xue Teng for patients with low white blood cell count; adding Yu Zhu, Huang Jing, Sheng Di, and Peanut Shell Inner Coat for those with low platelet count; adding Shou Wu, Dang Shen, Huang Qi, and Bai Zhu for those with low red blood cell count. In addition, the characteristics of bone marrow morphology and peripheral blood morphology are also important bases for formulating prescriptions for this disease. For obvious damage to bone marrow morphology, treatment should include 30–40 grams of Shan Yu Rou; for abnormalities in peripheral blood morphology, 15–30 grams of Long Yan Rou should be added. When treating non-jaundice infectious hepatitis, from a syndrome-differentiation perspective, some cases involve spleen-stomach qi deficiency, some involve liver qi stagnation, some involve liver-stomach disharmony, some involve liver-kidney yin deficiency, and some involve liver-gallbladder fire excess. Each type has a corresponding formula to choose from: for spleen-stomach qi deficiency, use Bu Zhong Yi Qi Tang; for liver qi stagnation, use Chai Hu Shu Gan San; for liver-stomach disharmony, use Xiao Yao San; for liver-kidney yin deficiency, use Yi Guan Jian; for liver-gallbladder fire excess, use Long Dan Xie Gan Tang.

From a disease-differentiation perspective, for liver function impairment characterized by elevated transaminases, add Gong Ying, Bai Jiang, Chui Pen Cao, and Ban Lan Gen, or alternatively give Wu Wei Zi San to drink; for decreased plasma protein with inverted albumin-to-globulin ratio, add Dang Shen, Bai Zhu, and Huang Qi. Regardless of the type of hepatitis, as long as there is persistent liver pain, add Yuan Hu and Ginger. When treating chronic nephritis, from a syndrome-differentiation perspective, some cases involve excess water, some involve spleen-stomach qi deficiency, and some involve internal wind in the liver; each type has a corresponding main formula: for yang-deficient excess water, use Jisheng Shenqi or Zhen Wu Tang; for spleen-stomach qi deficiency, use Bu Zhong Yi Qi or Liu Jun Zi Tang; for internal wind in the liver, use Qi Ju Di Huang Wan or Jian Ling Tang. From a disease-differentiation perspective, for those with high protein in urine, add Su Geng, Chan Yi, Yi Mu Cao, Qian Shi, and Jin Ying Zi; for those with many red blood cells, add Bai Mao Gen, Da Ji, and Xian He Cao; for those with many white blood cells, add Shan Zhi, Mu Tong, and Hua Shi. The above examples demonstrate that when formulating prescriptions in clinical practice, the concept of combining disease and syndrome can help the formula better adapt to the condition, thereby improving clinical efficacy. This concept is also an important component of integrated traditional and Western medicine in clinical practice.

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**Pei Zhengxue's TCM—Discussion on TCM Theory and Clinical Cases**

Published by Hefei Huitian Publishing House

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## Part One: Academic Thought

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## A Brief Discussion on the Format of Integrated Traditional and Western Medicine Medical Records—Pei Zhengxue

Western medical record writing, from medical history and physical examination to diagnosis and treatment, has formed a complete format suited to Western medical characteristics; traditional Chinese medical records, from ancient times to the present, though varying in complexity and tailored to individual practitioners, all follow a certain set of rules, but are always based on observation, auscultation, inquiry, and palpation to reflect the theory, method, and prescription. With the rise of the integrated traditional and Western medicine movement, we have raised a new issue: exploring the format of integrated traditional and Western medicine medical records. Many colleagues have already made attempts in this regard. The author believes that this issue still requires further discussion to achieve ideal perfection, because the format of integrated traditional and Western medicine medical records is closely related to the development of the integrated traditional and Western medicine movement, and among the many factors promoting this movement, this is a relatively important issue.

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**Pei Zhengxue's TCM—Discussion on TCM Theory and Clinical Cases**

Published by Hefei Huicao Publishing House

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Based on this foundation, implementing syndrome differentiation and treatment undoubtedly enhances the accuracy of such an approach, while also correspondingly improving the precision of disease prognosis. More importantly, it fosters the development of traditional Chinese medicine’s syndrome differentiation and treatment model; facilitates the transition from macroscopic syndrome differentiation to microscopic analysis; and promotes the integration of traditional Chinese medicine with modern science and technology.

The author began studying TCM 25 years ago with a profound interest and occasionally preferred to diagnose and treat outpatients entirely from a TCM perspective. There was once a case of exudative pleurisy that was misdiagnosed as Shaoyang syndrome and treated with modified Xiaochaihu decoction, resulting in a one-month delay in proper management. Later, upon more careful examination through local percussion, the diagnosis of pleurisy was confirmed. Following thoracentesis for fluid drainage and combined treatment with penicillin and corticosteroids, the patient recovered rapidly. This case serves as a thought-provoking reminder: in clinical practice, the Shaoyang syndrome complex is not only associated with recurrent, refractory colds but can also manifest during certain stages of liver-gallbladder disorders, pleural diseases, cardiopulmonary conditions, collagen-related illnesses, and other ailments. If a clear Western medical diagnosis is obtained prior to syndrome differentiation and treatment, it can prevent underestimating severe conditions or overemphasizing mild ones, thereby better leveraging the strengths of TCM’s syndrome-based approach. With a Western medical diagnosis, our understanding of the disease at a microscopic level is enhanced; subsequently, through TCM syndrome differentiation, we gain a macroscopic understanding of the illness. The former establishes the concept of the disease, while the latter forms the concept of the syndrome. The combination of these two perspectives embodies both the integration of disease and syndrome and the fusion of macroscopic and microscopic views.

In today’s highly industrialized society, medical instruments used to observe diseases are becoming increasingly sophisticated. Modern medicine has thus shifted its focus from macroscopic observation to detailed, microscopic analysis. For thousands of years, TCM practitioners have relied on sensory perception to assess patients’ conditions, using methods such as inspection, auscultation, inquiry, and palpation to understand diseases—this is a hallmark of TCM. The clinical records compiled by physicians represent invaluable summaries of clinical experience and should be studied diligently; however, some cases are overly simplified. In contrast, Western medical charts feature rigorous structure and meticulous documentation, with comprehensive physical examinations covering every part of the body, regardless of whether abnormalities are present, leaving no detail overlooked—though this approach can sometimes appear excessively exhaustive. Given the ongoing standardization of TCM diagnoses and the development and refinement of numerous modern techniques capable of accurately revealing internal pathological changes, it is essential to integrate “disease” and “syndrome,” balancing macroscopic and microscopic perspectives, in order to meet the needs of the integrated development of TCM and Western medicine.

## Tang Rongchuan’s “On Blood Disorders” by Pei Zhengxue and Mao Xinmin

“On Blood Disorders” is a specialized monograph dedicated to the study of blood-related conditions, offering many innovative insights into the subject. Its theoretical framework, therapeutic principles, prescriptions, and medicinal formulas are all rigorously structured, making it highly regarded by physicians for many years. The book emphasizes the integration of theory and practice, and in some areas even incorporates Western medical concepts, lending its arguments considerable persuasive power. Beyond providing a relatively systematic exposition of blood disorders, the text also explores fundamental TCM theories and various internal and gynecological syndromes in relation to blood disorders, making it a particularly valuable work within the corpus of modern TCM literature.

## Pei Zhengxue’s TCM Studies—Discussions on TCM Theory and Clinical Case Records

Published by Taiwan Book Publishing House

Zhu Danxi’s assertion that “excess qi becomes fire,” Zhang Zhicong’s view that “blood is the essence of the middle burner,” along with concepts such as “qi governs blood,” “blood nourishes qi,” and “water and fire achieve equilibrium,” all underscore the shared origins of qi, fire, blood, and water, as well as the mutual restraint and interdependence among them. However, the mutually generating relationship among water, qi, blood, and fire has long been overlooked. Tang Rongchuan conducted thorough research and synthesis in this area, arguing that “water transforms into qi,” “qi and water are fundamentally one; treating qi is treating water, and treating water is treating qi,” and “fire transforms into blood,” “blood and fire are inherently one; treating fire is treating blood.” He further provided numerous clinical examples to substantiate these claims. For instance, when solar qi fails to circulate properly, sweat cannot be released externally, while phlegm and fluids accumulate internally—this illustrates how qi and water can mutually contribute to disease. In terms of treatment, ginseng tonifies qi and also generates body fluids; Zhu Ling Tang moistens and drains phlegm and qi, demonstrating the clinical principle of treating water and qi together. This perspective has, to some extent, enriched our understanding of the relationships among qi, blood, water, and fire in syndrome differentiation.