4.1 Understanding of Chronic Myelogenous Leukemia in Traditional Chinese Medicine

4.1 Understanding of Chronic Myelogenous Leukemia in Traditional Chinese Medicine

4.1.1 Recognition of the Disease Name

Although there is no specific disease name for chronic myelogenous leukemia in ancient Chinese medical literature, traditional Chinese medicine has long recognized this condition. Numerous texts indicate that chronic myelogenous leukemia falls under categories such as "cancer," "deficiency fatigue," and "accumulation" in traditional Chinese medicine. Traditional Chinese medicine generally believes that the onset of this disease is caused by congenital deficiency or postnatal malnutrition leading to kidney essence deficiency and organ malnutrition; external pathogenic factors like the six climatic evils and internal emotional disturbances causing qi and blood dysfunction, organ dysfunction, liver qi stagnation, and prolonged qi stagnation resulting in blood stasis, blockage of meridians, accumulation of blood stasis, and long-term buildup into masses; dietary imbalances, overconsumption of rich, sweet, and alcoholic foods damaging the spleen and stomach, spleen deficiency impairing transportation and distribution of body fluids, internal dampness and turbidity forming accumulations, phlegm and qi clashing, poor blood flow, and formation of blood stasis masses; irregular living habits, improper temperature regulation, exposure to external pathogens, invasion of pathogenic factors harming organs, injuring blood and marrow, leading to qi deficiency and blood loss, pathogenic factors clashing with nutritive blood, blocking meridians, and long-term accumulation resulting in this disease. Pathogenic factors trapped inside, prolonged stagnation turning into heat, heat consuming body fluids, long-term accumulation forming knots; pathogenic factors clashing with qi and blood, remaining stagnant and combining to form masses; pathogenic factors accumulating and turning into heat, disturbing nutritive blood, burning yang meridians, forcing blood to flow abnormally. Therefore, clinically patients present with fever, fatigue, skin ecchymosis, gingival bleeding, nasal bleeding, abdominal distension or pain, enlargement of the spleen or liver, lymph nodes, and other symptoms.

4.1.2 Exploration of Causes and Pathogenesis

Regarding the causes and pathogenesis of chronic myelogenous leukemia, although modern medical scholars have differing views, they generally agree that it involves deficiency of vital energy and excess of pathogenic factors, with deficiency referring to insufficiency of qi, blood, and yin, and excess referring to the combination of phlegm, blood stasis, and toxins. "The Spiritual Pivot: Origins of All Diseases" states: "Wind, rain, cold, and heat cannot harm a person unless they are weak; pathogenic factors alone cannot injure someone." Li Zhongzi's "Essential Readings of Medical Classics: On Accumulation" says: "Accumulation occurs when vital energy is insufficient and pathogenic factors take hold." This confirms the theory that "if vital energy is present, pathogenic factors cannot invade; where pathogenic factors gather, vital energy must be deficient." Zhang Zihe said: "Accumulation may result from sudden anger, joy, sorrow, worry, or fear." Thus, external pathogenic factors and emotional disturbances are important conditions for the onset and development of this disease. In summary, this disease affects the bone marrow and blood, involving the five zang organs and six fu organs, and arises from the interplay of qi, blood, phlegm, food, and toxins. Therefore, this disease is essentially a syndrome of deficiency at the root and excess at the surface, requiring differentiation-based treatment and addressing the root cause. "On the Causes and Manifestations of All Diseases: Various Manifestations of Accumulation" argues: "Accumulation results from disharmony between yin and yang, weakness of the organs, exposure to wind pathogens, and interaction with the qi of the organs." Zhu Shu said: "People with deficiency fatigue have imbalanced yin and yang, stagnant qi and blood, unable to circulate freely, thus developing accumulation diseases." "On Blood Disorders" states: "Blood stasis between organs and meridians forms lumps and masses." "Complete Works of Jing Yue" says: "Any factor related to diet, qi, blood, wind, or cold can lead to accumulation." It also notes: "People with weak or deficient spleen and stomach often develop accumulation diseases." Therefore, the causes and pathogenesis boil down to external pathogenic factors like the six climatic evils and internal emotional disturbances causing organ dysfunction, qi and blood dysfunction, invasion of pathogenic factors, injury to blood and marrow, impaired circulation, and long-term blood stasis forming accumulations; improper diet damaging the spleen and stomach, internal dampness and turbidity accumulating over time. At the same time, "Plain Questions" points out that "vital energy must be present to prevent pathogenic factors from invading" and "where pathogenic factors gather, vital energy must be deficient," meaning that weakened vital energy is also a condition for disease onset. Summarizing, the key points are:

① Deficiency of vital energy: Congenital deficiency or postnatal malnutrition leading to organ deficiency; vital energy is generated from kidney essence. Due to kidney essence deficiency, insufficient vital energy fails to adequately nourish the organs, causing spleen deficiency unable to generate new qi, blood, and body fluids, or external pathogenic factors like the six climatic evils weakening vital energy, or internal emotional disturbances disrupting qi and blood, leading to organ dysfunction and weakened vital energy, reduced defensive function, inability to resist pathogenic factors, making it easier for pathogenic factors to invade and cause leukemia.

② Invasion of pathogenic factors: Prolonged stagnation and failure to restore vital energy.

③ Alcohol, sex, and fatigue: Emotional imbalance damaging the five zang organs and qi, causing organ dysfunction, qi and blood disruption, and insufficient production of vital energy.

④ Long-term illness: Lack of proper care, weakened vital energy and lingering pathogenic factors, leading to damage and long-term accumulation.

These causes and pathogenesis often coexist and interact with each other.

4.1.3 Summary of Treatment Methods and Formulas

Although traditional Chinese medicine has only been treating chronic myelogenous leukemia for about thirty years, records of treating lumps and accumulations already exist in "Plain Questions: On the Great Principles of Ultimate Truth," such as "hard masses should be cut away," "clumped masses should be dispersed," and "stagnant masses should be attacked." "Complete Works of Jing Yue: On Accumulation" further suggests that treating accumulation diseases involves only four methods: "attack, eliminate, disperse, and tonify—these are the only four."

Due to varying disease courses and different degrees of pathogenic and vital energy dominance, clinical manifestations of chronic myelogenous leukemia vary greatly. There is currently no unified classification standard in traditional Chinese medicine. Clinicians often adopt different approaches based on individual presentations. Traditional Chinese medicine's staging of chronic myelogenous leukemia is largely aligned with modern medical staging standards. Xiao Shi-ying divides chronic myelogenous leukemia into four stages:

① Latent stage of pathogenic factors: Approximately five to six years before clinical signs, blood tests, and bone marrow examinations reveal changes, during which abnormal Ph chromosome-positive cells already exist within hematopoietic stem cells, indicating that pathogenic factors have hidden themselves in the body's bloodstream.

② Stage of dominant pathogenic factors and strong vital energy: From the time clinical signs appear until the disease progresses noticeably, this is the stage of dominant pathogenic factors and strong vital energy, where pathogenic factors are abundant but vital energy is still robust, allowing for elimination of pathogenic factors.

③ Stage of overwhelming pathogenic factors: As the disease gradually worsens, pathogenic factors become overwhelming, vital energy weakens, accompanied by splenomegaly or blood disorders.

④ Stage of overwhelming pathogenic factors and declining vital energy: This is the stage of yin-yang exhaustion, where prolonged accumulation of pathogenic factors leads to depletion of vital energy, rapid increase in pathological masses, worsening of original symptoms, high fever, bleeding, headache, vomiting, or even coma, with most patients dying in this stage.

Wu Song-kang classifies the treatment of chronic myelogenous leukemia into the following four types:

① Yin deficiency with internal heat: Use Qinggu San with added ingredients;

② Internal heat with toxic pathogenic factors: Use Yuni Jian with anti-cancer drugs;

③ Heat injuring nutritive blood: Severe case of chronic myelogenous leukemia, use Xijiao Dihuang Tang with added ingredients;

④ Qi and yin deficiency: Use Shengmai San with adjustments.

Hou Pi-hua advocates combining disease diagnosis with syndrome differentiation to divide the treatment of chronic myelogenous leukemia into the following stages:

① Chronic phase: First, pathogenic factors invade the marrow, yin deficiency with excessive fire: Treatment focuses on detoxification first, combined with clearing heat and anti-cancer drugs; second, pathogenic factors lie dormant in the marrow, qi and yin depleted, pathogenic factors and blood stasis intertwined: Treatment prioritizes strengthening vital energy, supplemented by detoxification, with appropriate use of blood-activating drugs, but without breaking blood.

② Accelerated phase: Traditional Chinese medicine diagnoses this as heat and toxic fumes rising, qi and yin both injured, marrow and meridians blocked: Treatment focuses on clearing heat first, followed by detoxification and anti-cancer efforts, with emphasis on nourishing yin and clearing heat in the blood to dissipate heat and detoxify;

③ Blast phase: First, intense heat and toxic fumes disturbing the spirit and blood, vital energy weakened: Treatment should focus on clearing heat and anti-cancer, detoxifying and cooling blood while supporting vital energy; second, yin deficiency and yang decline, qi damaged and blood depleted.

Research on Pei Zheng-xue's Series of Formulas

Residual toxicity remains: Treatment should focus on tonifying yin and aiding yang, boosting qi and nourishing blood, eliminating residual toxins, and harmonizing the stomach.

Through long-term practice, we have realized that combining traditional Chinese medicine with chemotherapy drugs for chronic myelogenous leukemia can enhance efficacy, prolong survival, and improve quality of life. This is related to the comprehensive regulatory effects of traditional Chinese medicine on the patient's body, its ability to enhance immune function, reduce toxic side effects, and combat multi-drug resistance in tumor cells.