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Standard Chinese Medical Pattern Discrimination for Acute Leukemia I have written about the disease causes and the disease mechanisms of acute leukemia in my A Handbook of Chinese Hematology [1] and further elaborated on this topic, including the opinion of a modern expert, in the article The Modern-Day Clinical Treatment of Acute Leukemia [2]. However, the first comprehensive textbook on Chinese hematology, co-authored by my hematology teacher Sun Wei-zheng, has only appeared recently [3]. In that work, standard pattern discriminations for most hematological conditions are outlined.
Here, standard pattern discrimination refers to the standards set by all-China congresses and symposia in which some of the most experienced practitioners of Chinese medicine of certain specialties get together, analyze the diseases of the particular specialty and then come up with a list of patterns for the particular diseases. The signs and symptoms for these patterns are always exactly defined. Furthermore, treatmentprinciples and treatment formulas are defined for every pattern. These definitions serve as the standards of care in China and ensure that within the Chinese medical system in the PRC, there is a relatively high degree Following is a functional translation of the standard pattern discrimination for acute leukemia.[4] 1) Heat toxins accumulated and exuberant pattern Main symptoms: Fever, sweating, thirst, red facial complexion, headache, sores of the mouth and tongue, bleeding of the gums and nose, static speckles on the skin, a red and crimson tongue with scant liquid and yellow fur and a stringlike and rapid pulse.
Treatment principles: Clear heat and resolve toxins, cool the blood and stop bleeding, assisted by supporting Xi Jiao Di Huang Tang Jia Jian (Modified Rhino Horn and Rehmannia) Shui Niu Jiao (Cornu Bubali) substituted for Cornu Rhinoceri (Xi Jiao) clears heat and resolve toxins, uncooked Radix Rehmanniae (Sheng Di) and Radix Albus Paeoniae Lactiflorae (Bai Shao) clear heat and enrich yin, Cortex Moutan Radicis (Mu Dan Pi) cools the blood and stops bleeding. For pronounced bleeding, add Radix Rubiae Cordifoliae (Qian Cao Gen), Rhizoma Imperatae Cylindricae (Bai Mao Teng), Herba Agrimoniae Pilosae (Xian He Cao), Radix Arnebiae seu Lithospermi (Zi Cao), or Radix Pseudoginseng (San Qi). For severe heat, a modification of Qing Wen Bai Du San (Clear Heat ResolveToxins Powder) can be used. This prescription contains Flos Lonicerae Japonicae (Jin Yin Hua), Fructus Forsythiae Suspensae (Lian Qiao), Radix Isatidis seu Baphicacanthi (Ban Lan Gen), Fructus Gardeniae Jasminoides (Zhi Zi), Gypsum (Shi Gao), Herba Lophateri Gracilis (Dan Zhu Ye), Rhizoma Anemarrhenae Asphodeloides (Zhi Mu), Cornu Bubali (Shui Niu Jiao), uncooked Radix Rehmanniae (Sheng Di), andCortex Moutan Radicis (Dan Pi). For a swollen and painful throat, add Radix Sophorae Subprostratae (Shan Dou Gen), Herba Scutellariae Barbatae (Ban Zhi Lian), Herba Oldenlandiae Diffusae (Bai Hua She She Cao), Herba Solani (Long Kui) and Bulbus Shancigu (Shan Ci Gu). For exuberant heat with spirit clouding, add An Gong Niu Huang Wan (Peaceful Palace Bovine Bezoar Pill) or Zi Xue Dan (Purple Snow Elixir). For swollen and enlarged lymphnodes, add Bulbus Fritillariae Cirrhosae (Chuan Bei Mu), Fructus Forsythisae Suspensae (Lian Qiao), Concha Ostreae (Mu Li), and Spica Prunellae Vulgaris (Xia Ku Cao). For an enlarged liver, add Tuber Curcumae (Yu Jin), Radix Gentianae Scabrae (Long Dan Cao), Herba Aloes (Lu Hui), and Fructus Forsythisae Suspensae (Lian Qiao). For spleen enlargement, add Endothelium Corneum GigeriaeGalli (Ji Nei Jin), Semen Vaccariae Segetalis (Wang Bu Liu Xing), Rhizoma Sparganii (San Leng), Rhizoma Curcumae Zedoariae (E Zhu), and Pulvis Indigonis (Qing Dai). Furthermore, substances which not only clear heat and resolve toxins but also have an anti-leukemia function are Herba Solani Lyrati (Bai Ying), Herba Selaginellae Doederleinii (Shi Shang Bai), Rhizoma Smilcis Chinae (Ba Qia), Tuber Semiaquilegia (Tian Kui Zi), Radix et Rhizoma Fagopyri Cymosi (Tian Qiao Mai Gen), Ramulus et Folium Sarcandrae (Jin Jie Cha), Flos Lonicerae Japonicae (Jin Yin Hua), Fructus Forsythiae Suspensae (Lian Qiao), Radix Scutellariae Baicalensis (Huang Qin), Fructus Gardeniae Jasminoidis (Zhi Zi), and Cortex Phellodendri (Huang Bai).
Main symptoms: Somber white facial complexion, heart palpitations, shortness of breath, fatigue, lack ofstrength, reduced appetite, torpid intake, dizziness, tinnitus, dry mouth and throat, heat in the palms of hands and feet, spontaneous sweating, night sweats, pale red tongue with scant fur, and a fine and rapid pulse.
Treatment principles: Boost qi, supplement blood, and enrich yin, assisted by dispelling evil San Cai Feng Sui Dan He Liu Wei Di Huang Wan Jia Jian (Modification of Heaven, Human, and Earth Retain the Marrow Elixir Plus Six Ingredients Rehmannia Decoction)Radix Panacis Ginseng (Ren Shen), Radix Astragali Membranacei (Huang Qi), and Fructus Schizandrae Chinensis (Wu Wei Zi) fortify the spleen and boost the qi. Radix Angelicae Sinensis (Dang Gui), prepared Radix Rehmanniae (Shu Di), Rhizoma Polygonati (Huang Jing), Gelatinum Corii Asini (E Jiao), and Radix Polygoni Multiflori (He Shou Wu) supplement blood. Uncooked Radix Rehmanniae (Sheng Di), RhizomaDioscoreae Oppositae (Shan Yao), Fructus Corni Officinalis (Shan Zhu You), Tuber Asparagi Cochinchinensis (Tian Men Dong), and Tuber Ophiopogonis Japonici (Mai Dong) enrich yin and supplement the kidneys. Herba Agrimoniae Pilosae (Xian He Cao) astringes and constrains to stop bleeding.
Herba Oldenlandiae Diffusae (Bai Hua She She Cao) clears heat and resolves toxins; furthermore, it is an anti-cancerous medicinal. For copious sweating, add Semen Levis Tritici Aestivi (Fu Xiao Mai). For abdominal distension and torpid intake, add Fructus Crataegi (Shan Zha), Fructus Germinatus Hordei Vulgaris (Mai Ya), Massa Medica Fermentata (Shen Qu), Semen Raphani Sativi (Lai Fu Zi), and Fructus Amomi (Sha Ren). For yin vacuity fire effulgence, add Gelatinum Plastri Testudinis (Gui Ban), CarapaxAmydae Sinensis (Bie Jia), and Herba Artemisiae Apiacae(Qing Hao). For severe liver and kidney yin vacuity, add Fructus Lycii Chinensis (Gou Qi Zi), Fructus Ligustri Lucidi (Nu Zhen Zi), and Herba Ecliptae Prostratae (Han Lian Cao). For static macules and speckles of the skin and flesh, add Radix Arnebiae seu Lithospermi (Zi Cao) and Radix Rubiae Cordifoliae (Qian Cao). For nose bleeding, add Rhizoma Imperatae Cylindricae (Bai Mao Gen) and Cacumen Biotae Orientalis (Ce Bai Ye). For bloody urine, add Herba Cirsii (Da Xiao Ji). For blood in the stool, add carbonized Radix Sanguisorbae Officinalis (Di Yu), carbonized Radix et Rhizoma Rhei (Da Huang), and carbonized Fibra Stipulae Trachycarpi (Zong Lu).
Main symptoms: Concretion and accumulation under the ribside which is hard upon pressure, phlegm nodulation, distension and pain in the sternal bone, lackluster facial complexion, low-grade fever, bleeding, purple dark tongue or a tongue with static macules, and a rough or bowstring and rapid pulse.
Treatment principles: Quicken blood and transform phlegm, soften hardness and dissipate nodulation,assisted by supporting the righteous.
Ge Xia Zhu Yu Tang He Xiao Luo Wan Jia Jian (Modification of Expel Stasis Below the Diaphragm PlusDisperse Scrofula Pill) Radix Angelicae Sinensis (Dang Gui), Semen Pruni Persicae (Tao Ren), Flos Carthami Tinctorii (Hong Hua), Radix Rubrus Paeoniae Lactiflorae (Chi Shao), Feces Trogopterori seu Pteromi (Wu Ling Zhi), Cortex Moutan Radicis (Mu Dan Pi), Rhizoma Corydalis Yanhusuo (Yan Hu Suo) quicken blood and transform stasis. Fructus Meliae Toosendan (Chuan Lian Zi), Rhizoma Curcumae Zedoariae (E Zhu), Rhizoma Sparganii (San Leng), Thallus Algae (Kun Bu), Herba Sargassi (Hai Zao), Concae Ostreae (Mu Li) dispel phlegm, soften hardness, and dissipate nodulation. Tuber Curcumae (Yu Jin) and Rhizoma Cyperi Rotundi (Xiang Fu) soothe the liver and rectify qi. Rhizoma Polygonati (Huang Jing) and prepared Radix Rehmanniae (Shu Di) enrich and supplement kidney yin. Herba Oldenlandiae Diffusae (Bai Hua She She Cao) and Spica Prunellae Vulgaris (Xia Ku Cao) clear heat and resolve toxins. For dizziness and a bitter taste in the mouth, add Radix Gentianae Scabrae (Long Dan Cao), Herba Aloes (Lu Hui), and Radix Bupleuri (Chai Hu). For vomiting, add Pericarpium Citri Reticulatae (Ju Pi), Caulis Bambusae in Taeniis (Zhu Ru), and RhizomaPinelliae Ternatae (Ban Xia). For qi vacuity, add Radix Astragali Membranacei (Huang Qi), Radix Codonopsitis Pilosulae (Dang Shen), and Radix Pseudostellariae Heterophyllae (Tai Zi Shen). For blood vacuity, add Gelatinum Corii Asini (E Jiao) and Radix Polygoni Multiflori (He Shou Wu) and increase the dosages of Radix Angelicae Sinensis (Dang Gui) and prepared Radix Rehmanniae (Shu Di). Medicinals which quicken blood and transform stasis and also have and anti-cancerous function can also be included: Herba Salviae Chinensis (Shi Jian Chuan), Resina Myrrhae (Mo Yao), Resina Olibani (Ru Xiang), Radix et Rhizoma Polygoni Cuspidati (Hu Zhang), Pollen Typhae (Pu Huang), Semen Vaccariae Segetalis (Wang Bu Liu Xing).
Furthermore, medicinals which soften hardness and dissipate nodulation and have an anti-cancerous functioncan also be included: Tuber Ranunculi Ternati (Mao Zhao Cao), Bombyx Batryticatus (Tian Chong), Bulbus Main symptoms: Lusterless white facial complexion, lack of strength, dizziness, palpitations and fearful throbbing, shortness of breath upon activity, pale lips and nails, spontaneous sweating, reduced appetite, static macules of the skin and flesh, pale and enlarged tongue with teeth indentations and thin and white fur, and a Treatment principles: Boost qi and nourish blood, fortify the spleen and supplement the kidneys.
Ba Zhen Tang Jia Jian (Modified Eight-Gem Decoction) Radix Codonopsitis Pilosulae (Dang Shen), Radix Astragalis Membranacei (Huang Qi), Rhizoma Atractylodis Macrocephalae (Bai Zhu), Sclerotium Poriae Cocos (Fu Ling), and Radix Glycyrrhizae (Gan Cao) boosts qi and fortifies the spleen. Prepared Radix Rehmanniae (Shu Di), Radix Rubrus Paeoniae Lactiflorae (Chi Shao), Radix Angelicae Sinensis (Dang Gui), Radix Ligustici Wallichii (Chuang Xiong), Gelatinum Corii Asini (E Jiao), and Radix Polygoni Multiflori (He Shou Wu) nourish and supplement blood, Fructus Lycii Chinensis (Gou Qi Zi), Fructus Ligustri Lucidi (Nu Zhen Zi), Herba Ecliptae Prostratae (Han Lian Cao), andFructus Corni Officinalis (Shan Zhu You) enrich yin and supplement the kidneys. In addition, anti-cancerous medicinals from the heat clearing and toxin resolving category can be added: Herba Oldenlandiae Diffusae (Bai Hua She She Cao), Herba Scutellariae Barbatae (Ban Zhi Lian), Radix Sophorae Subprostratae (Shan Dou Gen), Bulbus Shancigu (Shan Ci Gu), Flos Lonicerae Japonicae (Jin Yin Hua), Flos Chrysanthemi Indici Main symptoms: Fever which does not resolve after sweating, dizziness, generalized heaviness, abdominal distension, torpid intake, sloppy and thin stools, aching and painful joints, yellow urination, a red tongue with yellow and slimy fur, and a slippery and rapid pulse.
Treatment principles: Clear heat and disinhibit dampness, transform turbidity and resolve toxins Liu Jun Zi Tang Jia Jian (Modified Six Gentlmen Decoction) Radix Panacis Ginseng (Ren Shen), Sclerotium Poriae Cocos (Fu Ling), Rhizoma Atractylodis Macrocephalae (Bai Zhu), Radix Glycyrrhizae (Gan Cao), Rhizoma Alismatis (Ze Xie), Sclerotium Polypori Umbellati (Zhu Ling) fortify the spleen and disinhibit dampness. Pericarpium Citri Reticulatae (Chen Pi) and Rhizoma Pinelliae Ternatae (Ban Xia) rectify the qi and harmonize the stomach. Radix Bupleuri (Chai Hu), Radix Scutellariae Baicalensis (Huang Qin), Radix Gentianae Scabrae (Long Dan Cao), Fructus Gardeniae Jasminoidis (Zhi Zi), and Herba Oldnelandiae Diffusae (Bai Hua She She Cao) clear heat and resolve toxins.
One can further add the anti-cancerous medicinals Fructus Trichosanthis Kirlowii (Gua Luo), Rhizoma Arisaematis (Nan Xing), and Rhizoma Dioscoreae Bulbiferae (Huang Yao Zi) to transform phlegm and Main symptoms: Fatigued spirit, lack of strength, fear of cold, cold limbs, aching and limp low back and knees, shortage of qi, laziness to speak, reduced appetite, sloppy stools, concretions and accumulations, scrofula,bright white facial complexion, enlarged tongue with white and slippery fur, and a deep and fine pulse.
Treatment principles: Warm and boost kidney yang, move stasis and dissipate nodulation.
You Gui Wan Jia Jian (Modified Restore the Right Pill) Prepared Radix Rehmanniae (Shu Di), Rhizoma Dioscoreae Oppositae (Shan Yao), Fructus Corni Officinalis (Shan Zhu You), Sclerotium Poriae Cocos (Fu Ling), Cortex Moutan Radicis (Mu Dan Pi), Cortex Eucommiae Ulmoides (Du Zhong), Fructus Psoraelae (Bu Gu Zhi), Semen Cuscutae Chinensis (Tu Si Zi), Radix Lateralis Praeparatus Aconiti Carmichaeli (Fu Zi), Radix Morindae Officinalis (Ba Ji Tian), and Herba Cistanches Deserticolae (Rou Cong Rong) warm and supplement kidney yang. Semen Myristicae Fragrantis (Rou Dou Kou), Fructus Amomi Tsao-ko (Cao Guo Ren), and Fructus Amomi (Sha Ren) fortify the spleen and harmonize the stomach. Rhizoma Curcumae Zedoariae (San Leng) and Rhizoma Sparganii (E Zhu)move depression and dissipate nodulations. Pulvis Indigonis (Qing Dai) and Radix Scutellariae Barbatae (Ban Zhi Lian) are anti-cancerous medicinals which also clear heat and resolve toxins.
[1] Blue Poppy Press, Boulder, CO, 2000, p. 160 - 174.
[2] Appeared first in the Journal of Chinese Medicine?s October 01 edition.
[3] Zhong Yi Xue Ye Bing Xue (Study of Chinese Medical Hematology), Sun Wei-zheng et al., eds., National Chinese Medicine Science and Technology Publishing House, Beijing, 2000.
[4] Ibid., p. 104-112.

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