1.The basic situation of leukemia
Leukemia is a heterogeneous group of hematopoietic system malignancies, mainly hematopoietic stem cells and progenitor cells malignancy, leukemia cells lose the ability to further differentiate and mature, blocked in different stages, involving bone marrow, liver, and lymph nodes, resulting in reduced normal blood cell production, fever, anemia, bleeding, bone pain, and enlarged liver and spleen lymph nodes. Xiping Dai, Department of Hematology, Guangdong Provincial Hospital of Traditional Chinese Medicine
Leukemia is one of the ten most prevalent malignant tumors in China, with an incidence rate of 2.76/100,000 population. Acute leukemia is significantly more frequent than chronic, and there is a trend of increasing year by year, which has become a serious threat to people’s life and health. According to the degree of maturation of leukemia cells and the natural course of the disease, it is divided into two categories: acute and chronic. Acute leukemia can be divided into acute myeloid leukemia and acute lymphocytic leukemia, chronic leukemia mainly includes chronic granulocytic leukemia and chronic lymphocytic leukemia two categories.
2, leukemia health care principles and methods
(1) Prevention and avoidance of various causes of disease
It is currently believed that the onset of leukemia is related to physical, chemical, genetic and biological factors, the prevention of leukemia should avoid and prevent these factors. The first step is to strengthen labor protection and reduce close contact with rays and toxins. Certain chemical substances have the potential to cause leukemia, especially benzene and its derivatives can cause leukemia, so reduce exposure to benzene and inhalation in related industries such as in the shoe manufacturing industry. Some drugs such as chloramphenicol, bismorpholine, diketazin, etc. can cause leukemia, cytotoxic drugs such as alkylating agents can cause secondary leukemia, should try to avoid the use of these drugs that can cause leukemia to occur. In daily life, you should avoid living in newly renovated houses, reduce the use of hair dyes and cosmetics containing toxic chemicals, especially for those with allergies and skin lesions; you should breathe more fresh air and avoid contact with toxic gases, pesticides and pesticides. In addition, quit smoking and alcohol, cautious application of relevant drugs is also an effective measure to prevent leukemia. Secondly, we should strengthen environmental protection, control environmental pollution, strictly control the discharge of industrial “three wastes”, and control the leakage of toxic substances and radiation. Currently, the pathogenic role of viruses has become a hot spot for research, so proper exercise to improve resistance to disease and avoid viral infections is also an important factor in preventing the onset of leukemia. According to Chinese medicine, “where evil comes from, its qi must be deficient”. Heat-clearing and tonic herbs have advantages in antiviral treatment, so once a viral infection occurs, Chinese herbal medicine can be applied.
Some patients with certain blood diseases may eventually develop into leukemia. For example, true erythrocytosis, primary thrombocytosis, myelofibrosis, myelodysplastic syndrome, paroxysmal sleep hemoglobinuria, lymphoma, multiple myeloma, etc. The conversion rate increases especially if the disease is not better controlled, treated with cytotoxic drugs, or treated with immunosuppressive drugs. Also secondary leukemia after radiotherapy for solid tumors is increasing year by year, so actively controlling related diseases and trying to avoid excessive radiotherapy and chemotherapy, etc. are also effective measures to prevent the transformation of these diseases into leukemia.
During the interval between chemotherapy and the stabilization period, leukemia patients should exercise appropriately to activate the blood vessels, relax the muscles, enhance physical fitness and improve resistance to disease, as well as to promote digestive function and increase appetite. Under the condition of sufficient sleep and rest, you can take outdoor walks, brisk walks, jogging, or play Taijiquan, Badaanjin, etc., or raise flowers and plants at home and engage in light to moderate housework.
(2) Early detection, early diagnosis, early treatment, regular consolidation and reinforcement, and adherence to maintenance treatment to avoid recurrence of the disease
The main clinical manifestations of the disease are twofold. First, the normal bone marrow hematopoietic cells are reduced, resulting in a decrease in red blood cells, neutrophils, platelets, etc. Anemia, infection, and bleeding can occur. Anemia is generally orthocytic orthopigmented, and combined bleeding can cause microcytic anemia. Hemorrhage can occur throughout the body, with subcutaneous, oral, and nasal cavities being common, and fatal intracranial hemorrhage can also occur. Common infections are respiratory tract infections, with bacteria and fungi being the most common. One is abnormal proliferation of leukemic cells and infiltration of hematopoietic tissues, such as bone marrow, spleen, liver and lymph nodes, and can involve tissues throughout the body, causing bone pain and enlarged liver and spleen lymph nodes. In addition to the above organs, the skin and gums may be invaded in acute monocytic leukemia. In addition, leukemic cell infiltration can occur in the central nervous system, bones, joints, muscles, kidneys, testes, and ovaries. Restricted primitive granulocytic tumors, called granulocytic sarcomas or green tumors, may appear in bone, orbit, skin, and lymph nodes. Once the above clinical manifestations or signs are present, medical attention should be sought promptly to perform blood and bone marrow examinations to clarify the diagnosis as soon as possible and provide early treatment.
Currently, leukemia recurrence is an important factor affecting the long-term survival of patients. In addition to patient factors and disease factors, leukemia relapse is also closely related to the patient’s compliance with treatment. It is important to understand leukemia correctly, build up confidence and courage to overcome the disease, carry out relevant treatment on time, and have regular laboratory review to avoid disease relapse. Once relapsed, one should actively face it and undergo chemotherapy for relapse, etc. At present, there are more mature treatment guidelines and conventional treatment protocols for various leukemias. The general principle is the implementation of individualized treatment measures under the guidance of guidelines, and individualized treatment should be carried out in strict accordance with these guidelines and norms in order to receive better results and avoid relapse. In addition, the emergence of new therapies such as molecular targeted therapy, monotherapy, immunotherapy, etc. should be applied appropriately according to the patient’s condition, treatment situation and financial ability.
Chinese medicine is used to support the deficiency of Chinese medicine such as ginseng, astragalus, shouwu, Xianling spleen, tianmen dong, bone marrow, chasteberry, atractylodes, etc. Some detoxifying and anti-cancer Chinese medicine such as white flower and snake tongue herb, half astragalus, Qing Dai, arsenic preparation, etc. are used to further clear the remaining toxins and kill the residual evil toxins, which can mobilize the autoimmune surveillance system to destroy the residual leukemia cells. Thus, we can reduce the recurrence of leukemia and obtain long-term disease-free survival.
Of course, we should pay attention to strengthening propaganda and education to raise patients’ awareness of the disease, so that they can realize both the long-term nature and complexity of leukemia treatment and the necessity of adhering to post-remission treatment, and to build patients’ confidence in treatment, overcome psychological barriers, and spiritually overcome the disease.
(3) Strengthen supportive treatment, pay attention to protection, and avoid infection and bleeding
At the onset of leukemia or when the disease progresses and relapses, anemia, infection and bleeding can occur due to the reduction of normal bone marrow hematopoietic cells, resulting in impaired production of red blood cells, granulocytes and platelets. Leukemia itself is a wasting tumor disease, and during treatment, chemotherapy and hematopoietic stem cell transplantation seriously affect the bone marrow hematopoietic function, body immunity, diet and nutrition of patients, which can easily lead to various infections and aggravate anemia and thrombocytopenia. Therefore, supportive therapy occupies a very important position and can be said to be the basis of leukemia treatment. Supportive therapy should be actively strengthened by paying attention to the prevention and control of infection and bleeding, correcting anemia, strengthening nutritional support, and applying immune enhancers to improve immunity when necessary.
Acute leukemia during induction chemotherapy, or during high-dose consolidation and intensification, or after radiotherapy pretreatment before hematopoietic stem cell transplantation, the bone marrow is severely depressed, and many conditional pathogenic bacteria can cause fatal infections, which are different from normal population infections in many ways due to granulocyte deficiency and low immunity: ① pathogenic bacteria and foci of infection are often unclear, and local foci are not easily formed; ② early diagnosis is difficult, the disease is aggressive and (3) the infection is easy to spread, with a high incidence of serious infections such as sepsis and severe pneumonia; (4) mixed infections are common, and can be a variety of bacterial infections, but also mixed infections of bacteria, fungi, viruses, etc.; (5) most of the infections are nosocomial, with a high rate of drug resistance, and the effect of conventional antibacterial therapy is poor; (6) the route of infection is mostly due to the reignition of potential infections in the body.
As the manifestation of infection is atypical in leukemic immunocompromised, fever is often the only manifestation. When non-infectious fever factors such as metabolic fever, drug fever and transfusion reaction in leukemia are excluded, fever without any explanation, temperature greater than 38 degrees and lasting for more than two hours can be clinically diagnosed as infectious fever. While actively looking for the basis of infection such as blood sedimentation, C-reactive protein, relevant body fluid culture and pulmonary imaging, the characteristics of blood disease infection, infection site, ward should be investigated as soon as possible based on Bacteriological surveillance information to speculate the possible causative organisms and apply anti-infective treatment. Generally, bacterial infections are considered first, followed by fungi, then viruses, and finally other specific infections such as tuberculosis, Pneumocystis, mycoplasma, chlamydia, etc. The distribution of pathogenic bacteria in hematopoietic stem cell transplantation infections is closely related to the time of transplantation, so the time after transplantation is also an important reference in differential diagnosis.
Recent data show that the majority of nosocomial infections in leukemia patients are still Gram-negative bacteria, accounting for about 50-70%, with Pseudomonas aeruginosa, Enterobacter, Klebsiella pneumoniae, Escherichia coli, Acinetobacter baumannii and Acinetobacter maltophilia taking the top six positions, and all of them are easily drug-resistant strains. The proportion of Gram-positive bacteria has increased, and the widespread use of intubation is one of the main reasons for this. The top three common ones include coagulase-negative Staphylococcus, Staphylococcus aureus and Enterococcus spp. Due to the bacterial selection pressure generated by the excessive application of third-generation cephalosporins, the detection rate of pathogenic bacteria that were rare in the past, such as Stenotrophomonas maltophilia and Bacillus immobilis spp. increased, and the ESBL-producing flora showed a significant increase in multidrug resistance. In addition, the emergence of AmpC enzyme-producing drug-resistant bacteria and vancomycin-resistant enterococci has added to the enormity of anti-infection.
It is now recognized that leukemic patients are immunocompromised and that prophylactic anti-infective therapy is necessary in certain special circumstances, especially in recipients with chronic granulocyte deficiency or in granulocyte deficiency receiving hematopoietic stem cell transplantation. Severe infections should be treated promptly with empirical therapy, followed by targeted therapy with adjustments in therapy based on culture results such as body fluids. For those with poor anti-infective treatment, attention should be paid to insufficient antibiotic concentration, lesions not incised and drained, pathogenic bacteria resistance, secondary infection, and low immunity of the patient, and timely measures should be taken to deal with them.
Patients with anemia and low platelets should be transfused with red blood cells and platelets as appropriate to correct anemia and bleeding, to supplement nutrition, to maintain water-salt-acid-base balance, and to hydrate and alkalize during chemotherapy to ensure targeted treatment.
Specific prevention of infection and bleeding can be performed with reference to the section on leukopenia and granulocyte deficiency and the section on idiopathic thrombocytopenia.
(4) Spiritual life conditioning
Leukemia should treat their condition correctly, avoid mental stimulation, and cooperate with medical personnel for active treatment. Establish confidence in overcoming the disease, and strengthen fitness activities appropriately during the remission period to continuously improve the ability to resist disease and reduce relapse to healing. Prevention in Chinese medicine includes prevention before the disease and prevention of changes in the disease. It is advisable to defend against poisonous evil, avoiding heat, warm poison, unclean water, contaminated and corrupt food, ionizing radiation and drug poisoning. Pay attention to environmental hygiene and adapt to environmental changes. Intrinsic mental and emotional factors have an important impact on the development of leukemia. The lack of sexual intercourse and excessive fatigue can deplete the essence, and damage to the righteousness of the evil is easy to invade. Therefore, moderate work and rest, restraint, regular living, in order to effectively prevent the occurrence of leukemia. Patients with leukemia should rest more, less strain, relax their emotions, reduce psychological burden and overcome pessimism, and actively cooperate with treatment, which has positive significance for the prognosis of the disease.
During the treatment of leukemia, you should maintain emotional stability, optimism, so that the body in a good state, as the so-called: “positive energy within, evil can not dry, the spirit of internal control, the disease is safe from”.
(5) Dietary regimen
Leukemia patients should eat a light and high calorie, high protein, high vitamin high nutrition diet, such as fresh milk, eggs, lean pork. But should not eat leeks, garlic, onions. Eat less cold, fried, fatty products, more fresh fruits and vegetables, less pickles, smoked meat, fish, etc. Do not smoke and drink less. Fruits and vegetables must be washed repeatedly. According to the condition, food therapy can be used to regulate, such as longan lotus seed porridge, anti-white drink, astragalus wu chicken soup.
In chemotherapy, avoid eating fatty, sweet, thick, cold and spicy food, and prefer to eat light and easily digestible food. After clinical remission, medicinal dietary therapy often focuses on nourishing the spleen and kidneys, and the diet can include eggs, pork ribs, carp soup and pork belly to enhance nutrition and improve resistance to disease. In response to the various clinical manifestations of leukemia, foods that help to combat anemia, bleeding, reduce fever, and eliminate swollen lymph nodes are used. Anti-anemia available pig liver, mushrooms, sesame, bee milk, yellow fish, peanuts, sea cucumber, abalone, shark fin, etc.; anti-hemorrhage available shark, fungus, mushrooms, mushrooms, grapes, lotus root, capers, etc.; fever available tempeh, white onion, dry winter tea, white fruit, plum, green beans, garlic, turtle, nori, etc.; swollen lymph nodes available taro, lychee, goat maw, oyster, clam, lily, water chestnut, jellyfish, etc.
(1) chemotherapy during dietary therapy
(1) Timothy Marrow Anti-Chemistry Drink. 30g of deer blood or chicken blood, 60g of asparagus, cooked together and served at any time, with the function of benefiting blood and filling marrow. It is suitable for bone marrow suppression caused by chemotherapy, and the essence of blood is not produced.
② Stomach harmonizing and chemopreventive soup. 1 carp, 30g of pecan clips, appropriate amount of onion and ginger. Cook together with extreme crispness and serve with meals. This formula of rabbit meat has the function of tonifying the middle and benefiting the qi, cooling the blood and detoxifying the toxin. It is suitable for chemotherapy-induced gastrointestinal discomfort such as nausea, nausea, vomiting, etc.
(2) Antipyretic food therapy formula.
①Earth bark dew. Ground bone bark 60g, steamed dew to drink. It has the function of cooling the blood and reducing steam, and clearing lung heat. This product is especially suitable for people with Yin deficiency and deficiency heat.
②Artemisia dew. Artemisia annua 60-120g. Steamed and taken as a dew, regardless of the time of day. It is especially suitable for people with Yin deficiency and heat.
(③) Coronaria jellyfish. Add jellyfish, sesame oil and soy sauce. The actual fact is that you will be able to get a lot more than just a few of these. This is a great way to get the most out of your life.
(3) Anti-anemia diet
①Mushrooms in Portuguese sauce. Mushrooms, magnolia slices, a number of shrimp, seasoning, and grape juice. All the products with seasoning fried, into the grape juice can be taken. This formula has the function of benefiting qi and replenishing blood. It is suitable for those who are anemic after chemotherapy.
②Ginseng and Astragalus Wu Chicken. Radix et Rhizoma Ginseng 15g, Radix Astragali 15g, and 1 black-boned chicken (giblets removed). Ginseng and astragalus are stuffed into the chicken and stewed. The Materia Medica Tongxuan says that the chicken “replenishes yin and reduces fever”, and the Materia Medica Compendium says that the chicken can “replenish weakness of deficiency”.
(3) Sea cucumber and yellow fish. Several sea cucumbers, 1 yellow fish and several seasonings. Cook the soup. In this formula, sea cucumber nourishes the kidney and essence, nourishes blood and moistens dryness; yellow fish benefits the spleen and stomach and the five viscera, which is an effective anti-anemia dietary therapy.
(4) Dietary therapy to stop bleeding
① Fish bladder and lotus root powder. 10g of fish bladder, 60g of lotus root powder, mixed with paste to eat. In this formula, fish bladder tonifies the kidney and benefits the essence, stops bleeding and disperses blood stasis; root powder benefits the blood and stops bleeding.
②Peanut of Radix Rehmanniae. 30g of Cyperus roots, 100g of peanuts. cooked with Cyperus, remove Cyperus and eat peanuts. In recent years, it is believed that peanut coat can reduce bleeding, and its mechanism of action may be similar to that of antifibrinolytic drugs. This product has a cooling effect on blood to stop bleeding.
③ Fava bean flower dew. Fava bean flowers 100g. Steamed and eaten. Hunan Medicine” said fava beans have “hemostatic” function (G6PD deficiency patients should not be).
(5) anti-leukemia diet
(1) Staghorn egg, 3g of staghorn, 2 eggs. Boil them together, remove the shells and eat the eggs. Male yolk can detoxify and dispel putrefaction. Toxic, pregnant women should not take, avoid fire calcination, should not be used continuously for a long time.
②Toadstool Carp. 2 toads, a number of lean pork, 2 tails of carp, a number of seasonings. Toad washed and gutted, mixed with lean pork, stuffed into the belly of the fish, add material steamed that is.
③ Toad boiled eggs. 1 toad, 1 egg. Wash the toad, cut open the abdominal wall, put in the egg, sew up the abdominal wall, add about 300ml of water, boil for 30-40 minutes, and then eat the egg. It is reported that one case of acute granulation was treated with one egg per day and was relieved by taking it for 7 days, and the remission period was 1 year and 8 months.
④Pig’s spleen powder. Equal parts of pig spleen and wild lily. The above products are mixed, dried and powdered, and packed into capsules of 0.25g each, with 3 capsules per serving. This product is detoxifying and anti-cancer.
⑤ Six gods bean and date soup. 5 red dates, 30g of adzuki beans, 30g of black beans, 25g of brown sugar, and 40 capsules of Six Gods Pill. Take red lentils, black beans and red dates, boil the soup and mix with brown sugar, then take Six Gods Pills. Take 1 dose daily in 3 doses.
(6) Yellow root and pork bone soup. Yellow root 50g, pig bone l200g, the above two flavors to water decoction, daily l dose divided into 4 times to take.
(6) Anti-lymph node enlargement dietary therapy formula
Carrot and chicken porridge: 50g of taro and several chicken juice. It is said in the “Food and Drink Manual” that taro “can be used to disperse scrofula”. The “Lingnan Caiyao Lu” also has the record that taro can cure children’s scrofula and deficiency scrofula.
(6) Medication
According to the patient’s evidence, Ginseng and Mai San is used for the type of Qi and Yin deficiency, Guei Spleen Pill is used for the type of Qi and Blood deficiency, Yi Qing Soft Capsule is used for the type of internal heat and toxicity, and Dissolve Scrofula Pill is used for the type of phlegm and stasis.
According to the actual situation of the patient, single prescriptions can be used, such as Anti-Bai Dan, Qing Huang San, Sheng Sheng Tang, Baicalin and Gentian Pills, etc. to regulate.
1. Anti-Bai Dan 4-8 pills each time, 3 times a day. Effects: Killing worms and detoxifying toxins, breaking up stagnation and removing blood stasis. It is suitable for acute non-lymphocytic leukemia with interlocking phlegm and blood stasis.
2. White Blood Kang 5-10 tablets each time, 3 times a day. Effects: Clearing heat and cooling the blood, detoxifying and anti-cancer. It is suitable for acute promyelocytic leukemia of heat toxicity type.
3. Liushen Pill 10-30 capsules each time, 3 times daily. Effects: Clearing and cooling the blood, detoxifying and anti-cancer. For acute non-lymphoblastic leukemia with internal stasis and toxicity.
4. Zhenqi Fuzheng Punch 1～2 sachets each time, 3 times a day. Effects: Benefiting Qi and nourishing Yin. For acute leukemia with bone marrow suppression after chemotherapy, manifesting as deficiency of both qi and yin.
5. Jian spleen and kidney punch 1~2 sachets each time, 3 times a day. Effects: Strengthening the spleen, benefiting the kidney, and helping the righteousness. For acute leukemia post-chemotherapy bone marrow suppression, manifesting as two deficiencies of spleen and kidney.
6. plum blossom point snake dan 2-3 capsules each time, 3 times a day. Effects: Clearing heat and detoxifying, relieving swelling in the throat. For acute non-lymphocytic leukemia with internal stasis and toxicity.
7. Qingkailing Oral Liquid 10-20ml per time, 3 times a day. Effects: Clearing heat and detoxifying, opening the orifices and awakening the mind. It is used for acute leukemia in which heat and toxin are incandescent and dizzy.
8. Arsenious acid injection 5-10mg per time, once a day, for 28 days as a course of treatment. For the treatment of acute promyelocytic leukemia.
9. Chuanxiongzin Injection 80～160mg once a day for prevention and reversal of multidrug resistance in leukemia.
(7) Single prescriptions
1.Toad wine 1 toad (each weighing 125g), 1500ml of yellow wine, clean the toad by dissecting the abdomen and removing the internal organs, put the toad and the yellow wine into a porcelain jar, close it, put it in an aluminum pot and steam it with water for 2 hours, then filter the liquid. Take 3 times a day, 15-30ml for adults and less for children, after meals. Generally take the medicine for 15 days, with an interval of 15 days. Take the medicine continuously until the symptoms are completely relieved, and then maintain the remission treatment. Effects: Detoxification and dispersion. Indications: Acute lymphoblastic leukemia, stasis and toxicity.
2. Gecko Gecko appropriate amount, roasted and powdered into powder. Each 2 to 3, divided into 3 times a day, served with boiling water. Effects: Detoxification and dispersion. Indications: Acute lymphoblastic leukemia, stasis and toxicity intertwined type.
3. Yellow croaker white (i.e. white in the belly of yellow croaker) in appropriate amount, roast yellow croaker white, and grind it into fine powder for internal consumption, 3g each time, 3 times a day. Efficacy: It is a great tonic for vital energy and regulates qi and blood. Indications: Acute granulocytic leukemia with deficiency of both qi and blood.
4. Radix Angelicae Sinensis Tang: 3g of Radix Angelicae Sinensis, 15g of Radix Astragali, 3g of Radix Panax Ginseng, 6g each of Morus Alba and Rhizoma Polygonati. 1 dose daily with water, divided into 2 doses. Effects: Benefiting Qi, replenishing blood, activating blood circulation and resolving blood stasis. Indications: Acute granulocytic leukemia with Qi and Blood deficiency and blood stasis.
5. Sheep’s Foot Root Soup Sheep’s foot root 60g, bitter ginseng 60g. decoction in water for 15-20 minutes, decoction of 2 juices, decoction into 200ml for internal use, 1 dose daily, divided into 2 doses. Effects: Fostering anti-cancer, relieving dampness and detoxification. Indications: Acute leukemia with internal dampness and heat.
6. Rhinoceros Horn and Dihuang Tang: 1.5g of rhinoceros horn (30g of water hyacinth), 30g of raw dihuang, 12g of peony, 9g of peony bark. decoction. 1 dose daily, divided into 2 doses. Effects: Cooling the blood to stop bleeding. Indications: Acute leukemia with high fever, epistaxis, blood in stool, delirium, irritability and other types of heat entering the blood.
7. Pig Spleen and Lily Pill: 1.5g of pig spleen (dried and grinded) and 1.5g of wild lily powder. Take 2 to 3 capsules 3 times daily. Efficacy: Nourishing Yin and helping to fight cancer. Indications: Acute leukemia with deficiency of both qi and yin.
8. Three Herbs Pill: 30g of Verbascum, 30g of Cyperus, 30g of Sunflower, 15g of Xia Gu Cao, decocted and concentrated into a paste, and made into small pills. Take 3 times daily, 6 pills each time. Efficacy: Clearing heat and detoxifying, reducing swelling and anti-cancer. Indications: Acute leukemia with heat and toxicity.
9. 200g of fresh or 75g of dried whole herb decocted with prednisone, 30mg/d. After 20 days of improvement, stop taking prednisone after 1 month and continue to take lacquer herb, after 6 months, change to 100g of fresh or 30g of dried whole herb daily.