十二、白血病 Leukemia

2014/9/3 初診， 某，女，50歲

ALL（急性淋巴細胞白血病）化療後難受異常要求出院。出院第二天應診，神疲、面黃、惡心、嘔吐、納呆，難寐、腳冷，手可。無脾腫大、體溫：下午會有低熱，平日可。

發病前無胸悶、氣短。更年期、經血多、用西藥止住。以前有婦科病：子宮肌瘤、做腎囊腫手術時血象正常，此後很快發現白血球低。診斷為T細胞白血病，急性。

白細胞0.9、血壓：146/90、84；體溫36.4度，平日下午晚上低熱38度左右。不喜冷飲，但想吃涼東西。納呆甚。

刻診：小腹痛、自稱是婦科問題。小便不通。病前換季發病，曾有胃潰瘍。不堪化療反應，自願出院。病容面色，有照。極度衰弱感覺。喝水即吐。

脈象：左：寸關浮大、尺沈數；右：寸關：沈大、尺：沈大。舌尖瘦，難出；唇紅。有照。尿少。出院時血小板正常，白細胞有所下降，正在服藥8項藥：針對染色體變異。

印象：寒熱夾雜，上下不通，關格，中州不轉，陽不下降，則郁而發熱，不納水谷；

治則：溫脾腎、散胸中郁熱、溫胃寒

藥後第5天，從5樓自己下來到院子裏散步，

2014.9.5號早查：中粒比率70%、淋巴細胞：0.2、中粒細胞0.7。藥後納稍好。可順利服藥。

2014/9/6神好、納轉好，達到正常食量50%，頭頂痛減，小腹隱痛十分困擾，舌紅、苔白膩，難寐，須服安眠藥。手腳麻木。血壓：116/69、105;117/68、97。 脈細數，較前緩和。屬於正脈。氣血虛之脈。

2014.9.11脈浮數，血壓：121/74,116;115/65,116。白細胞1.6， 先前0.9。 9.13. 下午去徐府，低燒37.6-37.3。血壓：心率：98，

2014.9.15 電告9.13日血象已經正常了。體溫正常，隨停服中藥。

小結：ALL（急性淋巴細胞白血病）是相對比較容易治療的一種。中醫認為是氣血大虛、陰液極虧而致虛火耗煉真陰所致。直補氣血滋陰清虛熱，結合他證治療，一般可以得到明顯緩解，乃至臨床治愈。筆者一般不建議驟停西藥，但化療似不可取。投鼠忌器，恐其直接傷耗正氣所需血液病最寶貴的津液。津液乃血液之母，津液一傷，加之食少，化源枯竭，何以生血？所以，此病化療，第一個癥狀就是惡心、嘔吐，納呆，脾胃大傷。雖一時有血象減輕，但因傷及脾胃，化源減少，很快出現惡兆。中醫治療當補脾胃，進食為第一要務。其他隨癥治療。



Female 50, Sep 3, 2014

ALL (acute lymphoblastic leukemia).  Felt so sick after Chemotherapy and chose voluntarily discharged from hospital. Home visit on the 2nd day.

Current: sitting in bed, very tiresome look. yellowish pale, nocuous, omitted, no appetite, sleeplessness, cold feet, hands ok, no spleen swell. high body temperature pm.

Before hospitalization, no stiffness in chest, and short of breath. BMS, heavy blood controlled by drugs. Blood test was normal before surgery removing cyst on kidney. Uterine fibroids. Diagnosed ATL (Adult T-cell Leukemia). 

WBC 0.9, BP" 146、90, Pulse 84, Temperature 36.4 (97.5°）. Afternoon temperature 38° （100.4°）. prefer to drink cold water but would throw up after drinking water. Lower tummy pain (symptoms of gynecology). very difficult to pee. 

Impression: mixture of heat and coldness, that blocked the passway of Qi

Principle: warm up spleen and kidney and dispel the stuffed heat

Too weak to take acupuncture, herbal therapy only

The fifth day, the patient came down from 5th story high apartment and took a walk in the garden.

Sep 5, neutrophile granulocyte 70%, Lympo:0.2,

neutrophile granulocyte 0.7.  No throw ups when drinking water.

Sep 6, looked very healthy, better appetite, could eat 50% as before. headache eased. cold not sleep, BP: 116/69, pulse 105.

Sep 11 BP 121/74, pulse 116, WBC 1.6,

Sep 13 temperature 37.3° (99.14°）.

Sep 15. called and said blood test has been normal and no fever. stopped taking herbs.

Note:

The patient had given up hope in WM treatment. And she took herbs for her son who invited me. She didn't believe herbs would help her blood disease, only expected to improve her female disease, urination and nausea. I didn’t think she would stop taking herbs right after her blood test was back to normal. To me, she still needs a long-time care with herbal therapy, to improve her body constitution.

I would not say the disease would not come back. But she would certainly survive quite a while if she kept taking herbs