Chronic Myelogenous Leukemia

also see APL

by: Joe Hing Kwok Chu        按此看中文

Treatment of Chronic Myelogenous Leukemia (CML) 

There are many formulae being used in cancer therapy in Traditional Chinese Medicine (TCM). The formula "Qing Huang San" is one of the popular formulae used by many modern hospitals because of its simplicity. Practitioners trained in modern medicine find it easy to understand.

Name of Formula: qing huang san 青黃散方

(Available in pre-manufactured form)

Prescription:

Mix two herbs-- qing dai,  and xiong huang--at the ratio of 9:1.

Grind them into fine powder. Load the powder into capsules. 

Dosage:

For inducing remission of chronic myelogenous leukemia:

take 6 to 14 g per day, divided into three servings and taken after meals.

For maintenance of remission of chronic myelogenous leukemia:

 take 3 to 6 g per day, divided into two or three servings and taken after meals.

Adjustments of Formula:

Adjust the formula according to the syndrome.

With obvious xue yu (blood clots), add ge xia zhu yu tang.

With qixu and xue xu (blood deficient), add ba zhen tang.

With piyangxu, add xiao jian zhong tang.

Effectiveness:

The clinical effectiveness of using this formula in conjunction with chemotherapy

has been documented by Zhou Ai Xiang at the Xi Yuan Hospital, part of the

Beijing Chinese Medicine Research Institute as follows:

Total patients: 25

Complete remission: 18 (72%)

Partial remission: 7 (28%)

Typically, after 10.1 days, the size of the spleen started to shrink. In 11.4 days,

the symptoms had either subsided or disappeared.

Active Ingredients:

The active ingredients of qing dai are ding yu hong (indirubin) and

ding lan (indigo, indigotin).

The chemical formulae of indirubin and indigotin are the same but the structures are different.  Indigotin does not possess the anti- cancer characteristics. The structure of indirubin deserves further study.

The active ingredient of xiong huang (realgar) is arsenic sulfide (As₂S₃).

Calcination of xiong huang can change the substance into highly toxic arsenic trioxide. (As₂O₃)

Explanation as to Efficacy:

Traditional Chinese Medicine (TCM) theory maintains that leukemia is caused by toxic yu

(obstruction in the blood), obstructing the organ (zang fu), the channels (jing luo),

and the bone marrow. If the toxic yu  is not expelled, new blood will not be produced.

The use of these two herbs--qing dai and  xiong huang--as directed above and in

conjunction with chemotherapy, can achieve the goals of ridding of  yu  and

promoting new blood.

Side Effects:

Possible side effects of this formula include nausea, stomach and solar plexus

discomfort, diarrhea, and perhaps blood in the stool (caused by bleeding in the

digestive tract) due to the cold characteristics of the herb qing dai

Note: In patients who are yinxu (yin deficient) with real heat,  use caution and monitor closely.

Background of arsenic in cancer therapy

Arsenic trioxide (As₂O₃) Therapy

The use of arsenic trioxide has a long history. Some classical formulae are found in writings dated back to the Han dynasty (more than two thousand years). The use of arsenic in modern clinic applications is much earlier than the use of ATRA.  As early as 1972 in mainland China, arsenic trioxide was being used in myelocytic leukemia. The result was reported in Chinese journals ^[1] that 22 patients out of 81 were completely in remission, 7 of M₂ and 15 of M₃. The substance used was extract of arsenic: As₂O₃ 1mg/ml and HgCl 0.01mg/ml. The result was that the Auer rods of promyelocyte gradually disappeared or shrunk. Later it was found that it was especially effective for APL. Subsequently the results were published in various Chinese journals. ^[2,3]  The common discovery was that the remission rates were 60 ~ 70%, regardless of if they were first- time patients or refractory patients, or recurring after ATRA or chemotherapy. Later it was discovered that excluding HgCl or just taking arsenic sulfide could achieve the same result. During the 90's the understanding of the apoptosis of cells, the transformation of bone marrow cells and peripheral blood led to the understanding of the function of arsenic trioxide that causes the apoptosis of cells leading to the cure of APL. The side effects include nausea, vomiting, lack of appetite, diarrhea, numbness in the extremities of limbs, edema in the lower limbs, settlement of skin pigments, abnormal function of the liver. Later, in vitro experiments also proved that arsenic trioxide also can cause apoptosis of cells, especially promyelocytes.

It is deemed that the first scientific report was written by Hong De Sun (孫洪德) et al of Harbin city, China, in 1992. Thirty- two patients with acute promyelocytic leukemia were treated with arsenic trioxide in combination with traditional Chinese medical diagnostics and therapy methods. The results: total remission was 65.6% (21 patients out of 32). 50% survived more than 5 years and 18.8% survived more than 10 years.

In 1995, Shi lin Huang (黃世林) ^[2] of Da Lian city, China, reported using a formula of qing dai (indigo) and xiong huang (realgar) as main Chinese herb treating 60 APL patients and resulted 98.3% with total remission. The ingredients of xiong huang are As₂S₃ and As₄S₄ and a small amount of As₂O₃. Before that there were reports of using the formula called "niu huang jie du pian" (also containing xiong huang) or just using xiong huang (realgar) by itself to treat APL The above shows that arsenic compounds are effective in treating APL.

A scientific report on using arsenic trioxide therapy was published by "Chinese Hematology Journal" (中華血液學雜誌) in 1996. It reported using arsenic trioxide therapy on 72 new patients and also on refractory patients. The complete remission rate on the new patients was 73.3% and  on refractory patients was 52.3% .

Note: In nature 95% of arsenic exists as As₂O₃. Its lethal dosage is 1 - 2.5 mg/kg according to the Information Toxic Chemicals Section of the Environmental Protection Agency of Republic of China in Taiwan.  In prescription, it is suggested not to exceed 0.1g.

According to a Chinese classics, "Ben Cao Gang Mu" (本草綱目) the antidote  for arsenic is to use mung bean (Phaseolus aureus Roxb) soaked overnight with cold water (for oral consumption) or use goat blood.

Caution:

There are opinions that do not use xiong huang if the white cell count is low.

According to recent research, most of the herb qing dai sold in the herb stores in Taiwan area are mainly pigments and do not contain any effective ingredient. [3]

Editor note: This can happen anywhere. It is better to analyze the herb first before using.

Bibliography

[3] Tong Chen Fu, Head Pharmacist, Pharmacology Dpt, Taiwan, Zhang Yong Xun, Dpt Head of

Chinese Herb, Pharmacology Dpt, Taiwan, ROC.

Arsenic therapy:  see  APL

See commonly used Chinese herb formulae for leukemia.

Also see xiao jin dan therapy for CML

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