Source: Please search "Digital Library of China Hospital-Development History and Current Situation of Childhood Leukemia", which is electronic material and needs special software, but I didn't download it.
1, the name of leukemia
Leukemia is named because the abnormal cells in blood are white blood cells, not because blood becomes white blood cells. This is because the main component of human blood is red blood cells, which are composed of red hemoglobin. The number of red blood cells in human blood is 500 to 1000 times that of white blood cells. Even if the white blood cells are abnormally increased by several times or dozens of times, the red color of blood cannot be changed.
Leukemia was discovered and named in a short time. /kloc-in the middle of 0/9th century, with the progress of microscope technology, medical scientists have a further understanding of leukemia. At first, French doctor Donet observed that some patients had unexplained anemia, laziness, burnout, fever, gingival and subcutaneous bleeding, hepatosplenomegaly and lymphadenopathy, and found a large number of colorless cell clusters in their blood. As these patients get weaker and weaker, they will all die soon. At that time, people didn't realize what kind of disease it was.
Influenced by the dominant clinical school in France at that time, Donet and others did not conduct further research and discussion on the basis of clinical observation. By 1847, British physician Bennitt and German physician Wilshaw pointed out almost at the same time that the abnormal proliferation of white blood cells and their immature cells in blood is a blood disease. At that time, Wilshaw called it leukemia and Bennett called it leukocytosis. ?
After graduating from the Medical College of Edinburgh University, Bennitt worked for two years under the guidance of the famous French doctor Donet. During this period, he noticed that Donet was deeply studying the infinite proliferation of white blood cells in hematopoietic cells. After returning home, he also conducted in-depth research and clearly pointed out that this is a special disease. However, when explaining the source of white blood cells, he mistakenly thought that it came from concentrated blood cells, while German medical scientist Wilshaw correctly pointed out that the direct cause of leukemia was the infinite increase of white blood cells during hematopoiesis.
2. Modern medical knowledge of leukemia:
Modern medicine has been able to clearly understand and explain leukemia. In fact, leukemia is not a single disease, but a disease, which means there are many kinds of leukemia. Vianshaw pointed out at that time that there are at least two kinds of leukemia, one is splenomegaly and the other is lymphadenopathy; /kloc-at the end of 0/9, German doctor Ebstein divided leukemia into acute and chronic types. In the 20th century, medical scientists had a deeper understanding of leukemia, and thought that leukemia was a malignant proliferative disease caused by abnormal proliferation and differentiation of hematopoietic cells, which not only affected bone marrow and the whole hematopoietic system, but also invaded other organs of the body. The main manifestations are anemia, skin, gums, nasal bleeding, hematochezia, hematuria, repeated infection, and the corresponding symptoms caused by leukemia cells infiltrating into various tissues and organs. For example, infiltration into the skin can lead to nodules and lumps; If it penetrates into the central nervous system, it will cause headache, vomiting and blurred vision; Infiltration into spleen, liver and ointment pills will cause swelling and so on.
3. Discovery and naming of human T-lymphocyte leukemia virus
In the early 1980s, Gallo laboratory in the United States and Miyoshi laboratory in Japan respectively isolated a retrovirus from T cells cultured in peripheral blood of adult T-lymphoblastic leukemia (ATL). In 1982, Kalyanaraman of Japan reported a patient with T-cell variant polychromatic erythroleukemia whose serum was cross-reactive. 1983 At the conference of T-cell leukemia virus held in Cold Spring Harbor, USA, the former was named human T-cell leukemia virus 1 (HTLV- 1), and the latter was named HTLV-2.
4. Records of leukemia in TCM
"Su Wen Yin and Yang should be like a big theory": "The shape is insufficient, and the temperature is the reason; Insufficient essence makes it taste. "
"On the Etiology of Diseases and Symptoms of Deficiency": "The husband who is tired also suffers from five pains, six poles and seven injuries.
"Qian Jin Fang Yao Volume 12 Hematemesis": "Rhinoceros horn Dihuang decoction is a prescription for treating typhoid and febrile diseases, those who should sweat without storing blood, those who vomit blood, those who have blood stasis, yellow face, black stool and blood stasis."
"Jing Yue Quan Shu Miscellaneous Syndrome Mo Xu": "All the causes of deficiency are as before, nothing more than wine, labor, seven emotions and diet." "Deficiency of this disease is different from metamorphosis. Because of five injuries and seven injuries, there is a camp to hide a house. However, in short, people live on it, but this essence, and illness is a deficiency, but this essence. Qi deficiency means yang deficiency; Those who are deficient in essence also lose yin. "
"Jing Yue Quan Shu Miscellaneous Evidence Don't Accumulate": "The accumulated treatments are like clouds, and they are also exhausted. But if you want to have it all the time, there are only four ways, attack, eliminate, disperse and make up. "
"Medical Sect Must Read Abolish Work": "A wife's deficiency does not return to gas, that is, to blood. There are five hidden houses and six houses, so it is impossible to be outside. Those who take the spleen and kidney alone, water is the yuan of all things, and soil is the mother of all things. The two are safe and harmonious, and all diseases are cured. "
5. Look at leukemia from the perspective of traditional Chinese medicine
Leukemia is a malignant disease of the blood system with unknown causes. It is characterized by uncontrolled proliferation of white blood cells and their immature cells (leukemia cells) in bone marrow or other hematopoietic tissues, and infiltration of various tissues produces different symptoms. This disease has been known abroad since 1845. Although a century and a half have passed, the etiology has not been fully clarified, which may be related to heredity, virus infection and some physical and chemical factors (such as ionizing radiation, benzene, chloramphenicol and some pesticide poisoning). There is no specific medicine at home and abroad that can be completely cured. Western medicine uses combined chemotherapy to induce remission, but the toxic and side effects are obvious. Some data show that the mortality rate of leukemia in China is 3 ~ 4/65438+ 10,000, and the prognosis is poor.
There is no name of leukemia in Chinese medicine, but similar symptoms have been recorded in some medical books of past dynasties. Like synopsis of the golden chamber? "Five labors are extremely thin" described in "Blood Stasis and Fatigue Disease" and "Urgent labor" described in "The Old Gate of Lu Xu, the Emperor of Shengjizong". With the development of the disease, it can gradually form an "accident". Therefore, leukemia can be classified as "exhaustion", "acute fatigue", "lump" and "phlegm core" in traditional Chinese medicine.
Modern Chinese medicine has been used to treat acute leukemia since about 1955. From then on, until the 1960s, it was the primary stage for China to study leukemia with traditional medicine and integrated traditional Chinese and western medicine. There are only 23 articles on clinical data and theoretical discussion in this period, and most of them are case-based treatment experiences. Most of the clinical experience was mainly accumulated in the 1970s and 1980s. In the mid-1970s, indirubin and harringtonine extracted from traditional Chinese medicine were proved to be effective in the treatment of leukemia, which was found in China, suggesting that the development and application of traditional Chinese medicine had broad prospects for the treatment of leukemia. 1980s, the number of reported cases continued to increase. Gundam 1990, there are nearly 200 articles published in domestic journals (including more than 50 cases and less than 5 cases). According to rough statistics, the total number of reported cases is 3000, which makes the research develop in depth. For example, the investigation of leukemia etiology and the discussion of traditional Chinese medicine have carried out various studies from different angles, such as cell dynamics, immunological indexes, animal experimental control treatment and the relationship between syndrome differentiation and hemogram, bone marrow, blood and urinary cyclic nucleotide, to explore the therapeutic mechanism of traditional Chinese medicine. Some people have systematically studied the pulse characteristics of 150 patients with acute leukemia, and think that the pulse changes have certain rules with the nature of the disease, the severity of pathogenic factors and the rise and fall of healthy qi, which further improves the systematicness and integrity of TCM diagnosis and treatment of leukemia. From the point of clinical application, Chinese medicine has two tendencies in treating leukemia:? It is precisely because of the known characteristics of Chinese medicine in treating leukemia, such as clear curative effect and small side effects, that Chinese medicine is the main treatment. Second, traditional Chinese medicine can adjust the advantages of the body and reduce the toxicity of chemotherapy drugs, supplemented by traditional Chinese medicine and western medicine. According to observation, the curative effect of integrated traditional Chinese and western medicine is generally better than that of traditional Chinese medicine or western medicine alone, so it is often used in clinic. In addition, there are some sporadic reports on the treatment of this disease with qigong, acupuncture and Chinese patent medicine.
Although we have accumulated a lot of experience in treating leukemia with traditional Chinese medicine, how to make the treatment plan and curative effect standard tend to be unified and stable, reduce the randomness of prescription medication and improve the curative effect of traditional Chinese medicine requires further clinical drug screening, effective component analysis and dosage form reform besides necessary literature research and summary.
Through 40 years of experience accumulation and etiological research, the etiology and pathogenesis of traditional Chinese medicine can be summarized as follows:
Deficiency of essence and qi, physical weakness or long-term partial eclipse, early marriage, fornication, multiple births and other factors lead to loss of essence and blood, damage of kidney qi, inability to lead bones to produce marrow, and essence and qi move to viscera, leading to deficiency of essence and weakness.
The evil of warming toxin lurks inside, invades the human body, the evil heat overflows, consumes qi and hurts blood, and the conflict between good and evil causes the middle kidney to hurt the marrow, which leads to the loss of yin and yang, and finally leads to the failure of yin and yang.
Too much and too little emotional injury caused by clearing qi can lead to qi stagnation, disharmony between qi and blood, and imbalance between yin and yang, thus reducing the body's ability to resist evil. In addition, emotional factors, as pathogenic factors, may cause secondary mental trauma to patients with leukemia who have been diagnosed, making their condition worse.
The pathogenesis of leukemia can be divided into three types: deficiency is deficiency, disease is deficiency, and excess and deficiency are mixed, especially the pathogenic factors of strain and warm toxicity, which can influence each other and cause and effect each other. In addition, poor blood supply and blood stasis are also the pathogenesis that cannot be ignored.
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1845 actinomycetes discovered by B.R.C.von. Bennett (J.H) first reported leukemia. Verjo (R.L.K.; In order to further describe leukemia, Wei Erxiao believes that thrombosis is the cause of sepsis.
Velpeau et al described the first case of leukemia in 1827. Bennett and Virchow reported leukemia as an independent disease in 1845. Virchow first defined leukemia in 1847, and then conducted a series of studies. 1856 leukemia is divided into two types: spleen type and lymphatic type. 1976 FAB collaboration group put forward the suggestion of morphological classification of acute leukemia, which marked the beginning of modern diagnosis and classification of acute leukemia. 180 for more than 80 years, after generations of hard exploration and bold innovation by many scholars, people's understanding of the etiology, classification and treatment of acute leukemia has been deepened, which has gradually changed from an "incurable disease" with unknown etiology to a malignant tumor of hematopoietic system caused by gene mutation and abnormal cloning of bone marrow stem progenitor cells.
1 June, 946, global leukemia chemotherapy1case was lifted, which opened a new era of leukemia treatment. With the deepening of people's understanding of the pathogenesis of acute leukemia, the gradual improvement of treatment strategies, the advent of new anti-leukemia drugs, the improvement of various chemotherapy schemes and supportive therapies, and the application of hematopoietic stem cell transplantation, the prognosis of acute leukemia has been greatly improved, the remission rate of leukemia patients has been significantly improved, the remission period and survival period, especially the asymptomatic survival period, have been prolonged, and a considerable number of patients have survived for a long time, or even been cured. In recent years, after combined chemotherapy, induced differentiation, hematopoietic stem cell transplantation, biological and immunotherapy, supportive therapy, traditional Chinese medicine treatment and other comprehensive treatments, the curative effect of acute leukemia has been continuously improved, the complete remission (CR) rate is 70-90%, and the five-year disease-free survival rate (DFS) is about 30-40%. However, there are still some problems, such as multidrug resistance, high cost of supporting treatment after chemotherapy, great side effects of chemotherapy, immature stem cell transplantation technology, lack of bone marrow bank resources, serious transplantation complications and high transplantation cost, which greatly limit the curative effect of modern medicine on acute leukemia. It is urgent to find a new drug with good curative effect, low toxic and side effects, low drug resistance and good cost-effectiveness to change the treatment status of acute leukemia.
Leukemia is the most common malignant tumor in hematopoietic system, and it is also one of the top ten common malignant tumors that pose the greatest threat to human health. The average incidence rate in the world is about 3. 1/65438+ 10,000, and the incidence rate in China is about 3 ~ 4/65438+ 10,000, accounting for the sixth to eighth place in tumor incidence, and it is one of the top ten malignant tumors. The incidence of this disease is higher than that of women, and it is the most common malignant tumor in children and adolescents with the highest mortality. According to the statistics of China 1986- 1988, its incidence rate is 2.76/65438+ ten thousand people, accounting for about 5% of the total cancer incidence rate. Anhui Children's Hospital investigated and analyzed the epidemiological characteristics of leukemia children diagnosed in Anhui Children's Hospital during the period of 1992-200 1. The results showed that 132 cases were 1-5 years old, accounting for 56. 1%. The most common type is acute lymphoblastic leukemia (ALL-L 1 type, 50.76%), followed by acute myeloid leukemia (AML, 15.9%). With the advent of industrialization and modernization, the incidence of leukemia is still on the rise. For example, the number of hospitalized cases of childhood leukemia increases by 2.42% every year (P&G T; 0.05), in which all cases showed an obvious upward trend, with an average annual increase of 9.1%(p < 0.01); AML showed a downward trend, with an average annual decrease of 65438 00.5% (P