慢性淋巴細胞白血病，簡稱慢淋 chronic lymphocytic leukemia (CLL) 是機體的淋巴細胞在體內異常增生和積蓄伴有免疫功能低下的疾病。由於慢淋患者淋巴細胞壽命極長，並經常伴有免疫反應缺陷，故又淋巴結腫 大為主，常伴有肝脾腫大，貧血及出血等症狀，少數患者還伴有皮膚損害。本病中老年人多見，偶見青年，男性多於女性。
Chronic lymphocytic leukemia (CLL) is where  lymphocytes dysplasia with extremely long life and over accumulating with  and immune The  lymph nodes are enlarged, often accompanied by hepatosplenomegaly, anemia and bleeding and other symptoms, and a small number of patients with skin damage. This disease is more common in the elderly, occasionally in young people. There are more occurances in men than women.

】 【Clinical symptoms

CLL is a slow progressing disease. About 25% of patients  without obvious symptoms. The discoveries are often due to other diseases or medical checkup and occasionally found in blood. Some patients may be due to anemia, swollen lymph nodes and treatment. General symptoms of the disease include fatigue, weakness, dizziness, palpitation, shortness of breath, teeth bleed at the nose, skin purpura, weight loss, skin itching, etc., often due to infection, due to immune dysfunction, coupled with long-term use of corticosteroids, prone to infections, particularly skin and lung infections occurred many opportunities, and might die of sepsis. Also due to infiltration of leukemic cells and bone pain caused by bleeding.


1. Lymph nodes: 80% of patients with systemic lymph nodes were swollen neck lymph nodes are the most common. Followed by the armpits, groin, and block lymph nodes. Showed a moderate enlargement of the general non-smooth surface, moderate hardness, adhesion, activity is good, and no tenderness. Such as the mediastinal lymph node involvement and bronchial compression caused by coughing, hoarseness or difficulty breathing. Prone to cause abdominal pain, abdominal lymph nodes.
肝脾腫大： 脾腫大約佔72%， 腫大程度不 及慢粒明顯，一般在肋下3～4cm內， 個別可平臍， 肝臟輕度腫大。
2. Hepatosplenomegaly: splenomegaly accounted for about 72%, The swellings are not as obvious as those in CML, generally 3 ~ 4cm below  the ribs, some can be as high as the belly buttons, liver can be slightly enlarged.

3. Skin damage: about 10% of patients in the course of the different types of skin lesions appear, including itching, pigmentation, urticaria, erythema, papules, wet clinic, exfoliative dermatitis, herpes simplex and herpes zoster. Because infiltration of leukemic cells, but also shows the specificity of nodular skin lesions and erythroderma.


】 【TCM treatment

First, the TCM diagnosis

1. Phlegm buried: in patients with symptoms and signs of ignorance and japonica, only occasional blood tests found elevated total white blood cells, classified mainly by mature lymphocytes, red tongue body fat, thin pulse.

2. Qi sputum Results: cluster of nodules over the body, according to the still soft, push the dynamic, not hot no pain, white fur, slippery pulse string.

3. Phlegm and blood stasis: Tuberous increasing, from soft to hard, hot flashes, night sweats, Xingshou Shenpi, ribs are the block, take root, dark purple tongue, the pulse was fine.

4. Phlegm heat: Apart from the phlegm and blood stasis syndrome, there are jaundice, lips, a pale, sallow face, urine, or skin purpura, or herpes skin, pale yellow greasy moss, small number of the pulse slightly.

Second, traditional Chinese medicine

1. Hidden Phlegm: Expelling Spleen Qi, accompanied by phlegm stasis, heat poison. 四君子湯加味：黨參，白術，茯苓， 生甘草，白花蛇舌 草，龍葵，半枝，陳皮，山慈菇 ，黃藥子，赤芍，莪術。

2. Qi sputum Results: Expelling Soothing Solutions with, phlegm 常用柴胡疏肝 湯合消瘰丸減：柴胡， 柴胡，香附，川芎，赤白芍，陳皮，牡勵，貝母，夏枯草，昆布，膽南星，黃藥子。

3. Phlegm and blood stasis; Expelling Qi and blood, soft-firm stasis. 可用和榮散堅丸合失 笑散，消瘰丸加減：黨 參，白 朮，茯苓，當歸，赤芍藥，川芎，五靈脂，蒲 黃，化 橘紅，貝母，昆布，海蛤粉，牡蠣。

4. Phlegm heat: Expelling dampness heat, 選用茵陳四苓散加味：白術，茯苓，澤瀉，豬苓，三棱，莪術，貝母，昆布，夏枯草，黃藥子，茵陳，陳皮 。濕熱留滯肌膚， 有串狀疱疹者， 治宜清瀉肝膽濕熱， 方選龍膽瀉肝湯


Modified: gentian, Scutellaria, Gardenia jasminoides, Bupleurum, white peony root, Rehmannia glutinosa, Akebia, Plantago, raw licorice, Alisma.

加減：龍膽草，黃芩，梔子，柴胡，白芍，生地黃，木通，車前子，生甘草，澤瀉。
 

二，中藥治療

1． 痰瘀隱伏：治宜健脾益氣， 佐以化痰祛瘀，清熱毒。選可以四君子湯加味：黨參，白術，茯苓， 生甘草，白花蛇舌 草，龍葵，半枝，陳皮，山慈菇 ，黃藥子，赤芍，莪術。

2. 氣郁痰結：治宜疏肝解隨，化痰散結， 常用柴胡疏肝 湯合消瘰丸減：柴胡， 柴胡，香附，川芎，赤白芍，陳皮，牡勵，貝母，夏枯草，昆布，膽南星，黃藥子。

3. 痰瘀互結；治宜益氣養血， 軟堅散瘀。可用和榮散堅丸合失 笑散，消瘰丸加減：黨 參，白 朮，茯苓，當歸，赤芍藥，川芎，五靈脂，蒲 黃，化 橘紅，貝母，昆布，海蛤粉，牡蠣。

4. 痰瘀濕熱：治宜清熱利濕， 佐以化痰軟堅，選用茵陳四苓散加味：白術，茯苓，澤瀉，豬苓，三棱，莪術，貝母，昆布，夏枯草，黃藥子，茵陳，陳皮 。濕熱留滯肌膚， 有串狀疱疹者， 治宜清瀉肝膽濕熱， 方選龍膽瀉肝湯

加減：龍膽草，黃芩，梔子，柴胡，白芍，生地黃，木通，車前子，生甘草，澤瀉。


【療效標准】
　
1．完全緩解：白細胞計數＜10×109/L；分類正常，無幼稚粒細胞（原始，早，中，晚幼粒細胞）。血小板計數正常

不超過450×109/L。

2. 部分緩解：白細胞計數降至治療前50%以上， 至少 < 20*109/L。血白細胞計數正常，但仍存在幼稚細胞及脾大。

3. 無效： 臨床及實驗檢查未達到上二項標准或惡化。

4.細胞遺傳學反應

A．無細胞遺傳學反應，Ph1染色體持續在所有分裂相中存在。

B．微小細胞遺傳學反應：Ph1染色體被抑制至佔分裂相的35%～95%。

C．部分細胞遺傳學反應：Ph1染色體被抑制至分裂相的5%～34%。

D．完全細胞遺傳學反應：Ph1染色體細胞消失。