clinical treatment of pernicious anemia
In Traditional Chinese Medicine, pernicious anemia falls under an extreme example of the category Blood deficiency and Spleen Qi deficiency. The conventional medicine explanation is a deficiency of vitamin B12 either from an inability to absorb it or simple insufficiency. The ensuing drop in red blood cells hinders the body’s ability to deliver oxygen to tissues. The resulting symptoms include shortness of breath; dizziness, especially when standing up; headache; coldness in hands or feet; pale skin, gums, and nail beds; heart palpitations and arrhythmias. Over time, the body will tap into reserves from the bone marrow and nerve myelin resulting in more severe symptoms such as neuropathy, wasting and tremors.
This is not an uncommon condition in elderly people and conventional physicians will often prescribe B12 injections. The problem is that many of these people no longer make the enzyme, intrinsic factor, which necessary for B12 absorption. In this situation, no amount of B12 will rectify the situation without replacing this crucial enzyme which is made in the stomach. It’s possible that formulas like Gui Pi Wan offer some improvement of pernicious anemia perhaps by enhancing the production of various enzymes including Intrinsic Factor.
When treating pernicious anemia adding B12 with intrinsic factor to any Traditional Chinese Medicine treatment protocol is like magic! Unless there is an autoimmune condition in which the body attacks intrinsic factor, there will always a significant improvement. As a general rule, any time you see a case with symptoms of Blood deficiency, B12 supplementation will almost always produce fast and marked improvements.
- Cyanocobalamin – 2000-3000 mcg per day for six weeks
- Intrinsic Factor 20mg per day
- Always include at least 800 mcg of folic acid and 25mg of B6.
**It’s important to keep in mind that B12 works with folic acid and vitamin B6 for effective methylation and detoxification in the liver. If there is a deficiency of B12 there is likely a deficiency of folic acid and B6 as well and I recommend including both of these.
- If you are dealing with a patient who clearly had lack of development as a child (smaller body, hands, cognitive or learning disabilities etc) there is likely an absorption problem along with a conversion problem in the liver. In these cases, I find hydroxocobalamin 3000-5000 mcg for six to eight weeks then a smaller maintenance dose to be very effective.
- If the condition has resulted in nerve symptoms such as tremors or neuropathy a combination of methylcolbalamin and cyanocobalamin 3000 mcg of each per day for six weeks. Then 1000-2000 mcg of each per day until the condition has resolved.
If the patient is on ProCrit, I have found no problems with adding the above.
Along with your primary formulae here are some helpful guidelines.
- Small doses of Suo Yang and Bu Gu Zhi can be very helpful for quicker recovery
- Dang Gui and Huang Qi combination in doses from 15-30g are extremely effective
- Caution with He Shou Wu – this is often thought of as a blood tonic but in this case where you have poor methylation in the liver, He Shou Wu can actually be a little toxic and may result in unexpected problems. In this case it can actually result in elevated liver enzymes.
- Ji Xue Teng – Strange herb. Very helpful if you are seeing signs that the body is tapping into its marrow reserves BUT if the patient is already having dizziness when standing, this herb can exacerbate the problem. In elderly people I would use this with extreme caution and start with small doses. Do not use this herb if they are on blood thinners.