Appreciating a Case of Lung Cancer Treated by Ai Rudi

Dr. Ai Rudi, born in 1944, is a professor at the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine. On April 10, 1981, he took on a lung cancer patient surnamed Xia; after more than two years of TCM treatment by Ai Rudi, the tumor basically disappeared and the patient lived in good condition.

The patient first visited on April 10, 1981. Previously, on March 12, 1981, an X-ray had shown a 4.5 × 7 cm tumor in the anterior segment of the right upper lobe above the hilum; this tumor was later diagnosed as bronchogenic carcinoma (central type).

The patient decided to be treated with TCM. At the first visit she reported coughing, chest pain, and low fever for over two months, with blood-streaked sputum; her temperature had ranged 37.3–38.4 °C for two months. Coughing was worse at night, sputum was blood-streaked, the right chest ached with a feeling of pressure, she felt dizzy each afternoon, had poor appetite, dry mouth and a desire to drink, a normal complexion, a red tongue with thin coating, and a wiry, thin, rapid pulse. She had a history of over 20 years of old pulmonary tuberculosis.

Ai Rudi considered the patient to have qi-yin dual deficiency with phlegm-toxin forming a mass, and treated according to the method of boosting qi and nourishing yin to moisten the lungs, plus resolving toxin and dispersing phlegm nodules. He decided to use modified Sheng Mai San combined with Gualou Xiebai Tang and Xiao Luo Wan.

First-visit formula: Xuan Shen (Scrophulariae Radix) 30 g, Xia Ku Cao (Prunellae Spica) 30 g, Mu Li (Ostreae Concha) 30 g, Mai Dong (Ophiopogonis Radix) 15 g, Bai Jie Zi (Sinapis Semen) 15 g, Qin Jiao (Gentianae Macrophyllae Radix) 15 g, Wu Wei Zi (Schisandrae Fructus) 12 g, Zhi Mu (Anemarrhenae Rhizoma) 12 g, Xie Bai (Allii Macrostemonis Bulbus) 12 g, Gualou Pi (Trichosanthis Pericarpium) 18 g, Yu Jin (Curcumae Radix) 20 g, Gu Ya (Setariae Fructus Germinatus) 20 g, Mai Ya (Hordei Fructus Germinatus) 20 g, Xing Ren (Armeniacae Semen) 10 g, Jie Geng (Platycodi Radix) 10 g. Decoct in water; one dose daily.

This formula uses Gualou Xiebai Tang to treat chest pain. Gualou Xiebai Tang comes from Zhang Zhongjing's Jin Gui Yao Lue (Essentials from the Golden Cabinet) and consists of Gualou (Trichosanthes), Xie Bai (Macrostem onion), and bai jiu (white wine); in this formula, Gualou and Xie Bai are used but no white wine. Gualou Xiebai Tang is the classic TCM formula for chest impediment and chest pain. This patient had persistent chest pain for over two months, so Gualou Xiebai Tang was used as the main treatment for chest pain, plus Qin Jiao and Yu Jin to strengthen the pain relief. Qin Jiao is a commonly used TCM herb for rheumatic bi pain; Yu Jin is a commonly used TCM herb for chest pain. Combined thus, chest pain is relieved.

Sheng Mai San consists of Ren Shen (Ginseng, or Dang Shen, Sha Shen, Xuan Shen), Mai Dong (Ophiopogon), and Wu Wei Zi (Schisandra). It is the classic TCM formula for boosting qi and generating fluids and astringing yin to stop sweating, indicated for fatigue and lassitude, dry throat and thirst, shortness of breath and reluctance to speak, a dry red tongue, and a thin, rapid pulse. This patient had these symptoms, so Sheng Mai San was used to generate fluids and boost qi, plus Zhi Mu to clear heat and drain fire, nourish yin and moisten dryness, assisting Sheng Mai San in boosting qi and generating fluids.

Xiao Luo Wan consists of Xuan Shen (Scrophularia), Mu Li (Oyster shell), and Zhe Bei Mu (Fritillariae Thunbergii Bulbus), and is a classic TCM formula for tumors. In this formula, Zhe Bei Mu was replaced by Bai Jie Zi, because Bai Jie Zi has similar effects to Zhe Bei Mu but also stops pain, which Zhe Bei Mu does not. With this change, the formula both achieves the goal of resolving the tumor and strengthens the effect of Gualou Xiebai Tang on chest pain.

Xing Ren and Jie Geng are cough-stopping herbs; Gu Ya and Mai Ya are used to improve the patient's appetite. Ai Rudi's composing approach is a typical pattern-differentiation approach—giving symptomatic treatment.

After taking 14 doses of the first formula, the patient's cough and chest pain markedly eased and the low fever gradually receded. But there was phlegm in the throat with a purulent, fetid smell, though there was no longer any blood in the sputum. The tongue tip was still red, the coating thin and yellow, and the pulse wiry. So to the original formula were added Dong Gua Zi (Benincasae Semen) and Bai Hua She She Cao (Hedyotis) 30 g each, and she continued taking it.

Dong Gua Zi was added because it expels pus and promotes urination; Qian Jin Wei Jing Tang is the classic formula for fetid sputum, and its main herb is Dong Gua Zi. Bai Hua She She Cao is a commonly used herb for clearing heat, resolving toxin, fighting cancer, and reducing swelling. With these added, the fetid sputum problem is addressed and the anti-cancer strength increased.

After taking the second-visit formula for over a month, the pressure feeling in the right chest lessened, the low fever fully resolved, and she still coughed with much sputum; everything else was normal. So to the above formula, Qin Jiao was removed and Sheng Huang Qi (raw Astragalus) 24 g added, and she continued. Qin Jiao was removed because the chest pain had eased and there was no further need for this rheumatic-bi-pain herb. Raw Astragalus was added because the patient had been ill long enough to become deficient; raw Astragalus was added to raise her strength.

After taking the above formula for a while, the patient learned the truth about her illness; her family had concealed it from her until then. On learning this she became tense; at the next visit the doctor gave her some counseling, and based on the previous response considered the overall treatment approach to be working. So he continued adjusting the above formula to strengthen the anti-cancer effect.

Fourth-visit formula: Sheng Huang Qi (raw Astragalus) 60 g, Ji Xue Teng (Spatholobi Caulis) 30 g, Bei Sha Shen (Glehniae Radix) 30 g, Xian He Cao (Agrimoniae Herba) 30 g, Ban Zhi Lian (Scutellariae Barbatae Herba) 30 g, Bai Hua She She Cao (Hedyotis) 30 g, Mai Dong (Ophiopogonis Radix) 15 g, Xia Ku Cao (Prunellae Spica) 15 g, Bai Jie Zi (Sinapis Semen) 15 g, Hai Zao (Sargassum) 15 g, Kun Bu (Eckloniae Thallus) 15 g, Zhi Mu (Anemarrhenae Rhizoma) 12 g, Gualou Pi (Trichosanthis Pericarpium) 18 g, Yu Jin (Curcumae Radix) 20 g, Xing Ren (Armeniacae Semen) 10 g, Jie Geng (Platycodi Radix) 10 g, Gan Cao (Glycyrrhizae Radix) 3 g.

The fourth visit basically followed the previous approach but with increased strength in supporting the righteous and fighting cancer; raw Astragalus was raised to 60 g. Ji Xue Teng was added to invigorate and nourish blood; Xian He Cao to fight cancer and support the righteous; while Ban Zhi Lian, Bai Hua She She Cao, Xia Ku Cao, Hai Zao, and Kun Bu are all anti-cancer, swelling-reducing herbs. The Sheng Mai San composition was retained; adding Gan Cao both strengthened the cough-stopping effect and harmonized the other herbs.

The patient continued this regimen for another three months; her clinical symptoms disappeared, her complexion became ruddy, her weight increased, and she had no discomfort. A chest X-ray on November 24, 1981 showed the lesion in the anterior segment of the right upper lobe had shrunk to about 1 cm × 1 cm, greatly to the patient's joy. Continuing along this treatment approach, by the second half of 1982 she could resume half of her work. A follow-up on April 26, 1983 showed the mass shadow in the right upper lung had basically disappeared. Follow-up through February 1984 found the patient had survived 2 years and 10 months and was in good condition, having returned to normal work.

Thus, with pattern differentiation and treatment in TCM, and a bit of luck, a patient can sometimes achieve a very good outcome.