Dr. An Maobin's Empirical Formula Combining Chinese and Western Medicine for Glioma

Between March 1982 and March 1990, Dr. An Maobin of the Qingdao Cancer Hospital treated four cases of brain glioma by applying Wang Qingren's modified Tongqiao Huoxue Decoction combined with western medical therapy, with notable clinical efficacy.

The Chinese medicine empirical formula he used was composed as follows: Chishao (Radix Paeoniae Rubra) 15 g, Honghua (Flos Carthami) 10 g, Chao Taoren (stir-fried Semen Persicae) 20 g, Chuanxiong (Rhizoma Ligustici Chuanxiong) 10 g, Danshen (Radix Salviae Miltiorrhizae) 30 g, Ruxiang (Olibanum) 10 g, Moyao (Myrrha) 10 g, Tubiechong (Eupolyphaga) 10 g, Xuejie (Sanguis Draconis, taken infused) 1.5 g, Shexiang (Moschus, taken infused) 0.1 g, Shanzha (Fructus Crataegi) 15 g, Jixueteng (Caulis Spatholobi) 30 g, Gouteng (Ramulus Uncariae) 10 g, Shengmuli (raw Concha Ostreae) 25 g, Erchou (black and white Qianniuzi, equal parts) 10 g, Juhua (Flos Chrysanthemi) 10 g, Cheqiancao (Herba Plantaginis) 15 g, Sanqi powder (taken infused) 1.5 g, Wugong (Scolopendra, roasted, ground and infused) 1 whole piece, Dazao (Fructus Jujubae) 10 g. Decoct in water for oral use, one dose daily, six doses per week with one rest day, repeating continuously.

This formula may be modified according to the patient's specific symptoms. If nausea and vomiting are due to stomach qi rising upward, Chenpi (Pericarpium Citri Reticulatae) 10 g and Zhuru (Caulis Bambusae in Taeniam) 9 g are added to harmonize the stomach and stop vomiting. If headache and dizziness are due to elevated intracranial pressure with upward hyperactivity of liver yang, Shijueming (Concha Haliotidis) 15 g and Sheng Longgu (raw Os Draconis) 15 g are added to pacify liver yang, lower pressure and stop dizziness. For insomnia, Hehuanpi (Cortex Albiziae) 15 g, Yejiaoteng (Caulis Polygoni Multiflori) 30 g and Chao Zaoren (stir-fried Semen Ziziphi Spinosae) 15 g are added to calm the spirit; Quanxie (Scorpio) 10 g may also be added to expel wind and unblock the collaterals.

When using this formula, 250 ml of 20% mannitol may be given under pressure by intravenous drip, followed by an intravenous push of 60 ml of 50% glucose solution, twice daily. After one week this may be changed to one intravenous drip daily, or once every other day. Patients who have taken the Chinese herbal decoction for three weeks no longer require mannitol for diuresis and pressure reduction, and can be treated entirely with the herbal decoction.

Of the four patients treated by Dr. An Maobin with this formula, two achieved clinical cure, were able to care for themselves, and could continue relatively light work; one had a marked effect and one improved. All four had fairly severe clinical symptoms at presentation, and after three months of medication most symptoms were relieved. Two patients were followed for five years after treatment with no recurrence, so this regimen should have some efficacy for patients.

Tongqiao Huoxue Decoction comes from Wang Qingren's Yilin Gaicuo (Correction of Errors in Medical Classics). It consists of Chishao, Chuanxiong, Taoren, Hongzao, Honghua, Laocong (green onion), Shexiang and Shengjiang, and mainly activates blood and resolves stasis, and opens the orifices and unblocks the collaterals. It is commonly used for alopecia areata, rosacea, urticaria, vitiligo and oil-wind (seborrheic alopecia) due to blood stasis. Its main site of action is the head; it has some efficacy for migraine, nausea, vomiting and hair loss caused by head disorders. Modern TCM uses this formula for brain trauma, stroke and its sequelae, and vitiligo, with good results.

Dr. An Maobin used Tongqiao Huoxue Decoction as the base and added many herbs that activate blood and resolve stasis, attack toxins and disperse nodules, extinguish wind and stop spasms, and promote diuresis and reduce swelling. This compositional approach fully embodies the TCM principle of combining pattern differentiation with disease differentiation. Dr. An also boldly adopted an integrated Chinese-Western approach: in the early stage of treatment he used fast-acting mannitol to eliminate cerebrospinal fluid and lower intracranial pressure, relieving the patient's clinical symptoms and buying the necessary time for TCM treatment.

This integrated Chinese-Western approach differs from combining chemotherapy with Chinese medicine. The western drugs Dr. An used were mainly intended to relieve the patient's clinical symptoms and improve quality of life. Anticancer Chinese herbs require a certain period of use before taking effect; before the Chinese herbs show their effect, using western medicine to reduce the patient's suffering makes the whole treatment tolerable. This approach is worth learning from.

Glioma has a poor prognosis, and apart from surgery there are few available treatment options. Dr. An's approach represents an alternative path and explores a new outlet for glioma patients. Only the case numbers are limited, and the response rate still needs further verification.

Shexiang in this formula is now mostly replaced by artificial musk, and the dose may be appropriately increased to 0.3-0.6 g. TCM treatment of tumors does not specifically categorize cancer types; it focuses more on the symptoms caused by the tumor. Therefore Dr. An's approach should also be applicable to secondary brain tumors arising from other cancers.