A Case of Advanced Esophageal and Hypopharyngeal Cancer Treated with Modified Can-Zhe Pei-Qi Decoction
Can-Zhe Pei-Qi Tang (Ginseng-Ochre Qi-Supplementing Decoction) is an empirical formula of Zhang Xichun from the late Qing and early Republican period. The original formula: Lu Dangshen (Codonopsis) six qian, Tiandong (Asparagus) four qian, raw Zheshi (Hematitum) eight qian (ground fine), clear Banxia (Pinellia) three qian, Cistanche four qian, Zhimu (Anemarrhena) five qian, Danggui (Angelica) three qian, persimmon-frost cake five qian (held in the mouth and slowly swallowed after dosing). Zhang used it for geshi (dysphagia), which he attributed to a weak central qi failing to descend.
Zhang added: if several doses of the original formula give little effect, there must be static blood at the cardiac orifice; add Sanleng (Sparganium) and Taoren (Peach kernel), two qian each. Zhang knew little of such cancers then. Clinically most esophageal, cardiac, and hypopharyngeal cancers present with geshi symptoms—difficulty swallowing, regurgitation—and using this formula as a base with modifications yields some effect.
Recently the daughter of a patient in Yueyang, Hunan, came to me on a local Dr. Liu's recommendation, seeking relief for her father, Mr. Han, with advanced esophageal and hypopharyngeal cancer. He had been hospitalized at Yueyang First People's Hospital (no. 1190395); the cancer was found in July 2020. He declined surgery and had chemoradiotherapy—63 radiotherapy sessions and one chemotherapy cycle. After chemotherapy his labs dropped, platelets and WBC below normal. He then took herbs at the Provincial TCM Institute; unable to swallow due to dysphagia, he had a gastrostomy. By May 5 he had been bedridden for days.
At the first consult: cervical spine pain began only after radiotherapy. Thirsty, poor appetite, dysphagia especially for liquids. Earlier stools were dry like sheep pellets, now normal. Fed via tube. Pain under the left rib margin; cough with thick sputum. External plaster made expectoration easier. Recent left subcostal pain on rising was excruciating. Yellow urine; night sweats severe enough to require bathing. Marked cold intolerance. Bedridden indoors, needing care. Palms/soles hot; no water drunk (cannot swallow). Heartburn without acid regurgitation. Red tongue with patchy coating; no bitter taste.
I decided on Can-Zhe Pei-Qi Tang combined with Qinghao Biejia Tang (Artemisia-Turtle Shell Decoction) and Xiaoluo Tang, with additions; given low platelets, blood-activating herbs were minimized.
Prescription: Dangshen (Codonopsis) 18 g, Tiandong (Asparagus) 12 g, raw Zheshi (Hematitum) 24 g (wrapped), Xuanfuhua (Inula) 10 g (wrapped), Fabanxia (processed Pinellia) 10 g, Cistanche 12 g, Zhimu (Anemarrhena) 15 g, Danggui (Angelica) 10 g, Shidi (persimmon calyx) 10 g, Zhuru (Bamboo shavings) 10 g, Dingxiang (Clove) 6 g, Gegen (Pueraria) 30 g, Qinghao 6 g (added later), processed Biejia (turtle shell) 18 g (decoct first), raw Rehmannia 15 g, Xuanshen (Scrophularia) 12 g, Zhebeimu 12 g, raw Muli (oyster shell) 30 g (decoct first), Xianhecao 50 g, Banzhilian 30 g, Baihuasheshecao 30 g, Shandougen 10 g, Jixueteng 30 g, fried malt 30 g, Shihu 15 g, Xiaoji 20 g, Shiwei 30 g, Tengligen 30 g.
Three doses; one daily; decoct twice, divide into three servings.
After three days the daughter reported delightedly that her father felt much lighter and could walk a few steps on his own, though very thirsty, with a burning throat and ongoing dysphagia. I added heat-clearing, toxin-resolving, yin-nourishing, and moisture-moistening herbs.
Prescription: Dangshen 18 g, Taizishen 15 g, Tiandong 12 g, raw Zheshi 24 g (wrapped), Xuanfuhua 10 g (wrapped), Fabanxia 6 g, Cistanche 12 g, Zhimu 15 g, Danggui 10 g, Shidi 10 g, Zhuru 10 g, Dingxiang 6 g, Gegen 30 g, Qinghao 6 g (later), processed Biejia 18 g (first), raw Rehmannia 15 g, Xuanshen 12 g, Zhebeimu 12 g, raw Muli 30 g (first), Xianhecao 50 g, Banzhilian 30 g, Baihuasheshecao 30 g, Shandougen 10 g, Jixueteng 30 g, fried malt 30 g, Shihu 15 g, Xiaoji 20 g, Shiwei 30 g, Tengligen 30 g, Maidong 15 g, Nanshashen 15 g, Beishashen 15 g, Jiaogulan 10 g, Daqingye 15 g, Banlangen 15 g.
Three doses; one daily; decoct twice, divide into three servings.
After another three doses, the daughter reported further improvement: spirit much better, no more spontaneous sweating, left subcostal pain and hot palms/soles clearly improved; only dry throat and parched mouth persisted. I added 30 g of Donglingcao (Rabdosia) to the second formula to continue.
The advantage of TCM pattern differentiation is choosing formula-matching herbs to improve quality of life. My prescription modified Zhang's original formula. After esophageal/hypopharyngeal cancer and 60 radiotherapy sessions, the patient had geshi plus heat-toxin damaging yin; treatment should supplement the central qi while clearing heat and toxin, nourish yin and moisten dryness, and add anticancer herbs to prolong survival.