Case Study: Ms. Wang, Advanced Dual Cancer (Colon Cancer With Liver Metastasis and Endometrial Cancer) Treated With TCM
Ms. Wang, female, born 1967, a native of Gansu, long resident in Lanzhou, employed at a Lanzhou university.
On December 25, 2016, she came to Beijing together with her fellow patient Ms. Chen for a first consultation with me.
The patient has a family history of colon cancer; several direct relatives have had colon cancer.
The patient herself was found in 2007 to have colon cancer with liver metastasis; in 2012 pulmonary metastasis appeared; in March 2016 endometrial cancer was found. Bone marrow suppression, grade 4. Her general condition is currently fair; she can come to the clinic on her own.
The patient's liver metastasis has fluctuated. Pathology showed moderately to poorly differentiated adenocarcinoma. After Western surgery, radiotherapy/chemotherapy and seed implantation, the checkup of December 17, 2016 showed CEA 310, CA125 53, CA199 38.
Imaging showed pleural effusion; radiotherapy fractured three right ribs; right soft tissue is hard; right lung fibrotic, without cough. Atelectasis; breathing sometimes difficult, but easier after practicing qigong. The endometrial cancer was not fully resected. Urination and defecation are normal.
The left pulse was deep, fine and weak; the right pulse wiry and slippery; the pulse overall rather chaotic. Tongue coating yellow and greasy; bitter taste in the mouth; dry mouth but not severe. The patient also has cholecystitis and gallstones.
The decoction was based on a modified Xiao Chaihu Tang (Minor Bupleurum Decoction) combined with Xiaoluo Wan.
Chaihu (Bupleuri Radix) 10g, Huangqin (Scutellariae Radix) 10g, Wuweizi (Schisandrae Fructus) 15g, Nüzhenzi 15g, Mohan Lian 30g, Tusizi 15g, Shayuanzi 15g, Fuling (Poria) 20g, Chao Baizhu 20g, Huai Shanyao (Dioscoreae Rhizoma) 20g, Sheng Huangqi 15g, Danshen (Salviae Miltiorrhizae Radix) 20g, Gegen (Puerariae Radix) 20g, Yuanhu (Corydalidis Rhizoma) 20g, Baiji (Bletillae Rhizoma) 10g, Lianqiao 20g, Zhebei (Fritillariae Thunbergii Bulbus) 15g, Xuanshen (Scrophulariae Radix) 12g, Sheng Muli (raw Ostreae Concha) 30g (decoct first), Haifushi 30g (decoct first), Kunbu (Eckloniae/Thallus) 30g, Yinchen (Artemisiae Scopariae Herba) 20g, Chao Zhizi (stir-fried Gardeniae Fructus) 15g, Sheng Gancao (raw Glycyrrhizae Radix) 15g, Baihua Shejicao (Oldenlandiae Herba) 30g, Tengligen (Actinidiae Radix) 30g, Shiwei (Pyrrosiae Folium) 30g, Suanzaoren (Ziziphi Spinosae Semen) 10g, Yuanzhi (Polygalae Radix) 10g, Jineijin (Galli Gigerii Endothelium Corneum) 30g, Haijinsha (Lygodii Spora) 15g, Ezhu 10g, Kushen (Sophorae Flavescentis Radix) 10g.
Patent medicines: Xihuang Wan (Beijing Tongrentang), once a day, 6–12g.
Pingxiao Pian (Xi'an Zhengda), three times a day, 4–8 tablets.
Xiaoyao Wan, twice a day.
Neixiao Sanjie San (my self-designed "using toxins to attack toxins" powder containing multiple anti-tumor medicinals).
Follow-up in Lanzhou on March 24, 2017
Both left and right pulses deep, fine and weak; tongue coating fair.
After the first consultation, the patient asked a local old TCM physician about my prescription; he considered the medicinals too risky and opposed her taking them. Alarmed, she did not take it. The disease progressed rapidly and she underwent radiotherapy; recently brain metastasis occurred.
Because her fellow patient Ms. Chen had taken my medicine for three months with striking effect, the patient gained confidence and once again decided to come to me.
Current symptoms: leg numbness, tight painful back, fatigue, aversion to cold, pain in the lymph nodes below the parotid gland, night sweats, shortness of breath, polyuria, and some bleeding.
Decoction:
Zhi Huangqi (honey-fried Astragalus) 30, Guizhi (Cinnamomi Ramulus) 12, Baishao (Paeoniae Alba Radix) 12, Danggui (Angelicae Sinensis Radix) 12, Dazao (Jujubae Fructus) 7 pieces, Shengjiang (Zingiberis Recens Rhizoma) 7 slices, Gegen 18, Qianghuo (Notopterygii Rhizoma) 6, Duhuo (Angelicae Pubescentis Radix) 6, Huainiuxi 12, Baiji 10, Xianhecao (Agrimoniae Herba) 30, Chenpi (Citri Reticulatae Pericarpium) 6, Fa Banxia (processed Pinelliae Rhizoma) 10, Yuanhu 15.
Patent medicines:
- Shenqi Shiyiwei Keli
- Jia Banmao Su Pian (norcantharidin tablets)
- Neixiao Sanjie San, twice daily, 2g dissolved each time
- Xihuang Wan, once daily, 6g each time
- Guifu Dihuang Wan, twice daily
Follow-up on May 15, 2017
After the last Lanzhou follow-up, the patient was readmitted for radiotherapy, then used Opdivo (PD-1) purchased from Hong Kong for immunotherapy.
Recently she came to Beijing for combined Chinese-Western treatment, staying at her son's home.
Currently: liver metastasis, lung metastasis, bilateral kidney metastasis, soft-tissue metastasis in the right phrenicocostal sinus, multiple lymph-node metastases, intracranial metastasis, spinal-cord metastasis, right pleural effusion. Albumin and total protein are low; clotting time is prolonged. She can no longer walk and came to the clinic in a wheelchair.
Genital bleeding.
Pulse fine and rapid; chi pulse weak.
Recently in Beijing for PD-1 treatment: foot swelling, nausea, no appetite, lower abdominal distending pain. She cannot defecate on her own and needs kaiselu (glycerin enema). After taking Guipi Wan, mouth ulcers appeared, and genital bleeding worsened.
Currently taking Jinkui Shenqi Wan; foot swelling slightly improved.
Proposed formula:
Sheng Huangqi 30g, Han Fangji (Stephaniae Tetrandrae Radix) 30g, Sheng Baizhu 30g, Fuling 30g, Zhuling (Polyporus) 30g, Huainiuxi 10g, Cheqiancao 15g, Mohan Lian 15g, Nüzhenzi 15g, Baiji 10g, Chenpi 10g, Fa Banxia 10g, Huoxiang (Agastachis Herba) 10g, Peilan (Eupatorii Herba) 10g, Xiaoji 10g, Daji 10g, Diyu (Sanguisorbae Radix) 10g, Jiao Sanxian (charred three immaturities) each 15g, Jineijin 30g, Pugongying 30g, Jinyinhua 30g (add later), Yejuhua 10g, Tiankuizi 10g, Diding 10g, Yiyiren (Coicis Semen) 60g, Xuanshen 15g, Zhebeimu 15g, Sheng Muli 30g (decoct first), Haifushi 30g (decoct first), Haizao (Sargassum) 30g, Kunbu 30g.
Fufang Banmao Jiaonang (Guizhou Yibai).
Xihuang Wan (Beijing Tongrentang), once a day at bedtime, 3–12g.
Jinkui Shenqi Wan.
Pingxiao Pian.
Shexiong San (not used for various reasons)
Shexiang (Moschus) 30g, Xionghuang (Realgar) 30g, Ruxiang (Olibanum) 30g, Moyao (Myrrha) 30g, Naosha (Sal Ammoniac) 30g, Tulufengwo (earth wasp nest) 15g, Lufengfang (Vespae Nidus) 15g.
Grind together to a very fine powder; take 1–3g each time, 1–2 times a day.
Later, because she could not urinate after taking a pain-relieving decoction, the formula was adjusted as follows:
Zhuling 30g, Fuling 30g, Zexie 15g, Huashi (Talcum) 15g (wrap), Ejiao (Asini Corii Colla) 15g (dissolved in three portions), Qianghuo 10g, Duhuo 10g, Jianghuang (Curcumae Longae Rhizoma) 6g, Chao Jiangcan 10g, Chanyi 6g, Chaihu 10g, Huangqin 10g, Wuweizi 15g, Sheng Dahuang (raw Rhei Radix) 10g (add later).
June 5, 2017
After two Opdivo treatments, the patient had swelling and pain.
After taking the decoction, pain was markedly reduced and she could sleep; without the decoction she could not sleep. But she sweats a great deal and her clothes are wet.
Aversion to cold, wrapped in thick quilts. Right pulse slippery, rapid and forceful; left pulse deep, fine and rapid. Tongue pale with thin white coating and teeth marks. Low back pain reduced.
Zhuling 30g, Fuling 30g, Zexie 15g, Huashi 15g (wrap), Ejiao 15g (dissolved in three portions), Qianghuo 10g, Duhuo 10g, Jianghuang 6g, Chao Jiangcan 10g, Chanyi 6g, Chaihu 6g, Huangqin 6g, Wuweizi 15g, Dibiechong (Eupolyphaga/Steleophaga) 10g, Taoren (Persicae Semen) 10g (add later), Sheng Dahuang 10g (add later), Sheng Huangqi 30g, Chao Baizhu 30g, Han Fangji 30g, Fangfeng (Saposhnikoviae Radix) 10g, Yinchen 20g, Cheqiancao 15g, Huainiuxi 15g, Duzhong (Eucommiae Cortex) 10g, Xuduan (Dipsaci Radix) 10g, Pugongying 30g, Jinyinhua 30g (add later), Yejuhua 10g, Tiankuizi 10g, Diding 10g, Yiyiren 60g, Xuanshen 15g, Zhebeimu 15g, Sheng Muli 30g (decoct first), Haifushi 30g (decoct first), Haizao 30g, Kunbu 30g, Baidoukou (Amomi Fructus Rotundus) 10g, Huoxiang 10g, Peilan 10g, Shudi (processed Rehmanniae Radix) 30g, Paofuzi (blast-fried Aconiti Radix) 10g (decoct first), Cangzhu (Atractylodis Rhizoma) 15g, Houpo (Magnoliae Cortex) 15g, Baiji 15g, Fengweicao (Pteris) 15g.
June 21, 2017
After taking the previous medicine, pain was basically gone, edema gone, white blood cells dropped, CEA markedly reduced; liver and kidney function poor. Stomach vaguely aches, no heartburn. Stool dry; with kaiselu she has daily bowel movements, formed. White blood cells low; recovered after leukocyte-injection. Red blood cells and platelets low, hemoglobin low. Sweating after taking the medicine. After the decoction she can walk on her own, occasionally still needing the wheelchair. Pulse deep, fine and choppy.
Proposed formula:
Pugongying 30g, Jinyinhua 30g (add later), Yejuhua 10g, Tiankuizi 10g, Diding 10g, Xuanshen 15g, Zhebeimu 15g, Sheng Muli 30g (decoct first), Haifushi 30g (decoct first), Haizao 30g, Kunbu 30g, Pian Jianghuang 6g, Chao Jiangcan 10g, Chanyi 6g, Dibiechong 10g, Taoren 10g (add later), Sheng Dahuang 10g (add later), Maidong (Ophiopogonis Radix) 10g, Tiandong (Asparagi Radix) 10g, Shengdi (raw Rehmanniae Radix) 12g, Danggui 12g, Chuanxiong (Chuanxiong Rhizoma) 10g, Chaihu 10g, Huangqin 10g, Wuweizi 15g, Fengweicao 15g, Xiaoji 15g, Daji 15g, Sheng Huangqi 60g, Roucongrong (Cistanchis Herba) 60g, Huomaren (Cannabis Semen) 30g, Chao Jineijin 30g (add later), Jiao Sanxian each 15g, Duzhong 10g, Xuduan 10g, Tusizi 10g, Shayuanzi 10g, Nüzhenzi 10g, Mohan Lian 10g, Sanleng (Sparganii Rhizoma) 6g, Ezhu 6g, Honghua (Carthami Flos) 3g, Chao Zhizi 10g, Mudanpi (Moutan Cortex) 10g, Yiyiren 60g.
Patent medicine: Pingxiao Pian, three times a day, 4–8 tablets.
Powder: Neixiao Sanjie San, 1–2g dissolved each time, twice a day.
July 7, 2017
Recently PD-1 was used again; lower abdomen bloated, legs swollen. Genital bleeding began yesterday.
Appetite has recovered well; abdomen bloated, stool not passing. After the Chinese medicine, waist and legs improved markedly; she has basically got off the wheelchair. Pulse deep, fine, moderate and calm.
Sheng Huangqi 30g, Dangshen (Codonopsis Radix) 20g, Fuling 20g, Chao Baizhu 30g, Zhi Gancao (honey-fried Glycyrrhiza) 10g, Chenpi 10g, Qingpi (Citri Reticulatae Viride Pericarpium) 10g, Houpo 20g, Cangzhu 20g, Shudi 15g, Danggui 10g, Chuanxiong 10g, Baishao 15g, Bajitian (Morindae Radix) 15g, Yinyanghuo (Epimedii Herba) 15g, Xianlingpi 15g, Tusizi 15g, Shayuanzi 15g, Zhuling 20g, Han Fangji 20g, Huainiuxi 15g, Cheqianzi (Plantaginis Semen) 15g, Duzhong 10g, Xuduan 10g, Chaihu 10g, Huangqin 10g, Wuweizi 15g, Chao Zhizi 10g, Yinchen 20g, Nüzhenzi 10g, Mohan Lian 10g, Yiyiren 60g, Fengweicao 15g, Shengdi 24g, Maidong 24g, Xuanshen 30g, Xianhecao 30g, Fengweicao 30g, Baiji 20g, Daji 20g, Xiaoji 20g, Jiao Sanxian each 15g, Chao Jineijin 30g, Lianqiao 15g, Zhebeimu 15g, Sheng Muli 30g (decoct first), Haifushi 30g (decoct first).
Patent medicines:
- Xihuang Wan
- Fufang Banmao Jiaonang (Guizhou Yibai)
- Neixiao Sanjie San
- Neixiao Luoli Wan
Follow-up in Beijing on July 16, 2017
Abdominal bloating much reduced; stool still not passing; legs walk better than last time but still numb. Pulse deep, fine, moderate and calm; hands and feet cold; easy subcutaneous bleeding.
Formula:
Sheng Huangqi 60g, Dangshen 20g, Fuling 20g, Chao Baizhu 30g, Zhi Gancao 10g, Chenpi 10g, Qingpi 10g, Houpo 15g, Cangzhu 15g, Shudi 15g, Danggui 12g, Chuanxiong 10g, Baishao 15g, Bajitian 15g, Xianlingpi 15g, Tusizi 15g, Shayuanzi 15g, Han Fangji 20g, Huainiuxi 10g, Cheqianzi 10g, Duzhong 10g, Xuduan 10g, Chaihu 10g, Huangqin 10g, Wuweizi 15g, Nüzhenzi 10g, Mohan Lian 10g, Huangjing (Polygonati Rhizoma) 15g, Yiyiren 60g, Xianhecao 30g, Fengweicao 30g, Baiji 20g, Daji 20g, Xiaoji 20g, Jiao Sanxian each 15g, Chao Jineijin 30g, Lianqiao 15g, Xuanshen 15g, Zhebeimu 15g, Sheng Muli 30g (decoct first), Haifushi 30g (decoct first), Ganjiang (Zingiberis Rhizoma) 30g, Rougui (Cinnamomi Cortex) 30g, Guizhi 30g, Shengjiang 30g, Mugua (Chaenomelis Fructus) 20g, Dazao 10 pieces, Fangfeng 10g, Zhi Shouwu (processed Polygoni Multiflori Radix) 30g.
Patent medicines:
- Xihuang Wan
- Fufang Banmao Jiaonang (Guizhou Yibai)
- Neixiao Sanjie San, 1–2g dissolved each time, twice a day
- Neixiao Luoli Wan
Follow-up in Beijing on August 7, 2017
Pulse soft, soggy, fine and rapid.
Recently, after taking Western medicine for constipation, the patient had stomach pain; on recent medication the stomach aches vaguely.
I drafted two formulas and asked the patient to compare their effects herself and use whichever worked better.
Formula One
Chaihu 12g, Yujin (Curcumae Radix) 12g, Xiangfu (Cyperi Rhizoma) 12g, Muxiang (Aucklandiae Radix) 6g, Chenpi 6g, Binglang (Arecae Semen) 10g, Foshou (Citri Sarcodactylis Fructus) 12g, Wuyao (Linderae Radix) 12g, Huoxiang 6g, Chao Baizhu 15g, Zhi Gancao 6g, Laifuzi (Raphani Semen) 30g, Danggui 12g, Baishao 12g, Fangfeng 15g, Baizhi (Angelicae Dahuricae Radix) 12g, Jingjie (Schizonepetae Herba) 10g, Manjingzi (Viticis Fructus) 10g, Chuanxiong 10g, Hupo Fen (Succinum) 3g (dissolved in two portions), Danshen 20g, Dan Nanxing (bile Arisaema) 10g, Rougui 10g, Shengma (Cimicifugae Rhizoma) 10g, Qianghuo 10g, Ruxiang 8g, Moyao 8g, Shengjiang 3 slices, Dazao 5 pieces, Tianma (Gastrodiae Rhizoma) 10g, Gouteng (Uncariae Ramulus) 15g, Gouqi (Lycii Fructus) 30g, Duzhong 10g, Xuduan 10g, Shayuanzi 10g, Tusizi 10g, Bajitian 10g, Xianlingpi 10g.
Formula Two
Pugongying 30g, Rendongteng (Lonicerae Caulis) 30g, Yejuhua 10g, Diding 15g, Tiankuizi 10g, Tengligen 30g, Daxueteng (Sargentodoxae Caulis) 30g, Dongguaren (Benincasae Semen) 30g, Yiyiren 30g, Xiaoji 12g, Daji 12g, Banzhilian (Scutellariae Barbatae Herba) 15g, Baihua Shejicao 15g, Machixian (Portulacae Herba) 30g, Yuxingcao (Houttuyniae Herba) 6g, Xuanshen 12g, Zhebeimu 12g, Sheng Muli 30g, Haizao 30g, Kunbu 30g, Gouqi 30g, Duzhong 10g, Baishao 12g, Danggui 12g, Xuduan 10g, Shayuanzi 10g, Tusizi 10g, Bajitian 10g, Xianlingpi 10g.
One dose a day; take Formula One on odd days and Formula Two on even days; after four days of medicine rest 1–2 days.
Patent medicines:
- Xihuang Wan
- Fufang Banmao Jiaonang
- Neixiao Sanjie San, twice a day
- Neixiao Luoli Wan
August 16, 2017
Pulse deep, fine and weak; tongue red, moist, with yellow greasy coating. Stomach occasionally aches vaguely. After taking Formula Two last time, she improved markedly. Proposed formula:
Pugongying 30g, Rendongteng 30g, Yejuhua 10g, Diding 15g, Tiankuizi 10g, Tengligen 30g, Daxueteng 30g, Dongguaren 30g, Yiyiren 30g, Lianqiao 15g, Chixiaodou (Phaseoli Semen) 30g, Xiaoji 12g, Daji 12g, Banzhilian 15g, Baihua Shejicao 15g, Machixian 30g, Yuxingcao 6g, Xuanshen 12g, Zhebeimu 12g, Sheng Muli 30g, Haizao 30g, Kunbu 30g, Gouqi 30g, Duzhong 10g, Baishao 12g, Danggui 12g, Xuduan 10g, Shayuanzi 10g, Tusizi 10g, Bajitian 10g, Xianlingpi 10g, Mohan Lian 10g, Nüzhenzi 10g, Shashen (Glehniae/Adenophorae Radix) 10g, Maidong 15g, Tiandong 15g, Wuweizi 15g, Tianma 15g, Gouteng 15g, Shancigu (Cragoe) 6g, Sanleng 6g, Ezhu 6g, Chaihu 10g, Huangqin 10g, Roucongrong 30g, Jiao Sanxian each 15g, Chao Jineijin 30g, Mudanpi 10g, Taoren 10g, Baiji 15g, Xianhecao 30g, Fengweicao 30g.
Added Yadanzi You Ruanjiaonang (Brucea oil soft capsules) to the patent medicines.
August 25, 2017
The patient has returned to Lanzhou; today she reports difficulty passing stool, and nausea and vomiting after taking the Brucea oil capsules, feeling very unwell.
Constipation had become a serious problem for her; this time I decided to try a large dose of raw Dahuang (Rhubarb).
Proposed formula:
Pugongying 30g, Rendongteng 30g, Yejuhua 10g, Diding 15g, Tiankuizi 10g, Xuanshen 30g, Maidong 24g, Shengdi 24g, Sheng Dahuang 30g (add later), Mangxiao (Natrii Sulfas) 30g (dissolved with the first morning dose only, not the second or third), Baiji 30g, Ceyebo (Platycladi Cacumen) 30g, Zonglütan (Trachycarpi Carbonisatum) 15g, Zhebeimu 12g, Sheng Muli 30g, Haifushi 30g, Haizao 30g, Kunbu 30g, Tianma 15g, Gouteng 15g, Huomaren (Cannabis Semen) 30g, Yuliren (Pruni Semen) 30g, Laifuzi (Raphani Semen) 30g, Yiyiren 30g, Lianqiao 15g, Chixiaodou 30g, Xiaoji 12g, Daji 12g, Banzhilian 15g, Baihua Shejicao 15g, Machixian 30g, Yuxingcao 6g, Jiao Sanxian each 15g, Chao Jineijin 30g.
Patent medicines and powder continued.
September 13, 2017
After taking the August 25 formula, bowel movements have become regular, and the patient has improved very markedly.
On September 3, follow-up at the Lanzhou Military Region Lanzhou General Hospital (image no. 113218454) showed multiple metastatic tumors clearly shrinking, though some had progressed. The patient asked to strengthen the anti-cancer effect on the basis of the previous formula.
The formula was adjusted as follows:
Pugongying 30g, Rendongteng 30g, Yejuhua 10g, Diding 15g, Tiankuizi 10g, Xuanshen 30g, Maidong 24g, Shengdi 24g, Sheng Dahuang 30g (add later), Baiji 10g, Ceyebo 30g, Qiancao (Rubiae Radix) 20g, Xianhecao 30g, Zonglütan 15g, Zhebeimu 12g, Sheng Muli 30g, Haifushi 30g, Haizao 30g, Kunbu 30g, Tianma 15g, Gouteng 15g, Huomaren 30g, Yuliren 30g, Laifuzi 30g, Yiyiren 60g, Lianqiao 15g, Chixiaodou 30g, Xiaoji 12g, Daji 12g, Banzhilian 20g, Baihua Shejicao 20g, Tengligen 30g, Shiwei 30g, Qumai (Dianthi Herba) 15g, Machixian 30g, Yuxingcao 6g, Jiao Sanxian each 15g, Mohan Lian 20g, Nüzhenzi 20g, Pian Jianghuang 6g, Chao Jiangcan 10g, Chanyi 6g, Gouqi 30g, Xiakucao (Prunellae Spica) 15g, Jixueteng (Spatholobi Caulis) 30g.
The patient's quality of life has now improved considerably; she continues Chinese-medicine treatment, and further efficacy awaits observation.
My note: This patient's course of treatment was relatively long, because later she lived at her son's home in Beijing and had many follow-up visits.
At the outset there was a clear failure of doctor-patient trust, which delayed treatment by three months—not a small regret.
Later, after seeing with her own eyes the striking tumor shrinkage of her fellow patient who had come with her, the patient developed firm confidence, and treatment gradually went much more smoothly.
At one point, disease progression and the side effects of Western treatment left her paralyzed; my Chinese medicine brought her back to her feet. She and her husband were very moved and asked me to share this case for the reference of similar patients.
At one point she had severe ascites and edema of the lower limbs, making walking and putting on shoes very difficult. I decided to use a large formula; within one day most of the edema was gone and she felt much lighter; after three doses she was basically back to normal.
After PD-1 therapy, the side effects caused severe, unbearable pain. Several of my prescriptions had little effect, but the patient kept coming back for adjustments; once the formula was right, pain stopped with a single dose—proof that a correctly matched TCM prescription can be remarkably effective.
During this period she brought her son to see me; he had suffered from ulcerative colitis and allergic rhinitis for years, with constant diarrhea and a torment of sneezing and perennial rhinorrhea from the rhinitis. I used a modified Guizhi Jia Gegen Tang (Cinnamon Twig plus Pueraria Decoction); after about a week of medicine the son was cured.
Later the patient's younger sister also consulted me.
This course shows how hard it is to build trust between a physician and a patient, and how closely therapeutic effect is tied to that trust.
A special note: the 30g dose of Dahuang (Rhubarb) in this case was exceptional. In over ten years of treating cancer, I have used Dahuang at 30g in only two patients; large-dose Rhubarb requires the greatest caution.
If this patient had not had intractable constipation unresponsive to various gentler laxatives, I would not have used large-dose Rhubarb.
The other time I used large-dose Rhubarb was in treating a cervical-cancer patient with intestinal obstruction; her obstruction was extremely severe with agonizing pain, and at 30g Rhubarb the obstruction resolved and the severe pain along with it.
This experience with large-dose Rhubarb is offered for reference, but it must be used cautiously; routine Rhubarb should be kept within 10g.