A Case Record: Patient Yu with Renal Pelvis Carcinoma

Patient Yu, female, a Beijing native, aged 85, a patient with renal pelvis carcinoma. On March 3, 2021, she went to the Chinese PLA General Hospital for CT examination (image no. 000171007) for hematuria; a 31.6 x 30.9 mm roundish, mixed-density shadow was found in the left kidney, preliminarily diagnosed as a left renal mass. The patient also had calcified foci in the liver and spleen, multiple bilateral renal cysts, and left renal stones. Further examination confirmed renal pelvis carcinoma.

Because she was elderly, no highly invasive treatment was undertaken. The family learned, through various channels, that Xihuang Wan (Rhino-Horn and Bezoar Pill) could relieve cancer symptoms, so they bought it for her; the hematuria improved. But the patient still had many problems, and new issues arose after taking Xihuang Wan. The family happened to read my article about Xihuang Wan and decided to consult me.

The first online video consultation was on September 28, 2021. Inquiry showed that for years the patient had been averse to wind and cold, sweated easily, and felt a cold back, which led to frequent colds and low immunity. After taking some anti-cancer drugs on her own, she also developed nausea and regurgitation, with poor appetite. Moreover, she had suffered anxiety for many years and slept poorly. She had sought treatment in Beijing for years without effect.

Weighing the patient's advanced age and multiple underlying conditions, the family decided on conservative TCM treatment, hoping I could relieve her suffering, improve her quality of life, and prolong survival as much as possible. This expectation was quite rational, so based on her symptoms I initially recommended Guizhi Jia Gengan Tang combined with Yuping Feng San, modified, to address the aversion to wind/cold and easy sweating, plus Xuanfu Daizhe Tang, modified, to relieve nausea and regurgitation.

Proposed formula, to be checked by a physician: Guizhi (Cinnamon Twig) 10 g, Baishao (White Peony) 10 g, Gegen (Kudzu Root) 15 g, Zhigancao (Honey-fried Licorice) 6 g, Baimaogen (Cogon Rhizome) 30 g, Xiaoji (Cirsium) 15 g, Shiwei (Pyrrosia) 30 g, Fabanxia (Processed Pinellia) 6 g, Chenpi (Tangerine Peel) 6 g, Jiaomaiya (Dry-fried Barley Sprout) 30 g, Xuanfuhua (Inula, wrapped) 6 g, Daizheshi (Hematite, wrapped) 6 g, Sheng Huangqi (Raw Astragalus) 30 g, Dangshen (Codonopsis) 20 g, Huangjing (Polygonatum) 20 g, Danggui (Angelica) 6 g, Fangfeng (Saposhnikovia) 6 g, Chao Baizhu (Fried Atractylodes) 6 g, Fuling (Poria) 10 g, Huanglian (Coptis) 3 g, Zhuru (Bamboo Shavings) 6 g, Shengjiang (Ginger) 15 g, Dazao (Jujube) 5 pieces. One dose daily, decocted in water, taken twice a day, morning and evening. Continue Xihuang Wan.

After taking this formula, the patient's long-standing aversion to wind and cold, cold back, and easy sweating resolved, and her appetite improved. But her anxiety and insomnia did not improve significantly. On October 24, the family asked whether the anxiety and insomnia could also be improved. I recommended Danzhuru Tang, modified, which TCM uses for women's zang-zao (visceral agitation).

Proposed formula, to be checked by a physician: Maidong (Ophiopogon) 15 g, Fuxiaomai (Light Wheat) 30 g, Zhigancao (Honey-fried Licorice) 10 g, Dangshen (Codonopsis) 15 g, Fuling (Poria) 15 g, Fabanxia (Processed Pinellia) 10 g, Danzhuru (Light Bamboo Shavings) 10 g, Shiwei (Pyrrosia) 30 g, Xiaoji (Cirsium) 20 g, Baimaogen (Cogon Rhizome) 20 g, Xianhecao (Agrimonia) 30 g, Yumixu (Corn Silk) 15 g, Lufengfang (Wasps' Nest) 10 g, Jiaoshanzha (Dry-fried Hawthorn) 30 g, Chao Maiya (Fried Barley Sprout) 30 g, Shengjiang (Ginger) 7 slices. One dose daily, decocted in water, taken morning and evening. Continue Xihuang Wan.

After this formula, the patient was no longer restless and anxious, and her sleep improved greatly. Thanks to Xihuang Wan, the renal pelvis cancer progressed slowly; the hematuria once improved markedly, though it later resumed. Diet, sleep, and general well-being all improved noticeably. The patient and family were satisfied, because all they wanted was relief from suffering and a modest extension of life.

New symptoms continued to appear, and each time I adjusted the formula slightly, with the goal of symptom relief. Doctor and patient trusted each other highly and cooperated smoothly.

Is Beijing short of good doctors? Yet after more than a decade of visits, some stubborn symptoms remained unsolved, so when my advice solved the patient's problems, trust quickly grew. Because our expectations matched, we got along well.

My diagnosis was not complicated; I simply followed the TCM formula-syndrome school approach, keeping in mind the indications of each formula (I cannot memorize the compositions and often look them up). In practice, after taking the history and hearing the relevant symptoms, the name of a matching formula comes to mind, then I look up its composition and decide whether it fits. This is exactly the spirit of evidence-based medicine.

Evidence-based medicine emphasizes consulting the literature, so many good Western doctors, treating difficult cases, look up many references before deciding. TCM tradition, by contrast, tests the physician's memory. Frankly, a good memory is no match for a scribbled note; I do not rote-memorize. Spending a day memorizing one or two formulas is less useful than spending the same time learning the rough scope of many formulas. In practice, I look up the literature by formula or herb name. That way I remember more indications, have more options in mind when solving problems, and look up references as needed; this is far more practical than rote memorization.

As long as things are explained clearly to them, patients do not actually care whether the doctor looks up references. Most patients I meet are delighted when a doctor is willing to look up literature on their disease, because it shows the doctor cares. I often resolve symptoms that had long resisted treatment simply because I look up references and know better ways, not because of a prodigious memory.

For TCM to survive in the modern world, it too should focus on solving patients' problems, building confidence through real results (even modest ones). In my experience, if a doctor makes no extravagant promises and works hard to solve problems, once symptoms are relieved, most patients and families trust the doctor and become lifelong friends, even referring friends and fellow patients. One patient's family told me that, compared with other TCM doctors she had seen, I made the fewest promises but surprised her most with results, so she trusted me deeply, while those who over-promised never won her trust.

A TCM physician who steadily solves problems without over-promises will, over time, build a large patient following, like a tree whose branches grow ever lusher. So in this era, rather than manufacturing stunts, courting attention, and exaggerating TCM's efficacy, a TCM doctor should settle down and solve patients' real problems. Revere heaven and love people; seek truth from facts; go steadily and far, and the road will naturally be both broad and long. Rush for quick success and use any means, and one's fame will inevitably be short-lived.