A Case Study of Pure TCM Treatment of Pleural Mesothelioma with Pleural Effusion
The patient, Jiang, female, 65, had pleural mesothelioma. She first came to me on the morning of February 21, 2018 (the sixth day of the Lunar New Year); she was also the first patient I saw after the 2018 Lunar New Year.
The patient had a history of asbestos exposure. Western examination showed enlarged mediastinal lymph nodes, pleural thickening, and intractable, recurrent pleural effusion. She rejected Western treatment, refused chemotherapy, and asked me to give her pure TCM treatment.
Pulse diagnosis: left pulse rolling, right pulse wiry.
The patient previously had constipation, often with dry stool, relieved by laxatives. Sleep was fair, about five hours a night. She had intercostal pain and ear pain. Recently: fatigue, dry mouth, cough, wheezing, chest tightness (left side), and chest pain. She had been treated by other TCM doctors and had even taken Shizao Tang (Ten-Jujube Decoction) on her own, without good effect. At the visit she had profuse urination.
The patient had been taking Xihuang Wan, originally 3g twice daily; after reading my article on the use of Xihuang Wan, she gradually increased the dose to 6g.
The patient felt unwell in cool drafts and often sweated spontaneously; she broke into sweats after morning activity. She had abdominal distension.
Based on her condition, I decided to combine Huangqi Fangji Tang (Astragalus and Stephania Decoction) with Guizhi Tang (Cinnamon Twig Decoction) to treat the pleural effusion and exterior-deficiency spontaneous sweating, adding herbs to fight cancer and reduce swelling. To prevent spleen-strengthening herbs from damaging the kidney, I added the Four Kidney Herbs (Mohanlian, Nüzhenzi, Shayuanzi, Tusizi) to tonify the kidney.
Decoction formula:
Sheng Huangqi 30g, Han Fangji 30g, Dangshen 30g, Fuling 30g, Zhuling 30g, Guizhi 15g, Baishao 15g, Zhigancao 10g, Shengjiang 10g, Dazao 7 pieces, Cheqiancao 15g, Cheqianzi 15g, Huainixi 15g, Mohanlian 20g, Nüzhenzi 20g, Shayuanzi 20g, Tusizi 20g, Tengligen 30g, Shiwei 30g, Chao Jineijin 30g, Jiao Sanxian each 20g, Banzhilian 30g, Sheshecao 30g, Xianhecao 50g, Pian Jianghuang 6g, Chao Jiangcan 10g, Chantui 6g, Pugongying 30g, Rendongteng 30g, Xingren 10g, Houpo 20g.
One dose daily, decocted twice, divided into three doses.
Patent medicines:- Guipi Wan (Spleen-Returning Pills), 3 times daily, dose per label.
- Jinkui Shenqi Wan (Golden Cabinet Kidney Qi Pills), twice daily, 20–30 pills each time.
- Xihuang Wan, once daily, 3–6–9–12–12 grams each time.
- Demethylcantharidin tablets, twice daily, 5–15 mg each time.
- Neixiao Sanjie Wan (Internal-Dissipating Mass-Reducing Pills), twice daily, 8 pills each time.
After taking the medicine, her symptoms clearly lessened. On follow-up on March 15, 2018, the pleural effusion had nearly halved. Her confidence grew, and she continued the medication.
Follow-up visit, April 17, 2018
Right pulse wiry, left pulse deep and weak.
Coating yellow, greasy, and thick. All symptoms had clearly lessened.
Other intake details were not recorded and are therefore missing. Because treatment had already shown effect, and based on my years of experience, complete resolution of pleural effusion depends on fundamentally controlling the cancer cells; over-diuresis, on the contrary, risks strengthening the spleen at the cost of the kidney. So I decided to temporarily stop the decoction and switch entirely to patent medicines, and also wrote a tea formula for her to steep. To prevent resistance from using the same medicines too long, the anti-tumor herbs were slightly adjusted.
Patent medicines:- Shugan Hewei Wan (Liver-Soothing Stomach-Harmonizing Pills), dosage per label.
- Xihuang Wan.
- Demethylcantharidin tablets.
- Neixiao Sanjie Wan.
- Duoying Wan.
After her first visit, I advised the patient to go to the hospital regularly to check the pleural effusion volume, CA125, and serum ferritin to monitor efficacy. She was later examined long-term at Beijing Changping TCM Hospital (her inpatient/outpatient number there: 00891175).
The following are her repeated test results.
February 22, 2018
B-ultrasound showed deepest pleural effusion 9.2 cm;
Tumor marker carbohydrate antigen CA125: 65.4 (normal 0–35); serum ferritin: 571.4 (normal 20–200).
March 15, 2018
B-ultrasound showed deepest pleural effusion 4.7 cm;
Tumor marker CA125: 37.7 (normal 0–35);
serum ferritin: 347.1 (normal 20–200).
April 12, 2018
B-ultrasound showed deepest pleural effusion 4.2 cm;
Tumor marker CA125: 31.3 (normal 0–35);
serum ferritin: 285.9 (normal 20–200).
June 7, 2018
B-ultrasound showed deepest pleural effusion 3.0 cm;
Tumor marker CA125: 27.1 (normal 0–35);
serum ferritin: 181.5 (normal 20–200).
Pure TCM treatment worked well for this patient's pleural effusion, and the anti-cancer effect of the Chinese herbs was also quite good. This was partly related to her stable mindset during treatment.
When I first saw this patient, I told her that I believe pleural and ascitic fluid should be reduced slowly, not by rushing. If cancer is not controlled and one uses harsh formulas like Shizao Tang, Zilong Wan, or Pengzheng Wan to induce strong purgation, the fluid may disappear briefly, but it will quickly reaccumulate. So, on one side one should drain fluid by tonifying the kidney and spleen, and on the other control the cancer.
Because the patient had previously taken Shizao Tang, she readily accepted my advice. So although the pleural effusion did not disappear quickly, she was never impatient and took the medicine patiently. The treatment course was quite steady, and the results were good.
Early in my career, influenced by some TCM monographs, I also used harsh purgation for pleural effusion, but the results were not ideal. Cancer patients are often weaker than average; over-purgation easily causes a rapid decline in constitution, making subsequent treatment very difficult.
So in recent years, treating pleural and ascitic effusion, I have consistently followed a steady, gradual principle: drain fluid as much as possible while protecting the patient's righteous qi to the greatest extent, and at the same time treat the cancer causing the effusion. The results are actually better than simply using harsh diuretics.
But this approach also requires the patient to be calm and cooperate without haste. In practice, most patients tormented by effusion are very anxious, always wanting to remove the fluid as fast as possible; the result is that haste makes waste and the treatment effect is poor.
TCM says that in treating disease one must seek the root. Treating cancer patients' pleural or ascitic effusion purely with diuretics only addresses the branch, not the root. The branch approach works fast but does not last; the root approach works slowly but lasts. So when serious complications like effusion appear, both doctor and patient need enough resolve not to be intimidated by the fluid, and to respond calmly.
Finally, I must point out that in clinical practice pleural and ascitic effusion are hard to handle. When a patient develops effusion, it is often a sign that life is entering its final stage; the effective rate of both Chinese and Western treatment is low.
Although I specialize in treating tumors and their complications, my success rate with pleural and ascitic effusion has never exceeded 30%. An important reason is that many patients come to me already showing signs of multiple organ failure; after repeated Chinese and Western treatments their constitution is extremely poor, making treatment very difficult.
Pleural and ascitic effusion should be treated early, while the patient's condition is still tolerable, using the correct approach. By the late stage, when there is no cure, one should focus as much as possible on hospice care to relieve the patient's suffering.