A Case: Professor Jia Kun Treating Esophageal Cancer

The renowned Shaanxi TCM physician Jia Kun (1919-2005) was an early pioneer in TCM anti-cancer research. The widely used Chinese patent medicine Pingxiao Pian (Pingxiao Jiaonang) was developed from Jia Kun's empirical anti-cancer formula "Pingxiao Dan." Besides contributing the Pingxiao Dan formula, Professor Jia authored books including Study of TCM Evidence-Based Tumor Treatment, Research on TCM Prevention and Treatment of Cancer, Witty Methods for Middle-Aged and Elderly People to Prevent Cancer and Keep Fit, and TCM Oncology, systematically summarizing methods and experience in treating tumors with Chinese medicine.

On August 21, 1976, Professor Jia Kun saw an esophageal cancer patient surnamed Wang, a native of Hua County, Shaanxi, then 74 years old. Eight months earlier he had developed choking and difficulty swallowing when eating. It was initially misdiagnosed as pharyngolaryngitis; after treatment for that failed, he went to Shaanxi Provincial People's Hospital, where a cauliflower-like mass was found on the right posterior esophageal wall 20 cm from the incisors. Biopsy showed grade 2 squamous cell carcinoma. Because of his age, he received no Western treatment and came directly to Professor Jia. At the visit he was emaciated with a sallow face and dry lips; the tongue coating was white with a red tip and edges, and the pulse was wiry, fine, and rapid. Dr. Jia differentiated it as dysphagia (ye ge) and treated it with his empirical Pingxiao Dan plus a decoction.

Decoction prescription: Lufengfang (Vespae Nidus) 9 g, Huangqi (Astragali Radix) 30 g, Quanxie (Scorpio) 8 g, Xuanfuhua (Inulae Flos) 9 g, Daizheshi (Haematitum) 18 g, Qing Banxia (processed Pinelliae Rhizoma) 15 g, Dangshen (Codonopsis Radix) 15 g, Shandougen (Sophorae Tonkinensis Radix) 9 g, Sheng Gancao (raw Glycyrrhizae Radix) 8 g, Shengjiang (Zingiberis Rhizoma Recens) 9 g. Six doses, decocted in water; each dose is decocted twice, the liquids combined and divided into three portions.

In addition, 600 g Pingxiao Dan (today Pingxiao Jiaonang may be prescribed on medical insurance; follow the package insert for usage and dose), 3 g each time, three times daily. After six doses, the patient returned on August 28. Symptoms were essentially unchanged; coating and pulse were as before. Dr. Jia added Longkui (Solanum Nigri Herba) 15 g to the decoction and continued for five more doses.

After five doses, at the third visit on September 4, 1976, swallowing had improved somewhat, and spirits and appetite had improved. The tongue was red with white coating and the pulse wiry and floating. Professor Jia told him to increase raw Huangqi to 60 g in the second-visit formula, keeping everything else, and to continue Pingxiao Dan. Meanwhile, from September 6 the patient began radiotherapy at the First Affiliated Hospital of the Fourth Military Medical University; Chinese medicine was not stopped during radiotherapy.

When the patient returned for the fifth visit on September 18, radiotherapy had left him fatigued with reduced appetite; other symptoms were much as before. Dr. Jia did not change the prescription, only telling him to continue the decoction and Pingxiao Dan and await effect.

By September 25, 1976, the patient returned for the sixth visit because of dysphagia and constipation. Fatigue and poor appetite persisted; the tongue tip and edges were red-purple, and the pulse was wiry, fine, and floating. Professor Jia adjusted the decoction slightly: Sheng Huangqi 90 g, Dangshen 30 g, Lufengfang 9 g, Quanxie 9 g, Xuanfuhua 9 g, Daizheshi 18 g, Qing Banxia 15 g, Shandougen 9 g, Zhiqiao (Aurantii Fructus) 12 g, Sheng Gancao 8 g, Shengjiang 9 g. Decocted as before; Pingxiao Dan continued.

By October 6, 1976, the patient's spirits had improved, swallowing was smoother, and bowels moved freely; the coating was white and the pulse wiry and floating. Since the formula worked, Dr. Jia did not change it and told him to continue.

On October 8, 1976, the patient returned again, symptoms further improved, able to eat about 500 g daily. Dr. Jia slightly adjusted the decoction, reducing the root-supporting Huangqi and adding Danshen to activate blood and resolve stasis.

The formula was: Huangqi 60 g, Dangshen 15 g, Lufengfang 9 g, Quanxie 9 g, Zhiqiao 12 g, Qing Banxia 15 g, Danshen 30 g, Shandougen 9 g, Sheng Gancao 3 g, Dazao (Jujubae Fructus) 6 pieces. Decocted as before; Pingxiao Dan continued.

The patient kept to this regimen. On August 26, 1977, examination at the First Affiliated Hospital of the Fourth Military Medical University showed the disease had resolved; all was well and he could eat normally. Medication was stopped. Follow-up on October 24, 1978 found him healthy with no abnormalities.

The patient in this case had esophageal squamous carcinoma, which generally progresses slowly; at his age, metabolism is slower than in the young, so the disease advanced more gradually—objectively buying Professor Jia time to achieve effect, one of the factors behind the cure. During TCM treatment, because the choking was severe, the patient also used integrated Chinese-Western care, receiving radiotherapy for the esophageal tumor—radiotherapy being one of the effective treatments for esophageal cancer—another reason for the good outcome. Once cancer arises, a comprehensive combined approach is called for. This patient's willingness to accept both Chinese and Western medicine rather than dogmatically trusting only one was an important guarantee of survival.

Professor Jia's regimen was not complex. His empirical Pingxiao Dan mainly contains Yujin (Curcumae Radix), Ganqi (dry lacquer), Maqianzi (Strychni Semen), and Wulingzhi (Trogopterori Faeces), combining "using poison to attack poison" with activating blood and resolving stasis. Pingxiao Pian is widely used today for many cancers because of its broad-spectrum anti-cancer action. Cancer treatment requires holding to a stable formula and working gradually until quantitative change becomes qualitative. Early on the patient did not see ideal results, but Dr. Jia persisted, ensuring continuity of treatment.

Dr. Jia's decoction followed the principles of supporting the righteous and securing the root, using poison to attack poison, and treating by pattern. Cancer patients often have righteous-qi deficiency, so he persistently used Huangqi and Dangshen to support them. After radiotherapy side effects appeared, he strengthened root support, raising Huangqi to 90 g; once righteous qi recovered, he reduced it again. This reflects the TCM principle of adjusting dosing to the patient's progress.

Lufengfang, Quanxie, and Shandougen in the decoction are all somewhat toxic, but all are effective herbs for esophageal cancer; Dr. Jia never stopped these root-treating herbs from start to finish. His prescriptions used few herbs but were concise and effective—an approach well worth learning.