Case Record: Ruyu, a Breast Cancer Patient with Lung, Liver, Bone, and Pleural Metastases

Doctor zhou November 21, 2015

Patient history:

December 2001: left breast mass excised; pathology unknown. Later the surgical site felt constantly uncomfortable, the wound inside turned hard, the patient felt fatigued and gradually wasted away.

May 9, 2003: re-examination confirmed breast cancer; left breast modified radical mastectomy performed. Pathology showed invasive ductal carcinoma, axillary lymph nodes 2/11 positive, ER+, PR+, P53-, Her-2 negative. Pre-operative CAF chemotherapy for 2 cycles; post-operative CAF chemotherapy for 3 cycles, followed by local radiotherapy, then another 3 cycles of chemotherapy after radiotherapy.

November 2003 to July 2008: oral tamoxifen (TAM) for 4 years 7 months; follow-up had been good. She stopped on her own because of endometrial thickening and because she wanted to become pregnant.

July 2008 to August 2009: no treatment. In July 2008 there were always blood streaks in the saliva; in November a CT done for a cold showed multiple nodular shadows of varying size in the right lung field, with relatively clear borders, and a crescent-shaped water-density shadow in the right thoracic cavity; lung metastasis was confirmed by the Beijing Armed Police General Hospital. By August 2009, CT showed bilateral lung metastatic tumors, right pleural effusion with atelectasis of the middle and lower lobes; cranial CT was negative; other tests were not done.

September to October 2009: oral medroxyprogesterone acetate 500mg twice daily (the Cancer Hospital of the Chinese Academy of Medical Sciences diagnosed multiple enlarged right supraclavicular lymph nodes, some fused, 1–2.5cm; left supraclavicular nodes 0.5–1cm; subcutaneous nodules on chest, back, and abdomen 1–2.5cm, hard). One month later appetite improved, and the superficial lymph nodes, right axillary nodes, and chest-wall subcutaneous nodules shrank slightly compared with before.

November 2009 to April 2011: began TXT + capecitabine chemotherapy for 7 cycles. The first 3 cycles used TXT 80mg; the last 4 cycles increased TXT to 120mg; capecitabine 1000mg morning and 1500mg evening; oral medroxyprogesterone. Bilateral supraclavicular enlarged nodes basically disappeared; chest and abdominal wall skin nodules markedly shrank and decreased, largest diameter about 1cm. Pre-chemotherapy B-ultrasound: multiple space-occupying liver lesions, largest 3.9 x 2.8cm; post-chemotherapy B-ultrasound: abnormal liver parenchymal echoes, largest 3.0 x 1.2; tumor markers negative; liver and kidney function negative.

April 2010 to April 2011: oral capecitabine, ibandronate (Aiben) once a month, oral medroxyprogesterone; bilateral supraclavicular nodes negative; bone ECT: multiple bone metastases, right chest wall largest about 0.5cm; tumor markers normal; liver B-ultrasound: liver parenchyma with decreased uneven echoes.

April to August 2011: gemcitabine + cisplatin chemotherapy for 6 cycles; oral medroxyprogesterone; ibandronate once a month. July 2011 CT: multiple nodules of varying size in both lung fields had basically absorbed; compared with March 2011 the intrapulmonary lesions and right effusion had absorbed. During this period CA153 rose to 71.36 then fell back to normal; everything else as before.

August 2011 to July 2013: oral etoposide (VP16) 50mg twice daily on days 1–10 (from October 2012 reduced to VP16 50mg once daily). Medroxyprogesterone stopped in 2012; ibandronate switched to zoledronic acid in December 2011 and continued to the present; tumor markers normal. November 2011 CT: bilateral lung metastatic tumors basically absorbed; right pleural effusion. 2012 abdominal CT: multiple nodular high-density lesions in the liver, ill-defined margins.

July 2013 to January 2014: July–August 2013 goserelin (Zoladex) + medroxyprogesterone; August–November 2013 goserelin + anastrozole (Arimidex); November 21, 2013 to January 2014 goserelin + exemestane (2 months). September 2013 CT: right lung patches and cord-like shadows; patchy low-density shadows in the right liver lobe; thoracic, lumbar, and sacral vertebrae progressed compared with January 2013. December 2014 tumor marker CA153: 55; rest normal.

February 2014 to January 2015: vinorelbine 29.1mg once weekly. October 2014 CT report: liver lesions increased and enlarged compared with before. December 2014 CT report: liver and lung lesions slightly enlarged; a new small nodule appeared in the lower left lung. CA153 values for August, October, and December 2014 were 80.97, 114.7, and 151.2 respectively.

January 2015 to present: oral toremifene. March 2015 CT: bilateral lung metastatic tumors slightly increased and enlarged; left lower lobe increased and enlarged; multiple liver metastatic tumors slightly enlarged; multiple small round low-density shadows in the spleen; rest as before. June 10, 2015 CT: bilateral lung metastatic tumors enlarged compared with before, left lower lung 2.4 x 1.5cm; liver and spleen as in March 2015.

July 2, 2015: one course of paclitaxel + tegafur-gimeracil-oteracil (S-1) chemotherapy, stopped due to respiratory infection and elevated bilirubin. August 2015 to present: oral megestrol acetate.

TCM treatment section (basically 3 doses per formula)

No TCM treatment before 2012; first came to me September 27, 2012. From 2012 to 2014, the handwritten case notes, pulse records, and in-person findings were lost, so this case record is compiled mainly from the prescriptions the patient preserved.

First-visit prescription:

Spatholobus (Jixueteng) 30g, Pseudostellaria (Taizishen) 10g, Ophiopogon (Maidong) 10g, Schisandra (Wuweizi) 10g, tangerine peel (Chenpi) 10g, processed Pinellia (Fa Banxia) 10g, Bupleurum (Chaihu) 15g, Scutellaria (Huangqin) 15g, Scrophularia (Xuanshen) 15g, Zhejiang Fritillaria (Zhebeimu) 15g, raw oyster shell (Sheng Muli) 30g (decoct first), honey-fried turtle shell (Zhi Biejia) 15g (decoct first), Polygonum orientale fruit (Shuihonghuazi) 15g, Patrinia (Baijiangcao) 15g, Coix (Yiyiren) 30g, Sargassum (Haizao) 15g, Ecklonia (Kunbu) 15g, Scutellaria barbata (Banzhilian) 20g, Oldenlandia (Baihua Sheshecao) 20g.

One dose over two days, taken with Xihuang Pills and Shenqi Pills.

October 21, 2012: Pseudostellaria (Taizishen) 15g, Ophiopogon (Maidong) 15g, Schisandra (Wuweizi) 15g, raw Astragalus (Sheng Huangqi) 20g, Spatholobus (Jixueteng) 30g, Salvia (Danshen) 20g, scorched Atractylodes (Jiao Baizhu) 15g, fried Atractylodes (Chao Baizhu) 15g, Poria (Fuling) 15g, Polyporus (Zhuling) 15g, Curcuma zedoariae (Sanleng) 12g, zedoaria (Ezhu) 12g, white peony (Baishao) 15g, honey-fried licorice (Zhi Gancao) 6g, Sichuan Achyranthes (Chuan Niuxi) 10g, Plantago seed (Cheqianzi) 10g, prepared turtle shell (Zhi Biejia) 15g (decoct first), tangerine peel (Chenpi) 10g, green tangerine peel (Qingpi) 10g, the three scorched digestants (Jiao Sanxian) 6g each, chicken gizzard lining (Jineijin) 15g, cicada slough (Chantui) 6g, turmeric (Jianghuang) 6g, stiff Silkworm (Jiangcan) 10g, Morinda (Bajitian) 15g, Psoralea (Buguzhi) 15g, raw Rehmannia (Shengdi) 30g, madder (Qiancao) 15g, Scutellaria barbata (Banzhilian) 15g, sandalwood (Tanxiang) 10g, Amomum (Sharen) 6g.

Three doses, each dose over two days; Jinkui Shenqi Pills twice daily.

November 4, 2012

The patient felt the subcutaneous nodules soften and shrink; after taking the medicine her abdomen felt cold, abdominal pain improved, lower back pain improved.

Spatholobus (Jixueteng) 30g, Pseudostellaria (Taizishen) 10g, Ophiopogon (Maidong) 10g, Schisandra (Wuweizi) 10g, tangerine peel (Chenpi) 10g, processed Pinellia (Fa Banxia) 10g, Bupleurum (Chaihu) 10g, Scutellaria (Huangqin) 10g, Scrophularia (Xuanshen) 15g, Zhejiang Fritillaria (Zhebeimu) 15g, raw oyster shell (Sheng Muli) 30g (decoct first), honey-fried turtle shell (Zhi Biejia) 15g (decoct first), pumice (Haifushi) 15g (decoct first), Polygonum orientale fruit (Shuihonghuazi) 15g, wax gourd seed (Dongguaren) 15g, Patrinia (Baijiangcao) 10g, Coix (Yiyiren) 30g, Sargassum (Haizao) 30g, Ecklonia (Kunbu) 30g, Scutellaria barbata (Banzhilian) 30g, Oldenlandia (Baihua Sheshecao) 30g, the three scorched digestants (Jiao Sanxian) 10g each, chicken gizzard lining (Jineijin) 15g, fresh ginger (Shengjiang) 10g, jujube 7 pieces, broken open.

Additionally, add Cinnamon twig (Guizhi) 10g to each dose, packed separately; if the abdomen still feels cold, add the 10g of Guizhi, otherwise do not.

One dose over two days, taken with Xihuang Pills and Shenqi Pills.

November 13, 2012

After taking the medicine, stools were formed; prone to sweating; arms occasionally a bit numb; tongue coat slightly yellow; stools sometimes green; lower abdominal pain decreased; subcutaneous nodules continued to shrink. Physical strength improved. Lower back pain better. Mood improved; personality no longer irritable.

Spatholobus (Jixueteng) 30g, raw Astragalus (Sheng Huangqi) 30g, Angelica (Danggui) 6g, tangerine peel (Chenpi) 6g, processed Pinellia (Fa Banxia) 10g, Curcuma aromatica (Yujin) 10g, zedoaria (Ezhu) 10g, scorched Atractylodes (Jiao Baizhu) 10g, Poria (Fuling) 10g, Scrophularia (Xuanshen) 15g, Zhejiang Fritillaria (Zhebei) 15g, raw oyster shell (Sheng Muli) 30g (decoct first), honey-fried turtle shell (Zhi Biejia) 15g (decoct first), pumice (Haifushi) 15g (decoct first), Polygonum orientale fruit (Shuihonghuazi) 15g, Patrinia (Baijiangcao) 10g, Coix (Yiyiren) 30g, Sargassum (Haizao) 30g, Ecklonia (Kunbu) 30g, luffa vine (Sigualuo) 15g, Clematis (Weilingxian) 15g, Scutellaria barbata (Banzhilian) 30g, Oldenlandia (Baihua Sheshecao) 30g, Lycium (Gouqi) 15g, scorched hawthorn (Jiao Shanzha) 15g, chicken gizzard lining (Jineijin) 15g, fresh ginger (Shengjiang) 10g, jujube 10 pieces, split.

Two doses, decocted in water.

One dose over two days, twice daily, once at 10 a.m. and once at 4 p.m.

Morning: Xiaojin Pills 6g; evening: Xihuang Pills 6g; Shenqi Pills twice daily.

Take for six days, then stop for three.

November 28, 2012

Prone to sweating at night, especially in the early morning; the past couple of days the mouth tasted a bit sweet, sometimes a bit bitter; lower back sore and weak; feet afraid of cold; bowel movements not very smooth, feeling of incomplete evacuation; liver area occasionally a bit uncomfortable; left side of navel occasionally a dull pain; that area had more bowel sounds these two days; upper abdomen occasionally a bit bloated and painful; the whole digestive tract rather uncomfortable; throat dry; clear runny nose.

The patient reported that during the period she used Xihuang Pills, the subcutaneous nodules basically all disappeared; after stopping they grew back outward again, but overall they were markedly smaller.

Spatholobus (Jixueteng) 30g, raw Astragalus (Sheng Huangqi) 15g, Pseudostellaria (Taizishen) 15g, Ophiopogon (Maidong) 10g, Schisandra (Wuweizi) 10g, Bupleurum (Chaihu) 10g, Scutellaria (Huangqin) 10g, Atractylodes (Baizhu) 10g, white peony (Baishao) 10g, tangerine peel (Chenpi) 10g, processed Pinellia (Fa Banxia) 10g, Saposhnikovia (Fangfeng) 6g, Scrophularia (Xuanshen) 15g, Zhejiang Fritillaria (Zhebeimu) 15g, raw oyster shell (Sheng Muli) 30g (decoct first), honey-fried turtle shell (Zhi Biejia) 15g (decoct first), pumice (Haifushi) 15g (decoct first), Polygonum orientale fruit (Shuihonghuazi) 15g, wax gourd seed (Dongguaren) 15g, Patrinia (Baijiangcao) 10g, Coix (Yiyiren) 30g, Sargassum (Haizao) 30g, Ecklonia (Kunbu) 30g, Scutellaria barbata (Banzhilian) 30g, Oldenlandia (Baihua Sheshecao) 30g, the three scorched digestants (Jiao Sanxian) 10g each, chicken gizzard lining (Jineijin) 15g, fresh ginger (Shengjiang) 10g, jujube 7 pieces broken open, Ganoderma (Lingzhi) 20g (ordinary Ganoderma is fine, decoct first), whole Trichosanthes (Gualou) 30g, Lycium fruit (Gouqizi) 15g.

Morning: Guipi Pills; evening: Xihuang Pills.

December 3, 2012

After using the above formula, sweating was no longer obvious, abdominal pain lessened, stools slightly dry.

Spatholobus (Jixueteng) 30g, raw Astragalus (Sheng Huangqi) 15g, Pseudostellaria (Taizishen) 15g, Ophiopogon (Maidong) 10g, Schisandra (Wuweizi) 10g, Bupleurum (Chaihu) 10g, Scutellaria (Huangqin) 10g, Atractylodes (Baizhu) 10g, white peony (Baishao) 10g, Angelica (Danggui) 10g, raw Rehmannia (Shengdi) 10g, tangerine peel (Chenpi) 10g, processed Pinellia (Fa Banxia) 10g, Saposhnikovia (Fangfeng) 6g, Scrophularia (Xuanshen) 15g, Zhejiang Fritillaria (Zhebeimu) 15g, raw oyster shell (Sheng Muli) 30g (decoct first), honey-fried turtle shell (Zhi Biejia) 15g (decoct first), pumice (Haifushi) 15g (decoct first), Polygonum orientale fruit (Shuihonghuazi) 15g, wax gourd seed (Dongguaren) 15g, Patrinia (Baijiangcao) 10g, Coix (Yiyiren) 30g, Sargassum (Haizao) 30g, Ecklonia (Kunbu) 30g, Scutellaria barbata (Banzhilian) 30g, Oldenlandia (Baihua Sheshecao) 30g, the three scorched digestants (Jiao Sanxian) 10g each, chicken gizzard lining (Jineijin) 15g, fresh ginger (Shengjiang) 10g, jujube 7 pieces broken open, Ganoderma (Lingzhi) 20g (ordinary Ganoderma, decoct first), whole Trichosanthes (Gualou) 30g, Lycium fruit (Gouqizi) 10g.

One dose over two days, twice daily.

Morning: Guipi Pills; evening: Xihuang Pills.

December 13, 2012

Spatholobus (Jixueteng) 30g, raw Astragalus (Sheng Huangqi) 15g, Codonopsis (Dangshen) 15g, Ophiopogon (Maidong) 10g, Schisandra (Wuweizi) 10g, Atractylodes (Baizhu) 10g, white peony (Baishao) 10g, Angelica (Danggui) 10g, prepared Rehmannia (Shudi) 10g, Polygonatum (Huangjing) 10g, tangerine peel (Chenpi) 10g, processed Pinellia (Fa Banxia) 10g, Saposhnikovia (Fangfeng) 6g, Scrophularia (Xuanshen) 10g, Zhejiang Fritillaria (Zhebeimu) 10g, raw oyster shell (Sheng Muli) 30g (decoct first), Polygonum orientale fruit (Shuihonghuazi) 10g, wax gourd seed (Dongguaren) 15g, Patrinia (Baijiangcao) 10g, Coix (Yiyiren) 30g, licorice (Gancao) 10g, the three scorched digestants (Jiao Sanxian) 10g each, chicken gizzard lining (Jineijin) 30g, fresh ginger (Shengjiang) 10g, jujube 7 pieces broken open, Ganoderma (Lingzhi) 20g (ordinary Ganoderma, decoct first), hemp seed (Huomaren) 15g, bush cherry seed (Yuliren) 15g.

December 29, 2012

Spatholobus (Jixueteng) 30g, raw Astragalus (Sheng Huangqi) 15g, Codonopsis (Dangshen) 15g, Ophiopogon (Maidong) 10g, Schisandra (Wuweizi) 10g, Atractylodes (Baizhu) 10g, white peony (Baishao) 10g, Angelica (Danggui) 10g, prepared Rehmannia (Shudi) 10g, Polygonatum (Huangjing) 10g, tangerine peel (Chenpi) 10g, processed Pinellia (Fa Banxia) 10g, Saposhnikovia (Fangfeng) 6g, Scrophularia (Xuanshen) 10g, Zhejiang Fritillaria (Zhebeimu) 10g, raw oyster shell (Sheng Muli) 30g (decoct first), Polygonum orientale fruit (Shuihonghuazi) 10g, Patrinia (Baijiangcao) 10g, Coix (Yiyiren) 30g, licorice (Gancao) 10g, the three scorched digestants (Jiao Sanxian) 10g each, chicken gizzard lining (Jineijin) 30g, fresh ginger (Shengjiang) 10g, jujube 7 pieces broken open, Ganoderma (Lingzhi) 20g (ordinary Ganoderma, decoct first), hemp seed (Huomaren) 15g.

Three doses, decocted in water.

2013

Dates unclear due to lost records; basically 3 doses per formula, each dose over 2 days.

Formula 1

Raw Astragalus (Sheng Huangqi) 20g, honey-fried licorice (Zhi Gancao) 10g, Pseudostellaria (Taizishen) 15g, Ophiopogon (Maidong) 10g, Schisandra (Wuweizi) 10g, honeysuckle vine (Rendongteng) 30g, Spatholobus (Jixueteng) 30g, luffa vine (Sigualuo) 10g, Eclipta (Mo Hanlian) 10g, Ligustrum (Nüzhenzi) 10g, fried Phellodendron (Chao Huangbai) 10g, Atractylodes (Cangzhu) 10g, Coix (Yiyiren) 30g, Sichuan Achyranthes (Chuan Niuxi) 10g, Eucommia (Duzhong) 10g, Curcuma aromatica (Yujin) 10g, zedoaria (Ezhu) 10g, Patrinia (Baijiangcao) 15g, Polygonum multiflorum vine (Shouwuteng) 15g, Albizia bark (Hehuanpi) 15g, Costus (Muxiang) 6g, Polygala (Yuanzhi) 10g, Poria spirit (Fushen) 10g, rose flower (Meiguihua) 6g, Scutellaria barbata (Banzhilian) 10g, Oldenlandia (Baihua Sheshecao) 10g, chicken gizzard lining (Jineijin) 30g.

Formula 2

Raw Astragalus (Sheng Huangqi) 20g, honey-fried licorice (Zhi Gancao) 10g, Pseudostellaria (Taizishen) 15g, Ophiopogon (Maidong) 10g, Schisandra (Wuweizi) 10g, Eclipta (Mo Hanlian) 10g, Ligustrum (Nüzhenzi) 10g, Cuscuta (Tusizi) 10g, Psoralea (Buguzhi) 15g, Drynaria (Gusuibu) 15g, fried Phellodendron (Chao Huangbai) 10g, Atractylodes (Cangzhu) 10g, Coix (Yiyiren) 30g, Sichuan Achyranthes (Chuan Niuxi) 10g, Eucommia (Duzhong) 10g, Curcuma aromatica (Yujin) 10g, zedoaria (Ezhu) 10g, Aconite (Fuzi) 6g, Patrinia (Baijiangcao) 15g, Polygonum multiflorum vine (Shouwuteng) 15g, Albizia bark (Hehuanpi) 15g, Costus (Muxiang) 6g, Polygala (Yuanzhi) 10g, Poria spirit (Fushen) 10g, Saposhnikovia (Fangfeng) 10g, deer-horn slice (Lujiao Pian) 10g (decoct first), Morinda (Bajitian) 15g, chicken gizzard lining (Jineijin) 30g, Salvia (Danshen) 20g, sandalwood (Tanxiang) 10g, Amomum (Sharen) 3g.

Formula 3

Raw Astragalus (Sheng Huangqi) 20g, Atractylodes (Baizhu) 20g, Alisma (Zexie) 20g, Poria (Fuling) 20g, Polyporus (Zhuling) 20g, cinnamon (Rougui) 10g (added later), plantago herb (Cheqiancao) 15g, Coix (Yiyiren) 30g, Pseudostellaria (Taizishen) 15g, Ophiopogon (Maidong) 15g, Schisandra (Wuweizi) 15g, Eclipta (Mo Hanlian) 10g, Ligustrum (Nüzhenzi) 10g, Cuscuta (Tusizi) 10g, Psoralea (Buguzhi) 15g, Drynaria (Gusuibu) 15g, Morinda (Bajitian) 15g, Epimedium (Yinyanghuo) 6g, Sichuan Achyranthes (Chuan Niuxi) 10g, hemp seed (Huomaren) 30g, Eucommia (Duzhong) 10g, Dipsacus (Xuduan) 10g, deer-horn slice (Lujiao Pian) 10g (decoct first), Aconite (Fuzi) 15g, Patrinia (Baijiangcao) 15g, Sargentodoxa (Hongteng) 30g, Costus (Muxiang) 6g, Salvia (Danshen) 20g, sandalwood (Tanxiang) 10g, Amomum (Sharen) 3g, Saposhnikovia (Fangfeng) 10g, chicken gizzard lining (Jineijin) 30g, prepared Rehmannia (Shudi) 30g.

Formula 4

Raw Astragalus (Sheng Huangqi) 30g, Atractylodes (Baizhu) 15g, Poria (Fuling) 15g, Polyporus (Zhuling) 15g, Alisma (Zexie) 15g, dried ginger (Ganjiang) 10g, cinnamon (Rougui) 15g (added later), Coix (Yiyiren) 30g, Pseudostellaria (Taizishen) 15g, Eclipta (Mo Hanlian) 10g, Ligustrum (Nüzhenzi) 10g, Cuscuta (Tusizi) 10g, Psoralea (Buguzhi) 15g, Drynaria (Gusuibu) 15g, Morinda (Bajitian) 15g, Epimedium (Yinyanghuo) 15g, Sichuan Achyranthes (Chuan Niuxi) 10g, Eucommia (Duzhong) 10g, Dipsacus (Xuduan) 10g, deer-horn slice (Lujiao Pian) 10g, Aconite (Fuzi) 15g, Patrinia (Baijiangcao) 15g, Sargentodoxa (Hongteng) 30g, Costus (Muxiang) 10g, Salvia (Danshen) 20g, Saposhnikovia (Fangfeng) 15g, chicken gizzard lining (Jineijin) 30g, prepared Rehmannia (Shudi) 30g, Ranunculus (Maozhaocao) 30g, myrrh (Moyao) 12g, white peony (Baishao) 15g, honey-fried licorice (Zhi Gancao) 10g.

Formula 5

Raw Astragalus (Sheng Huangqi) 30g, Atractylodes (Baizhu) 15g, Poria (Fuling) 15g, cinnamon (Rougui) 8g, blast-fried ginger (Pao Jiang) 2g, Coix (Yiyiren) 30g, Codonopsis (Dangshen) 15g, Eclipta (Mo Hanlian) 10g, Ligustrum (Nüzhenzi) 10g, Cuscuta (Tusizi) 10g, Psoralea (Buguzhi) 15g, Drynaria (Gusuibu) 15g, Morinda (Bajitian) 10g, Epimedium (Yinyanghuo) 15g, Sichuan Achyranthes (Chuan Niuxi) 10g, Eucommia (Duzhong) 10g, Dipsacus (Xuduan) 10g, deer-horn cream (Lujiaoshuang) 15g, Spatholobus (Jixueteng) 30g, chicken gizzard lining (Jineijin) 30g, prepared Rehmannia (Shudi) 40g, Ephedra (Mahuang) 2g, Ranunculus (Maozhaocao) 30g, zedoaria (Ezhu) 12g, white peony (Baishao) 15g, honey-fried licorice (Zhi Gancao) 10g, Schisandra (Wuweizi) 10g, Scutellaria barbata (Banzhilian) 30g, tangerine peel (Chenpi) 10g, processed Pinellia (Fa Banxia) 10g, radish seed (Laifuzi) 10g, Costus (Muxiang) 10g, Salvia (Danshen) 20g, stiff Silkworm (Jiangcan) 10g, cicada slough (Chantui) 6g, turmeric slice (Pian Jianghuang) 6g.

Formula 6

Raw Astragalus (Sheng Huangqi) 30g, Atractylodes (Baizhu) 15g, Poria (Fuling) 15g, cinnamon (Rougui) 8g, blast-fried ginger (Pao Jiang) 2g, Coix (Yiyiren) 30g, Codonopsis (Dangshen) 15g, Eclipta (Mo Hanlian) 10g, Ligustrum (Nüzhenzi) 10g, Cuscuta (Tusizi) 10g, Psoralea (Buguzhi) 15g, Drynaria (Gusuibu) 15g, Morinda (Bajitian) 15g, Epimedium (Yinyanghuo) 15g, Sichuan Achyranthes (Chuan Niuxi) 10g, Eucommia (Duzhong) 10g, Dipsacus (Xuduan) 10g, deer-horn cream (Lujiaoshuang) 15g, Spatholobus (Jixueteng) 30g, chicken gizzard lining (Jineijin) 30g, prepared Rehmannia (Shudi) 40g, Ephedra (Mahuang) 2g, Ranunculus (Maozhaocao) 30g, zedoaria (Ezhu) 12g, white peony (Baishao) 15g, honey-fried licorice (Zhi Gancao) 6g, Schisandra (Wuweizi) 10g, Scutellaria barbata (Banzhilian) 30g, tangerine peel (Chenpi) 10g, processed Pinellia (Fa Banxia) 10g, radish seed (Laifuzi) 10g, Salvia (Danshen) 20g, stiff Silkworm (Jiangcan) 10g, cicada slough (Chantui) 6g, turmeric slice (Pian Jianghuang) 6g.

Formula 7

Bupleurum (Chaihu) 6g, Scutellaria (Huangqin) 6g, Curcuma aromatica (Yujin) 6g, zedoaria (Ezhu) 6g, cicada slough (Chantui) 6g, stiff Silkworm (Jiangcan) 10g, turmeric (Jianghuang) 6g, red peony (Chishao) 10g, madder (Qiancao) 10g, Pseudostellaria (Taizishen) 15g, Angelica (Danggui) 12g, Atractylodes (Baizhu) 12g, Poria (Fuling) 12g, tangerine peel (Chenpi) 6g, processed Pinellia (Fa Banxia) 10g, Sargassum (Haizao) 15g, Ecklonia (Kunbu) 15g, pericarpium arecae (Dafupi) 10g, chicken gizzard lining (Jineijin) 30g. One dose daily, 3 doses.

Formula 8

Codonopsis (Dangshen) 15g, fried Atractylodes (Chao Baizhu) 15g, Poria (Fuling) 15g, Coix (Yiyiren) 15g, tangerine peel (Chenpi) 10g, Spatholobus (Jixueteng) 30g, Angelica (Danggui) 6g, honey-fried Astragalus (Zhi Huangqi) 30g, Salvia (Danshen) 20g, honey-fried licorice (Zhi Gancao) 10g.

Patient's record: dry eyes, bitter mouth; tongue coat slightly yellow in the morning, thick white, thinning after meals and no longer very yellow; after meals the stomach aches a bit and feels uncomfortable, a twinge of pain; fatigue; hunger sensation; morning urine on the yellow side.

Formula 9:

Codonopsis (Dangshen) 10g, Atractylodes (Baizhu) 10g, Poria (Fuling) 10g, honey-fried licorice (Zhi Gancao) 10g, tangerine peel (Chenpi) 10g, processed Pinellia (Fa Banxia) 10g, Spatholobus (Jixueteng) 30g, Salvia (Danshen) 20g, Bupleurum (Chaihu) 6g, Scutellaria (Huangqin) 6g, prepared turtle shell (Zhi Biejia) 15g, Sweet wormwood (Qinghao) 6g (added later), Moutan bark (Danpi) 10g, raw Rehmannia (Shengdi) 10g, Angelica (Danggui) 10g, Ligusticum (Chuanxiong) 6g, white peony (Baishao) 10g, combined spicebush (Wuyao) 10g.

Patient's record: bitter mouth, better by day, worse at night; stomach sometimes feels full and bloated, sometimes a bit nauseated; liver seems better.

One dose daily.

Patient's record: after taking the medicine appetite was a bit better; eating more still causes fullness; left upper abdomen better, but the area around the lower navel still aches, especially between 5 and 7 a.m.; inner thighs feel warm at night; hepatic flexure sometimes feels unrestrained, sometimes a twinge of pain; bitter mouth, better by day; heart discomfort; occasionally dark green stools.

Formula 10:

Sweet wormwood (Qinghao) 6g (added later), prepared turtle shell (Zhi Biejia) 15g, prepared tortoise shell (Zhi Guiban) 15g, raw Rehmannia (Shengdi) 12g, Anemarrhena (Zhimu) 6g, Moutan bark (Danpi) 9g, Bupleurum (Chaihu) 6g, Scutellaria (Huangqin) 6g, Curcuma aromatica (Yujin) 12g, honey-fried Astragalus (Zhi Huangqi) 20g, Polygonatum (Huangjing) 12g, Angelica (Danggui) 12g, Solomon's seal (Yuzhu) 12g, Salvia (Danshen) 20g, Spatholobus (Jixueteng) 30g, Ligustrum (Nüzhenzi) 10g, Eclipta (Mo Hanlian) 10g, Psoralea (Buguzhi) 10g, Cuscuta (Tusizi) 10g, Lycium bark (Digupi) 10g, processed Pinellia (Fa Banxia) 10g, Artemisia capillaris (Yinchen) 10g, deer-horn cream (Lujiaoshuang) 15g, Codonopsis (Dangshen) 15g, Atractylodes (Cangzhu) 10g, Poria (Fuling) 10g, Magnolia bark (Houpo) 10g, Costus (Muxiang) 10g, Polygala (Yuanzhi) 10g, luffa vine (Sigualuo) 10g, the three scorched digestants (Jiao Sanxian) 10g each, Dipsacus (Xuduan) 10g, Eucommia (Duzhong) 10g, Coix (Yiyiren) 20g, white peony (Baishao) 12g, red peony (Chishao) 12g, frankincense (Ruxiang) 6g, myrrh (Moyao) 6g, dragon's blood (Xuejie) 3g, Sargassum (Haizao) 15g, Ecklonia (Kunbu) 15g, Scrophularia (Xuanshen) 15g, Zhejiang Fritillaria (Zhebeimu) 15g, raw oyster shell (Sheng Muli) 15g, raw Dragon bone (Sheng Longgu) 15g, Oldenlandia (Baihua Sheshecao) 60g, Scutellaria barbata (Banzhilian) 60g.

Formula 11

Raw Astragalus (Sheng Huangqi) 30g, Codonopsis (Dangshen) 12g, Angelica (Danggui) 12g, Ligusticum (Chuanxiong) 12g, fried Aurantium fruit (Chao Zhiqiao) 6g, red peony (Chishao) 12g, white peony (Baishao) 12g, honey-fried licorice (Zhi Gancao) 6g, Bupleurum (Chaihu) 12g, Scutellaria (Huangqin) 12g, Cyperi (Xiangfu) 10g, processed Pinellia (Fa Banxia) 10g, Chinese chive white (Jiubai) 10g, whole Trichosanthes (Gualou) 30g, Ranunculus (Maozhaocao) 30g, Oldenlandia (Baihua Sheshecao) 30g, apricot kernel (Xingren) 10g, Poria (Fuling) 10g, Polyporus (Zhuling) 8g, Scrophularia (Xuanshen) 12g, Zhejiang Fritillaria (Zhebeimu) 12g, raw oyster shell (Sheng Muli) 30g (decoct first), Dipsacus (Xuduan) 10g, Psoralea (Buguzhi) 10g, Sichuan Achyranthes (Chuan Niuxi) 10g, Eucommia (Duzhong) 10g (jujube 5 pieces broken open, fresh ginger 5 slices), tangerine seed (Juhe) 50g packed separately, Magnolia bark (Houpo) 30g packed separately, fried Aurantium fruit (Chao Zhiqiao) 15g packed separately. One dose daily; pour in 10ml vinegar and decoct together; take 3 times a day, one hour after meals.

During this period TCM treatment was basically on-and-off, mostly unable to continue medication because of chemotherapy and other reasons.

In 2014, because she joined the chemotherapy control group at the Cancer Hospital of the Chinese Academy of Medical Sciences, she received no TCM treatment for the whole year. That year's chemotherapy was the most physically damaging the patient had experienced in all her years; her condition worsened considerably. Her physical status declined sharply, already too weak to withstand wind, and the cancer pain caused by bone metastases was unbearable; online prescriptions were ineffective. On October 23, 2015 she again came to Beijing for an in-person consultation:

Left pulse deep, fine, rapid; right pulse fine and rapid, more forceful than the left. Tongue tip red; averse to cold; abdominal distention; brown stools; lower back pain; liver-area discomfort. Breast cancer had progressed to lung metastasis, bone metastasis, and pleural metastasis, with cirrhosis. Much thinner than before; complexion yellow-turbid and lusterless; obvious sickly appearance.

Prescription as follows:

Prepared Rehmannia (Shudi) 40g, deer-horn glue (Lujiaojiao) 12g, white mustard seed (Baijiezi) 8g, cinnamon (Rougui) 4g, raw licorice (Sheng Gancao) 4g, blast-fried ginger (Pao Jiang) 2g, Ephedra (Mahuang) 2g, Bupleurum (Chaihu) 12g, Scutellaria (Huangqin) 12g, Schisandra (Wuweizi) 12g, Eclipta (Mo Hanlian) 30g, Ligustrum (Nüzhenzi) 15g, Bletilla (Baiji) 12g, turmeric slice (Pian Jianghuang) 6g, stiff Silkworm (Jiangcan) 10g, cicada slough (Chantui) 6g, Poria (Fuling) 12g, Polyporus (Zhuling) 12g, fried Gardenia (Chao Zhizi) 12g, Trichosanthes root (Tianhuafen) 12g, white peony (Baishao) 30g.

Pills: Renshen Yangrong Pills (Ginseng Yangrong Pills) 3 times daily, one pill each time; licorice zinc capsules; lactasin 3–6 tablets before meals.

After taking the prescription, whole-body bone pain intensified, requiring painkillers to sleep; abdominal distention did not improve much. I instructed her to stop the decoction and continue Renshen Yangrong Pills, waiting until strength recovered before resuming treatment. But the patient, during this period, continued taking the formula by reducing the dose.

November 21, 2015

After taking Renshen Yangrong Pills for a while, the patient's physical strength had recovered somewhat, and she asked for a prescription. Her main complaints now were lower back pain (requiring painkillers), abdominal distention, and pain around the lower abdomen and navel, sometimes also in the armpit.

The patient reported that in 2013, taking Formula 3 had given the best pain relief, and asked me to try modifying it on that basis for pain. Because the patient had been ill for many years and Xihuang Pills were too expensive for her to afford, she now hoped for a treatment plan without Xihuang Pills.

The original "Formula 3" was as follows:

This time I decided to adopt a dual-prescription A/B approach, taken on alternating odd and even days.

Formula A, taken on odd days: tonify the kidney, strengthen bone, fortify the spleen, soften hard masses, scatter nodules, and fight cancer:

Prepared Rehmannia (Shudi) 15g, Cornus fruit (Shanzhuyu) 10g, Eclipta (Mo Hanlian) 10g, Ligustrum (Nüzhenzi) 10g, Cuscuta (Tusizi) 10g, Astragalus complanatus (Shayuanzi) 10g, Psoralea (Buguzhi) 15g, Drynaria (Gusuibu) 15g, Sichuan Achyranthes (Chuan Niuxi) 10g, Eucommia (Duzhong) 10g, Dipsacus (Xuduan) 10g, deer-horn slice (Lujiao Pian) 10g (decoct first), Alisma (Zexie) 10g, Moutan bark (Danpi) 10g, Poria (Fuling) 10g, Dioscorea (Huai Shanyao) 10g, Pyrrosia (Shiwei) 15g, Actinidia vine (Tengligen) 30g, tangerine peel (Chenpi) 10g, processed Pinellia (Fa Banxia) 10g, Magnolia bark (Houpo) 10g, Atractylodes (Cangzhu) 10g, whole Trichosanthes (Gualou) 30g, the three scorched digestants (Jiao Sanxian) 30g, fried Gardenia (Chao Zhizi) 10g. One dose daily, divided into 2–3 portions.

Patent medicines: 1. Renshen Yangrong Pills, 2–3 times daily; 2. Biejiajian Pills (Turtle Shell Hardening Pill), taken according to the package insert.

Formula B, taken on even days: treat the liver:

Raw Astragalus (Sheng Huangqi) 30g, Codonopsis (Dangshen) 15g, Atractylodes (Cangzhu) 10g, Magnolia bark (Houpo) 10g, radish seed (Laifuzi) 10g, white peony (Baishao) 15g, red peony (Chishao) 15g, prepared turtle shell (Zhi Biejia) 15g (decoct first), Curcuma zedoariae (Sanleng) 6g, zedoaria (Ezhu) 6g, frankincense (Ruxiang) 6g, myrrh (Moyao) 6g, Scrophularia (Xuanshen) 15g, Panxie tuber (Tu Bei) 15g, raw oyster shell (Sheng Muli) 30g (decoct first), Sargassum (Haizao) 15g, Ecklonia (Kunbu) 15g, Cyperi (Xiangfu) 10g, Actinidia vine (Tengligen) 30g, Scutellaria barbata (Banzhilian) 15g, Oldenlandia (Baihua Sheshecao) 15g, Gardenia (Zhizi) 10g, Moutan bark (Danpi) 10g, Bupleurum (Chaihu) 10g.

One dose daily, divided into 2–3 portions.

Patent medicines: 1. Renshen Yangrong Pills, 2–3 times daily; 2. Biejiajian Pills, taken according to the package insert.

Two doses of each formula; one dose of medicine per day. Observe the effect after taking and report back.

November 27, 2015

The patient took Formula A together with Renshen Yangrong Pills and Biejiajian Pills for two days; lower back pain relieved, urination improved, diarrhea.

Formula A modified as follows:

Prepared Rehmannia (Shudi) 10g, Cornus fruit (Shanzhuyu) 10g, Eclipta (Mo Hanlian) 10g, Ligustrum (Nüzhenzi) 10g, Cuscuta (Tusizi) 10g, Astragalus complanatus (Shayuanzi) 10g, Psoralea (Buguzhi) 10g, Drynaria (Gusuibu) 10g, Sichuan Achyranthes (Chuan Niuxi) 10g, Eucommia (Duzhong) 10g, Dipsacus (Xuduan) 10g, deer-horn slice (Lujiao Pian) 10g (decoct first), Moutan bark (Danpi) 10g, Poria (Fuling) 10g, Dioscorea (Huai Shanyao) 10g, Pyrrosia (Shiwei) 15g, Actinidia vine (Tengligen) 30g, tangerine peel (Chenpi) 10g, processed Pinellia (Fa Banxia) 10g, the three scorched digestants (Jiao Sanxian) 30g, fried Gardenia (Chao Zhizi) 10g, Bupleurum (Chaihu) 10g.

Pause the decoction and Biejiajian Pills; take Yangrong Pills and Shenling Baizhu Pills.

When taking Formula B, remove the turtle shell.

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