A Case Study: Relieving Cancer Pain from Liposarcoma with a Chinese Herbal Decoction
The patient, Mr. Shi, from Huaihua, Hunan Province, was born in 1989. In 2015 he underwent surgical resection of a liposarcoma at Hunan Provincial Cancer Hospital; the sarcoma was located in the lumbar spine. After surgery he still had pain in the right lower abdomen, which local doctors misdiagnosed and treated as prostatitis. Recurrence was found on follow-up in June 2018, but the patient declined further surgery. In October 2018, due to tumor progression, he underwent a second surgical resection at Hunan Provincial Cancer Hospital.
On March 11, 2019, MRI performed in the Radiology Department of Zhongshan Hospital, Fudan University (radiology number ZS19045066) showed: status post paraspinal myxoid liposarcoma resection; at the L4–S1 level a mass-like abnormal signal lesion within the right erector spinae muscle, maximal cross-section approximately 29×24×33 mm, hypointense on T1WI, markedly hyperintense on T2WI with septations, on opposed-phase images showing fine signal dropout, with marked persistent enhancement after contrast; a second smaller similar lesion, about 8×5×12 mm, in the right erector spinae at the L3 level; no other signal lesions. Diagnosis: local recurrence within the right erector spinae at L3 and L4–S1 after paraspinal myxoid liposarcoma surgery.
After the second recurrence, the patient refused any Western treatment and sought my help on March 15, 2019. From then on I continuously adjusted the prescription according to his symptoms; the tumor sometimes shrank and sometimes rebounded. Over about three years of TCM treatment, control was reasonably maintained.
On April 13, 2022, repeat MRI at Huaihua First People's Hospital showed the paraspinal mass near the lumbar and sacral vertebrae had enlarged slightly compared with before, but not significantly; a cystic cavity had formed within the larger tumor, filled with fluid. The small nodular abnormal signal within the vertebral body was unchanged, and no significant new lesions appeared; the rest was broadly as before.
The imaging suggested that the larger tumor, after more than three years of treatment, may have necrosed, but the cyst it had formed had enlarged slightly, compressing the lumbar spine and causing intermittent, sometimes unbearable pain. The patient asked me for help to reduce it. I first advised Guizhi Fuling Capsules (Cinnamon Twig and Poria), to no effect. Switching to Jinkui Shenqi Wan (Golden Cabinet Kidney-Qi Pill) made the pain worse. Yuanhu Zhitong Pian (Corydalis Pain-Relieving Tablets) also failed.
On May 7, 2022, seeing that these patent medicines had failed, I conducted a remote video consultation and switched to a decoction for pain relief, prescribing a modified Simiao San (Four-Marvel Powder): Cangzhu (Atractylodes lancea) 6 g, Huangbai (Phellodendron) 6 g, Huainiuxi (Achyranthes) 6 g, Yiyiren (Coix seed) 30 g, Yuanhu (Corydalis) 10 g, Tubiechong (Eupolyphaga) 15 g, Jixueteng (Spatholobus) 30 g.
After taking this formula, the patient reported no relief. On May 11 I adjusted the prescription to clear heat and detoxify, cool blood and reduce swelling, and resolve stasis to stop pain. Formula: Machixian (Purslane) 50 g, Daqingye (Isatis leaf) 30 g, Banlangen (Isatis root) 30 g, Jinyinhua (Honeysuckle) 30 g, Lianqiao (Forsythia) 30 g, Yejuhua (Wild chrysanthemum) 30 g, Chishao (Red peony) 15 g, Shengdi (Raw rehmannia) 15 g, Xuduan (Dipsacus) 15 g, Honghua (Safflower) 3 g, Sumu (Sappan wood) 10 g.
After three doses, the patient reported reduced pain but nausea after taking the medicine, which improved after eating. I therefore made a slight adjustment: Machixian 50 g, Daqingye 30 g, Banlangen 30 g, Jinyinhua 30 g, Lianqiao 30 g, Yejuhua 30 g, Chishao 15 g, Shengdi 15 g, Xuduan 15 g, Honghua 3 g, Sumu 10 g, Fabanxia (Processed Pinellia) 10 g, Chenpi (Tangerine peel) 10 g, Shengjiang (Fresh ginger) 5 slices, Dazao (Jujube) 5 pieces.
Continuing until May 22, 2022, the patient reported marked improvement: no more unbearable pain and no gastrointestinal discomfort after dosing. Some discomfort remained, so I advised that since the formula was working, it should be continued unchanged.
The cancer pain in this case was probably caused by tumor compression of the nerves within the spinal canal, but its root lay in the enlargement of the tumor after liquefaction; therefore pain relief could not rely on analgesics alone. I chose a combination of heat-clearing, detoxifying, blood-cooling, swelling-reducing, and stasis-resolving herbs aimed at shrinking the cystic tumor; only by shrinking the cyst could pressure on the spinal nerves be relieved and pain controlled. The formula worked out well, fortunately.
This patient has been treated by me with Chinese herbs since March 15, 2019. These three-plus years have had some effect, but drug resistance and tumor rebound have occurred repeatedly; after adjusting my approach each time, control was re-established. Although not cured, the goal of survival with the tumor has been achieved, showing that TCM treatment of tumors has genuine practical value.