A Case Study of Professor Shen Yannan Treating Nasopharyngeal Carcinoma with Lymphatic Metastasis

Yesterday I introduced Professor Shen Yannan's empirical formula for cervical lymphoma. Today, taking a case of nasopharyngeal carcinoma with lymphatic metastasis treated by Professor Shen himself, we will further study his experience.

Huang, male, 50 years old, worker. First visit March 8, 1984.

The patient accidentally discovered a mass on the right side of his neck in June 1983. A local hospital provisionally diagnosed an inflammatory mass and treated him with gentamicin and kanamycin for half a month without effect. On October 15, 1983, he went to the oncology hospital affiliated with a certain hospital for diagnosis and treatment. Examination revealed four enlarged lymph nodes on the right side of the neck, the largest measuring 3.5 cm x 4 cm and the smallest 1 cm x 1 cm, of medium consistency, still movable. A slight thickening was seen on the posterior roof of the nasopharynx, a submucosal tumor with a smooth surface; the right fossa was shallowed to 1 cm x 1 cm. The radiology department's X-ray films of the chest, skull base, and lateral nasopharynx reported: heart and lungs normal; no destruction above the middle cranial fossa; the posterior wall of the nasopharyngeal roof slightly thickened, presenting a double-contour shadow. Pathological examination reported: biopsy of the mass showed metastatic poorly differentiated carcinoma of lymph node. Diagnosis: right cervical lymph-node metastatic carcinoma; nasopharyngeal carcinoma. Radiotherapy was given immediately and completed by mid-December, with intervals of rest. Reexamination showed the nasopharyngeal mass controlled, with one lymph node about 0.5 cm remaining on the right neck, and symptoms of sore throat, poor appetite, and nausea appeared.

In March 1984, by referral, the patient came to Professor Shen Yannan. He was supported into the consultation room, complaining of fatigue and lack of strength, dry throat and mouth, poor appetite, nausea after eating, yellow-colored stool, and a burning sensation at the affected cervical site. Examination: pharynx red, voice hoarse, right side of neck slightly swollen with local skin reddened. Above the right sternocleidomastoid muscle a spherical mass about 1 cm x 1.5 cm could be palpated, medium-hard, with fairly clear borders, movable, without marked tenderness. Tongge: pale red, with gray-black scorched-dry coating; pulse: wiry and fine.

TCM diagnosis: shirong (withered flesh). Treatment principle: soften hardness and disperse nodules, nourish yin and rescue fluids.

Initial prescription: Xiakucao (Spica Prunellae) 15 g, Shengmuli (Raw Oyster Shell) 15 g, Tianhuafen (Trichosanthes Root) 12 g, Shengdi (Raw Rehmannia) 12 g, Chuanbeimu (Sichuan Fritillary) 9 g, Maidong (Ophiopogon) 9 g, Xuanshen (Scrophularia) 9 g, tianlong (gecko) 2 pieces (dry-fried, ground and swallowed). One dose daily, decocted in water.

After 13 doses, the right-sided mass had shrunk, local skin heat had lessened, spirit had improved, dry mouth had eased, stool had turned yellow, the scorched-black coating had receded to a yellow-black mixed coating, and the pulse remained wiry and fine. Tianhuafen and Shengdi in the original formula were increased to 15 g, and Beishashen (Glehnia) 15 g was added; one dose daily.

After 7 more doses, the mass continued to shrink and soften, the local skin gradually returned to normal color; the tongue was pale red with yellow-greasy coating interspersed with black coating, and the pulse was wiry and fine. He continued the previous formula orally, and externally applied Shuanghoufeng San mixed with water to the affected area.

Fourth visit, May 8, 1984. After 42 doses of the above, he reported that on April 27 he had gone to the oncology hospital for reexamination and was told he had greatly improved; the right cervical mass had disappeared, and the planned radiotherapy was canceled. He requested continued Chinese medicine treatment, which the hospital's doctors agreed to. Examination showed the right cervical mass had completely disappeared, local skin had returned to normal, spirit was good, and his voice was clearer than before. He still had dry throat and abundant phlegm; tongue pale red with yellow-greasy coating interspersed with black coating; pulse wiry and fine. To the original formula was added Baishao (White Peony) 12 g; one dose daily.

Fifth visit, May 29, 1984. On May 22 he had gone to the oncology hospital for reexamination; nothing abnormal was found in the nasopharynx or neck, and no enlarged lymph nodes were seen. Spirit and appetite were good, urination and defecation regular, with only slight dry mouth; aside from frozen shoulder of the right shoulder joint, he was otherwise as usual. Tongue pale red with yellow-white mixed coating and a little black coating; pulse fine.

Prescription: Xiakucao 15 g, Tianhuafen 15 g, Shengdi 15 g, Beishashen 15 g, Shengmuli 15 g, Xuanshen 9 g, Maidong 9 g, Chuanbeimu 9 g, Baishao 12 g, Gancao (Licorice) 6 g, decocted in water, one dose every other day. Tianlong (gecko) 2 pieces, ground into powder and swallowed, once daily. On January 26, 1986, he returned for follow-up, reporting vigorous spirit and normal life; he took three doses of the above formula each month as consolidation.

Commentary: The method Professor Shen used for this case was basically consistent with his summarized approach to cervical lymphoma. In this patient, the condition was already severe at the first visit, with typical symptoms—heat at the affected cervical site, red pharynx, and dry mouth—which in TCM correspond to an abscess-type yang pattern of exuberant heat-toxin; treatment should clear heat and resolve toxin, soften hardness and disperse nodules.

Professor Shen's empirical formula, based on Xiaoluo Wan and Zengye Tang, is precisely a formula that clears heat, resolves toxin, softens hardness, and disperses nodules. After the initial medication, the patient already achieved a relatively ideal effect. Thereafter, following the principle that "if a method works, do not change it," only minor adjustments were made while adhering to the law and the formula; ultimately a good outcome was obtained and the patient's tumor was completely eliminated. In TCM treatment of cancer, once an effective and appropriate approach is found, it should not be changed frequently.