A Case: Zhang Xichun Treating Dysphagia (Esophageal or Cardiac Cancer)
A certain Mr. Sheng of Tianjin, around fifty years of age, developed dysphagia (ye ge).
Cause: His circumstances had long been unfavorable, and he was by nature impatient and prone to liver-rage, whereupon he contracted this illness.
Symptoms: At first he only felt food go down with occasional difficulty; later it was always so, and he summoned physicians for treatment. After half a year of medicine and more than ten different physicians, there was no effect. He felt the disease worsening, believed it incurable, and had stopped taking medicine. It happened that his friend Mr. He urged him to ask me for help. His six pulses were fine, weak, and forceless. Forcing him to eat a little dry biscuit, it had to be chewed into a thin pulp before it could go down; occasionally on swallowing he felt an obstruction and vomited, bringing up phlegmy saliva. He could only drink the thin broth of Japonica rice without difficulty. His stools were dry and hard like sheep droppings and difficult to pass.
From Zhang Xichun's record of the symptoms, this patient's disease was esophageal cancer. Zhang Xichun was a famous physician of the Republican era, by which time Western medicine had entered China. Zhang judged the patient to have gastric cancer, but the symptoms look more like esophageal cancer. Given the patient's means, the very expensive Western treatment of the day was unrealistic, so his earlier consultations were all with TCM physicians. But esophageal cancer has always responded poorly to internal TCM medicine alone; the Qing master Xu Lingtai even declared "true ye ge" incurable. Many physicians were also bound by prejudice, misunderstanding the mechanism of esophageal cancer and using chaotic herbs, so it is no surprise that earlier treatments failed.
Zhang Xichun was then very famous; the patient's relatives came to him because of that fame, hoping against hope, and asked him for a prescription.
Zhang Xichun quoted Yang Supu's discussion of ye ge: "This disease and loss of blood differ in presentation but share a source. When blood comes violently and ruptures the membrane of the stomach wall, it is hematemesis; when it comes slowly and cannot rupture the stomach membrane, it stasis in the upper epigastrium, narrowing the esophagus and producing ye ge." Yang Supu was not a famous physician, but his insight surpassed that of ordinary TCM doctors. I once wrote another article on two very interesting esophageal-cancer cases recorded in Ancient and Modern Medical Cases Annotated (Gujin Yi'an An), introducing the two ye ge patients Yang Supu mentioned.
Yang Supu's original text reads: "In my hometown there was someone who treated this by binding the patient to a pillar in the scorching sun, priing open the mouth and pressing down the tongue, whereupon something like a polyp could be seen in the throat, directly obstructing the esophagus; this was cut away with a sharp blade, with profuse bleeding. The patient took days to recover.... Another scoundrel, old and suffering from this, whom everyone hoped would die; in desperation he thrust the handle of a wisteria whip into his throat seeking quick death. He vomited several sheng of blood, and his illness was cured. These two cannot serve as models, but it is clear that something tangible was blocking the esophagus rather than a causeless narrowing!"
Yang Supu's two cases are recorded in detail, with a treatment resembling today's surgery, though its safety cannot compare with modern operations. Yang Supu's understanding of ye ge differed radically from that of earlier TCM physicians; he must have personally seen a tumor in the throat of a ye ge patient, and so realized that ye ge was not caused by emotional disorder as others claimed.
Many ancient Chinese masters described the cause of ye ge absurdly wrongly. For example, Zhu Danxi held that ye ge arose "from vacuous vessels and fiery qi, qi deficiency with blazing fire, blood already consumed, stomach and intestines dried of essence, and faulty transmission." Zhang Jingyue's famous dictum on ye ge: "This condition must be caused by sorrow, anxiety, rumination, accumulated toil and depression, or excess wine and sex, causing damage. Excess sorrow and anxiety knot qi; knotted qi fails to move and transform. Excess wine and sex damage yin; damaged yin dries up essence and blood. Non-moving qi produces ye ge above; dried-up essence and blood produce dry constipation below." Such statements are miles from the facts, so the results were questionable.
Zhang Xichun's insight stood out. Zhu Danxi was one of the four great Jin-Yuan masters, and Zhang Jingyue a towering Ming physician, yet Zhang Xichun did not accept their accounts of ye ge and trusted Yang Supu's more. But Zhang Xichun could not treat patients in the appalling way Yang Supu described, as that would easily cause medical accidents. Accepting Yang Supu's mechanism, he formulated targeted prescriptions based on TCM theory.
Zhang Xichun's prescription: Sheng Daizheshi (raw Haematitum) one liang (ground fine), Yeshentai (wild Taishan Codonopsis) five qian, Huaishanyao (Shan Yao, Dioscoreae Rhizoma) six qian, Tianhuafen (Trichosanthis Radix) six qian, Tiandong (Asparagi Radix) four qian, Taoren (Persicae Semen) three qian (peeled and crushed), Honghua (Carthami Flos) two qian, Tubiechong (Eupolyphaga) five pieces (crushed), Sanqi (Notoginseng Radix) two qian (pounded fine, swallowed with the decoction). Except for Sanqi, the other herbs were decocted together into one large cup; the warm decoction was used to wash down the Sanqi.
Zhang Xichun explained his own formula: Taoren, Honghua, Tubiechong, and Sanqi all dissipate static blood. Heavily using one liang of raw Daizheshi conducts blood downward. Using Yeshentai and Shanyao cultivates the transforming qi of the stomach so that the stomach is not damaged by the dispersing herbs. Tiandong and Tianhuafen were used for fear that stomach fluids would dry up, making the static blood even more congealed.
We see today that Zhang Xichun's explanation has its age-related limitations. His prescribing logic was sound and the explanation basically reasonable, though limited by the science of his time. Honghua, Taoren, Tubiechong, and Sanqi all activate blood, resolve stasis, and have anti-tumor action. Sanqi especially, when used at over 3 g per dose, can shrink a tumor or break it into smaller pieces. But using Sanqi alone can easily cause tumor emboli; pairing it with blood-activating stasis-resolving herbs like Taoren, Honghua, and Tubiechong lowers that risk. Yeshentai and Huaishanyao support the righteous and secure the root; late-stage esophageal cancer patients have fading righteous qi and need such support, or their low immunity accelerates the cancer. Raw Daizheshi descends counterflow and stops vomiting; Zhang Zhongjing's Xuanfua Daizheshi Tang in the Treatise on Cold Damage uses it for regurgitation and vomiting. Tiandong and Tianhuafen are both anti-tumor and moisten the intestines to unblock the bowels; late esophageal cancer patients almost always have constipation. Zhang Xichun's formula thus combined supporting the righteous, expelling evil, and treating symptoms.
After two doses the patient could eat a little; after five doses the constipation eased. At the second visit Zhang Xichun reduced raw Daizheshi to eight qian and had him continue; eating gradually increased. He later doubled Sanqi to four qian, taken in two portions. Following the advice, the patient passed pus and blood in the stool, and the illness was cured.
I must add a note on Zhang Xichun's record: this patient had no follow-up, so we do not know whether the disease recurred. Generally, whether in esophageal or cardiac cancer, once stools become like sheep pellets, cure is not so easy. The patient may have enjoyed temporary symptom relief and later recurred and metastasized.
But even if the patient later recurred or metastasized, fully relieving his symptoms was enough to prolong life and improve quality of life. A modern patient using this method should combine it with Western medicine, making full use of comprehensive treatment for better results.
Notes: 1. In Zhang Xichun's time one qian was about 3.75 g today. 2. Raw Daizheshi is today's Daizheshi (Haematitum); long-term use may be mutagenic and carcinogenic and can injure the liver, so use carefully and stop once dysphagia resolves. 3. Yeshentai is Dangshen (Codonopsis) produced on Wutai Mountain in Shanxi, not wild ginseng.