Chai Ge Jie Ji Tang in Two Difficult Cases and One Case of Cancer Pain/Fever: Experience Report

Chai Ge Jie Ji Tang (Bupleurum-Kudzu Muscle-Resolving Decoction) comes from Tao Hua's Shanghan Liu Shu of the Ming dynasty. It was designed to treat combined disease of the three yang channels (Taiyang, Yangming, and Shaoyang). It thus uses Shaoyang herbs Chaihu (Bupleurum) and Huangqin (Scutellaria), Yangming herbs Gegen (Kudzu) and Shigao (Gypsum), and Taiyang herbs Qianghuo (Notopterygium) and Baizhi (Angelica Dahurica), and combines Jiegeng (Platycodon) with Gancao (Licorice) to drain pus. The composition is rigorous.

The formula is now commonly used for colds, pneumonia, bronchitis, gingivitis, conjunctivitis, otitis media, and intercostal neuritis.

Tao's original text says it releases the muscle layer and clears heat, indicated for wind-cold that has bound and transformed into heat, with aversion to cold and fever, headache and aching limbs, eye pain and dry nose, orbital pain, irritability and insomnia, thin yellow tongue coating, and a floating, slightly surging pulse.

I have used this formula of Tao's for several stubborn cases with good results. My usual doses are:

Chaihu 12g, Gegen 9g, Gancao 3g, Huangqin 9g, Qianghuo 6g, Baizhi 6g, Shaoyao 6g, Jiegeng (Platycodon) 6g, Shigao (Gypsum) 12g.

Three cases follow.

Case 1: Post-thyroid-cancer head fullness and numbness

Luo, female, first visit April 15, 2019.

The patient had a mixed-space-occupying lesion at the lower pole of the right thyroid lobe found on June 29, 2010, surgically removed that year and diagnosed as papillary thyroid carcinoma, stage pT2N1M0.

She reported weakness after surgery plus a wind-cold contraction; because hospital beds were tight she was discharged before recovery.

After discharge she had persistent discomfort: bitter mouth, cold aversion, easy colds, a stuffy, heavy feeling in the head as if wrapped, deep aching in the right shoulder and left lower back, very poor sleep (could not sleep normally all night after surgery), and nasal congestion. Western doctors thought the symptoms might be from surgical nerve injury.

For years she traveled, seeing major hospitals and many Chinese and Western doctors, without relief of the head fullness.

Pulse: weak and forceless. She also had vaginal bleeding, pelvic effusion, vaginitis, and an itchy scalp—all sorts of strange symptoms, greatly distressing her.

On first visit I thought it might fit Guizhi Jia Gegen Tang (Cinnamon Twig plus Kudzu Decoction) and prescribed seven doses. After two doses she improved slightly; by the fifth, improvement stopped and symptoms worsened.

She asked how to adjust. On reflection, she had all three yang patterns; since Chai Ge Jie Ji Tang resolves the three yang together, I prescribed three doses.

After three doses, her symptoms improved greatly. Asked how to continue, I told her to keep the same formula for another three to five doses and stop once symptoms cleared.

For ten years she had sought doctors everywhere; this symptom pattern is indeed unusual, so many treatments failed and doctors could not explain it.

If I were to explain her cause, I could not give a clear reason either. But from her symptoms I could find a matching proven formula in the classics. Following my standing principle of treating the pattern, I boldly used the historical proven formula when it matched the pattern—and obtained a satisfactory result.

Case 2: Intractable insomnia

Gu, female, first visit October 8, 2018. A staff member at a Lanzhou university, referred by a colleague, came for years of intractable insomnia.

Since 2016, work and home renovation had caused severe anxiety; she began insomnia on moving day, July 9, 2016, and never recovered. No skin allergy or sneezing. After moving, the house was damp and she had diarrhea for a month or two.

She had been cold-averse before; after insomnia it worsened, and she dared not wear sandals in summer or sit in office drafts. Left shoulder pain since late 2016. Stool normal. She feared wind and sweated. On moving night the house was ventilated and she felt very cold. Pulse: slippery; tongue: moist with thin coat; no dry mouth or throat.

She had sought doctors for years without effect. When a colleague with cancer did well under my care, she asked for an introduction.

Her symptoms at first seemed to fit Guizhi Jia Gegen Tang, so I prescribed the base formula: Guizhi 10g, Baishao 10g, Zhi Gancao 6g, Gegen 15g, Shengjiang 3 slices, Dazao 3 pieces.

She reported no effect at all. Then family matters and her father's cancer left her needing care, worsening anxiety; insomnia persisted.

Earlier this year, worn down by insomnia, she begged me to prescribe again. On reflection, her symptoms seemed again a combined three-yang disease with prolonged binding transforming to heat: anxiety is Shaoyang; shoulder-neck pain is the Gegen series of Yangming/Taiyang combination. I decided on Chai Ge Jie Ji Tang.

After taking it, her insomnia finally improved.

Case 3: Intractable pneumonia with cancer fever and cancer pain

Zhang, male, late-stage lung cancer, first visit March 10, 2019.

After surgery and chemo-radiation his original qi was badly damaged; he then had several PD-1 treatments and now has recurrent fever every afternoon, resolving at midnight. After fever he is weak all over, with intolerable pain in shoulders, neck, and legs, severe headache, orbital pain, and frequent nosebleeds. Pulse: fine, wiry, weak. Mouth and throat bitter and dry.

He has long taken OxyContin for pain, now up to 80mg per dose, with severe constipation after dosing. In the terminal stage, he has given up hope of cure and only wants relief from cancer fever and pain.

By his symptoms, he again had all three yang patterns. I decided to try the base Chai Ge Jie Ji Tang.

Because his condition was severe, I did not expect much. Yet on the very day he took it, fever and pain improved; after seven days, the cancer fever was gone.

After the fever resolved, his strength and appetite improved markedly, and his will to live returned; he asked for further anti-tumor treatment. He is still under treatment.

These three patients had different diseases, but from the six-channel pattern-differentiation view they shared symptoms, and all were treated with the same Chai Ge Jie Ji Tang—an example of TCM treating different diseases with the same method.