Appreciation of Chen Ningsheng's Case of Treating a Suspected Intracranial Space-Occupying Lesion

The patient, Li, male, 37 years old, was carried in to Professor Chen Ningsheng on September 29, 1971, suffering from high fever for over a month, loss of consciousness, and right upper-limb paralysis. An outside hospital had found a likely space-occupying lesion in the right frontal lobe; the family declined surgery and brought him to Professor Chen.

This patient had a years-long history of chronic headache. On the afternoon of August 12, 1971, he suddenly developed high fever, convulsions of the hands and feet, and loss of consciousness lasting about half an hour. He was rushed to a local hospital, where emergency treatment failed to help and no cause could be found. He was then transferred to a Changsha hospital, where on August 26 a right-side cerebral angiogram was performed. The results showed relative displacement of the right anterior cerebral artery toward the opposite side, and, on the right lateral view, downward displacement of most of the second segment of the middle cerebral artery, with no aneurysm or obvious vascular malformation. The hospital considered a right frontal space-occupying lesion likely and recommended surgery; the family did not consent.

The patient had headache and fatigue, with episodes of mental dullness, convulsions, sometimes frothing at the mouth, loss of consciousness, and right upper-limb paralysis. The tongue coating was white, rough, and scant in fluids; a patch on the right side of the tongue was somewhat dark and static; the pulse was floating and rapid. Chen Ningsheng planned treatment by activating blood and moving qi, resolving stasis and extinguishing wind.

Initial prescription as follows: Chaihu (Radix Bupleuri) 12 g, Chishao (Radix Paeoniae Rubra) 10 g, Dangguiwei (Radix Angelicae Sinensis, tail) 10 g, Shengdi (Radix Rehmanniae) 15 g, Chuanxiong (Rhizoma Chuanxiong) 5 g, Taoren (Semen Persicae) 10 g, Honghua (Flos Carthami) 10 g, Niuxi (Radix Achyranthis Bidentatae) 10 g, Gujingcao (Flos Eriocauli) 25 g, whole Wugong (Scolopendra) 2 pieces, Gancao (Radix Glycyrrhizae) 3 g, Baihuasheshecao (Herba Hedyotis Diffusae) 30 g, Zhiqiao (Fructus Aurantii) 10 g.

This formula was based on Xuefu Zhuyu Tang (Drive Out Blood Stasis in the Chest Decoction) with modifications. Xuefu Zhuyu Tang comes from Wang Qingren's Qing-dynasty Yilin Gaicuo (Correction of Errors in Medical Classics), composed of Taoren, Honghua, Shengdi, Chuanxiong, Dangguiwei, Chishao, Niuxi, Chaihu, Zhiqiao, Gancao, and Jiegeng (Radix Platycodi). Its actions are to activate blood and resolve stasis, move qi and stop pain; it is commonly used for stabbing pain in the chest and hypochondria, dysmenorrhea, traumatic injuries, and other stasis-stagnation conditions. Modern pharmacological research shows it can lower blood viscosity, inhibit platelet aggregation, and antithrombotic. Professor Chen removed Jiegeng from the formula and added Gujingcao, Sheshecao (Baihuasheshecao), and Wugong.

Gujingcao disperses wind and heat, brightens the eyes, and screens out corneal opacity; it is an important herb for wind-heat headache. Sheshecao is Baihuasheshecao (Oldenlandia diffusa), which clears heat, detoxifies, drains dampness, and fights cancer. Wugong (scolopendra) extinguishes wind and stops spasms, uses poison to attack poison, and fights cancer and reduces swelling. Adding these three to Xuefu Zhuyu Tang is, in effect, a combination of pattern-based treatment and disease-based treatment—a rational, comprehensive approach, with herbs well matched to the condition and kept simple.

The patient took the medicine until November 8 of that year—over 30 doses in all—when his condition improved markedly. Previously bedridden, he could now get up and move about, and could manage his own eating and toileting. But he still sometimes felt dizzy and headache, was still occasionally a little confused, felt an occasional involuntary throbbing at the heart or in the head with a buzzing sound; the right upper-limb paralysis had eased and movement had returned.

Since the treatment was already showing effect, the therapeutic direction should not be changed lightly, so Professor Chen told the patient to continue for another 20 doses and see. After continuing through November 30, appetite improved markedly—he could eat 150-200 g per meal—but muscles still twitched and the head still buzzed; the tongue was red, dark, and static, and the pulse was choppy and fine. To achieve better results, Professor Chen added to the original formula processed Nanxing (Arisaema cum Bile prepared), Baifupian (Radix Aconiti Lateralis Praeparata), and Quanxie (Scorpio), wind-expelling and phlegm-resolving herbs. The patient then took another 70-plus doses and could gradually walk to the hospital for follow-up.

By June 1, 1972, the patient returned to the hospital for a cerebral angiogram, which found the brain had essentially returned to normal. Follow-up through November 23, 1972 found the patient in general good condition, able to care for himself and perform some simple household work.

Because this patient rejected surgery, pathological examination could not confirm whether he had a malignant brain tumor. In treating him, Professor Chen followed the principle of combining Western diagnosis with TCM diagnosis and pattern-based treatment with disease-based treatment, using modified Xuefu Zhuyu Tang. Once effective, he held to the formula unchanged, persisting until a turn for the better before modifying it—this is a relatively prudent approach.

Although this patient's final diagnosis could not be definitively established, a brain tumor was indeed possible; of course, an incidental cerebrovascular lesion was also possible. Although, by Western medicine's principles, the treatment of brain tumor and cerebrovascular accident must differ, under TCM pattern differentiation they can be treated by the same method. That is, different diseases with the same zheng (pattern) may be treated the same way. This formula has both antithrombotic and anticancer, swelling-reducing effects, and can also specifically improve the patient's headache; so it is not surprising that this patient obtained a healing effect.