Appreciation of Chen Ningsheng's Case of Treating a Thyroid Tumor

Chen Ningsheng (b. 1933) is a chief physician at the First Affiliated Hospital of Hunan University of Chinese Medicine, a committee member of the Professional Committee on Liver and Gallbladder Diseases of the Internal Medicine Branch of the China Association of Chinese Medicine, a first-term standing committee member and committee member of the Infectious Diseases Branch of the China Association of Chinese Medicine, and the academic leader of the National TCM Liver Disease Medical Center. With over fifty years of clinical experience, he specializes in treating various malignant tumors.

This article presents a medical case of a thyroid tumor patient treated by Professor Chen Ningsheng. The patient, Ge, first consulted Chen on July 18, 1971, at the age of 31, married. The patient had first noticed thyroid enlargement in 1965; metabolic tests done at the time were all normal, so she paid it no attention. In December 1970, because the thyroid tumor kept growing and developing rapidly, she went to a Beijing hospital, which diagnosed a simple thyroid tumor. Thereafter it continued to enlarge, and at a relatively fast pace. After comprehensive examinations, hospitals all diagnosed a thyroid tumor with high suspicion of malignancy. But the patient feared surgery and was unwilling to undergo it, so she sought out Professor Chen Ningsheng, requesting purely TCM treatment.

The patient was irritable and prone to anger, with irregular menstruation: periods came early, were heavy, and contained clots. Her appetite was average, with no palpitations, hand tremor, or exophthalmos. On palpation, a duck-egg-sized mass could be felt in the right side of the neck; the tongue coating was thin and white, and the pulse was wiry and fine. TCM diagnosis was yingliu (thyroid tumor). Professor Chen's pattern differentiation was liver depression and qi stagnation with phlegm-dampness obstructing the collaterals; he planned treatment by soothing the liver and resolving depression, and softening hardness and scattering nodules.

Initial prescription: Chaihu (Radix Bupleuri) 10 g, Danggui (Radix Angelicae Sinensis) 12 g, Baishao (Radix Paeoniae Alba) 15 g, Yujin (Radix Curcumae) 10 g, Kunbu (Thallus Eckloniae) 15 g, Haizao (Sargassum) 15 g, Shengmuli (Concha Ostreae, raw) 30 g, Cheqianzi (Semen Plantaginis) 15 g, Xiangfu (Rhizoma Cyperi) 10 g, Chuanxiong (Rhizoma Chuanxiong) 10 g, Xiakucao (Spica Prunellae) 10 g, Gancao (Radix Glycyrrhizae) 5 g. Seven doses, decocted in water.

After seven doses, the patient's condition was stable. Professor Chen instructed her that, since the formula was effective, she should not change it, and should patiently take medicine for three months before returning. At the three-month follow-up (October 28, 1971), the yingliu showed a tendency to shrink, but the irritability, anger, and irregular menstruation had not improved. The previous formula was partly effective but partly below expectations, so he switched to a method of clearing the liver and purging fire.

Prescription: Longdancao (Radix Gentianae), Heishanzhi (Fructus Gardeniae, charred), Huangqin (Radix Scutellariae), Chaihu, Shengdi (Radix Rehmanniae), Danggui, Zexie (Rhizoma Alismatis), Cheqianzi, Kunbu, Haizao, Xiangfu, and Beimu (Bulbus Fritillariae). The patient continued taking the medicine for several more months; the thyroid tumor shrank markedly, the irritability, anger, and menstrual irregularity resolved, and there were no longer obvious subjective symptoms. Western re-examination showed no thyroid abnormality.

Since the previous treatment had succeeded, and following the principles of "if it is effective, do not change the formula" and "chronic diseases are treated slowly," the senior Chen converted the decoction into pills for continued use to consolidate the effect. The pill formula was based on the previous decoction with minor modifications.

Pill formula: Mudanpi (Cortex Moutan), Shanzhi (Fructus Gardeniae), Longdancao, Danggui, Baishao, Huaishanyao (Rhizoma Dioscoreae), Fuling (Poria), Kunbu, Haizao, Xiakucao, and Zhiqiao (Fructus Aurantii). Take 10-20 g each time, 2-3 times daily. Follow-up observation continued through December 1973, with no recurrence.

The senior Chen's initial consultation treated the patient with Chaihu Shugan San (Bupleurum Soothing the Liver Powder) with additions; the main action of Chaihu Shugan San is to soothe the liver and resolve depression, because this patient had clear symptoms of liver qi stagnation and emotional disturbance. The formula also added Kunbu, Haizao, Shengmuli, and Xiakucao to soften hardness and scatter nodules; among them, Kunbu and Haizao are iodine-rich marine products, and iodine therapy has some effect on thyroid tumors. Shengmuli softens hardness and scatters nodules; Xiakucao clears heat, detoxifies, reduces swelling, and scatters nodules. Yujin was added to resolve stasis, reduce swelling, and resolve depression; Xiangfu was added to move qi and resolve depression.

But although the initial consultation shrank the tumor, it did not achieve the hoped-for regulation of the emotions and menstruation, so the second prescription was changed to Longdan Xiegan Tang (Gentian Drain the Liver Decoction) with modifications. Longdan Xiegan Tang soothes the liver and drains the gallbladder, clears heat and drains dampness; the formula also added Kunbu, Haizao, and Beimu to soften hardness and scatter nodules, and still used Xiangfu to move qi and resolve depression. After taking the medicine, not only did the tumor shrink, but the irritability, anger, and menstrual irregularity also improved. Judging from the patient's irritability and menstrual disorder, she may have had an estrogen imbalance, and Longdan Xiegan Tang may regulate hormone levels.

Longdan Xiegan Tang was more effective than the earlier Chaihu Shugan San; the patient's thyroid tumor was now well controlled. There was no need to continue decoctions, and one should also guard against excessive bitter-cold herbs. But a thyroid tumor is no minor ailment; although some therapeutic effect had been achieved, it was still necessary to consolidate with pills, so the senior Chen built a pill formula on the basis of Longdan Xiegan Tang that also supported zheng and secured the root for aftercare.

From this case we can see that even an experienced clinician may not get the formula right on the first try; one must adjust based on the patient's response. But for such chronic diseases, once an adjusted formula is effective, one cannot rush results; long-term treatment is needed. Thus the senior Chen adjusted the formula infrequently and later used pills for slow, consolidating treatment. This unhurried, unflappable therapeutic approach is worth learning from.