Integrated Chinese-Western Medicine Case: Colorectal Cancer with Multiple Metastases to Liver, Spleen, Lung, and Mediastinum in Patient Qin
Qin, born in 1972, from Suining, Sichuan, long resident in Lanzhou (about 20 years). Both his maternal grandfather and uncle had cardia cancer. On September 11, 2018, he came to me for the first visit, accompanying an established elderly patient of mine who was returning for follow-up.
The patient was found to have colorectal cancer with diffuse abdominal metastases in 2016 when he presented with intestinal obstruction. On August 27, 2018, examination at Gansu Provincial Cancer Hospital showed elevated CEA, CA199, and CA724.
The CT report of August 27, 2018 (CT No. CT12974) showed: post-surgery for colon cancer, subcutaneous artificial stoma on the left abdominal wall; slightly low-density space-occupying lesion in the right lobe of the liver—considering liver metastasis in light of the history; fluid accumulation and dilation of the left renal pelvis and upper left ureter—please correlate clinically; multiple nodular shadows in both lungs—considering bilateral lung metastases; enlarged lymph nodes in the mediastinum, retroperitoneum, and abdominal aortic chain area; low-density focus within the spleen—please correlate clinically.
The patient had previously received Western treatment at the 9540 Hospital of the Joint Logistics Support Force in Lanzhou (ID No. 63301054) and other hospitals. During chemotherapy the side effects were severe, and his weight dropped sharply by nearly 30 jin. The Western doctor giving him chemotherapy dared not continue, fearing life-threatening danger.
Left pulse deep and faint, right pulse deep and faint; tongue tip and edges red; watery-slippery tongue coating. Stool sometimes dry, sometimes loose; urination with a sense of incomplete emptying, yellow in color. The patient had previously been treated at a local TCM doctor with Sijunzi Tang (Four-Gentlemen Decoction) plus some heat-clearing and detoxifying herbs, but after taking them he developed bile reflux and severe vomiting. Before coming to me, the patient was too weak to travel; referred by a fellow patient, he consulted me online. I advised him to take Pingwei Wan (Stomach-Calming Pill); afterward his uncontrollable vomiting improved markedly, he could eat, and his stamina recovered somewhat. So he traveled a long distance to see me.
Because the patient also wanted to consult the West-treatment options at Peking Union Medical College Hospital, it could not yet be determined whether the next step would be pure TCM or integrated Chinese-Western treatment. So after the first visit, I mainly advised the patient to take some Chinese and Western patent medicines:
Pingwei Wan; Huangqi Shengmai Yin (Astragalus Pulse-Generating Drink, ginseng formula); Sanjin Pian; Trimebutine Maleate Tablets; Fufang Banmao Jiaonang (Guizhou Yibai Pharmaceutical); Kushen Pian (Sophora tablets); Neixiao Sanjie Wan (my self-formulated pill); Huajie Wan (my self-formulated pill); Xihuang Wan (Beijing Tongrentang).
Dietary restrictions: all coarse-fiber foods and gas-producing beans, pickled vegetables, hot pot, spicy and greasy foods, sweet potatoes, potatoes, seafood, river crabs, river shrimp, citrus, etc.
Take medicine for 5 days then stop for 2 days; stop during fever; return for follow-up every 3 months. Report any developments remotely at any time.
After returning home, the patient decided to continue chemotherapy. To complete chemotherapy smoothly, I had him take the following formula to reduce the various side effects chemotherapy caused him:
Renshen (ginseng) 6g, Sheng Huangqi (raw Astragalus) 30g, Danggui (Angelica) 6g, Zhi Gancao (honey-fried licorice) 10g, Chenpi (aged tangerine peel) 6g, Fabanxia (processed Pinellia) 6g, Fuling (Poria) 15g, Nüzhenzi (Ligustrum) 6g, Mohanlian (Eclipta) 6g, Shayuanzi (Astragalus complanatus) 6g, Tusizi (Cuscuta) 6g, Dingxiang (clove) 6g, Shidi (persimmon calyx) 6g, Jiao Sanxian each 10g.
Second visit, January 10, 2019
After the first visit, five chemotherapy cycles were given; after taking my decoction, chemotherapy side effects no longer appeared. Appetite was excellent, and stamina and weight recovered noticeably. The first four chemotherapy cycles were evaluated as effective: CEA dropped markedly, the liver metastatic tumor shrank significantly, retroperitoneal metastases shrank significantly, lung nodules became smaller, and mediastinal lymph nodes became smaller.
Hemoglobin still low; white blood cells normal. Dizziness. Discomfort from nostril to eye, distending pain. Fatigue after chemotherapy. Urination and defecation normal; renal effusion markedly reduced.
Left pulse deep and faint; right pulse deep, thin, slightly rapid.
Decoction:
Renshen 6g, Maidong (Ophiopogon) 10g, Wuweizi (Schisandra) 10g, Sheng Huangqi 30g, Danggui 6g, Zhi Gancao 10g, Chenpi 6g, Fabanxia 6g, Fuling 15g, Nüzhenzi 6g, Mohanlian 6g, Shayuanzi 6g, Tusizi 6g, Bajitian (Morinda) 10g, Dingxiang 6g, Shidi 6g, Jiao Sanxian each 10g, Ejiao (donkey-hide gelatin) 12g (dissolved in two divided doses).
Patent medicines: Jinkui Shenqi Wan; Huanyuan Dan (my self-formulated 77-herb formula).
Follow-up, April 14, 2019
The patient had begun to develop resistance to chemotherapy. The discharge summary read: post-surgery for colon cancer; multiple enlarged retroperitoneal lymph nodes, considered metastatic tumors, somewhat larger in range than before; obstructive dilation and fluid accumulation in the left abdominal ureter and renal pelvis, worse than before; left perirenal exudation, worse than before. Liver metastatic tumors, not much change in size. Cysts in the left lateral and left medial lobes of the liver. Small cysts in both kidneys. Multiple bilateral lung nodules, considered metastatic tumors, slightly larger than before. CA724 and CEA rose.
Right pulse deep, soft, weak; left pulse deep, soft, weak. Considering the patient was still young, I decided to intensify the anti-cancer effort and take a gamble for him.
Decoction:
Renshen 6g, Maidong 10g, Wuweizi 10g, Sheng Huangqi 30g, Danggui 6g, Zhi Gancao 10g, Fuling 30g, Nüzhenzi 6g, Mohanlian 6g, Shayuanzi 6g, Tusizi 6g, Bajitian 10g, Jiao Sanxian each 10g, Baizhu (Atractylodes) 20g, Zhuling (Polyporus) 20g, Yimucao (Leonurus) 20g, Zelan (Lycopus) 10g, Yiyiren (Coix) 60g, Zexie (Alisma) 10g, Huainiuxi (Achyranthes) 10g, Cheqianzi (Plantago seed) 15g, Cheqiancao (Plantago) 15g, Huaishanyao (Diocorea) 30g, Chenpi 10g, Fabanxia 10g, Shengjiang (ginger) 10 slices, Dazao (jujube) 7 pieces.
Patent medicines: Huoliu Wan (my self-formula), twice daily, 15-50 pills each time; Huanyuan Dan (my self-formula), twice daily, 15-50 pills each time; Qisheng Dan (my self-formula), three times daily, 5-20 pills each time; Chanyi Jiaonang (toad-skin capsules—made by grinding toad slough into powder and filling into size-0 empty capsules; note that here "chanyi" refers to the thin, cicada-wing-like slough on the toad's body, not the dried toad skin sold in pharmacies), twice daily, 1-3 capsules each time; Neixiao Sanjie Wan (my self-formula), twice daily, 8 pills each time; De-methylcantharidin tablets, twice daily, 5-15 mg each time.
Because this time the number and dosage of medicines was large, and toad slough is very expensive, worrying that the patient could not bear it either physically or financially, I instructed the patient to take the various patent medicines on alternating odd and even days: on odd days take several, on even days take the others. This would achieve the anti-cancer effect while lessening the physical and financial burden.
The patient and his family worried that I was thinking only of economics, saving them money at the risk of delaying treatment; after returning home, they took all the medicines every day. As a result, they developed vomiting, diarrhea, abdominal distension, and abdominal pain, and asked me how to handle it. I told them to stop all the other medicines first and take Huoxiang Zhengqi Wan (Agastache Qi-Rectifying Pill) to stop vomiting and diarrhea; once that stopped, then take the anti-cancer medicines on alternating odd/even days.
In less than two days of Huoxiang Zhengqi Wan, the vomiting and diarrhea stopped. This time the patient followed my order, taking different medicines on odd and even days, and there was no more vomiting or diarrhea. The patient then continued taking medicines according to this regimen while continuing Western treatment.
On May 24, 2019, the patient returned to the 9504 Hospital of the Joint Logistics Support Force for follow-up. Results: the liver metastatic lesion had shrunk from 1.6×1.1 to 1.2×1.1; the retroperitoneal metastatic tumor had shrunk from 3.5×4.0 to 2.5×2.5; all examined metastatic tumors had shrunk to varying degrees (the lungs were not examined, fearing too much CT radiation and not daring to do checks too frequently). Tumor marker CA724 dropped greatly, from the previous 124 to 31; CA199 dropped from 12.4 to 9.9; CEA rose somewhat, from 6.24 to 9.62.
The patient's current condition is quite good; treatment continues.
Chinese and Western medicine each have their strengths; treating tumors requires multidisciplinary cooperation. Without the help of TCM, the Western treatment of this patient could not have continued. When Western anti-cancer treatment was ineffective, intensifying the anti-cancer power of Chinese medicine again produced obvious results. The patient's condition was severe; with integrated Chinese-Western treatment, achieving such efficacy is already quite good.
In treating cancer, patients and their families must themselves be rational. Both Chinese and Western medicine have strengths and weaknesses, and every doctor's insight differs; so one should not excessively superstition TCM or excessively superstition Western medicine.
When the body is in poor shape and cannot bear the burden, following the Western regimen completely easily leads to overtreatment. When cancer is progressing rapidly, using TCM or Western medicine alone easily leads to undertreatment. At such times, the patient's own judgment and choice is often more important than the doctor's.
I previously knew a liver cancer patient for nearly ten years; a sentence he said I still cannot forget: "If I had completely obeyed the doctor, I would not be alive today; if I had completely disobeyed the doctor, I would also not be alive today." Precisely because, in medical decisions, he had his own judgment and independent views, choosing Chinese or Western treatment at the opportune moment, he was able to create a survival miracle.