Commentary on One Case of Breast Cancer Treated by Professor Li Jiren

Professor Li Jiren is a modern-day patriarch of the Xin'an medicine school. He has treated many cancer patients and published many case records. Here I excerpt one breast-cancer case and add brief commentary.

The patient, Zhang, female, 45, a worker, first visited on November 20, 1995. She had found a lump in the upper part of her left breast in October 1993; biopsy confirmed breast cancer. In November of the same year she underwent radical resection of the left breast cancer, followed by radiotherapy for over two years. Lately she felt the old illness recur: pain at the operative site, nausea and vomiting, poor appetite, fatigue, lassitude, and dry, difficult stools. On palpation a hard lump could be felt in the chest, tender to pressure. The tongue body was dark, the coating yellow and greasy, and the pulse wiry and slippery. Professor Li differentiated the pattern as qi stagnation with phlegm congelation and stasis obstructing the channels. The treatment principle was to move qi and downbear counterflow, resolve phlegm and soften hardness, and resolve toxin and anticancer.

Formula: Xuanfugeng (Inulae Caulis), Chenpi, Jiegeng, Zhuru, Fabanxia, Chishao, Chuanlianzi, and Yanhusuo, each 10 g; Zheshi (Hematitum, crushed, decocted first) 20 g; Xiakucao (Prunellae Spica), Pugongying, Haizao (Sargassum), and Muli (Ostrea Concha), each 15 g; Baihua Sheshucao (Oldenlandiae Herba) 30 g; Longkui (Solanum nigrum) 20 g. Decocted in water, one dose daily.

Professor Li's formula combines several famous prescriptions—Xuanfu Daizhe Tang, Jupi Zhuru Tang, Erchen Tang, and Jinlingzi San—with suitable modification. Xuanfu Daizhe Tang, Jupi Zhuru Tang, and Erchen Tang all resolve phlegm and downbear counterflow; Jinlingzi San is a famous TCM analgesic. Xiakucao, Pugongying, Haizao, and Muli soften hardness and dissipate nodules; Baihua Sheshucao and Longkui clear heat, resolve toxin, and anticancer. Thus this formula is composed according to the strategy of combining pattern-based and disease-based treatment.

After seven doses, the various symptoms lessened; nausea and vomiting stopped and appetite improved, though the operative site still gave occasional dull pain. Once the nausea and vomiting abated, the counterflow-downbearing, vomiting-stopping herbs of Xuanfu Daizhe Tang, Jupi Zhuru Tang, and Erchen Tang should be removed; with appetite and upright qi somewhat recovered, the time had come to attack. So at the second visit, Professor Li adjusted the formula as follows:

Xiakucao, Pugongying, Haizao, Muli, Danggui, Danshen, and Shancigu, each 15 g; Chenpi, Jiegeng, Fabanxia, Chishao, Yanhusuo, Chuanlianzi, Beimu, Sanleng, and Ezhu, each 9 g; Baihua Sheshucao 30 g; Longkui, Gualou (whole), and Wangbuliuxing, each 15 g. Decocted in water, one dose daily.

This formula strengthens the action of softening hardness and dissipating nodules, and of activating blood and reducing swelling. Xiakucao, Pugongying, Haizao, Muli, Shancigu, and Beimu all resolve phlegm and dissipate nodules; the ancients often used Gualou alone to treat breast lumps, which is why Professor Li's second formula also included it. It adds anticancer, swelling-reducing herbs such as Sanleng and Ezhu, plus blood-activating, blood-nourishing medicinals such as Chishao, Danggui, and Danshen. Wangbuliuxing is also a common herb in TCM gynecology. This formula focuses on anticancer and reducing swelling.

It is worth noting that in both prescriptions Professor Li used Pugongying (dandelion) and Xiakucao (selfheal-spica)—two inexpensive herbs quite effective for breast tumors. Pugongying in particular is one I often use for breast lumps. For benign breast lumps I often use dandelion alone, having patients dry-fry its root until yellow and brew it as tea, persisting for months; it often works well.

Over half a month on the second formula, the symptoms clearly lessened, the pain stopped, the lump softened, and the greasy tongue coating cleared. Professor Li then followed the principle of "if it works, do not change the formula," continuing the second-visit prescription thereafter without further alteration. After several months of treatment, the breast lump resolved completely. Seven years of follow-up showed no recurrence; the patient worked and lived normally, unaffected by the disease.

At the first visit, because the patient had nausea and vomiting, Professor Li used symptom-directed herbs. At the second visit, those symptoms had cleared, leaving only the pain and other symptoms from the breast lump, so he focused on resolving the tumor. Once the second formula proved effective, seeing the result, he kept it unchanged to the end.

What deserves special mention is this principle of "if it works, do not change the formula," which is all too rare in today's medical climate. Many TCM doctors now adjust prescriptions frequently—some every week—adding unnecessary burden to patients and making seeing a doctor a wearying affair, a double economic and psychological strain on the chronically ill. Many patients have grown used to asking the doctor to adjust the prescription every week or two, and after endless adjustments it no longer works. This haste defeats its own purpose and is a bad bargain.

In my own practice I have also seen many anxious patients repeatedly demanding that the doctor adjust the formula to speed treatment. Some come to the doctor every few days asking for re-diagnosis and a new prescription; such patients are also hard to treat effectively. Chronic disease cannot be treated hurriedly; as long as it works, hold the formula steady and persist for a while.

Looking at this case treated by Professor Li, the herbs used were unremarkable and the course of treatment very steady, yet the outcome was striking. This reflects exactly the deep skill of an old master. In treating chronic diseases such as cancer, the doctor must keep his composure and need not strike poses or seek novelty. The patient must also keep composure, accepting that chronic disease takes slow treatment, and cooperate with the doctor. Only thus is there hope of good results against this intractable disease.

Note: This case is only for commentary and explanation of the principles of TCM treatment of breast cancer. The formulas in the case are prescribed by clinicians according to each patient's specific situation and are not suitable for all patients. Please take medicine only under a physician's guidance; do not copy others' prescriptions to treat yourself, lest mishaps occur.