Commentary on Two Cases of Nasopharyngeal Carcinoma Treated by Professor Qian Bowen

The late Professor Qian Bowen, a famous Shanghai physician, was one of China's great masters of TCM anticancer treatment. He devoted his life mainly to research on treating cancer with Chinese medicine, leaving behind much valuable experience as well as some case records worth studying. This article presents two cases of nasopharyngeal carcinoma cured by Professor Qian, with commentary, for everyone's reference.

Case 1: a 42-year-old man, Zhang, with late-stage nasopharyngeal carcinoma. He was diagnosed at a hospital in 1972, with dizziness and headache as the main symptoms. At the face-to-face visit, his right eyeball was deviated outward; both cheeks felt distended and burning; opening the mouth and swallowing were often difficult; appetite was poor; the throat was dry; the tongue was red with little moisture; the mouth was dry; and the pulse was fine and wiry.

After diagnosis, Professor Qian considered the nasopharyngeal carcinoma to be caused by yin deficiency with blazing fire, and decided to treat him by nourishing yin and generating fluids, and clearing heat and resolving toxin. The patient chose integrated Chinese and Western medicine, taking Chinese herbs while undergoing radiotherapy and chemotherapy.

Professor Qian's formula mainly used yin-nourishing and heat-clearing, toxin-resolving herbs: Xuanshen (Scrophulariae Radix), Tiandong (Asparagi Radix), Maidong (Ophiopogonis Radix), Tianhuafen (Trichosanthis Radix), Shashen (Glehniae/Adenophorae Radix), Yuzhu (Polygonati Odorati Rhizoma), Shihu (Dendrobii Caulis), Pugongying (Taraxaci Herba), Yejuhua (Chrysanthemi Indici Flos), Zhimu (Anemarrhenae Rhizoma), Shengdi (Rehmanniae Radix), Shandougen (Sophorae Tonkinensis Radix), Banlangen (Isatidis/Baphicacanthi Radix), and others.

After radiotherapy, the headache and outward deviation of the eyeball improved somewhat, but ulcers in the mouth and on the gums remained. Professor Qian added Sheng Gancao (raw Glycyrrhizae Radix), Jiegeng (Platycodi Radix), Digupi (Lycii Cortex), Mudanpi (Moutan Cortex), and Tianlong (earthworm/pheretima-like crawling insect) to the original formula. After taking the above formula for over a year, the symptoms gradually lessened and finally disappeared; examination of the posterior nasopharynx showed no recurrence or suspicious signs. Follow-up to October 1978 found him doing well and back at work.

Case 2: a 47-year-old man, Hua, whose nasopharyngeal carcinoma had metastasized to cervical lymph nodes. After radiotherapy, the cervical nodes remained enlarged; he also had dry throat and mouth, difficult expectoration of cough with blood-streaked sputum, dizziness and headache, weakened vision, poor appetite, loose stools, fatigue, and limb weakness. The tongue coating was thick and greasy, the tongue dry, and the pulse fine and wiry.

Professor Qian considered this patient's constitution to be one of phlegm-heat binding together, and treated by clearing heat and draining dampness, and resolving phlegm and dissipating nodules. The herbs used were: Fuling (Poria), Sheng Yiyiren (raw Coicis Semen), Shu Yiyiren (roasted Coicis Semen), Tufuling (Smilacis Glabrae Rhizoma), Gualoupí (Trichosanthis Pericarpium), Shiwei (Pyrrosiae Folium), Pugongying, Fo'ercao (Gnaphalii/Helichrysi Herba), Jiegeng, Sheng Gancao, Chenpi, Biandou (Lablab Semen), Zexie (Alismatis Rhizoma), Zhebeimu (Fritillariae Thunbergii Bulbus), Baimaogen (Imperatae Rhizoma), Shichangpu (Acori Tatarinowii Rhizoma), and others. The patient persisted with the above formula for about two years; the various symptoms gradually lessened and disappeared. Seven years of follow-up and local re-examination showed no abnormality, and he continued to work and live normally.

Professor Qian held that nasopharyngeal carcinoma should be treated according to the principle of pattern differentiation, with the treatment principle determined on that basis. Most nasopharyngeal carcinoma cases are caused by heat-toxin, but in some the heat-toxin arises from yin deficiency with internal heat, and in others from damp-heat obstructing the interior. Different types require different treatment plans. For example, Case 1 was yin deficiency with internal heat, so yin-nourishing, fire-descending herbs had to be used heavily; Case 2 was phlegm-heat binding, with heat mixed with dampness and dampness mixed with heat, so treatment had to, while clearing heat and resolving toxin, heavily use dampness-draining and phlegm-resolving, nodule-dissolving herbs.

At the same time, Professor Qian strongly advocated integrated Chinese-Western anticancer treatment. Radiotherapy works well for nasopharyngeal carcinoma, and he particularly recommended combining radiotherapy with Chinese herbs, as this raises the patient's chance of beating the disease.

Neither of these two case records gives the dosages of the herbs. This calls for an explanation on Professor Qian's behalf: first, dosages may have changed each time the formula was adjusted; second, in TCM the dose must be individualized, so only the therapeutic strategy is for reference, and one should not plagiarize a specific formula to treat patients.

That is why most of Professor Qian's case records are brief, recording only the overall therapeutic strategy rather than each specific prescription. When clinicians study his cases, they must medicate according to the patient's own condition. We should also learn from Professor Qian's attitude of putting the patient first and discarding sectarian prejudice—we must not elevate Chinese medicine by disparaging Western medicine at the cost of the patient's treatment. We should encourage patients to combine Chinese and Western medicine to raise the chance of cure.

In China, nasopharyngeal carcinoma is mainly highly prevalent in Guangdong Province and in the bordering Guangxi and Hunan, so it is also called the "Guangdong tumor."

There are patients with nasopharyngeal carcinoma in other provinces too, but the incidence is relatively lower. The cities of Foshan, Guangzhou, and Zhaoqing in Guangdong are the regions with the highest incidence in China. Cangwu in neighboring Guangxi and Shuangpai County in Hunan also have high mortality from nasopharyngeal carcinoma. These regions have a hot climate, and from the TCM viewpoint their residents are also prone to heat-toxin; hence TCM treatment of nasopharyngeal carcinoma mostly uses heat-clearing, toxin-resolving herbs.

Modern medicine holds that the onset of nasopharyngeal carcinoma is related to EBV infection, toxic environmental exposures, dietary habits, and genetic factors. Patients with high EBV markers are a high-risk group; in addition, eating salted fish, salted eggs, pickled vegetables, and fried, grilled, and barbecued foods in early childhood makes nasopharyngeal carcinoma more likely in adulthood. The disease also tends to cluster in families, so it has a certain hereditary and familial character. On one hand, EBV spreads easily among close contacts; on the other, family members share similar dietary habits, so it is not surprising that several cases appear in one family.

Preventing nasopharyngeal carcinoma requires early intervention in patients with high EBV markers, and dietary attention on the part of certain high-risk groups.