Experience in Treating Gastric Cancer with Traditional Chinese Medicine

I began researching the TCM treatment of gastric cancer because my own mother suffered from it. Over the years I have put enormous effort into studying its treatment; it could be said that gastric cancer is the cancer I have studied most. Because the immediate relatives of gastric cancer patients have a more than five-fold higher risk of developing gastric cancer than the general population, I also pay special attention to its prevention.

China is a high-incidence country for gastric cancer, with the world's highest incidence rate. The five-year survival rate of Chinese gastric cancer patients is very low, far behind that of neighbors such as Japan and South Korea. This is mainly because China's early screening for gastric cancer is not yet as good as that in developed countries.

Patients whose gastric cancer is detected early are relatively fortunate, because they have more treatment options.

Gastric cancer is mostly induced by persistent, refractory chronic stomach disease and poor lifestyle habits. Helicobacter pylori positivity, gastric ulcer, and atrophic gastritis are all precancerous lesions. A taste for pickled foods, hot food, grilled food, hotpot, and chronic late nights are all high-risk behaviors that readily trigger gastric cancer.

It is generally held that H. pylori is the chief culprit behind most chronic stomach disease and gastric cancer. H. pylori positivity is common among Chinese residents (a C-13 or C-14 urea breath test easily detects it). It spreads through shared eating utensils and similar means. Because Chinese people are not accustomed to separate meals, more than half of all Chinese are H. pylori-positive.

H. pylori positivity is more common in the north than in the south: roughly over 60% of northerners and about 40% of southerners are positive. The proportion among Buddhists is far higher than in the general population—over 90% of lamas are positive—mainly because Buddhists tend toward communal living and shared meals.

The standard treatment for H. pylori is triple or quadruple therapy. Because the prevalent strains differ by region, the specific triple- or quadruple-therapy regimens vary slightly from place to place. Those worried about H. pylori can ask a gastroenterologist to order a test during a checkup; if positive, they can seek local treatment. Even after eradication, one must still maintain dietary hygiene and avoid sharing utensils.

Patients with a family history of gastric cancer and long-standing symptoms such as gastric distension, stomach pain, acid regurgitation, and reflux should undergo regular gastroscopy and H. pylori testing to prevent gastric cancer.

The best treatment for carcinoma in situ and early gastric cancer is surgery. It is generally held that over 90% of patients with carcinoma in situ or early gastric cancer can achieve a radical cure through surgery. The higher five-year survival rate among gastric cancer patients in developed countries such as Japan is tied to their active early screening. In fact, once gastric cancer reaches the middle-to-late stage, treatment results in Japan are also unsatisfactory.

Early gastric cancer usually causes no symptoms and is hard to detect. Most Chinese gastric cancer patients are already in the middle-to-late stage when first found. The progression from in situ/early gastric cancer to middle-to-late disease is a long stage, but the further progression from middle-to-late to end-stage disease and then to death is much shorter.

Common symptoms of gastric cancer include refractory anemia, black stools (occult blood in stool), nausea and vomiting, gastric bleeding, acid regurgitation and heartburn, gastric distension and pain, and vomiting food eaten in the morning by evening or vice versa; late-stage gastric cancer also has complications such as ascites and hepatic coma. These symptoms are easily confused with gastritis and gastric ulcer. Many chronic stomach patients have already undergone malignant transformation without realizing it, believing all along that they merely have an old stomach complaint. By the time most patients notice something abnormal, their gastric cancer is already in the rapidly progressive middle-to-late stage.

Middle-to-late gastric cancer patients basically have no surgical option. The standard Western approach is chemotherapy drugs plus oral targeted drugs, with a certain success rate. Overall, however, the survival time of middle-to-late gastric cancer patients is short—generally only a few months to two or three years.

Patients with early-to-mid gastric cancer easily relapse and metastasize in the second to third year after surgery; intra-abdominal metastasis is common, and late-stage disease often metastasizes to the liver. After recurrence or metastasis, treatment becomes much harder. Early gastric cancer patients also easily develop remnant gastric cancer in the 13th to 14th postoperative years.

Gastric cancer has many names in TCM; the traditional disease names 'stomach reversal' (wei fan), 'dysphagia' (ye ge), 'epigastric pain' (wei wan tong), and 'abdominal mass' (ji ju) all relate to it. However, modern TCM physicians treating gastric cancer should keep pace with the times, because today's gastric cancer patients usually turn to TCM for 'regulation' and follow-up recurrence prevention only after Western surgery and chemotherapy, or they come to TCM after repeated failed Western treatments when their condition is already poor.

Thus the gastric cancer patients contemporary TCM physicians face are in relatively poor condition, differing from the diseases recorded in traditional medical texts. Contemporary TCM physicians should conduct fresh pattern differentiation based on each patient's new presentation.

Postoperative and post-chemotherapy patients are weak and in a clear state of 'antipathogenic qi deficiency' (zheng xu), so treatment should focus on supporting antipathogenic qi and consolidating the root. Once their condition has recovered reasonably well through regulation, appropriate treatment to expel pathogen and shrink the tumor should be adopted. Professor He Ren's cancer-treatment principle—'continuously support antipathogenic qi, expel pathogen at the right time, and treat according to the pattern'—is highly instructive in treating gastric cancer.

Besides helping support antipathogenic qi and consolidate the root, TCM also plays an important role in preventing recurrence in gastric cancer patients. The longest-surviving middle-to-late gastric cancer patient I have seen maintained on TCM after surgery has now lived more than twenty years. Several gastric cancer patients I have personally treated have also survived over five years with no sign of recurrence.

TCM treatment of gastric cancer should be carried out in two parts: first, treatment based on pattern differentiation; second, disease-based treatment.

Pattern-differentiation treatment mainly uses the patient's pulse, signs, and clinical symptoms to prescribe targeted formulas that relieve symptoms and suffering.

Disease-based treatment regards gastric cancer as a specific disease and uses drugs with broad anticancer action to attack the tumor and residual cancer cells.

TCM has a rich, mature repertoire of formulas for gastric cancer and other digestive-tract diseases, and most work well. Common patent medicines such as Sijunzi Wan, Liujun Wan, Xiangsha Liujun Wan, Shugan Hewei Wan, Guipi Wan, Renshen Jianpi Wan, Erchen Wan, Pingwei Wan, and Baohe Wan are all excellent medicines for stomach complaints.

Among the classical formulas (jing fang), Banxia Xiexin Tang, Shengjiang Xiexin Tang, Gancao Xiexin Tang, Xiao Jianzhong Tang, Chaihu Guizhi Ganjiang Tang, Lizhong Tang or Wan, and Xuanfu Daizhe Tang, as well as later (shi fang) formulas such as Buzhong Yiqi Tang, Guipi Tang, Renshen Yangrong Tang, Bazhen Tang, Danshen Yin, and Jinlingzi San, are all representative formulas commonly used by gastric cancer patients.

As long as a physician is familiar with the indications of these formulas and prescribes according to the patient's pulse and chief complaint, it is not hard to write a pattern-based decoction. Treating gastric cancer by pattern differentiation is not very different from treating common stomach complaints; both aim to relieve symptoms, ease suffering, and build the patient's confidence in the doctor.

Disease-based treatment requires the physician to be familiar with the properties and side effects of the common Chinese herbs and patent medicines that inhibit gastric cancer, and to prescribe differently according to each patient's specific condition. Combining pattern-differentiation and disease-based treatment greatly improves clinical results.

Common patent medicines that inhibit gastric cancer include various preparations of banmao (cantharides), Sophora flavescens (kushen) preparations, Pingxiao Pian, Xihuang Wan, Yunnan Baiyao, and various preparations of Chinese toad venom (chansu).

Common Chinese herbs that inhibit gastric cancer include Sanleng, Ezhu, Sanqi (Notoginseng), Danshen (Salvia), Xiangfu, Tenggen, Huzhang (Polygonum Cuspidati), Banzhilian, Baihua Shebancao, Tu Beimu, Zhe Beimu, Chuan Beimu, Xuanshen, raw Muli, Haizao, Kunbu, Xiakucao, Ruxiang (Olibanum), Moyao (Myrrha), Huaruishi, Xianhecao (Agrimoniae Herba), Daji, Xiaoji, Quanxie (scorpion), Wugong (centipede), Banmao (cantharis), Hongnichong, Qingnichong, Tenghuang, and Maqianzi (Strychni Semen).

Although each gastric cancer patient's symptoms differ, most are similar: chronic digestive-tract bleeding, nausea and vomiting, abdominal distension and pain, progressive weight loss, and refractory anemia. Therefore, when treating gastric cancer, the TCM physician should focus on these symptoms—supplementing blood and stopping bleeding, regulating qi and stopping vomiting, resolving phlegm and dissipating nodules, and reducing distension and fullness. The patient and family should be told to watch the stool; if black stools appear, hemostatic measures should be intensified.

I now illustrate my usual approach to treating gastric cancer with two cases.

Case 1: A poorly differentiated gastric adenocarcinoma patient surnamed Zhang from Cixi, Zhejiang

The patient's first visit was sometime around 2012-2013; I cannot recall the exact date, and the early records were lost when a notebook went missing. At the time she had just finished surgery and chemotherapy and was weak, and she asked me for TCM treatment.

She was emaciated with a dark, sallow complexion; her pulse was likely fine and rapid. I therefore treated her with a modified Shengmai Yin combined with Sheng Jiang San; the patient herself kept some of the early prescriptions.

The general medication followed the approach of Professor Zhao Shaoqin, using Shashen (Glehniae/Adenophorae Radix), Maidong (Ophiopogonis Radix), Wuweizi, Huangqi, Danggui (Angelicae Sinensis Radix), Pian Jianghuang, stir-fried Jiangcan, Chanyi, Tenggen, Shiwei, Banzhilian, Baihua Shebancao, and Pugongying as the main formula, with patent medicines such as Fufang Banmao Jiaonang.

For the first two or three years she came for a follow-up about every three months, with a few herbs adjusted each time. After three years I had her come every six months, again adjusting a few herbs on the same basis; in the most recent two years I have mainly had her take patent medicines.

Because this patient's results were stable and her condition improved markedly—despite the high-grade malignancy of her poorly differentiated adenocarcinoma—the gastric cancer has remained well controlled all these years. I have therefore gradually reduced her dosage year by year to ease the burden of taking medicine and the financial strain.

When she first came to me, her household had three cancer patients including herself, and her son was still in school, so the financial pressure was severe. In those early years I treated her free of charge, and at festivals she would always try to bring me local specialties as a token of gratitude; the doctor-patient relationship stayed excellent. In this way she persisted despite her family's poverty.

Later her son finished school, her own condition recovered well, and she returned to work. Considering that I also had a family to support, she offered to pay. Treatment has continued to this day; everything is going well, no follow-up has shown recurrence, and she remains on staged medication to prevent recurrence while working normally.

Case 2: A patient surnamed Yang with inoperable poorly differentiated gastric adenocarcinoma from Dandong, Liaoning

Mr. Yang, male, born in 1946, first visited on March 5, 2019, having been diagnosed locally with advanced poorly differentiated gastric adenocarcinoma.

His wife had just died of cancer. Having witnessed the suffering their mother endured through Western treatment, the children did not want their father to endure the same, and they resolved to seek TCM treatment from me.

He had long been a farmer; his family favored pickled foods such as sour cabbage, he was H. pylori-positive, and he had suffered atrophic gastritis for many years, which gradually progressed to poorly differentiated gastric adenocarcinoma. His pulse was wiry, slow, and regularly irregular (jie dai); blood pressure/heart rate: 131/76/50.

He was prone to anger, hiccups, poor appetite, epigastric pain, gastric distension, and heartburn; sleep was fair but there was no acid regurgitation. After taking a series of patent medicines locally, his eyes became dry, many red bumps appeared on his scalp, and his skin occasionally itched. His stools had been formed but became unformed after taking Chinese medicine; his urine turned yellow, he had a bitter taste in the mouth, and his stools became loose.

The previous doctor's prescription was:

Longdancao (Gentianae Radix) 10 g, Chaihu 10 g, Huangqin 10 g, Zhizi (Gardeniae Fructus) 10 g, Cheqianzi 15 g, Jiu Dahuang (wine-processed rhubarb) 10 g, Shengdi 20 g, Zexie (Alismatis Rhizoma) 10 g, raw Gancao 10 g, Danshen 25 g, Maidong 10 g, Huangjing 10 g, Yuanhu (Corydalis Rhizoma) 15 g, Zhiqiao (Aurantii Fructus) 10 g, Qingpi (Citri Reticulatae Pericarpium Viride) 10 g, Binglang (Arecae Semen) 10 g, Muxiang (Aucklandiae Radix) 10 g, Yujin (Curcumae Radix) 10 g, Sanleng 15 g, Ezhu 15 g, Baihua Shebancao 15 g, Banzhilian 15 g, Kushen (Sophorae Flavescentis Radix) 10 g.

I decided to treat him by fortifying the spleen and supporting antipathogenic qi, and by countering upward rebellion to stop vomiting.

I prescribed: Dangshen 15 g, Baizhu 10 g, Zhi Gancao 6 g, Fuling 10 g, Xuanfuhua (Inulae Flos) 6 g (wrapped), Daizheshi (Haematitum) 6 g (wrapped), Zhuru (Bambusae Caulis in Taeniam) 6 g, Fabanxia 6 g, Chenpi (Citri Reticulatae Pericarpium) 6 g, Jiao Sanxian 10 g each, Baiji (Bletillae Rhizoma) 6 g, Sharen (Amomi Fructus) 3 g, Tanxiang (Lignum Santali) 3 g, Danshen 30 g, raw Huangqi 30 g, stir-fried Yiyiren 60 g, Danggui 10 g, Muxiang 10 g, Shidi (Kaki Calyx) 10 g, Dingxiang (Caryophylli Flos) 6 g, Baihua Shebancao 10 g, Banzhilian 10 g, Tenggen 30 g, Foshou (Citri Sarcodactylis Fructus) 30 g, Houpo (Magnoliae Officinalis Cortex) 15 g, Jianghuang 6 g, Jiangcan 10 g, Chanyi 6 g, Shengjiang 7 slices, Dazao 7 pieces. One dose daily, taken once after each morning, noon, and evening meal, about half an hour after eating.

I also used patent medicines such as Shugan Hewei Wan and Fufang Banmao Jiaonang, and pills made from Chuan Beimu, Tu Beimu, Zhe Beimu, Xuanshen, Muli, Xiakucao, Liangtoujian, Wugong, Quanxie, Baihuashe, Caoshe, Shanjiazhu (pangolin scales), Ruxiang, Moyao, Huaruishi, Shexiang (musk), and Niuhuang (cow bezoar).

I imposed dietary restrictions: spicy and greasy foods, pickled foods, grilled food, hotpot, citrus, sweet potato, all beans and bean products, tobacco, and alcohol. I required him to take the medicine for five days and rest for two, giving the liver, kidneys, and stomach a chance to recover.

He responded clearly: weight and strength returned, and his symptoms gradually lessened until basically gone. Each time his daughter asked me about the next step, I told her not to change the working prescription. He has kept taking that one prescription until now; he has recovered well and can already do farm work.

I repeatedly suggested a follow-up gastroscopy, but the patient refused. Because he is currently doing well and cooperating, his children and I did not press the old man, and for now we continue the original regimen.

This patient's family and he himself had experience dealing with cancer and were no longer terrified by it, nor did they live in constant dread after repeated checkups. The family had also given up on modern medical treatment, so the results were good.

Poorly differentiated gastric adenocarcinoma is among the most malignant types of gastric cancer. The two poorly differentiated adenocarcinoma patients above have remained stable and in good condition under TCM treatment, showing that TCM does indeed have a definite role in treating gastric cancer.

Limited by space, I will not list more cases here; in the future I will publish separate case reports of my gastric cancer treatments for reference.

Overall, when it comes to gastric cancer, prevention matters more than treatment. Both patients above had long histories of chronic stomach disease before turning malignant. Had they received good treatment before the malignant transformation, they would not have developed gastric cancer.

The families of these two patients also face a high risk of gastric cancer. For them, changing the family's dietary and daily habits and eradicating H. pylori are of great preventive significance.

From a young age my own mother suffered severe gastric ulcer that repeatedly failed to respond to both Chinese and Western treatment, eventually progressing to gastric cancer. It was witnessing my mother tormented by stomach disease and in great suffering when I was a child that first gave me a strong desire to study medicine.

Not long ago, while teaching Banxia Xiexin Tang to students, I also told them about this original driving force behind my choice of medicine. I told them to use what they learned to help patients with chronic stomach disease eradicate it early and prevent its progression to gastric cancer.

We physicians, when we see H. pylori-positive patients with symptoms, should likewise try our patient's patience to persuade them to eradicate their stomach disease early and prevent gastric cancer.