Experience in Treating Obstructed Lymphatic Drainage and Tumor Enlargement After Biopsy in Follicular Lymphoma

After a tumor undergoes needle biopsy for pathology, it sometimes grows rapidly as a result of the biopsy's irritation; this is not uncommon in clinical practice, and I myself have encountered such a patient.

This is a female lymphoma patient. I had previously published part of her case, but at that time I had not yet solved the problem of the steadily enlarging tumor at the biopsy site. Recently, because her growing inguinal lymphoma had compressed the lymphatic drainage and caused edema of the lower limb, she again asked me to find a solution. While treating her leg edema, I inadvertently also shrank the inguinal tumor that I had previously been unable to control.

The patient, surnamed He, was born in 1981 and is from Sichuan. Because of work and marriage, she had lived for a long time in Nanning, Guangxi after reaching adulthood. She first came to me for an in-person consultation on December 7, 2017.

In August 2017 she was diagnosed at the First Affiliated Hospital of Guangxi University of Chinese Medicine (her inpatient number there was 000000029388) with stage 3-4 follicular lymphoma. After four months of treatment there with no obvious effect, she came to me on December 7, 2017.

At the first visit, she had enlarged lymphomas on both sides of the neck, in both axillae, and in both groins, accompanied by night sweats and poor appetite. Her pulse was deep, fine, and slightly rapid, with a thick, greasy tongue coating. She worked in an office, did not stay up late, and the cause of her lymphoma was unclear.

At the first visit I prescribed several patent medicines for internal use: Neixiao Luoli Wan, Shenqi Shiyiwei Keli, Xihuang Wan, Xiaojin Wan, Fufang Banmao Jiaonang, Neixiao Sanjie Wan, Pingxiao Pian, Erzhi Wan, and others. I also imposed dietary restrictions, forbidding citrus fruits, seafood, pickled foods, grilled food, crab, shrimp, and carp.

After returning home, because of a cold she stopped taking the medicine for about a month, and the tumors continued to grow and multiply. Later, once she began taking the various patent medicines I had prescribed, the tumors stabilized and stopped changing.

At her follow-up visit on March 27, 2018, she reported that her sleep had recently been good and that she occasionally had diarrhea after taking the medicine, but this did not noticeably affect her strength. Her pulse was fine, slippery, rapid, and forceful, with a thin white tongue coating.

I then gave her a decoction plus patent medicines.

Decoction: Pugongying (Taraxaci Herba) 30 g, Rendongteng (Lonicerae Japonicae Caulis) 30 g, Jinyinhua (Lonicerae Flos) 15 g, Lianqiao 15 g, Diding (Violae Herba) 15 g, Yejuhua (Chrysanthemi Indici Flos) 10 g, Tiankuizi 15 g, Chaihu 10 g, Huangqin 10 g, Wuweizi (Schisandrae Fructus) 10 g, Huoxiang 10 g, Peilan (Eupatorii Herba) 10 g, raw Huangqi (Astragali Radix) 30 g, Nüzhenzi (Ligustri Lucidi Fructus) 15 g, Mohanlian (Ecliptae Herba) 15 g, Haizao (Sargassum) 30 g, Kunbu (Eckloniae Thallus) 30 g, Huangyaozi (Dioscoreae Bulbiferae Rhizoma) 15 g, Shancigu (Cremastrae Pseudobulbus) 15 g, Xuanshen (Scrophulariae Radix) 12 g, Zhe Beimu 12 g, raw Muli (Ostrea Concha) 30 g (decocted first), Biejia 24 g (decocted first), Guiban (Testudinis Plastrum) 15 g (decocted first), Xiakucao (Prunellae Spica) 15 g, Chonglou (Paridis Rhizoma) 15 g, Sanleng (Sparganii Rhizoma) 10 g, Ezhu (Curcumae Rhizoma) 10 g, Chanyi 6 g, stir-fried Jiangcan 10 g, Pian Jianghuang 6 g, Baihua Shebancao (Hedyotidis Diffusae Herba) 30 g, Banzhilian (Scutellariae Barbatae Herba) 30 g, Tusizi (Cuscutae Semen) 15 g, Shayuanzi (Astragali Complanati Semen) 15 g, Dangshen 30 g, Baizhu 30 g, Fuling (Poria) 30 g, Yiyiren (Coicis Semen) 60 g, Cangzhu 10 g, Huangbai (Phellodendri Cortex) 10 g, and Jiao Sanxian (the three charred digestives), 15 g each.

I instructed her to take each packet over two days, three times a day, about half an hour after meals, while also taking the patent medicines Xihuang Wan, Xiaojin Wan, Neixiao Sanjie Wan, and Fufang Banmao Jiaonang.

She returned for several more follow-up visits, with adjustments of herbs along essentially the same approach. The lymph nodes on her neck gradually shrank until they disappeared; the axillary nodes and the inguinal nodes on the side not biopsied also shrank in step. Her strength improved markedly and she continued working normally.

Only the lymph node at the site biopsied in the left groin, where the lymphoma was first diagnosed, kept enlarging; despite repeated changes of prescription, it would not shrink.

In August 2019, lymphatic drainage obstruction appeared in her left thigh, and the whole thigh became swollen and uncomfortable; the left leg was about twice as thick as the right. She sought help remotely, and I guided her to take the diuretic and detumescent patent medicine Jinkui Shenqi Wan together with the Western drug spironolactone.

After the edema had lessened somewhat, she came back for a follow-up on September 5, 2019. I learned that the lymph node on the right side of her neck had disappeared, but the left leg was badly swollen, and the lymph node below the left groin had enlarged, with pain and itching. Her left pulse was deep and faint, and the right pulse was fine and rapid.

I then prescribed a diuretic, detumescent decoction using my usual approach: raw Huangqi 30 g, Han Fangji (Stephaniae Tetrandrae Radix) 30 g, stir-fried Baizhu 30 g, Fuling 30 g, Zhuling (Polyporus) 10 g, Cheqiancao (Plantaginis Herba) 15 g, Cheqianzi (Plantaginis Semen) 15 g, Huai Niuxi (Achyranthis Bidentatae Radix) 10 g, Xiangfu (Cyperi Rhizoma) 20 g, Yimucao (Leonuri Herba) 20 g, Yiyiren 60 g, Daji (Cirsii Japonici Herba) 20 g, Xiaoji (Cirsii Herba) 20 g, Pugongying 30 g, Rendongteng 30 g, Tiankuizi 10 g, Diding 10 g, Yejuhua 10 g, Dangshen 15 g, Huangjing (Polygonati Rhizoma) 15 g, Mohanlian 10 g, Nüzhenzi 10 g, Shayuanzi 10 g, Tusizi 10 g, Banzhilian 20 g, Baihua Shebancao 20 g, Tenggen (Actinidiae Radicis) 30 g, Shiwei (Pyrrosiae Folium) 30 g, Jiao Sanxian 10 g each, and stir-fried Jineijin (Galli Gigerii Endothelium Corneum) 30 g.

At the same time I instructed her to take four pill-form patent medicines including Simiao Wan and Herong Sanjian Wan, and to eat more foods that promote diuresis, unblock the collaterals, and reduce swelling, such as winter melon, bottle gourd, white radish, and loofah.

On September 27 she reported that the leg edema had basically cleared, with only slight swelling remaining above the knee. A hospital ultrasound of the left inguinal lymph node showed it had shrunk by more than 1 centimeter compared with September 3. Her condition had clearly improved in every respect, with no adverse reactions. She asked me to guide the next step, and since the regimen was working I told her not to change it but to continue.

This patient's situation was unusual: from start to finish she trusted me completely and never considered changing doctors. The treatment during the initial period was actually not obviously effective, but she patiently persisted, giving me the chance to adjust the medication.

Later, although there was some effect, the lymphoma in her left groin kept growing; she did not panic, refused other treatments, and patiently kept taking the Chinese medicine. Even when her left leg swelled from obstructed lymphatic drainage, she remained willing to let me keep exploring treatment options. It took nearly two years before the tumors all over her body finally shrank.

Follicular lymphoma itself is fairly indolent and does not grow fast, which was also an important reason this patient could persist so long and eventually see comprehensive results. For faster-growing tumors, even a trusting patient might not be so fortunate.

I had previously been stumped by how to deal with the enlarging tumor at this patient's biopsy site. It was only when her symptoms worsened and her leg swelled that I thought of using diuretic, detumescent methods to relieve the edema, inadvertently shrinking the tumor as well.

So sometimes, in TCM treatment of cancer, the more pronounced the symptoms, the clearer the doctor's line of treatment and the easier it is to achieve good results. Patients with no abnormal symptoms at all leave the TCM physician without any basis for pattern differentiation, and the physician may feel at a loss as to how to proceed.

As an aside, whether TCM can treat cancer has always been highly controversial; there are even extreme skeptics who claim TCM cannot treat any disease. I have always responded calmly, never joining such debates and avoiding contentious ground whenever possible.

Patients who believe in TCM like the one in this article are quietly supporting it all the time; we need only treat these trusting patients patiently.

Personally, I have always kept my distance from those who question TCM: I do not provoke them, do not argue with them, and do not get angry at them. Let them say whatever they like about TCM. We practitioners should spend our energy and time raising our own skill and clinical results, and devote our minds to serving the patients who need us.