Experience in Treating Cancer Fever and Leg Pain in a Child with Neuroblastoma

Once neuroblastoma relapses after treatment, re-treatment becomes extremely difficult. In a child with neuroblastoma, the appearance of anemia, fever, bone pain, limping, incontinence of urine and stool, swollen orbits, protruding eyeballs, blurred vision, scalp swelling, cough, enlarged superficial lymph nodes, or difficulty breathing generally means the disease is progressing.

When most children develop these symptoms, the only recourse is chemotherapy. But for children who cannot be cured despite repeated chemotherapy, chemotherapy becomes less and less effective, side effects grow worse, and the interval of remission after each course becomes shorter, until the child's body can no longer bear it. Seeking TCM treatment is often their last-resort option. If TCM can relieve some of the child's symptoms, maintain a reasonably good quality of life, and solve anemia, bone pain and fever without relying on chemotherapy, it can improve the child's quality of life and prolong survival.

Moreover, because neuroblastoma is an embryonic pediatric tumor arising from the neural crest and belonging to the sympathetic nervous system, as the child develops, the tumor cells in some children may regress spontaneously. So if a treatment can keep the child alive, it may be possible, by drawing on the child's nervous system development, to create a miracle of cure.

It is precisely for this purpose that I adopted the strategy of "Western diagnosis, TCM treatment," combining TCM pattern differentiation with Western disease differentiation to treat some high-risk stage-4 neuroblastoma children who still relapse despite repeated modern-medicine treatment. In a few children the disease has remained stable for three to four years and continues to remain stable, with their normal life and schooling unaffected. Whether these children will create a miracle still requires more than ten years of observation and judgment; I will continue to follow these children under treatment.

The child introduced in this article is fairly typical. The child, surnamed Chen, could not be seen in person because of the pandemic, and first sought my help by online video on October 17, 2020.

The child was born on November 19, 2010, and was diagnosed on May 23, 2018 with stage-4 high-risk neuroblastoma of the left adrenal gland in the retroperitoneum. After four chemotherapy cycles, it relapsed on August 29. Another four chemotherapy cycles achieved partial remission; on January 8, 2019 the child entered the ward for autologous stem cell transplantation, and on March 15 of the same year completed 14 radiotherapy sessions at the primary site, followed by half a year of retinoic acid therapy. It relapsed again in May 2020, and has since received four chemotherapy cycles, now maintained on oral temozolomide. The last chemotherapy ended on September 3, and temozolomide was started the day before yesterday.

The ultrasound from Shanghai Children's Medical Center, affiliated to Shanghai Jiao Tong University School of Medicine (ultrasound no. 136949, October 12, 2020) showed: post-operative status of left adrenal neuroblastoma; several irregular, heterogeneous hypoechoic areas in the spleen, the larger measuring 11x6x10 mm, with unsatisfactory CDFI; splenic-hilar vessels running normally; an irregular hyperechoic area in the upper region of the left kidney, with distinguishable borders and fairly regular shape, measuring 26x15x17 mm, with no obvious CDFI blood-flow signal; increased pancreatic echogenicity; the rest of the liver, gallbladder and peritoneum normal. Blood tests on October 12, 2020 showed tumor cells at about 42%.

This child had already been treated repeatedly by every means of Western medicine, yet the cancer cells stubbornly relapsed again and again. The child's father asked me for TCM treatment. At the first visit, I prescribed according to the multi-target anti-cancer TCM compound approach I had developed (the detailed medication strategy and protocol are given in the link). I also advised the parents to buy Liushen Wan (Six-Miracle Pills) and Compound Mylabris Capsules separately to strengthen the anti-cancer effect.

After the medication, the child's appetite improved and the condition was stable for a while, but on December 24, 2020 the parents reported fever and aching legs. These are typical symptoms in adrenal neuroblastoma children, and their appearance meant the disease was once again out of control. I asked them to try Xiao Chaihu Keli (Minor Bupleurum Granules) first; after three days the parents reported it was ineffective. The fever had reached 39°C and the leg aching had worsened; after further inquiry I decided to treat with Chaihu Gegen Tang (Bupleurum and Pueraria Decoction).

Prescription: Chaihu (Bupleurum) 12 g, Gegen (Pueraria) 9 g, Gancao (Licorice) 3 g, Huangqin (Scutellaria) 9 g, Qianghuo (Notopterygium) 6 g, Baizhi (Angelica Dahurica) 6 g, Shaoyao (Peony) 6 g, Jiegeng (Platycodon) 6 g, Sheng Shigao (raw Gypsum) 12 g (decoct first for half an hour). Each dose was to be decocted and divided into two servings; two doses daily, taken once every two hours, regardless of meals. After the fever subsided, reduce to one dose daily, morning and evening, for about a week of maintenance. The anti-tumor drugs were continued with the addition of Xihuang Capsules, but the dosage of each anti-cancer drug was correspondingly reduced somewhat.

After six doses of the above formula, the high fever subsided and the legs no longer ached, though low-grade fever remained. I reduced the dose to one daily, morning and evening. Soon the fever stopped, the decoction was discontinued, and the anti-cancer patent medicines continued.

The condition remained stable until February 17, 2021, when the child again developed fever, leg aching, and a swelling on the head. Chaihu Gegen Tang was again ineffective and the child felt fatigued. The prescription was modified to: Shuiniujiao (Water Buffalo Horn) 30 g, Shengdihuang (raw Rehmannia) 30 g, Chishao (Red Peony) 12 g, Mudanpi (Moutan Bark) 12 g, Huainiuxi (Achyranthes) 10 g, Muguɑ (Chaenomeles) 30 g, Yiyiren (Coix Seed) 30 g, Banzhilian (Scutellaria Barbata) 30 g, Baihuasheshecao (Oldenlandia) 30 g, Sanleng (Sparganium) 10 g, Ezhu (Curcuma) 10 g, Shandougen (Sophora Tonkinensis Root) 10 g, Tiankuizi (Semiaquilegia) 15 g, Pugongying (Dandelion) 10 g, Yejuhua (Wild Chrysanthemum) 10 g, Diding (Viola) 10 g, Jinyinhua (Honeysuckle) 30 g, Sangbaipi (Morus Bark) 15 g, Sangye (Mulberry Leaf) 15 g, Lianqiao (Forsythia) 10 g, Chao Maiya (fried Malt) 30 g, Jiao Shanzha (charred Hawthorn) 10 g, Xuanshen (Scrophularia) 12 g, Zhebeimu (Fritillaria Thunbergii) 12 g, Sheng Muli (raw Oyster Shell) 30 g, Dannanxing (Bile Arisaema) 10 g; 3 doses, decocted in water, taken once after breakfast, lunch and dinner.

The medication was ineffective. On February 26, 2021, tests at a local hospital showed hs-CRP 252.4 mg/L (reference 0–8), anemia, red blood cell count 1.73, and platelet count 69. Children after transplant tend to develop such systemic infections; after several days of IV anti-infective treatment in hospital, the high fever resolved, but the leg pain did not improve.

Judging from the symptoms and reports, the main problems this time were anemia and neuroblastoma relapse. I decided to strengthen the supporting (fuzheng) approach, greatly supplementing qi and blood, using Guipi Tang (Spleen-Returning Decoction) combined with the "Four Kidney-Tonifying Herbs" plus additions. Prescription: Sheng Huangqi (raw Astragalus) 30 g, Dangshen (Codonopsis) 30 g, Fuling (Poria) 30 g, Baizhu (Atractylodes) 15 g, Danggui (Angelica) 10 g, Muxiang (Aucklandia) 10 g, Yuanzhi (Polygala) 10 g, Suanzaoren (Zizyphus Seed) 10 g, Longyanrou (Longan Aril) 6 g, Zhi Gancao (honey-fried Licorice) 10 g, Mohanlian (Eclipta) 10 g, Nüzhenzi (Ligustrum Fruit) 10 g, Shayuanzi (Astragalus Complanatus Seed) 10 g, Tusizi (Cuscuta Seed) 10 g, Xianhecao (Agrimonia) 100 g. The anti-cancer patent medicines were reduced.

After taking the above, the leg pain improved. On March 8 the parents brought the child for a repeat blood count, which showed that red blood cells and albumin continued to trend downward.

I therefore further strengthened the supporting approach: Sheng Huangqi 30 g, Dangshen 30 g, Fuling 30 g, Baizhu 15 g, Danggui 10 g, Muxiang 10 g, Yuanzhi 10 g, Suanzaoren 10 g, Longyanrou 6 g, Zhi Gancao 10 g, Mohanlian 10 g, Nüzhenzi 10 g, Shayuanzi 10 g, Tusizi 10 g, Xianhecao 100 g, Shudi (processed Rehmannia) 30 g, Huangjing (Polygonatum) 15 g, Baishao (White Peony) 10 g, Zhi Shouwu (processed Polygonum Multiflorum) 15 g.

After taking it, the leg pain further improved. The swelling on the head had not resolved but had not progressed further either. I asked the parents to report the condition every 3–4 days so that I could adjust the prescription at any time. I then continued to add herbs to this formula to strengthen the anti-cancer effect:

Sheng Huangqi 30 g, Dangshen 30 g, Fuling 30 g, Baizhu 15 g, Danggui 10 g, Muxiang 10 g, Yuanzhi 10 g, Suanzaoren 10 g, Longyanrou 6 g, Zhi Gancao 10 g, Mohanlian 30 g, Nüzhenzi 10 g, Shayuanzi 10 g, Tusizi 10 g, Xianhecao 100 g, Shudi 30 g, Huangjing 15 g, Baishao 10 g, Zhi Shouwu 15 g, Shandougen 10 g, Baitouweng (Pulsatilla) 15 g, Muguɑ 30 g, Banzhilian 20 g, Baihuasheshecao 20 g, Xuanshen 10 g, Zhebeimu 10 g, Duan Muli (calcined Oyster Shell) 30 g, Maozhuacao (Ranunculus Ternatus) 20 g, Tengligen (Actinidia Root) 20 g, Chanyi (Cicada Slough) 6 g, Jiangcan (Stiff Silkworm) 10 g, Jianghuang (Curcuma Longa) 6 g, Pugongying 30 g, Rendongteng (Honeysuckle Stem) 20 g, Diding 6 g, Tiankuizi 10 g, Yejuhua 6 g, Jiao Maiya (charred Malt) 30 g, Jiao Shanzha 10 g, Jiao Shenqu (charred Medicated Leaven) 10 g

I instructed that this formula be decocted and finished over two days, taken twice daily.

On March 17, 2021, the parents again reported that the child had developed fever. I prescribed a separate formula: Lianqiao 10 g, Jinyinhua 30 g, Bohe (Mentha) 10 g, Sangye 10 g, Yejuhua 10 g, Sangbaipi 15 g, to try to address the fever.

This child is still under treatment. From October 17, 2020 to now, chemotherapy has been stopped and the child has been treated continuously with TCM. The symptoms common in neuroblastoma children have recurred again and again, but have basically been resolved with Chinese medicine. Those unfamiliar with neuroblastoma may not know how difficult it is to maintain this state; but for me and for the parents of neuroblastoma children, who have dealt with it for years, the hardship is understandable. Many children can only maintain stability for 10–40 days after chemotherapy, and must endure its side effects: nausea, vomiting, fatigue, anemia, hair loss. More importantly, as this child had already experienced, every costly treatment failed to stop relapse and progression, instead worsening the patient's constitution.

I will continue to research the TCM treatment pathway for neuroblastoma children and continue to explore TCM solutions for their various clinical symptoms, as in the case of Chen. Each time I bring a child from a dangerous state back to safety and watch them walk back to school with a backpack, I feel deep comfort.

Neuroblastoma is known as the king of pediatric tumors; it consumes not only the child's body and life, but also the hearts of the parents and of the doctors treating it. For years I have only accepted high-risk stage-4 neuroblastoma children for whom Western medicine has failed. This is chiefly a choice made from the standpoint of medical ethics, because I know the success rate of TCM for neuroblastoma is still not high, so I refuse requests from parents of relatively early, low-risk children to abandon Western medicine in favor of pure TCM. But I also hope that in future clinical practice I can improve the success rate of TCM diagnosis and treatment of neuroblastoma, opening a new path for more children so that when Western medicine fails, they are not left with nowhere to turn.