Exploring TCM Approaches to Treating Malignant Melanoma

Exploring TCM Approaches to Treating Malignant Melanoma

Malignant melanoma was called "black nodule" (heizi), "gangrene" (tuoju), or "malignant sore" (echuang) in ancient TCM texts, and was generally considered to have a poor prognosis.

For example, Waike Zhengzong records of black nodules: "A black nodule is a name for a mole. This arises when turbid qi from the kidney muddies and obstructs yang, and yang qi contracts and binds into a black nodule, hard and un dispersing. Anyone who develops this is ultimately unlucky. Unwanted facial moles should be removed: take a thin copper tube, fit it over the mole, twist six or seven turns so the mole enters the tube, and pull it out in one motion. For moles too superficial to pull out, use a needle to prick the mole, apply a little Bingsi Powder, cover with paper paste, and in three days it detaches on its own; or apply Huimi plaster. After it falls off, sprinkle Zhenzhu Powder (Pearl Powder) dry to grow skin and heal. Avoid soy sauce and vinegar to prevent spots.

Huimi Plaster

Thicken burnt lye into a paste, insert white rice into the ash leaving half a grain outside; after a short while, when the rice is cooked, use the rice to dot the mole, and it will come off.

Bingsi Powder

Five large river snails, shelled, threaded and sun-dried; 1.2 qian of white arsenic (wrapped in dough and baked), 1 fen of borneol, 2 fen of sal ammoniac (naosha).

Slice the dried snail meat, grind together with the baked white arsenic into fine powder, add the naosha slices and grind again, store sealed in a small jar. To use, first moxa the nodule seven cones, then wait until the moxa blister forms; prick it with a small needle, mix one to two li of the above medicine with saliva into a cake, apply it on top of the moxa, and seal over the nodule with thick paste on cotton paper; do not disturb and let no air escape. After seven days cracks appear around the edges; after another seven days the nodule falls off by itself. Then apply Yuhong Ointment and take internal tonics to help close the wound. This medicine also treats goiter-like tumors with a large body and small stalk, and all kinds of raised, oddly shaped lesions.

Zhenzhu Powder (Pearl Powder)

Qingganghua 5 fen (if unavailable, use the first-cut, light, glossy indigo flower, but it is not as good as ganghua); pearl 1 qian (regardless of size, choose new white ones; boil in tofu for several rolls and grind until silent); real calomel (qingfen) 1 liang.

Grind the three together for a thousand turns until fine as flying flour, then store in a jar. Apply to skin lesions and they heal."

That is the complete text on treating black nodules as recorded in Chen Shigong's Ming-dynasty Waike Zhengzong.

From this passage we can see that the ancients already recognized melanoma and recognized its poor prognosis: "Anyone who develops this is ultimately unlucky." Malignant melanoma is extremely aggressive and progresses rapidly; if not caught early it metastasizes very quickly, so the ancients also knew that having this disease was ultimately inauspicious.

Chen Shigong's treatment of malignant melanoma in Waike Zhengzong first advocated surgery: the method was to fit a thin copper tube over the melanoma, twist it six or seven times, and pull out the lesion. For those that could not be pulled out, external treatments were considered.

Later dermatological and surgical TCM treatment of melanoma mostly followed combined internal-and-external methods: on the outside, corrosive medicines attack toxin and eat away the sore; on the inside, decoctions and pills are taken to sever the root. Pure external therapy has some effect on early- and mid-stage malignant melanoma without distant metastasis, but is mostly ineffective for mid-to-late, already metastasized melanoma.

As for the etiology and pattern differentiation of melanoma, opinions differ: some consider it damp-heat, others a yin deep-abscess.

Modern epidemiological research shows that malignant melanoma is related to excessive sun exposure; it is generally believed that ultraviolet light in sunlight can trigger malignant transformation of moles. Queensland, Australia, has the highest melanoma incidence in the world—16 cases per 100,000 people. The region is hot year-round, and this climate is an important cause of malignant melanoma. That is why the West now strongly promotes sun protection to prevent melanoma.

I personally believe that, from the TCM pattern-differentiation perspective, most malignant melanoma patients are caused by damp-heat. The Huangdi Neijing's "Treatise on Resembling Qi and Communicating with Heaven" especially emphasizes that human disease is closely tied to the external natural environment. Melanoma is a tumor that is characteristically tied to the external environment: when the body is inadequately protected and overexposed to sunlight, melanoma is triggered. So this disease should first be considered an injury by heat-toxin.

Melanoma is a kind of skin tumor; it usually begins as an external skin lesion, and the malignant mole often itches and even oozes fluid.

The Huangdi Neijing says: "When sweating meets dampness, acne and prickly heat arise. The changes of rich, fine food beget great boils; the body receives them as if it were empty. Sweating at labor exposed to wind, cold pressing gives rise to rosacea, and constrained it becomes acne." This passage explains the causes of skin lesions—mostly from "sweating meeting dampness," "sweating at labor exposed to wind," and overindulging in rich, heavy food. This fits the pathogenic pattern of melanoma occurring in hot regions and in people overexposed to the sun.

The early- and mid-stage melanoma patients I have seen clinically mostly have a rapid pulse. The Neijing holds that "when yin cannot control yang, the pulse flows hurried and rapid"; a rapid pulse is mostly due to yang hyperactivity and yin weakness, so yin and yang cannot balance and the pulse flows rapidly.

In sum, I believe the disease mechanism here is mostly yang hyperactivity with exuberant heat; heat generates dampness, dampness stagnates on the body surface and lingers without departing, gradually forming a damp sore; the damp sore, left untreated for a long time, malignant-transforms into a malignant sore. That is what today we call inflammatory change at the mole site: long-term inflammation leads to gene mutation, which malignant-transforms into malignant melanoma.

Therefore TCM treatment of malignant melanoma should still start from heat-toxin. Local lesions may be treated externally; under today's medical conditions, one should first consider surgical treatment, which carries less risk and is technically mature.

Those who lose the chance of surgery may consider traditional TCM external therapies to attack toxin and erode the sore locally, combined with internal decoctions and pills. For patients with metastasis, external therapy alone is no longer useful; they also need internal herbs that attack toxin and erode sores to counter the rapidly developing cancer cells in the body.

Malignant melanoma is a typical hematogenously metastasizing tumor, fast-growing and dangerous; without timely treatment the patient easily dies. In fact, ordinary gentle heat-clearing and toxin-resolving TCM formulas can hardly contain the progression of malignant melanoma.

So, what are the medicines that typically attack toxin and erode sores for this kind of malignant sore? From my review of ancient and modern literature, arsenic preparations (arsenolite/pishuang and realgar/xionghuang) are a poison-attacking-poison herb hard to avoid in malignant melanoma. In Sun Simiao's Qianjin Fang of the Tang dynasty there is already "Shexiang Gao" (Musk Ointment) for treating malignant sores and removing malignant flesh: it uses equal parts of Shexiang (Musk), Xionghuang (Realgar), Fan shi (Alum), and Jianru (alternatively Zhenzhu), ground fine and mixed with pig fat into a paste to apply; when the malignant flesh is gone, stop, then apply shengrou ointment. This is one of the earliest external formulas recorded for treating malignant sores and malignant flesh. Later formulas mostly followed this line of thought and gradually developed.

Research literature on TCM treatment of melanoma is already sparse, and ancient case records of such diseases are even fewer, but some contemporary TCM case records of malignant melanoma survive. We can extract the principles of treating malignant melanoma from successful contemporary TCM cases.

Liang Xiuqing's case of treating a patient named Ning

Ning, male, 30, a driver at the Houma City Motor Transport Company, Shanxi Province; first visit June 23, 1984.

Half a year earlier, the patient had noticed a peanut-sized black-purple mass on the left dorsal chest wall, soft in texture, mobile under pressure, with no pain or itch, growing slowly; whenever he ate spicy food like ginger or scallion, the tumor itched. In May 1984, examination at Houma People's Hospital diagnosed "melanoma" and suggested surgical excision, which the patient declined, so he came for TCM care.

The patient's tongue was red with gray coating; the pulse was wiry and long.

Pattern diagnosis: nutritive-defensive disharmony, stasis obstructing the channels and collaterals, blood not returning to its vessels, accumulating into a nodule.

Treatment method: fortify the spleen and harmonize the stomach, activate blood and resolve stasis.

Medication:

1. Decoction prescription

Danggui (Angelica) 20 g, Honghua (Safflower) 10 g, Cang'erzi (Xanthium) 6 g, Baijili (Tribulus) 6 g, Chuanxiong (Ligusticum) 10 g, Danshen (Salvia) 20 g, Cangzhu (Atractylodes lancea) 12 g, Baishao 20 g, Shudi (processed Rehmannia) 12 g

Decoct in water for oral use.

2. External medicine

Xionghuang (Realgar) 30 g, Banmao (blister beetle) 10 pieces, Shexiang (Musk) 5 g, Sanleng (Sparganium) 20 g, Ezhu (Curcuma) 20 g, Yunmu (Mica) 10 g, Baizhi (Angelica dahurica) 20 g

Grind all together into fine powder and store in a sealed porcelain container. Each time take 2 g, mix with cold water into a thick paste and apply to the tumor; cover with a cloth and secure with adhesive tape. Change once daily.

After 50 days of treatment the tumor disappeared completely.

Liang Xiuqing considered this disease to arise from heat-toxin accumulated in the blood phase, so treatment should focus on herbs that remove putrid flesh and generate new tissue, activate blood and resolve stasis, plus toxin-resolving herbs. Thus internal treatment used Siwu Decoction (Four-Agents Decoction) plus blood-activating, stasis-resolving, blood-cooling, and dampness-draining herbs, while external treatment used the toxin-attacking, sore-eroding "Xiong She Powder" (this Xiong She Powder has a similar idea to the Musk Ointment in the Qianjin Fang). Combining internal and external treatment, addressing both root and branch, the patient was cured.

I believe the patient in this case was early-to-mid stage, but not too early, because the tumor had already begun to itch; it was definitely more than a superficial invasion.

In addition, our TCM dermatology expert Xiao Guoshi also applied external herbs such as Wu Hu Dan (Five-Tiger Pellet) and Hong Sheng Dan (Red-Generated Elixir), combined with internal Ju Zao Wan (Chrysanthemum-Algae Pill), to treat melanoma; among his treated patients, six were cured.

Wu Hu Dan is refined from five ingredients—Shuiyin (mercury), Bai Fan (white alum), Qing Fan (green vitriol), Ya Xiao (niter), and Shiyan (salt)—according to the method of Bai Jiang Dan (White-Drop Elixir); white crystals are best. Wu Hu Dan has the actions of drawing out toxin, eliminating putrescence, softening hardness, and dispersing tumors.

Wu Hu Dan can be made into two forms: a paste and a nail (stick). The paste uses Wu Hu Dan crystals plus Chan'su (toad venom), Hong Niangzi (red ladybug), Banmao (blister beetle, head and feet removed), and Yangjinhua (Datura), mixed into a paste with starch; it is mainly used for ulcerative malignant melanoma. When used, apply to the ulcer surface, cover with an ordinary plaster, and change dressing once daily.

Wu Hu Dan nail sticks have the same herbal composition; using rice as an excipient, roll them into diamond-shaped nails pointed at both ends, about 4 cm long, about 3 mm in diameter at the middle, weighing about 0.7 g, and air-dry. When used, insert them into the center of the cancer at its base; depending on tumor size, insert 2-5 half-sticks at a time. For large tumors, insert in stages: after the first inserted portion necroses and falls off, insert the second. Cover with a surgical plaster.

Some surgeons also make the famous TCM external-medicine formula "San Pin Yi Tiao Qiang" (Three-Grade One-Nail Gun) into powders and pastes for external use, to attack toxin and erode sores on surface-palpable malignant melanoma.

Here I must especially caution: when using external preparations, note that they may be used on the limbs and trunk, but on key locations one must be extremely careful; used improperly, the ulcer will not close, and the consequences can be very serious.

The ingredients of the Ju Zao Wan used by Xiao Guoshi are Juhua (Chrysanthemum), Haizao (Sargassum), Sanleng, Ezhu, Dangshen (Codonopsis), Huangqi (Astragalus), Jinyinhua (Honeysuckle), Shandougen (Sophora tonkinensis), Shancigu (Pseudobulbus Cremastrae), Lilu (Veratrum), Huanglian, Chonglou (Paris), Malinzi (Iris seed), processed Maqianzi (Strychnos), Wugong (Centipede), Zicao (Arnebia), Shu Da Huang (processed Rhubarb), and Ziyingshi (Fluoritum). The formula is as follows:

Hang Juhua, Haizao, Sanleng, Ezhu, Dangshen, Huangqi, Jinyinhua, Shandougen, Shancigu, Lilu, and Huanglian, each 100 g; Malinzi 75 g; processed Maqianzi and processed Wugong, each 50 g; Zicao 25 g; Shu Da Huang and Zaoxiu (Paris), each 15 g; Ziyingshi 30 g.

Grind all above into fine powder and make into pills the size of a parasol seed; take 25-30 pills, 2-3 times daily, swallowed with warm water one hour after meals.

This formula's main actions are clearing heat and resolving toxin, softening hardness and dissipating nodules, and expelling wind and stopping pain; it may be used for malignant melanoma with marked heat-toxin.

In addition, I collected from elsewhere two more pill prescriptions with a similar approach for heat-toxin-type melanoma patients; I append them together.

Formula One: Niuhuang She Chan Wan (Bezoar-Musk-Toad-Venom Pill)

Zaoxiu root, Juye Sanqi root (Chrysanthemum-leaf Notoginseng), Yiyiren (Coix), Chishao (Red Peony), and Danggui, each 60 g; Honghua, Kunbu (Ecklonia), and Haizao, each 30 g; processed Maqianzi 25 g; Zhenzhu mo (Pearl powder) 20 g; Niuhuang (Bezoar) 6 g; Chan'su 4 g; Shexiang and Xionghuang, each 3 g.

Grind all into fine powder and make into 400 pills. Take 1 pill twice daily. This formula also clears heat and resolves toxin, activates blood and resolves stasis, and supports the right and secures the root; it may be used for heat-toxin-type malignant melanoma at all stages.

Formula Two: Chan'su Wan (Toad-Venom Pill)

Chan'su, Xionghuang, processed Ruxiang (Frankincense), and processed Moyao (Myrrh), each 180 g; Woniu (snail) 60 g; Wugong 30 g; Xuejie (Dragon's Blood) 20 g; Zhusha (Cinnabar) 10 g; Danfan (chalcanthite/blue vitriol), Qingfen (calomel), and Hanshuishi (Gypsum fibrosum), each 6 g; Niuhuang, Bingpian (Borneol), and Shexiang, each 3 g.

Grind all into fine powder and make with water into pills the size of mustard seeds; take orally 5-10 pills each time, once in the morning and once in the evening.

This formula also clears heat and resolves toxin, dispels stasis and dissipates nodules; it may also be used for malignant melanoma of all stages belonging to the heat-toxin accumulation type.

The Sina blog user Shengdi Meiya collected several TCM treatment cases of malignant melanoma; I now transcribe them and analyze them for readers' reference.

Liu Kezun's case of treating an elderly melanoma patient

Patient, male, 75; first visit April 24, 1988.

At the midpoint of the lower right eyelid, 0.5 cm from the eyelashes, he had had a millet-sized black mole since childhood; over the past half month it enlarged, itched, and pained. After he scratched it open with his fingernail for 5-6 days, the black mole suddenly grew to peanut size, the pigment deepened, and it radiated outward; the hair on the tumor fell out. Pathology diagnosed advanced malignant melanoma. Because he was elderly and frail, he refused surgery. Symptoms: local ulceration, a dirty wound surface with foul odor, granular nodules around, difficulty opening the right eye, vision dropping from 0.5 to 0.05. He had dizziness and headache, fever and night sweats, poor appetite and weight loss, fatigue and lassitude, a pained expression, dry stool, and scanty dark urine. The tongue was deep purple and dry without coating; the pulse was fine, rapid, and weak. The pattern was toxin-hexin accumulation with liver-kidney yin deficiency. Treatment: boost qi and nourish blood, nourish yin and clear heat, resolve stasis and detoxify.

Internal: Sheng Caowu (raw Aconitum kusnezoffii) 10 g, Chonglou 30 g; soak both in urine of young boys for 72 hours, dry in the sun, grind into powder, and store in a bottle. Each time take 2-5 g after meals with warm water. At the same time give Renshen (red ginseng) 10 g, Tianqi (Pseudoginseng), Shuiniujiao (Water Buffalo Horn, decocted first), Shengdihuang, Xuanshen (Scrophularia), and Maidong, each 15 g; Lujiaojiao (deer-horn glue, melted) 20 g. One dose daily, decocted and divided into 3 doses before meals. External: Yuxingcao (Houttuynia), Shiwei (Pyrrosia), and Gusonbu (Drynaria), each 10 g, soaked in 100 ml of 75% alcohol for 3 days; use a sterile cotton swab to apply the tincture to the local area several times daily as needed.

After 5 days of treatment, the tumor body and ulcer surface both shrank by one quarter, and the surrounding nodules decreased. Continuing the same formula for half a month, the tumor body and surrounding nodules completely disappeared, the ulcer healed, and the remaining symptoms resolved. He was advised to dissolve one tube of Liu Shen Wan (Six-Miracle Pills) daily before bed with an appropriate amount of rock sugar, and take two tubes of Lurong oral liquid in the morning to consolidate. Follow-up for over 2 years: all normal.

Addressing the disease mechanism of toxin accumulated in the organs with true yin scorched and consumed, and following the treatment principle of supporting the right to expel the pathogen and combining internal and external treatment, he internally used Renshen, Lujiaojiao, Shengdihuang, Xuanshen, Maidong, Xijiao (rhinoceros horn), and Tianqi to supplement both qi and blood, nourish yin, clear heat, and resolve stasis; Caowu and Chonglou to expel wind and detoxify; and the external medicinal wine to resolve stasis and toxin and soften hardness.

(Quoted from Zhejiang Journal of TCM, issue 11, 1991)

In this case, the physician also considered melanoma to be caused by heat-toxin damaging yin, with yin unable to control yang; but because the patient was elderly and frail with qi and blood deficiency, he used the Warm-disease school's famous formula Zengye Decoction (Fluid-Increasing Decoction) plus blood-nourishing herbs.

Zhang Yongxiang's experience: Fuling Baidu Powder for ulcerative melanoma

Take equal parts of Fuling (Poria), Xionghuang (Realgar), and Fanshi (Alum), grind into fine powder, sieve through a No.7 sieve, and mix well for use. After routinely disinfecting the skin at the affected area, apply this formula externally; change dressing 1-2 times daily. If applying the powder causes pain, mix into an ointment or blend with sesame oil. If there is bleeding at the site, dust a little Sanqi powder. At the same time internally take Jinyinhua 50 g and Lianqiao (Forsythia) 50 g, strongly decocted as a tea substitute, one dose daily for several months.

Using the above formula to treat 10 cases of ulcerative melanoma—6 pathologically confirmed and 4 clinically diagnosed—the ulcer surfaces were all controlled after medication, exudate clearly decreased, tumor growth slowed, and pain and itch lessened. Five cases, after 5-12 months of conservative treatment, underwent lesion excision with no metastasis found; 2-year follow-up showed no recurrence. The other 5 cases survived on conservative treatment for as long as 5 years and as little as 1 year.

Melanoma that ulcerates is mostly caused by damp-toxin congelation; treatment should draw out toxin and dry dampness together. The formula uses Fuling's water-draining nature to remove dampness, and Xionghuang and Fanshi to resolve toxin; simultaneously taking Yin Qiao decoction, acting internally and externally, thus achieves good effect.

(Quoted from Zhongliu Liangfang Daquan, Anhui Science and Technology Press, 1994)

The patients Zhang Yongxiang treated all had ulceration of the tumor surface. In his external formula he used Fuling because Zhang considered these patients damp-heat, matching the Neijing's description of surface damp sores mentioned earlier; thus while attacking toxin and eroding the sore, he added Fuling to drain dampness. But this dampness still lies deep in the interstices, so using Fuling externally alone is insufficient.

In recent years, research on the Chinese herb Mahuang (Ephedra) has found that ephedrine and pseudoephedrine in Mahuang have good efficacy against melanoma. From a TCM pharmacology perspective, Mahuang can expel damp-toxin deep in the interstices, drive the pathogen outward, and reduce swelling and dissipate nodules; it indeed has anti-tumor effects. This action of Mahuang is already recorded in Shennong Bencao Jing. Famous TCM anti-tumor formulas such as Yanghe Decoction, Qixingjian Decoction, and the folk Zhanningjian Decoction all list Mahuang as an important herb; colleagues may refer to them.

Duan Guiqing's case of treating a patient named Tan

Tan, male, 32, a medical assistant at a certain unit's clinic. From birth he had a soybean-sized black mole on the upper outer side of the right patella, which gradually grew to bowl size during puberty. In August 1973, while working, he accidentally scraped it and it bled; afterward the skin ulcerated and did not heal for a long time. In November of the same year, examination at Nanjing General Hospital of the Military Region reported pathologically "malignant change of mole," pathology slide No. 117315. He underwent surgical excision and post-operative IV cyclophosphamide 3 g. But the wound never healed.

First visit February 11, 1974: chronic ill appearance, emaciated, fatigued. The right leg had not healed after surgery. The tongue coating was greasy and slightly yellow, with a purplish tinge; the pulse was fine and moderate. Treatment used heat-clearing and toxin-resolving, blood-activating and stasis-resolving, and right-supporting root-securing methods, with modified Ziyuan Dan, Liu Shen Wan, and Buyang Huanwu Decoction (Yang-Supplementing Five-Returns Decoction).

Formula One: Niuhuang 6 g, Qiyeyizhihua root (Paris polyphylla) 60 g, Juye Sanqi root 60 g, Yimi (Coix) 60 g, Chishao 60 g, Danggui 60 g, Honghua 30 g, Kunbu 30 g, Haizao 30 g, processed Maqianzi 25 g, Zhenzhu fen (Pearl powder) 20 g, Shexiang 3 g, Xionghuang 3 g, Chan'su 400 mg. Grind into powder and make honey pills; make 400 pills. Take one pill each time, twice daily.

Formula Two: Sheng and Zhi Huangqi (raw and honey-fried Astragalus), each 9 g; Taizishen (Pseudostellaria) 12 g; Yimi 30 g; Fuling 9 g; Danshen 9 g; Chuanjiazhu (pangolin scale) 6 g; Pugongying (Dandelion) 30 g. Decoct in water, one dose daily, modified according to symptoms; taken on and off.

Follow-up visit September 1975: after over a year of the above treatment, symptoms had improved and the incision healed. Right inguinal lymph node biopsy showed "chronic lymphadenitis." Believing the condition stable, the patient stopped treatment for over three months, whereupon the disease recurred with high fever and general malaise. Lymph node biopsy at Bayi Hospital showed "metastatic melanoma," pathology slide No. 109911. Examination: emaciated and fatigued with acute ill appearance; the right inguinal lymph node was swollen to egg size, and a hard mass 5×4×2 cm was palpable at the upper outer right buttock, with irregular borders, fixed to the touch, and tender on pressure—called a lower stone abscess. The tongue coating was yellow greasy with a purplish tinge; the pulse was fine and moderate.

So treatment should mainly clear heat and expel the pathogen, soften hardness and dissipate nodules, assisted by supporting the right and securing the root. He kept the original formula and added Ruxiang 30 g, Moyao 30 g, and Duan Muli (calcined oyster shell) 30 g, and increased the dosage: one pill each time, three times daily, while continuing the decoction. After 3 months of treatment, the lymph nodes and mass disappeared and all symptoms resolved. The dose was reduced to one pill twice daily, continued until 1978. The condition stabilized and medication stopped; follow-up to date is 12 years, with complete cure.

Duan Guiqing's case of treating a patient named Liu

Liu, male, 39, an assistant at a certain unit's warehouse. Seen October 24, 1978. The patient had had a peanut-sized black mole on his right shoulder-back since childhood; over the past 2 years it gradually grew to broad-bean size and itched, and had been scraped and bled several times while bathing. In the same year, he underwent three surgical excisions at a Jinan hospital; pathology reported "malignant change of black mole." Three broad-bean-sized lymph nodes in the right axilla were excised, with pathology reporting "metastasis." Examination: the surgical wound had long failed to heal, with discharge but no foul odor. Chronic ill appearance, poor appetite, abdominal distension; the tongue coating was thick and greasy with a purplish tinge and teeth marks; the pulse was fine and slippery. Treatment was the same as for Tan; externally applied Yangyin Shengji Powder (Yin-Nourishing Flesh-Generating Powder). After 2 years of treatment, all symptoms resolved; 5-year follow-up showed stable condition.

Duan Guiqing's case of treating a patient named Xiong

Xiong, female, 44, a cadre at a certain unit. At age eight she fell and injured the ulnar side of her left palm; after healing it left a brown, rough small patch, soybean-sized, which over the past 2 years gradually grew into a 1.2×1.8 cm black patch. From October 1980 to January 1981 it ulcerated and bled three times while washing clothes. From March to April 1981, a second surgery excised 5.6 cm; pathology reported "junctional or compound nevus of the left hypothenar, early malignant change." In April 1982 she had chemotherapy but stopped due to low fever, and turned to TCM.

On my examination: chronic ill appearance, poor appetite, no bowel movement for four days, temperature 37.4°C, and rice-grain-sized black dots on the outer upper sclera of both eyes. A broad-bean-sized pigmented patch in the left axilla had been surgically excised and was found to be fat and blackish material; pathology experts from various hospitals, in consultation, considered it metastatic. The tongue coating was greasy and slightly yellow, the tongue was rather red with purple spots; the pulse was fine and slippery. Using the treatment methods of cases 1 and 2, follow-up for 3 years showed basically stable condition.

(Quoted from Journal of Nanjing College of TCM, issue 4, 1986)

The three malignant melanoma cases treated by Duan, with broadly similar methods, all followed the approach of clearing heat and expelling the pathogen, and using poison to attack poison; the results were satisfactory.

Xiao Zirong's experience in treating malignant melanoma with combined internal and external treatment

Xiao Zirong—the same Xiao Guishi mentioned earlier—was our late famous TCM surgery professor, a Hunan native. He researched surface cancers extensively, and his work won a 1987 Hunan Provincial Science Conference achievement award. He mainly used Wu Hu Dan to treat 115 cases of surface malignant tumors, with a total effective rate of 79.1%; among them were 6 cases of malignant melanoma, all with satisfactory results.

Xiao's treatment of malignant melanoma had the following features: first, external treatment as the main method, using poison to attack poison and extract the lesion. The Wu Hu Dan preparation he used excels at removing putrescence and drawing out toxin; 1-3 weeks after application or insertion into the tumor tissue, the cancerous lesion necroses and falls off, followed by Hong Sheng Dan (Red-Generated Elixir), which removes putrescence and draws out pus to promote wound healing.

Clinical observation showed that, besides acting on the local lesion, Wu Hu Dan preparations can also clear toxin latent or residual in surrounding tissue, even toxin already metastasized to the lymph nodes. Of 55 cases of squamous cell carcinoma treated, 18 had enlarged nearby lymph nodes before treatment; after treatment 14 resolved. Second, external treatment combined with internal treatment: Ju Zao Wan is a self-composed empirical formula that activates blood and resolves stasis, softens hardness and dissipates nodules, clears heat and resolves toxin, and expels wind and stops pain; it has some efficacy against cancer. Only by attacking from inside and outside together can the residual toxin latent in the body be thoroughly cleared to eliminate future trouble.

Example 1: Yan ××, female, 64, cadre. Admitted June 19, 1972.

Three years earlier the patient had noticed a black nodule on the left sole, mung-bean sized, growing relatively fast; later it ulcerated with a foul odor. A hospital's pathology section diagnosed malignant melanoma and she was transferred to our hospital. Admission examination: a mass at the base of the second toe of the left sole, about 3.5×3×1 cm, with a small amount of black discharge on the sore surface and a foul odor; the left inguinal lymph node was swollen to broad-bean size. Treatment: Wu Hu Da paste applied twice; after 2 weeks the tumor tissue necrosed and fell off, followed by Hong Sheng Dan, changed every 2 days; internally she took Ju Zao Wan. After 3 months the wound healed completely; repeat biopsy showed numerous inflammatory cells and no malignant melanoma cells. At discharge, the originally enlarged left inguinal lymph node had disappeared. She was hospitalized 118 days and discharged clinically cured. Multiple follow-ups showed good general condition, with local tissue soft, smooth, and flat, and no metastasis.

Example 2: Ouyang ××, male, 58. Admitted May 14, 1973.

One year earlier the patient had developed a small black growth on the right heel, which then ulcerated and failed to heal for a long time. A hospital's pathology section reported malignant melanoma of the right heel. Admission examination: a black ulcer on the right heel about 3.5×2.5 cm, with a small amount of black discharge; the right inguinal lymph node was slightly enlarged. Wu Hu Dan paste was applied 6 times; after 3 weeks all the tumor tissue necrosed and fell off, followed by Hong Sheng Dan, and internally Ju Zao Wan. Half a year later the wound gradually healed; two biopsies showed no melanoma cells. He was hospitalized 230 days and discharged clinically cured.

Example 3: Sun ××, male, 47, worker. Admitted June 2, 1973.

Three years earlier the patient had noticed a new growth on the left back, mung-bean sized, growing rapidly. Later several satellite lesions appeared around it, the largest about 3×4×0.5 cm, purple-red and painless. A hospital's pathology section reported malignant melanoma. Locally applied Wu Hu Dan nail sticks twice, each time 2 half-sticks containing about 3 g of the elixir; the necrotic tumor tissue fell off. Then Hong Sheng Dan was applied to promote wound healing, changed every 2 days; internally she took Ju Zao Wan plus blood-stasis-breaking, hardness-softening, anti-cancer and toxin-resolving herbs (Shengdi 12 g, Yinhua 12 g, Zicao 9 g, Lilu 9 g, Sanleng 9 g, Ezhu 9 g, Guiwei 9 g, Juhua 9 g, Tu Fuling 15 g) for over 50 doses; the wound healed flat. Hospitalized 70 days, discharged clinically cured.

Example 4: Li ××, male, 35, worker. Admitted June 11, 1974.

Ten years earlier the patient had noticed a black mass on the right thigh; a hospital pathology section reported malignant melanoma. He underwent local excision twice, in 1964 and 1972; only one month after the second surgery it recurred, with enlarged right inguinal lymph nodes. He went to a Hangzhou hospital for wide local excision and was given bleomycin. Three months later another black mass appeared on the left buttock. On admission the tumor was about 2.5×1.5 cm, medium-hard, with clear borders and not adherent to the skin. Wu Hu paste was applied twice, containing about 15 g of the elixir; after 2 weeks the mass tissue necrosed and fell off. Then Hong Sheng Dan was applied, and internally Ju Zao Wan was taken; after 2 months the wound healed completely, the scar was flat, and repeat biopsy showed no malignancy. Hospitalized 81 days, discharged clinically cured.

Example 5: Wang ××, male, 70, farmer. Admitted March 2, 1976.

Half a year earlier the patient had noticed a growth on the left sole near the little toe, at first soybean-sized and growing quite fast, with local pain; after ulceration it discharged yellow watery fluid. A hospital pathology section reported malignant melanoma. Admission examination: a mass on the left sole near the little toe about 2.5×2.5 cm, ulcerated with yellow-black discharge, small in amount and foul; no enlargement of surface lymph nodes. Locally applied Baidu nails (toxin-drawing nails) 3 times, each time two half-sticks; after about 3 weeks the tumor tissue necrosed and fell off. Then Hong Sheng Dan was applied, changed every 2 days; internally he took Ju Zao Wan plus stasis-resolving, nodule-dispersing, anti-cancer and toxin-resolving herbs (basically the same as in Example 3) for over 120 doses; the wound healed flat, and repeat biopsy showed no malignant change. Hospitalized 202 days, discharged clinically cured.

Example 6: Liu ××, male, 46, cadre. Admitted May 12, 1978.

Two years earlier the patient had noticed a mass on the dorsum of the left foot, broad-bean sized, red and painless, growing relatively fast; after ulceration the granulation tissue was black, cauliflower-like and everted, about 2.5×2.5 cm. A hospital pathology section confirmed malignant melanoma. He had taken Chinese and Western medicines with no clear effect, and amputation was suggested. On admission the bilateral inguinal and left supraclavicular lymph nodes were enlarged. Wu Hu Dan nail sticks were applied 3 times, each time 3 half-sticks; after 3 weeks the mass tissue necrosed and fell off. Then Hong Sheng Dan was applied, and internally Ju Zao Wan plus hardness-softening, nodule-dispersing, anti-cancer and toxin-resolving herbs (Zicao, Tiankui, Muli, Xiakucao, Shandougen, Jinyinhua, Baiying, Yiyiren, Xiangfu, Gancao) for over 50 doses; the wound basically healed and the inguinal lymph nodes clearly shrank. Hospitalized 64 days, discharged as improved.

(Quoted from Gu Jin Ming Linchuang Jinjian • Zhongli Juan, China TCM Press, 2011)

These six cases treated by Xiao, and the three cases treated by Duan above, both had reproducible results. Though the specific medications differ, the basic approach is similar: clearing heat and resolving toxin, softening hardness and dissipating nodules, and attacking toxin and eroding sores.

Zhang Renji's cases treating Qisijia Kewa and Sakurai ××

Patient Qisijia Kewa, female, 50, a Belarusian. In spring 1987 she came from the Soviet Union to Beijing for treatment. She was robust, with no sickly appearance, but her right lower limb was covered with melanoma lesions and pain. After TCM treatment the pain lessened, the lower-limb masses shrank, and the number of melanomas decreased. Routine herbs: Baihuasheshecao (Oldenlandia), Baixianpi (Dictamnus), Difuzi (Kochia), Xixiancao (Siegesbeckia), Biandoulian (Lobelia), Banzhilian (Scutellaria barbata), Zaoxiu (Paris), Huzhang (Reynoutria), Yuanhu (Corydalis), Shidachuan (Salvia chinensis), Zhumagen (Boehmeria root), Xishupi (Camptotheca bark), Rendongteng (Lonicera stem), Zihuadiding (Viola), and Pugongying (Dandelion). After 15 doses she was in good spirits, strong, and had a better appetite. After another 15 doses, hemoglobin had normalized, white blood cells returned to the normal range, platelets were around 160,000, lower-limb edema was clearly gone, and tumor patches clearly decreased. She returned home after 8 months of treatment.

Patient Sakurai ××, female, 60, a Japanese citizen of Chinese origin from Dalian. She was examined at major Japanese hospitals and diagnosed with melanoma. The primary lesion was in the middle of the labium majus, later metastasizing to the inguinal lymph nodes, which swelled to peach-pit size. Since Japan could not treat her, she came to China in 1986 to seek my help. After one month of Chinese medicine, the inguinal mass disappeared, her spirit and appetite returned to normal, and she moved about like a healthy person. Internal herbs: Haizao, Kunbu, Baihuasheshecao, Banzhilian, Xixiancao, Shuihonghuazi (Polygonum orientale), Biandoulian, Huzhang, Shidachuan, Yuanhu, Xianhehe (Agrimonia), Shengdi, Shudi, Danggui, and Qiyeyizhihua. Later modified according to changes in the condition. The patient was treated for nearly a year and returned to work after one year. Because she was nearly sixty and overworked, in mid-January 1987 the inguinal lymph node on the contralateral lower limb enlarged to egg size and she could not walk. Despite surgery her condition worsened; heart disease recurred, both lower limbs swelled, and she could not get out of bed. She died in late May 1988. From the time she began treatment with me, she survived over two and a half years.

(Quoted from Zhang Renji and Zhang Daning, eds., Zhongyi Zhina Xinlu, Scientific and Technical Literature Press, 1992)

The herbs Zhang Renji used for melanoma were the contemporary common anti-cancer herbs that clear heat and resolve toxin and soften hardness and dissipate nodules, plus some common dermatological herbs. The basic formula in the first case was Wuwei Xiaodu Yin (Five-Ingredient Detox-Drink); his treatment was relatively prudent. Without follow-up on his patients, I suspect his approach was low-risk but that the patients may later have recurred.

All the above cases are credible. Synthesizing them, we can see that these TCM physicians mostly considered malignant melanoma to arise from heat-toxin and damp-toxin lingering for a long time, gradually leading to cancer; thus the basic treatment approach was broadly similar—attacking toxin and eroding sores, clearing heat and resolving toxin, and draining dampness and expelling the pathogen.

Another melanoma patient who is still alive was treated by Sun Bingyan and has survived about twenty years. This patient, an old friend of many years, cannot have his case published for reasons of privacy. He was an advanced case of intestinal melanoma with multiple metastases to important organs such as the liver and lungs. In treating him, the veteran TCM physician Sun Bingyan mainly used the approach of using poison to attack poison.

Because the patient's tumor had already metastasized distantly, external toxin-attacking agents were of little use. On the basis of protecting the patient's spleen-kidney yang, Sun Bingyan combined several highly toxic herbs taken internally, such as Qingfen (calomel), Xionghuang (realgar), Mao Cigu, and Pishuang (arsenic), to attack toxin and erode sores. After two months of Sun's treatment, the patient's condition was controlled and did not recur for over ten years.

In sum, we can roughly sort out the approach to treating malignant melanoma: it is mainly of the heat-toxin and blood-heat type. But some patients, as they progress to mid-to-late stage, because of tumor consumption and qi-blood deficiency, also show dual deficiency of yin and yang and blood vacuity; so treatment must be tailored to the specific patient.

Besides the external preparations and pill formulas above, there are also some established formulas for treating malignant melanoma; I list them one by one for readers' reference.

Wuwei Xiaodu Yin (Five-Ingredient Detox-Drink)

Pugongying 30 g, Jinyinhua 30 g, Zihuadiding (also called Diding) 30 g, Yejuhua (Wild Chrysanthemum) 60 g, Zi Beitiankuizi (also called Tiankuizi) 20 g

Taken internally together with Xihuang Wan (Rhinoceros Yellow Pill), this formula clears heat and resolves toxin, reduces swelling and dissipates nodules. The dregs may also be applied externally to surface tumors. When heat-toxin is exuberant with oozing yellow foul fluid, add Yiyiren (Coix), Cheqianzi (Plantago), Jinqiancao (Lysimachia), and Tu Fuling (Smilax); for itchy skin add Baixianpi, Difuzi, and Quanxie (Scorpion); for ulcerated masses with uncontrolled bleeding, grind Baiji (Bletilla) into powder or apply Yunnan Baiyao externally to the site while taking it internally.

Modified Shentong Zhuyu Tang (Painful-Body Stasis-Expelling Decoction)

Qinjiao (Gentiana macrophylla) 6 g, Chuanxiong 5 g, Taoren (Peach Kernel) 10 g, Honghua 10 g, Chishao 10 g, Shengdi 10 g, Qianghuo (Notopterygium) 5 g, Danggui 10 g, Wulingzhi (Trogopterus) 6 g, Xiangfu (Cyperus) 5 g, Niuxi (Achyranthes) 10 g, Dilong (Earthworm) 6 g. For qi deficiency add Dangshen and Huangqi; for blood deficiency add Shudi and Ejiao.

Modified Liuwei Dihuang Tang (Six-Ingredient Rehmannia Decoction)

Shudi 15 g, Shanyao (Dioscorea) 15 g, Shanzhuyu (Cornus) 10 g, Zexie (Alisma) 10 g, Fuling 10 g, Mudanpi (Moutan) 10 g, Duzhong (Eucommia) 10 g, Chuan Duan (Dipsacus) 12 g, Sangshen (Morus fruit) 30 g.

If the patient feels cold with cold limbs, add Fuzi and Rougui; for dizziness, forgetfulness, and five-center heat, add Maidong and Shashen (Adenophora).

Modified Bazhen Tang (Eight-Treasure Decoction)

Renshen 10 g, Baizhu 10 g, Fuling 10 g, Baishao 10 g, Danggui 12 g, Shudi 12 g, Chuanxiong 10 g, Sheng Huangqi 30 g, Zhi Gancao 10 g, Ziche (Placenta) 15 g, Muxiang (Aucklandia) 10 g.

This is mainly for advanced patients with great depletion of qi and blood, or patients extremely weak after radiotherapy and chemotherapy. Such patients urgently need to greatly supplement their original qi to secure the root first, then gradually plan anti-cancer treatment.

The treatment of cancer patients today is extremely complex; most patients are undergoing multiple treatments simultaneously. So when to take which measures, and how to add or subtract the treatment plan, requires the physician to follow TCM's principle of "treating according to the pattern," adjusting at any time to the patient's specific situation and addressing each patient's individuality, combining pattern differentiation with disease differentiation.

If the relevant treatment methods are well applied, even patients with metastasis still have the possibility of cure or long-term survival with cancer.