Appreciating Professor Feng Zhirong's Case of Lateral Gingival Tumor
Professor Feng Zhirong, former head of the Zigong Hospital of TCM, once treated a patient with a lateral gingival tumor. The patient, a 62-year-old married man surnamed Liu, first came to Professor Feng on April 16, 1999.
The patient had had swelling and pain of the left gingiva for over four years, with intermittent gingival bleeding of bright red blood, bad breath, and a fondness for cold drinks. The gums were red, swollen, eroded, and tender to the lightest touch. His tongue was pale red with a white greasy coating, and his pulse was moderate. Previous treatment in many places had failed; Western medicine diagnosed a left lateral gingival tumor (granulomatous type), and antibiotics had been ineffective. Professor Feng differentiated the pattern as accumulated heat-toxin with qi stagnation, blood stasis, and damp obstruction, and planned treatment by clearing heat, resolving toxins, cooling blood, invigorating blood, and resolving dampness.
Initial prescription: rehmannia root (shengdi) 15g, moutan bark (mudanpi) 10g, red peony root (chishao) 10g, scrophularia root (xuanshen) 15g, lycium fruit (gouqizi) 30g, Poria (yunfuling) 15g, coix seed (yiyiren) 30g, cogongrass rhizome (baimaogen) 30g, lotus node (oujie) 30g, gardenia fruit (zhizi) 10g, eupatorium (peilan) 15g, honeysuckle stem (jinyinhua teng) 30g, atractylodes (cangzhu) 15g, Phellodendron bark (huangbai) 15g, peach kernel (taoren) 10g. Four doses, decocted in water, taken morning and evening.
At the return visit on April 22, after four doses, the patient reported that gingival bleeding had stopped and the swelling and pain had improved. His tongue and pulse were as before. Since the formula had taken effect, Professor Feng held to the disease mechanism and made no major change. Only because bleeding had lessened did he remove the blood-cooling, hemostatic lotus node and cogongrass rhizome, and add 10g of Chinese angelica (danggui) and 15g of safflower (honghua) to invigorate blood and reduce swelling. The patient took the adjusted formula for 12 more days, and the swelling and pain completely resolved.
This patient's gingival swelling and pain had a long history, dragged on for four years, and resisted treatment everywhere, becoming a stubborn ailment. From his symptoms, Professor Feng reasoned that bad breath and a fondness for cold drinks showed exuberant internal heat, so treatment must clear heat; hence the heavy use of honeysuckle stem, gardenia, and Phellodendron to clear heat and resolve toxins. Long-standing blockage by heat-toxin necessarily leads to blood stasis, so while clearing heat he also resolved stasis—using rehmannia, moutan, red peony, and peach kernel to activate blood and resolve stasis. Persistent gingival bleeding with marked heat signs required some blood-cooling hemostatics to treat the manifestation, hence cogongrass rhizome and lotus node. Heat-toxin in the mouth is often related to spleen deficiency with damp obstruction, so atractylodes and eupatorium aromatically transformed dampness, and Poria and coix seed fortified the spleen and percolated dampness. Exuberant internal heat necessarily also consumed kidney yin, so lycium fruit and scrophularia nourished kidney yin; scrophularia also cooled blood and reduced swelling—one herb serving two purposes.
Such a comprehensive prescribing approach produced an immediate effect: after just four doses, gingival bleeding that had persisted for over four years stopped. This not only gave the patient confidence and hope but also greatly encouraged the doctor. Once trust between doctor and patient was established and the therapeutic direction found, the later course went far more smoothly.
To be honest, such results are partly chance. Every doctor over a career encounters many difficult cases. Whether the first visit quickly shows effect largely determines the patient's later trust and compliance, so the initial result is often the key to building doctor-patient trust. Doctors should strive to show some effect—even a partial one—at the first visit.