Appreciation of Feng Zhirong's Case: Treating Radiation Pneumonitis in a Breast Cancer Patient
Doctor Feng Zhirong, former president of the Zigong Hospital of Traditional Chinese Medicine in Sichuan Province, treated a 64-year-old breast cancer patient who sought his help on December 10, 1998 for radiation pneumonitis caused by post-operative radiotherapy for left-sided breast cancer. At the visit, the patient had frequent coughing, abundant clear thin sputum, fatigue and lack of strength, a lusterless complexion, shortness of breath and reluctance to speak, a pale tongue with a thin coating, a fine pulse, acceptable appetite, and normal urination and defecation.
Feng Zhirong differentiated the patient as having the pattern of failure of the lung to diffuse and downbear, and planned to treat it by the method of warming yang and resolving fluid retention. The first-visit prescription was as follows: Fuling (Poria) 15 g, Ganjiang (Zingiberis Rhizoma) 15 g, Gancao (Glycyrrhizae Radix) 10 g, Wuweizi (Schisandrae Fructus) 15 g, Xixin (Asari Herba) 3 g, Fabanxia (processed Pinelliae Rhizoma) 15 g, Xingren (Armeniacae Semen) 10 g, Baijiezi (Sinapis Semen) 10 g, Suzi (Perillae Fructus) 10 g, Qianhu (Peucedani Radix) 30 g, Chuanbei (Fritillariae Cirrhosae Bulbus) 15 g. Two doses, decocted in water.
This formula was a modified combination of Linggan Wuwei Jiangxin Tang (Poria, Licorice, Schisandra, Ginger, and Asarum Decoction) and Sanzi Yangqin Tang (Three-Seed to Parents Decoction). Linggan Wuwei Jiangxin Tang warms the lung and resolves fluid retention, dispels phlegm and stops cough; Sanzi Yangqin Tang warms the lung and resolves fluid retention, downbears qi and digests food. The two are combined, with Qianhu, Chuanbei, Fabanxia, and Xingren added to dispel phlegm and stop cough. Because the patient's appetite was acceptable, Laifuzi was removed. Such a composition can symptomatically relieve the patient's symptoms.
After taking the medicine, the patient's cough eased and sputum volume markedly decreased; the tongue and pulse were unchanged. Since the first-visit treatment was already effective, one should follow the ancient maxim "if effective, do not change the formula." So at the second visit, Doctor Feng instructed the patient to continue the original regimen until recovery. After another two months of medication, cough and sputum production had basically disappeared and the spirit was markedly improved, so the medicine was stopped.
Radiation pneumonitis is a common sequela in patients with brain and chest tumors undergoing radiotherapy. The condition lingers and is difficult to heal, seriously affecting the patient's quality of life; some patients may suffer from it for life. Radiation pneumonitis differs from viral or bacterial pneumonia; this disease is very intractable and easily recurs. This patient's symptoms were fairly obvious, making it easy to judge that a lung problem had arisen.
Some patients with radiation pneumonitis have no obvious cough or sputum symptoms, only aversion to cold, fatigue, dry mouth, and reduced or excessive sweating. Moreover, radiation pneumonitis may appear years after radiotherapy and is not easily linked by patients or doctors to the radiation history. If the doctor lacks sufficient clinical experience, it is easy to miss or misdiagnose, treating it as another cause; after trying every kind of medicine without effect, the patient also becomes discouraged over time.
TCM pattern differentiation and treatment has certain advantages in treating radiation pneumonitis. The doctor, based on the patient's clinical manifestations, differentiates the pattern, selects formulas, and chooses herbs, which can significantly improve the patient's quality of life. But before differentiating the pattern, the doctor should inquire in detail about the patient's medical and treatment history and carefully analyze its cause, so as to ultimately find a highly targeted medication regimen.