A Case of Gallbladder-Cancer Patient Yu, Treated with Chinese Medicine for Two and a Half Years After Surgery and Chemotherapy

Yu, a nurse at a hospital in Dalian, female, born 1967, first visited me on April 27, 2018, after two surgeries and chemotherapy for gallbladder cancer (T3N0M0), with hepatitis B. Pulse fine, wiry, and rapid; tongue coating yellow and greasy; bitter and dry mouth; discomfort in the ribs and back. Weak body with spontaneous sweating and shortness of breath; occasional transient dizziness.

Decoction: Chaihu 10 g, Huangqin 10 g, Wuweizi (Schisandrae Fructus) 10 g, Guizhi 10 g, Baishao 10 g, Zhigancao 6 g, Sheng Huangqi (Astragali Radix) 30 g, Danggui 10 g, Baizhu 20 g, Fangfeng (Saposhnikoviae Radix) 10 g, Fabanxia 10 g, Pianjianghuang (curcuma slice) 6 g, Jiangcan (Bombyx Batryticatus) 10 g, Chan Yi (Cicadae Periostracum) 6 g, Yinchen (Artemisiae Scopariae Herba) 15 g, Zhizi 15 g, Dangshen 15 g, Kushen (Sophorae Flavescentis Radix) 10 g, Banzhilian 20 g, Baihua Sheshucao 20 g, Xianhehe (Agrimoniae Herba) 30 g, Sanleng 10 g, Ezhu 10 g, Jiao Sanxian (three parched digestives) 10 g each, Chao Jineijin (fried Galli Gigerii Endothelium) 30 g.

This was combined with the patent medicines Xihuang Wan, demethylcantharidin tablets, and Shugane Hewei Wan, while insect medicines such as chansu (toad venom), shanquchong (spirobolus), wugong (centipede), and quanxie (scorpion) were made into pills for oral use.

Follow-up, July 27, 2018 (during menstruation):

For the past half month she felt discomfort around the surgical incision, with occasional colicky pain just below the stomach. Appetite fair, sleep poor and easily waking. A rash had appeared on the left arm, itching on sun exposure; no hair loss.

Stools formed, no mucus or black stool; urination normal. Tongue coating yellow and greasy; when sleep was poor the tongue was dry and mouth bitter. Eye discharge copious. Breast distending pain before menstruation. Recent re-examination showed CA125 and neuron-specific enolase on the high side. Blood lipids high, somewhat overweight.

Pulse moderate and even; tongue coating slightly yellow-greasy.

Decoction: Chaihu 10 g, Danggui 10 g, Baishao 10 g, Baizhu 10 g, Fuling 10 g, Gualou 18 g, Beimu 10 g, Fabanxia 10 g, Dannanxing 6 g, Sheng Muli 15 g (decocted first), Shancigu 10 g, Pugongying 20 g, Banzhilian 15 g, Baihua Sheshucao 15 g, Kushen 10 g, Ezhu 10 g, Xianhehe 50 g, Mohanlian (Ecliptae Herba) 15 g, Nüzhenzi (Ligustri Lucidi Fructus) 15 g, Shayuanzi (Astragali Complanati Semen) 10 g, Tusizi (Cuscutae Semen) 10 g, Mudanpi 10 g, Doukou (Amomi Fructus Rotundus) 10 g, Yiyiren 30 g, Chao Maiya 30 g, Chao Guya 30 g, Huaishanyao (Dioscoreae Rhizoma) 30 g, Zhigancao 6 g, Jiao Sanxian 10 g each, Chao Jineijin 30 g.

Patent medicines: Jiawei Xiaoyao Wan (stopped once the dry/bitter mouth cleared) and demethylcantharidin tablets; insect medicines such as chansu, shanquchong, wugong, quanxie, and bihu (gecko) made into pills.

Follow-up, October 13, 2018:

Pulse wiry and moderate; blood pressure 138/80; mouth slightly bitter, more so around 2–3 a.m. and on waking. Faint discomfort in the stomach; slight discomfort below the right ribs. Tongue coating white and greasy, tongue slightly bluish-purple. Averse to wind and cold, discomfort in the shoulder blades. Able to sweat a little, not much; occasional night sweats. Bowels normal, once daily, occasionally twice, basically formed, occasionally loose. Urination normal. Because of endometriosis and adenomyosis there was excessive bleeding and dysmenorrhea; no abnormal discharge. Western medicine advised injecting leuprorelin acetate microspheres.

Decoction 1: Guizhi Jia Gegen Tang (may be replaced by Japanese Kampo Gegen Tang granules): Guizhi 10 g, Baishao 10 g, Zhigancao 6 g, Shengjiang 3 slices, Dazao 5 pieces, Gegen 20 g.

Decoction 2: Huangtu Tang (Yellow Earth Decoction): Zaoxin tu (hearth-cooked earth) 30 g, Chao Baizhu 10 g, Pao Fuzi (processed Aconiti Radix) 10 g, Ejiao (Asini Corii Colla) 10 g, Huangqin 10 g, Zhigancao 10 g.

Decoction 3: Modified Guipi Tang: Sheng Huangqi 30 g, Chao Baizhu 10 g, Fuling 10 g, Dangshen 15 g, Muxiang 10 g, Longyanrou (Longan Arillus) 6 g, Danggui 6 g, Yuanzhi (Polygalae Radix) 10 g, Huaishanyao 20 g, Huangjing (Polygonati Rhizoma) 10 g, Mohanlian 10 g, Nüzhenzi 10 g, Shayuanzi 10 g, Tusizi 10 g, Tengligen (Actinidiae Root) 20 g, Shiwei 20 g, Baihua Sheshucao 15 g, Banzhilian 15 g.

Patent medicine: Shugane Hewei Wan; insect medicines such as chansu, shanquchong, wugong, quanxie, and bihu made into pills.

Follow-up, March 22, 2019. She had stopped the decoctions around the Lunar New Year. Right pulse wiry, moderate, and hard; left pulse fine and moderate; tongue slightly purple; otherwise normal. Occasional bitter mouth when rest was poor; bowels normal; urine not yellow when she drank much water. After the last menstruation, CA125 and other markers had returned to normal.

Fearing that prolonged decoction use would injure the stomach, I switched her to pills, treating according to my approach of multi-target anticancer therapy with compound Chinese medicine (see the linked article for the treatment strategy and medicinals). I told her to keep monitoring Ca125, ca199, ca153, cea, AFP, and other markers.

Follow-up, August 28, 2019:

Right pulse moderate, slippery, slightly wiry; left pulse moderate and slightly wiry; tongue slightly bluish-purple; she had taken red-colored medicine, and the tongue underside was stasis-purple. After over a year of treatment, her hepatitis-B viral load had fallen to normal.

Treatment therefore continued along the previous strategy.

Follow-up, November 25, 2019:

On October 23, after 15 days of elemene infusion at a local hospital, four days after discharge she developed hemorrhoids, and at the same time hip-bone pain so severe it woke her at night. A week later the hemorrhoids resolved, but she then had vaginal bleeding, leg pain, generalized discomfort, chest oppression, and nausea without vomiting. Left pulse fine, moderate, wiry; right pulse fine, wiry, moderate. Fingernail lunulae indistinct; eyelids fair. CA125 had risen again over recent months to 45.722 (reference 0–32.68), though down from August. The adenomyosis had improved greatly. Tongue coating yellow-greasy; stools formed and regular.

Following the principle of "if it works, do not change the formula," I continued along the previous strategy. I also told her to soak her feet or sitz-bathe in boiled ai ye (mugwort leaf). Dietary restrictions: seafood, river crab, river shrimp, citrus, pickled foods, fried foods, spicy and greasy foods, hotpot, barbecue, rooster, carp, and various gas-producing foods such as beans and tubers.

After this, the pandemic prevented follow-up visits, but she kept to the fixed regimen. At the follow-up on October 20, 2020, both pulses were moderate and even; the tongue was slightly dark-purple with thin white coating, and the tongue underside basically normal.

Bowels were normal, regular, and formed, once each morning. Energy good. Adenomyosis was well controlled, and all lab results were satisfactory. Apart from slight discomfort at the right surgical site, she felt fine; no aversion to cold. Slight dry mouth, but no longer a bitter taste; the center of the tongue was slightly dry from midnight to 3 a.m.

I told her to halve the dosage of all medicines and continue for two and a half years to prevent recurrence.

This patient's TCM treatment was mainly adjunctive after surgery and chemotherapy; after two operations she had no solid tumor left. But liver-gallbladder symptoms remained and her hepatitis-B viral load was high; after TCM treatment these symptoms cleared one by one, the viral load was controlled, the complications were all resolved, and her quality of life greatly improved.

The patient herself is an experienced healthcare worker; while taking Chinese medicine she also practiced Guolin qigong to build her constitution. Gallbladder cancer generally has a poor prognosis and recurs very easily even after surgery and chemotherapy, so she actively took Chinese medicine to improve her condition and control and prevent recurrence, achieving good results.