How to Tonify When a Debilitated Patient Cannot Tolerate Tonics

Many late-stage patients have reached the point of being too deficient to tolerate tonification; taking tonics actually makes them worse. The first patient I saw, apart from my own mother, was a terminal colorectal cancer patient. At the time, Western medicine gave him only a week or two to live; in fact, maintained on Chinese medicine, he survived nearly two months. I believe his daughter mishandled things at the time; had she not, this patient would have lived longer.

When the patient's daughter sought my help, the patient was unresponsive to any painkiller; Western analgesics not only failed but had obvious side effects. I prescribed a large formula of about thirty or forty herbs. Because at that time I had no habit of recording prescriptions, I cannot recall it now. After about two weeks, the patient's cancer pain and cancer fever were brought under control; he went from being bedridden to being able to go downstairs for sunlight, and his appetite improved.

However, the patient's daughter was a Western-medicine nurse; seeing her mother wasted to skin and bone, she grew very anxious and hoped I could put some flesh on her mother. On this I was truly helpless. After treating for a while longer, she took her mother to the hospital for intravenous fat emulsion and amino acids. Within a few hours of the nutrient infusion, the patient developed breathing difficulty. When the daughter called me for help, I said I was powerless—because I was in Beijing and the patient in Sichuan, I could not provide emergency care. A few hours after the call ended, the patient died.

Terminal patients have poor heart and lung function; nutrients must be carried throughout the body by the blood, and the heart is the pump that circulates blood. Nutrients exceeding the heart's carrying capacity place a huge burden on the heart, so they directly cause heart-lung failure. Excessive tonification can, in severe cases, be fatal.

I later encountered several more cases of heart-lung failure caused by nutrient infusions. One Inner Mongolian lung-cancer patient developed heart-lung failure and shortness of breath while receiving a nutrient infusion in hospital; his son called me in distress, and I told him to have the doctor stop the infusion. As soon as the nutrient solution was stopped, the patient immediately felt relieved and his breathing steadied. There were also patients who developed heart-lung failure after taking ginseng or powerful Tibetan tonics. Hence the TCM saying: "Ginseng kills without blame, while rhubarb saves without credit." Ordinary people, by common sense, think that when a patient is weak they should be tonified; if too much tonic kills them, they do not blame the tonic, merely feeling their relative was too sick. And laxatives like rhubarb, though truly life-saving for the patient, are fearsome in nature; even when they save a life, people remain wary and do not remember their merit.

Historic TCM physicians understood that this kind of patient belongs to the category of "too deficient to tolerate tonification"; many other chronic-disease patients are the same. When the patient cannot tolerate tonification, tonification must be cautious; heavy tonification will be too much for them. When Li Dongyuan formulated prescriptions for such patients, his doses were extremely light, emphasizing the gradual, step-by-step recovery of the patient's spleen and stomach function.

I once read in old TCM doctor Jiao Shude's books about his treatment of a woman in a similar situation—she was too deficient to tolerate tonification, and could not handle even 2-3 qian of rehmannia and similar herbs. Later, Old Jiao solved this by using tiny doses, as low as five fen or one qian, keeping the formula's composition unchanged and adjusting only the dosage. The woman's years-old stubborn illness was cured.

In Pu Fuzhou's case records I also saw a similar case: a patient in poor condition, unable to withstand medicinal force, who had sought doctors for years and was allergic to over two hundred Chinese herbs. Pu Fuzhou reduced the dose of Zisheng Pian (Life-Nourishing Tablets) to one-third of the standard amount, and the patient gradually recovered. According to Yue Meizhong's account, when Pu Fuzhou treated a certain deficient patient with a cold, he also used tiny doses of Yuping Feng San (Jade Screen Powder) and achieved a cure.

Nowadays, many chronic-disease patients react badly to medication; they cannot stand tonics, yet they are genuinely extremely deficient. At such times one can consider treating according to the principle of "too deficient to tolerate tonification—medication should be light." When Zhao Shaoqin treated weak chronic-disease patients, he often used as little as 0.5g of ginseng, 3g of Atractylodes macrocephala, and 1g of tangerine peel—a micro-dosing approach that worked very well.

Wang Qishi, author of Li Xu Yuan Jian (Origins and Guidance on Consumptive Insufficiency), mentions that some patients must be treated slowly for two to three years before success. Old TCM doctor Yue Meizhong recounted that when he was young he saw an old physician treating a weak youth by holding to the same formula for over a year to achieve a cure. Hu Shenrou, author of Shen Liu Wu Shu, especially emphasized that when treating consumptive and other chronic diseases, one must proceed slowly and use small doses. Fei Bohong, in Yi Chun Sheng Yi, emphasized that physicians should use mild, balanced herbs for chronic-disease patients.

It is clear that on this question, physicians through the ages have all had deep clinical insights: when a patient's body is weak, it cannot withstand attack and cannot tolerate tonification. At such times, whether attacking or tonifying, one can only proceed in small amounts and slowly; if the dose is too large and the medicinal force too fierce, the patient dies before the disease is gone. Many families, when their relative is weak, wish they could instantly build them up robust; this is unrealistic, and the actual result backfires.