Appreciating Medical Cases of Professor Hua Liangcai Treating ENT Malignant Tumors (Part 2)

Case 3: Kang, male, 37 years old. First visit October 5, 1979.

Two years earlier the patient had found a thumb-nail-sized round mass on the hard palate of the oral cavity, with little pain. Thereafter the mass grew relatively fast, accompanied by difficulty swallowing and bleeding from the mouth and nose. He was poorly nourished and emaciated. Examination: on the hard palate of the oral cavity there was a 4 cm x 4.5 cm tumor, uneven on the surface, ulcerated, foul-smelling, brittle, and bleeding easily. There was bleeding from the left nasal cavity, the left nasal cavity was narrow, and the nasal floor was bulging upward. Because of local tumor compression, the left side of the nose was pushed forward, the nose was left-right asymmetrical, and the teeth were loose. There were enlarged lymph nodes on the left side of the neck. Biopsy showed cystic basal-cell epithelioma of the hard palate and paranasal sinuses. After radiotherapy, the patient could not tolerate it and requested TCM consultation.

At the visit the patient felt unbearable dizziness, fatigue and weakness, dry mouth and throat, red and swollen eyes, greatly reduced appetite, stool dry and hard like sheep pellets, once every several days, and afternoon fever, with temperature around 38 degrees every afternoon at 4 o'clock.

Professor Hua Liangcai considered this to be internal accumulation of pathogenic heat, which, together with radiotherapy, had led to exhaustion of essence, blood, yin, and fluids. He planned to treat by clearing heat and detoxifying, while additionally nourishing blood and yin.

The first-visit prescription was as follows:

Wuhuaguo (Fici Fructus) 60 g, Danggui (Angelicae Sinensis Radix) 10 g, Tianhuafen (Trichosanthis Radix) 30 g, Baihua Shejiacao (Oldenlandiae Herba) 30 g, Pugongying (Taraxaci Herba) 30 g, Shandougen (Sophorae Tonkinensis Radix) 15 g, Haiercha (catechu) 15 g, Shengdi (Rehmanniae Radix) 15 g, Baiyaizi (Stephaniae Cephalanthae Radix) 15 g, Daji (Cirsii Japonici Herba) 15 g, Xiaoji (Cirsii Herba) 15 g. One dose daily, decocted and taken in four divided doses.

The patient received radiotherapy simultaneously with TCM treatment. After taking 35 doses of the Chinese medicine, radiotherapy had also ended; after integrated Chinese-Western treatment, the difficulty swallowing and the nosebleeds had disappeared, the tumor had flattened, the enlarged lymph nodes had resolved, and diet and urination and defecation were all normal.

To prevent recurrence, Professor Hua Liangcai had the patient continue: take 3 doses of the above formula, grind into powder, refine with honey into pills; take 3 times a day, 10 g each time, washed down with a decoction of kiwifruit root.

Follow-up of this patient through April 27, 1986 showed no recurrence.

The patient in this case presented symptoms of dry mouth and tongue, red swollen eyes, dry hard stool, and afternoon fever; these belong to the pattern of exuberant heat-toxin with damage to yin fluids. Thus treatment needed to center on clearing heat and detoxifying, with nourishing and yin-enriching as secondary, while also attending to the symptomatic aim of stopping bleeding. In Professor Hua's formula, Tianhuafen, Baihua Shejiacao, Pugongying, Shandougen, Haiercha, and Baiyaizi are all heat-clearing, detoxifying herbs, and all have some anti-cancer effect; Wuhuaguo, Shengdi, and Danggui nourish yin and fluids, moisten dryness, and unblock the bowels; Daji and Xiaoji cool the blood and stop bleeding. Thus the whole formula for this patient combined pattern differentiation with disease differentiation, and addressed both the root and the branch.

While receiving TCM treatment, this patient did not abandon radiotherapy but adopted a comprehensive integrated Chinese-Western plan, which can raise the success rate of treatment. The treatment effect was very good; it is hard to say how much TCM and radiotherapy each contributed, but that integrated Chinese-Western treatment overall raised the patient's chance of successful treatment is beyond doubt.

Case 4: Zhang, 60 years old. First visit October 7, 1982.

For many years the patient had had left-sided nasal obstruction, and for a year had had left-sided epistaxis with a poor sense of smell. He had left-sided headache, blurred vision, and numb pain in the left zygomatic region. For half a year the left hard palate had ulcerated, discharging pus and bloody fluid with a foul stench. Examination found a polyp in the left nasal cavity, reaching the anterior edge of the inferior turbinate in front and the choana behind. The left maxillary sinus showed no external bulge but marked tenderness; there was an ulcer on the left hard palate of about 4 cm x 3 cm with an uneven surface.

X-ray showed: the left maxillary sinus was hazy, and the inner wall was hazy; extending to the ethmoid sinuses, sphenoid sinuses, the upper margin of the left orbit, and the skull base near the foramen ovale, there was hazy destruction. Biopsy showed mucoepidermoid epithelioma of the maxillary sinus. After radiotherapy, symptoms improved only slightly, and right-lung metastasis was found.

At the visit there were chest oppression and breathlessness, weak cough, dry cough without sputum or blood-streaked sputum, dry mouth and throat, greatly reduced eating, dry hard stool once every several days, a dull complexion, faint breathing, emaciated and haggard appearance with loss of flesh, a deep faint pulse on the verge of expiry, and a tongue smooth as a mirror. This was already a critical condition with yin and yang, qi and blood on the verge of exhaustion; the urgent measure was to support the righteous and suppress cancer, supplementing both yin and yang.

First-visit prescription: Xiyangshen (Panacis Quinquefolii Radix) 8 g, Wuhuaguo (Fici Fructus) 60 g, Sheng Huangqi (raw Astragali Radix) 30 g, Fuling (Poria) 30 g, Shanzhurou (Corni Fructus) 20 g, Nüzhenzi (Ligustri Lucidi Fructus) 15 g, Beishashen (Glehniae Radix) 15 g, Huangjing (Polygonati Rhizoma) 15 g.

Simmer the above over low heat into a concentrated decoction and drink frequently. After 3 doses the patient's spirits gradually improved, breathing steadied, and then two pieces of dry stool were passed; the complexion and pulse turned harmonious. He continued with 5 more doses of the original formula and was discharged. In early January 1983 he died of massive hematemesis.

This patient was already at the terminal stage at the visit, with a poor prognosis. Treatment of such patients should focus on improving quality of life and providing good hospice care. Professor Hua acted precisely on this idea, centering on supporting the righteous and securing the root. In the first-visit prescription, Xiyangshen, Sheng Huangqi, Fuling, Shanzhurou, Nüzhenzi, Beishashen, and Huangjing are all root-supporting herbs, and even Wuhuaguo can be classed among them. This formula basically has no side effects; it adds no suffering to the patient but can improve the clinical symptoms. Such treatment, on a practical basis, eased the patient's suffering.

The four ENT tumor patients Professor Hua treated had different conditions and were treated by different methods, yet the results were all fairly ideal. His medication logic and clinical thinking are worth learning from.