Huajian Wan (Hardness-Dissolving Pill) from Yangke Xinde Ji for Breast Lumps and Lymph Node Enlargement
In Yangke Xinde Ji (Reflections on Surgery) there is a formula called Huajian Wan (Hardness-Dissolving Pill), recorded in the chapter "Household Plasters, Elixirs, Pills and Powders." It is indicated for constrained fire in the Liver channel, breast phlegm nodules (ru tan), breast lumps (ru pi), as well as lost-nutrition nodules (shiying) and blade-shaped scrofulous swellings (madao) at the neck, and constrained-phlegm scrofulous nuclei—roughly corresponding to today's breast nodules or breast cancer, and cervical and axillary lymph node enlargement.
The composition is: large Rehmannia (Dadihuang) 4 liang, Sichuan Lovage Rhizome (Chuanxiong, wine-fried) 2 liang, White Peony (Baishao, wine-fried) 2 liang, Sichuan Melia fruit (Chuanlianzi, crushed with kernel and stir-fried) 2 liang, Angelica (Danggui, wine-fried) 2 liang, Salvia (Danshen, wine-fried) 2 liang, oyster shell (Muli, calcined) 3 liang, Selfheal spike (Xiakucao, dried) 3 liang, Trichosanthes root pollen (Huafen, fried) 2 liang, Cyperus (Xiangfu, vinegar-fried) 2 liang, Pinellia (Banxia, fried) 2 liang, Haliotidis shell (Shijueming, calcined) 3 liang, Curcuma (Yujin, fried) 2 liang, Green tangerine peel (Qingpi, fried) 2 liang, tangerine seed (Juhe, fried) 3 liang, scorpion (Quanxie, wine-fried) 1 liang 5 qian, Lignum Aquilariae (Chenxiang, scraped and powdered) 5 qian, Poria (Fuling) 2 liang, Tribulus fruit (Cili, fried) 2 liang, Paniculate Bolbostemma tube (Tu Beim, core removed) 2 liang, Corydalis (Yuanhu, fried) 2 liang, Bupleurum (Chaihu, fried) 5 qian, Perilla stem powder (Su Geng Fen) 1 liang, Anemone raddeana rhizome (Liangtoujian, fried) 3 liang.
This formula is built on the famous blood-activating and stasis-resolving Four Substances Decoction (Siwu Tang—Rehmannia, Ligusticum, Peony, Angelica), with additions. TCM also says, "Salvia alone is as effective as the Four Substances"; adding Salvia enhances the blood-activating and blood-nourishing action.
Oyster shell, Selfheal, Trichosanthes root, processed Pinellia, and Paniculate Bolbostemma soften hardness and disperse nodules, clear heat and resolve toxicity, and drain pus and reduce swelling; they also have antitumor effects. Scorpion (Quanxie = Quanxiong, whole scorpion) "uses poison to attack poison" and is a key herb in TCM treatment of sores, scrofula and similar conditions.
Bupleurum, Cyperus and Haliotidis soothe the liver and regulate qi, and anchor liver yang. Green tangerine peel, tangerine seed, Lignum Aquilariae and Perilla stem are qi-regulating herbs; green peel and tangerine seed additionally reduce swelling and disperse nodules, and modern pharmacology confirms they also have antitumor effects. Tribulus and Anemone raddeana both reduce swelling and disperse nodules. Poria in this formula strengthens the spleen and promotes urination, while also helping reduce swelling and disperse nodules.
Modern pharmacology confirms that Corydalis has an analgesic effect reaching about 40% of morphine's. It is used here for its pain relief. Breast lumps and lymph node enlargement both cause pain, and during treatment these blood-activating, stasis-resolving, swelling-reducing and nodule-dispersing herbs can also cause pain, so Corydalis is added to relieve pain.
Overall, Huajian Wan is a fine formula; it has some efficacy for breast and lymph node enlargement of the qi-stagnation and blood-stasis pattern identified under TCM pattern differentiation. However, it is strongly blood-activating and is not suitable for patients with a bleeding tendency.