Clinical Experience: Huangqi Fangji Tang as the Principal Formula Effectively Treated One Case of Renal Failure and One Case of Advanced Ovarian Cancer
Case 1: Advanced ovarian cancer with pleural effusion and pericardial effusion and ascites and pelvic effusion
Zhang, female, 75 years old, from Xingtai, Hebei
The patient first consulted on May 30, 2018. Earlier that year, a large pelvic mass was discovered, and she went to a local hospital in Xingtai for examination, where she was diagnosed with ovarian cancer.
Imaging showed a multiloculated cystic-solid pelvic mass measuring 10.3 × 9.4 × 7.0 cm; an anechoic (fluid) area about 1.7 cm deep in the rectouterine pouch; separation of the uterine cavity with a large amount of intrauterine effusion; a small amount of fluid in the rectouterine pouch; ascites (no cancer cells found in the ascites); pericardial effusion; and right-sided pleural effusion.
Past medical history: In 1981 she had lymph-node dissection surgery on the right side of the neck; there were inflammatory changes in the lower right lung.
At the time of consultation, the patient had intractable coughing, which worsened with changes in posture, along with shortness of breath. The cough produced sputum—white sputum. She had chest tightness but no chest pain.
The pulse was wiry, slippery, rapid, and forceful. Bowel movements were normal, once daily, soft and formed. Urination was normal. No bitter taste in the mouth; she felt a dry mouth when waking at night.
She had previously had a fever for about twenty to thirty days, but was no longer febrile. Some time before, she had been angry; afterward she felt a mass in her abdomen and, upon examination, was diagnosed with ovarian cancer. When tumor markers were checked at the Third Hospital of Xingtai, CA125 was as high as 443.8 (normal ≤ 35).
Appetite was fair. She had lost weight noticeably over the past two or three months, her complexion had darkened, and her energy was poor.
Earlier, the patient's husband had rapidly died after surgery at a hospital for suspected lung cancer. As a result, the family was no longer willing to undergo any Western medical treatment. The patient's niece knew me and recommended that she consult me. The family hoped for purely TCM treatment, and the patient said she was willing to take Chinese medicine, willing to live however long she lived.
This was the case of cachexia I had seen at its most severe, so I had little confidence in treating it. But since she had been referred by an acquaintance, I steeled myself to give it a try.
I prescribed the following:
Dietary therapy:
Daji (thistle, Cirsium) 50–150 g, Xiaoji (cephalanophora thistle) 50–150 g, Chenpi (aged tangerine peel) 30 g, one white radish; stew together with meat, eat the meat and drink the soup.
Decoction:
Sheng Huangqi (raw Astragalus) 30g, Sheng Baizhu (raw Atractylodes) 30g, Han Fangji (Stephania) 30g, Fuling (Poria) 30g, Zhuling (Polyporus) 30g, Cheqianzi (Plantago seed) 15g, Cheqiancao (Plantago herb) 15g, Jiao Shanzha (charled Hawthorn) 15g, Chao Maiya (fried Barley sprout) 30g, Sheng Maiya (raw Barley sprout) 30g, Chao Guya (fried Rice sprout) 30g, Zhi Gancao (honey-fried Licorice) 10g, Pian Jianghuang (Curcuma) 6g, Chao Jiangcan (fried Bombyx Batryticatus) 10g, Chan Yi (Cicada slough) 6g, Huai Niuxi (Achyranthes) 10g
Patent medicines:- Niuhuang Shenqi Wan (Japanese kampo formula)
- Spironolactone (Western diuretic; take according to package instructions)
- Xi Huang Wan, once daily, 3–6 g each time, taken before bedtime
- Duoying Wan, three times daily, 15 pills each time
- Fufang Banmao Jiaonang (Compound Cantharis Capsule), twice daily, 2–3 capsules each time
After about a month of medication, on July 3 the patient came to Beijing for a follow-up. She no longer had coughing or wheezing; her energy had markedly improved, her complexion had improved noticeably, and she was already able to do housework.
On rechecking the tumor marker CA125, it had dropped to 146. The largest cystic-solid mass had changed from the original 10.3 × 9.4 × 7.0 cm to 10.8 × 9.4 × 5.0 cm. Pelvic effusion had decreased by nearly half, and the pleural effusion had essentially disappeared.
Since the formula was effective, I did not change it. Building on the above formula, I further added some anti-cancer herbs.
The reason this patient achieved such rapid efficacy may be that her body had not been damaged by surgery, radiotherapy, or chemotherapy; her overall function was still fair, and she was sensitive to Chinese medicine.
Case 2: Patient with hereditary renal cystic disease and renal failure
Peng, female, born in 1955, from Shandong
First visit: June 10, 2018.
The patient's father, the patient herself, her son, her elder sister, and her younger brother all had renal cysts. Her blood pressure was on the high side, reaching 180–190 when elevated. She was currently on antihypertensive medication—Betaloc and Norvasc—to control her hypertension. The condition had now progressed to renal failure.
The patient had not undergone dialysis. She had been treated with TCM at a kidney-disease hospital in Henan Province, taking several of that hospital's self-formulated capsules for kidney disease. After taking the medicine, she vomited.
When she was not taking medicine, her appetite was extremely poor, she lost weight rapidly, and she felt fatigued. She had been losing weight markedly since 2015, and her sleep was poor. Urination was normal; bowel movements once daily. After stopping the patent medicine, her mouth felt sticky, the tongue was watery-slippery with a thin yellow coating, and there were red veins visible at the base of the tongue.
Both left and right pulses were deep, wiry, and forceful; no bitter taste in the mouth. The abdomen was distended and hard-full. There was occasional back pain, described as a constricting pain.
Red blood cells, hemoglobin, and hematocrit were low; mean platelet volume and mean hemoglobin concentration were low; platelet distribution width was high; lymphocyte ratio was low. Several anechoic (fluid) echoes were visible within the liver.
Both kidneys were enlarged, with abnormal shape and an uneven, irregular surface. The parenchymal echoes were unevenly distributed and filled with multiple anechoic areas of varying sizes; the larger one in the left kidney was about 54 × 79 mm, and in the right kidney about 49 × 54 mm, with clear borders, along with multiple echogenic plaques.
Western medicine diagnosis: gallstones, hepatic cysts, dense hepatic parenchymal echoes, polycystic kidney disease with calcification.
The patient was cold-intolerant and did not sweat easily. Her feet were swollen. She had shortness of breath and wheezing.
TCM pattern differentiation: phlegm-rheum (tan yin).
Given the patient's condition, I decided to treat her with Huangqi Fangji Tang plus the "four kidney herbs" (Si Wei). However, I was not certain whether this approach could achieve results in such severe renal failure. Considering that it was not easy for the patient to come all this way, I wrote two prescriptions and told her to take the first; if it did not work, she should switch to the second. The second prescription was Ling Gui Zhu Gan Tang (Poria Cinnamon Twig Atractylodes Licorice Decoction) with additions.
Decoctions:
Prescription 1:
Sheng Huangqi 30g, Han Fangji 30g, Fuling 30g, Zhuling 30g, Mo Hanlian (Eclipta) 15g, Nüzhenzi (Ligustrum fruit) 15g, Shayuanzi (Astragalus complanatus seed) 10g, Tusizi (Cuscuta seed) 10g, Sheng Baizhu 15g, Zhi Gancao 10g, Huai Niuxi 15g, Cheqianzi 15g, Shengjiang 7 slices, Dazao 7 pieces, Haijinsha (Lygodium spores) 10g, Shiwei (Pyrrosia) 15g
Prescription 2:
Fuling 12g, Guizhi 9g, Baizhu 6g, Zhi Gancao 6g, Haijinsha 6g, Shiwei 15g, Gouteng (Uncaria) 15g (added later)
Patent Chinese medicines:- Guipi Wan (Spleen-Returning Pill)
- Jineijin Pian (Chicken Gizzard Lining tablets)
Both patients are currently undergoing further treatment. That Chinese medicine could so rapidly relieve the suffering caused by these two conditions—both of which rank as world medical challenges—is truly remarkable. Renal failure and advanced ovarian cancer are both diseases that leave doctors at a loss.
The medication strategy for these two patients was basically the same: both centered on the classic TCM formula Huangqi Fangji Tang, with slight adjustments to the strategy based on the two patients' different conditions; the results were satisfactory in both cases. The reason is that, although these two diseases look completely unrelated, in TCM their disease mechanism is the same—both belong to phlegm-rheum.
The pulse in phlegm-rheum diseases is generally deep-wiry or slippery; because retained water is present in the body, the complexion tends to be dark. Severe cases show swelling of the limbs. Therefore I treated both primarily with Huangqi Fangji Tang, the famous TCM formula for promoting urination and reducing swelling. This is a typical case of the TCM principle of pattern differentiation and treatment—treating different diseases with the same method.
The Japanese kampo physician Dōmoto Junshin attributed the causes of human disease to three kinds of "poison": blood poison, food poison, and water poison. Although this summary is not comprehensive, it has considerable plausibility. Whatever the cause, once water-fluid disorder arises within the body, it produces all kinds of symptoms.
The cachexia caused by the malignant tumor in Case 1, the renal failure and hypertension triggered by renal cysts in Case 2, and even the coughing and wheezing of asthma patients caused by internal water-fluid disorder—all can actually be treated according to the same strategy of promoting urination and reducing swelling.
This treatment, of course, does not necessarily eradicate the root cause: the Case 1 patient still needs other herbs to fight the tumor, and the Case 2 patient still needs other herbs to strengthen the spleen and benefit the kidneys. But the basic strategy can be the same. As long as the body's disordered water-fluid is restored to normal with the help of medicine, most of the patient's self-reported clinical symptoms will disappear.
What remains can, on the one hand, be addressed by the body's own self-recovery capacity, and on the other hand, be treated more targetedly with other, supplementary medicines. Even if the patient cannot be cured, the quality of life can already be markedly improved, and survival time undoubtedly prolonged.