A Case Record: TCM Treatment of Intracranial Chordoma Patient Qiu over Approximately One Year

Patient Qiu, male, born in 1957, from Cangzhou, Hebei, suffered from intracranial chordoma. Referred by relatives and friends, he came to me for his first visit on July 15, 2018.

Before visiting me, the patient had already undergone surgery and radiotherapy, with poor results. He had undergone transnasal endoscopic tumor resection in March 2018, but much residual tumor remained, compressing the brainstem and complicated by cerebral edema. In May he underwent gamma knife treatment, also with poor effect. At present the patient was drowsy, with cerebral edema, hypertension, and fatigue; his family pushed him in a wheelchair to the visit.

Left pulse deep and faint (left-hand arterial sclerosis), right pulse wiry and slippery; tongue coating yellow and greasy; stool sticky and difficult to pass; whole-body weakness; frequent hiccups; urinary urgency with hesitancy; mind clear; no sweating or fever.

First-visit Prescription 1: Sanren Tang (Three-Nut Decoction) combined with Fangji Fuling Tang (Stephania and Poria Decoction), modified to dissipate hydrocephalus.

Xingren (apricot kernel) 10, Fabanxia (processed Pinellia) 10g, Huashi (talc) 10g (wrapped), Yiyiren (Coix) 30g, Tongcao (rice paper pith) 6g, Baikouren (white cardamom) 10g, Zhuye (lophatherum) 6g, Houpo (Magnolia bark) 10g, Chao Maiya (fried barley sprout) 30g, Chao Guya (fried rice sprout) 30g, Dadouhuang (soybean Yellow) 15g, Hanfangji (Stephania tetrandra) 20g, Chao Baizhu (fried Atractylodes) 20g, Fuling (Poria) 20g, Zhuling (Polyporus) 20g, Zexie (Alisma) 10g, Cheqianzi (Plantago seed) 15g, Cheqiancao (Plantago) 15g, Xuanfuhua (Inula) 6g (wrapped), Daizheshi (Hematite) 6g (wrapped), Shidi (persimmon calyx) 10g, Peilan (Eupatorium) 10g, Huainiuxi (Achyranthes) 10g.

5 doses, one dose per day, decocted twice, taken in three divided doses.

First-visit Prescription 2:

Danggui (Angelica) 12g, Fangfeng (Saposhnikovia) 15g, Baizhi (Angelica dahurica) 12g, Jingjie (Schizonepeta) 10g, Manjingzi (Vitex) 10g, Chuanxiong (Ligusticum) 10g, Binglang (areca) 10g, Hupo (amber) 6g, Xixin (Asarum) 3g, Danshen (Salvia) 20g, Dannanxing (bile Arisaema) 10g, Rougui (cinnamon) 10g, Shengma (Cimicifuga) 10g, Qianghuo (Notopterygium) 10g, Tianma (Gastrodia) 10g, Gouteng (Uncaria) 30g (added later), Ruxiang (Olibanum) 8g, Moyao (Myrrh) 8g, Gancao (licorice) 8g, Hanfangji (Stephania) 20g, Chao Baizhu (fried Atractylodes) 20g, Fuling (Poria) 20g, Zhuling (Polyporus) 10g, Zexie (Alisma) 10g, Cheqianzi (Plantago seed) 15g, Cheqiancao (Plantago) 15g, Huainixi (Achyranthes) 10g, Chao Maiya 30g, Chao Guya 30g, Shengjiang (ginger) 3 slices, Dazao (jujube) 5 pieces, Huajiao (Sichuan pepper) 10g, Shidi (persimmon calyx) 10g, Peilan (Eupatorium) 10g, Changpu (Acorus) 6g.

Each time dispense 5 doses, one dose per day, decocted twice, taken in three divided doses.

Patent medicines: Zhenfeng Sanjie Wan (Wind-Settling and Mass-Resolving Pill), three times daily, 10 pills each time; Huajie Wan (Mass-Resolving Pill), three times daily, 10 pills each time; Fufang Banmao Jiaonang (Compound Cantharis Capsule), twice daily, 1-3 capsules each time; Neixiao Sanjie Wan (Interior-Dissolving and Mass-Resolving Pill), twice daily, 8 pills each time.

Second visit, September 16, 2018

After taking the first-visit medicines, effect was minimal; basically no improvement.

Left pulse deep and faint, right pulse wiry and thin. Aversion to cold; frequent urination; occasional clouding of consciousness. Stool sticky and difficult to pass; without medicine, he could not defecate. Tongue coating yellow, greasy, and watery-slippery. At night much mucus in the mouth, sometimes dripping out. The head is clearest in the early morning; other times not so good.

TCM pattern differentiation: spleen-kidney yang deficiency, water-dampness internal accumulation.

Decoction:

Fuzi (Aconite) 10g, Baizhu (Atractylodes) 6g, Fuling (Poria) 10g, Zhuling (Polyporus) 10g, Baishao (white Paeonia) 10g, Chao Maiya 30g, Chao Guya 30g, Shengjiang (ginger) 7 slices.

One dose per day, morning and evening.

Patent medicines: Zhenfeng Sanjie Wan, three times daily, 10 pills each time; Huajie Wan, three times daily, 10 pills each time; Fufang Banmao Jiaonang, twice daily, 1-3 capsules each time; Neixiao Sanjie Wan, twice daily, 8 pills each time; Xihuang Wan (Beijing Tongrentang), once daily, 6 g at bedtime; Xiaojin Wan (Beijing Tongrentang), once daily, 3 g on an empty stomach in the morning; Jinkui Shenqi Wan (Beijing Tongrentang), twice daily, 20-30 pills each time.

After taking the above, the first few days showed some improvement, then no further improvement.

After four months of continuous treatment, improvement was minimal. I had become discouraged and asked the patient's family to seek a better doctor. The patient and his family refused to change doctors; the patient's son repeatedly begged me to think of another way. The patient himself also said that although there was no great improvement, he felt his mind was clearer than before after taking my medicines.

So I then combined Huoliu Wan (Tumor-Dissolving Pill), Neixiao Sanjie Wan, and Zhenfeng Sanjie Wan together, using over sixty herbs in total. On one side, draining water and reducing swelling; on the other, softening hardness and resolving masses; on one side, activating blood and resolving stasis to reduce swelling; on the other, supporting righteous qi and firming the root. By the time treatment was approaching half a year, the patient could finally stand up from the wheelchair and walk. At first he could walk 500 meters; afterward, every month showed noticeable improvement over the last. Up to now he can normally go out for a stroll, walking two to three kilometers each time.

The patient's request was simple: to improve his quality of life, and especially to be able to stand and walk again. By now walking was no longer a problem, so there was no need to change the treatment plan; treatment continues. Because in the later stage the decoction was removed and everything was changed to pills, the patient's medication was less unpleasant and easier to adhere to.

Chordoma originates from notochord tissue residual from the embryo. During embryogenesis, the upper end of the notochord is distributed in the sphenoid and occipital bones at the skull base, partially reaching the intracranial surface and connecting with the dura mater above the sella turcica; in the occipital portion it can reach the undersurface of that bone (the pharyngoglossal surface), and a part may also lie between the skull base bone and the pharyngeal wall. The lower end of the notochord is distributed in the central and paracentral regions of the sacrococcygeal area. Thus chordomas favor these sites, especially the spheno-occipital region of the skull base and the sacrococcygeal region, with spinal chordomas next in frequency.

Qiu was the first chordoma patient I treated; previously I had no experience treating such diseases. TCM treatment of tumors does not care about the Western disease name; TCM simply selects formulas and herbs based on the location of the lesion and the clinical symptoms the patient presents.

The base formula for treating this patient was a family-transmitted formula from my master for treating traumatic brain injury. On the basis of my master's ancestral formula, considering the characteristics of tumor disease, I integrated the experience of the Japanese doctor Kazudo Yasusuji (Yakazu Dōmyō) in treating brain tumors and the family-transmitted experience of the veteran TCM doctor Duan Fengwu in treating brain tumors. Using my multi-target anti-cancer approach and following the TCM channel-entering theory, I selected herbs effective against brain diseases and built the formula, treating slowly until it finally took effect.

Had the patient and his family not trusted me so much, this treatment would not have worked. Most of the patients I treat clinically switch doctors after one month of no effect. If there is no effect in two months, I suggest the patient seek another doctor; if four months bring no effect, I politely decline further visits. But this family, when my treatment had little effect, still trusted me and persisted—something very rare.

Chordoma is also a slowly growing tumor, so although this patient's disease was severe, it did not kill him quickly, giving the doctor time to trial and error. If it were a very rapidly growing tumor, there would have been no such opportunity.

To achieve efficacy in treating disease is truly not easy. Between doctor and patient there must be firm mutual trust, and the disease must have objective conditions allowing treatment. If the disease is already so severe that treatment is impossible, then no matter how firm the trust between doctor and patient, efficacy is hard to come by.

Incidentally, the regimen that worked in this patient was later used in two glioma patients and was also effective in both. A recent case I am treating is also a brain tumor (glioma) compressing the brainstem, which had already left the patient unable to move his hands and feet. The family could only grind my self-formulated Zhenfeng Sanjie Wan and Huoliu Wan into powder, mix with water, and feed through a gastric tube. A few days after taking it, the patient's limbs could move again, and he could eat.

This shows that TCM treatment of brain tumors is not, as some doctors claim, a matter of drugs being unable to cross the blood-brain barrier and reach effective concentrations. As long as the right herbs are used, TCM can treat brain tumors.