Appreciation of a Medical Case by Jiao Shude Treating an Intracranial Space-Occupying Lesion

Professor Jiao Shude treated patients with intracranial space-occupying lesions during his lifetime. Although the intracranial masses in these patients were not biopsied to confirm malignancy, Professor Jiao's treatment strategy can still serve as a reference for brain-tumor patients and for TCM physicians treating brain tumors. One of the two cases is recorded in relative detail; it is reprinted below.

The patient, Li, male, 38, a farmer of Korean ethnicity. On July 23, 1987, he felt dizzy after working and immediately set out for a local hospital, but on the way he suddenly fainted and lost consciousness (without convulsions or incontinence of urine or stool). After about four hours of treatment at the local hospital, he regained consciousness.

From then on, whenever he exerted himself or was in low spirits, he developed right-sided headache, a paroxysmal distending pain, with a bitter taste in the mouth; bowel movements once daily, the stool dry; appetite and sleep fair; no diplopia, nausea, or tinnitus.

The patient had undergone CT and other examinations at the Yanbian Neuropsychiatric Prevention and Treatment Hospital, which diagnosed an intracranial space-occupying lesion, suspected to be a glioma or tuberculoma, and advised surgery. Fearing surgery, the patient refused. Thereafter he was treated with various medications without improvement.

In late August 1987, Professor Jiao Shude was lecturing and supporting the frontier in the Yanbian area and saw the patient. At the initial visit, the tip of the tongue was red, the root coating slightly yellow, and the pulse string-like, especially at the two cun positions. Professor Jiao's pattern differentiation was liver-qi stagnation generating wind, with phlegm and blood stasis congealing. The method was to soothe the liver and disperse stagnation, resolve phlegm and dissipate stasis.

Initial prescription: Tribuli (Baijili) 12 g, Angelica sinensis (Danggui) 12 g, Red Peony (Chishao) 12 g, Safflower (Honghua) 9 g, Earthworm (Dilong) 6 g, Tangerine Pith-exocarp (Huajuhong) 12 g, Pinellia (Banxia) 9 g, White Bombyx (Baijiangcan) 6 g, Poria (Fuling) 18 g, Astragalus (Huangqi) 18 g, Ligusticum chuanxiong (Chuanxiong) 12 g.

On November 11, 1987, the patient traveled specially to Beijing China-Japan Friendship Hospital for a follow-up. He reported that after taking more than 70 doses, the right-sided headache had lessened but still flared on exertion. His complexion was red, the tongue tip red, the root coating yellow and thick, and the pulse string-like. Professor Jiao diagnosed liver yang ascending upward, qi and blood counterflowing, and the channels and network vessels not free. Treatment was to settle the liver and subdue yang, free the channels and downbear counterflow.

Second-visit prescription: Haliotidis calcedonicum (Sheng Shijueming) 30 g (decoct first), Haematitum (Sheng Zheshi) 30 g (decoct first), Tribuli (Baijili) 12 g, Prunellae Spica (Xiakucao) 15 g, Schizonepeta (Sheng Jiesui) 9 g, Viticis Fructus (Manjingzi) 10 g, Red Peony (Chishao) 15 g, Safflower (Honghua) 10 g, Curcuma Ezhu (Ezhu) 3 g, Pinellia (Banxia) 10 g, Tangerine Pith-exocarp (Huajuhong) 12 g, Poria (Fuling) 20 g, White Bombyx (Baijiangcan) 10 g, Ligusticum chuanxiong (Chuanxiong) 5 g. He was told to take 20 doses, then remove Chuanxiong and continue for another 60 doses.

On March 28, 1988, the patient returned to Beijing for another follow-up. He reported that the migraine was basically cured, flaring only occasionally on overexertion or during a cold; his spirits were good and his complexion radiant. Repeat CT showed: the nodular space-occupying lesion in the posterior cortical region of the right temporal lobe had disappeared. The tongue coating was thin and white, and the pulse deep and slightly slippery.

To consolidate the effect and prevent relapse, Professor Jiao added Raw Rehmannia (Shengdi) 18 g, Scutellaria (Huangqin) 10 g, Angelica Dahurica (Baizhi) 9 g, and Ostreae Concha (Sheng Muli) 30 g (decoct first) to the second prescription, and increased Haematitum (Sheng Zheshi) to 35 g (decoct first). He advised taking 15 doses, then one dose every other day for another 15 doses before stopping.

Professor Jiao once treated another patient with an intracranial space-occupying lesion along the same lines. That patient recovered and, on 15-year follow-up, was still alive with no relapse.

Intracranial space-occupying lesions are not necessarily malignant tumors; meningiomas, gliomas, hematomas, abscesses, and cysts are all possibilities. To determine the nature of the lesion, biopsy pathology is the gold standard. Although the nature is uncertain, the clinical symptoms are mostly similar. Symptoms depend on the lesion's location, size, and growth rate; patients usually come to attention because of headache, epilepsy, unilateral or bilateral limb numbness or weakness, diplopia, tinnitus, disturbance of consciousness, syncope, nausea, vomiting, and so on.

Neither of the two patients Professor Jiao treated had a biopsy, so the nature of the lesions cannot be determined. But throughout, Professor Jiao adhered to the strategy of activating blood and resolving stasis, resolving phlegm and dissipating nodules, and counteracting cancer and reducing swelling. His medication combined TCM pattern differentiation with disease-based treatment; each adjustment of the prescription was based on the patient's specific condition.

Professor Jiao's approach can also serve as a reference for patients with other kinds of neurological disease (such as stroke sequelae and traumatic brain injury). But when borrowing the medication strategy from this case, a professional TCM physician should adjust it to the patient's condition. The formula logic here closely resembles the family-transmitted empirical prescription for traumatic brain injury used by my own teacher.

Incidentally, the herb Tribuli (Baijili) in this case is effective against several brain disorders and also has some blood-pressure-lowering effect. Throughout treating this patient, Professor Jiao adjusted his approach several times but never stopped using Baijili. TCM research on disease-specific key herbs is not yet deep enough; that is a weakness. This case is for reference only. Patients with intracranial space-occupying lesions, especially those biopsy-confirmed as gliomas, should still prioritize surgery when it is available.