After a Month and a Half of Treatment with a Large Compound Formula, the Patient Emerged from a Vegetative State

On June 20, I wrote an article titled "On Severe Stroke Sequelae, the Advantage of the Large Multi-Target Compound Formula in Chinese Medicine Is Once Again Demonstrated." In that article, I introduced my recent approach to treating a certain stroke patient who, after successful emergency rescue from a cerebrovascular accident, was basically in a vegetative state. But after treatment based on the large-compound, multi-target approach, the patient awoke.

Because time was limited, that article was written hastily, and the reasoning behind the prescription was not explained in detail; not only could ordinary readers not understand it, even some PhD students of TCM could not. I now write specifically to continue introducing the patient's subsequent treatment outcomes while explaining my prescription-thinking in detail, for the reference of my colleagues.

This patient was an elderly woman who suffered a sudden cerebral hemorrhage one year earlier; the hemorrhage volume was as high as over 100 ml. Because Beijing's medical facilities are excellent, such a severe cerebral hemorrhage could still be rescued. However, after being rescued, the patient was basically close to a vegetative state. Since awakening she has been unable to speak, her consciousness has been unclear, her upper-limb muscle tone has been excessively high, her lower limbs cannot move, and she is completely paralyzed in bed, requiring around-the-clock care from family and a caregiver.

The patient's family sought care at major hospitals in the capital and also underwent rehabilitation at specialized rehabilitation institutions, with basically near-total lack of effect. Brain MRI showed that the patient's cerebral edema had never subsided.

On May 16, 2026, at the request of the patient's daughter, I saw this patient for the first time. I looked at the prescriptions written by the TCM physicians she had consulted previously; they were basically simple modifications of formulas used in TCM for stroke sequelae, such as Taohong Siwu Tang (Peach-Blossom Four-Material Decoction), Buyang Huanwu Tang (Yang-Supplementing Five-Returning Decoction), and Tianma Gouteng Yin (Gastrodia-Uncaria Decoction), using no more than a dozen or so herbs.

Such an approach is, of course, within standard practice, but unfortunately it was completely ineffective; taking the medicine was a waste. In speaking with the patient's family, I said that treating this kind of refractory, severe condition with a simple approach held little hope; I could only attempt to try a comprehensive, large prescription for the patient, possibly using as many as nearly a hundred herbs.

Over the past year I have been studying Western medicine at school and have acquired some understanding of the pathology of stroke sequelae. From a Western-medicine perspective, after a stroke the patient's brain undergoes liquefactive necrosis, with complex pathological changes including brain tissue injury, inflammation, edema, and tiny thrombi within the cerebral vessels. TCM's pathological description of the patient's state is comparatively vague; it generally holds that there exist various problems such as blood stasis, phlegm turbidity, and toxic heat.

For a disease with such a complex mechanism, treatment following routine approaches will not work. In theory, we should design a very comprehensive treatment plan for the patient, one that encompasses eliminating hydrocephalus, anti-inflammation and antibacterial action, unblocking the vessels, improving cerebral circulation, and repairing cranial nerves; the TCM treatment principles should combine clearing heat and detoxifying, promoting diuresis and dispersing swelling, resolving phlegm and dissipating nodules, activating blood and resolving stasis, and opening the orifices and arousing the spirit. Therefore, treating such a patient with a simple formula approach is unlikely to be effective; this is the fundamental reason the patient could not recover.

The prescription I initially drafted was as follows: Sheng Huangqi (raw Astragali Radix) 120 g, Dangguiwei (Angelicae Sinensis Radix tail) 30 g, Chishao (Paeoniae Rubra Radix) 30 g, Dilong (Pheretima) 30 g, Chuanxiong (Chuanxiong Rhizoma) 15 g, Tianma (Gastrodiae Rhizoma) 30 g, Yuanzhi (Polygalae Radix) 15 g, Shichangpu (Acori Tatarinowii Rhizoma) 15 g, Hanfangji (Stephaniae Tetrandrae Radix) 60 g, Chao Baizhu (stir-fried Atractylodis Macrocephalae Rhizoma) 30 g, Fuling (Poria) 30 g, Zhuling (Polyporus) 30 g, Yiyiren (Coicis Semen) 30 g, Zexie (Alismatis Rhizoma) 15 g, Yimucao (Leonuri Herba) 30 g, Nuzhenzi (Ligustri Lucidi Fructus) 30 g, Mohanlian (Ecliptae Herba) 30 g, Baizhi (Angelicae Dahuricae Radix) 30 g, Fangfeng (Saposhnikoviae Radix) 30 g, Jingjie (Schizonepetae Herba) 30 g, Manjingzi (Viticis Fructus) 60 g, Bajitian (Morindae Officinalis Radix) 30 g, Wushaoshe (Zaocys) 10 g, Wugong (Scolopendra) 20 pieces, Quanxie (Scorpio) 15 pieces, Weilingxian (Clematidis Radix et Rhizoma) 30 g, Ruxiang (Olibanum) 15 g, Moyao (Myrrha) 15 g, Danshen (Salviae Miltiorrhizae Radix et Rhizoma) 30 g, Honghua (Carthami Flos) 10 g, Taoren (Persicae Semen) 15 g, Cheqianzi (Plantaginis Semen) 15 g, Yujin (Curcumae Radix) 30 g, Qianghuo (Notopterygii Rhizoma et Radix) 15 g, Duhuo (Angelicae Pubescentis Radix) 15 g, Shengma (Cimicifugae Rhizoma) 15 g, Niuxi (Achyranthis Bidentatae Radix) 30 g, Gouteng (Uncariae Ramulus cum Uncis) 30 g, Shidi (Kaki Calyx) 15 g, Chenpi (Citri Reticulatae Pericarpium) 15 g, Zhuru (Bambusae Caulis in Taeniam) 15 g, Fabanxia (processed Pinelliae Rhizoma) 30 g, Xianhecao (Agrimoniae Herba) 50 g, Huanglian (Coptidis Rhizoma) 10 g, Huangqin (Scutellariae Radix) 15 g, Zhizi (Gardeniae Fructus) 15 g, Huangbo (Phellodendri Cortex) 10 g, Dandouchi (Sojae Semen Praeparatum) 15 g, Tianzhuhuang (Bambusae Concretio Silicea) 15 g, Dannanxing (Arisaema cum Bile) 15 g, Baishao (Paeoniae Alba Radix) 30 g, Zhigancao (honey-fried Glycyrrhizae Radix et Rhizoma) 30 g, Shenjincao (Lycopodii Herba) 30 g, Baijili (Tribuli Fructus) 30 g, Pianjianghuang (Wenyujin Rhizoma Concisum) 15 g, Chanyi (Cicadae Periostracum) 15 g, Baijiangcan (Bombyx Batryticatus) 15 g, Cangzhu (Atractylodis Rhizoma) 30 g, Shudihuang (Rehmanniae Radix Praeparata) 90 g, Shanzhuyu (Corni Fructus) 30 g, Rougui (Cinnamomi Cortex) 30 g, Yinyanghuo (Epimedii Folium) 30 g, Duzhong (Eucommiae Cortex) 30 g, Xuduan (Dipsaci Radix) 30 g, Lujiaoshuang (Cervi Cornus Degelatinatum) 90 g, Shengdihuang (Rehmanniae Radix) 30 g, Mudanpi (Moutan Cortex) 15 g, Hangjuhua (Chrysanthemi Flos) 15 g, Gouqizi (Lycii Fructus) 30 g, Shayuanzi (Astragali Complanati Semen) 30 g, Tusizi (Cuscutae Semen) 30 g, Gegen (Puerariae Lobatae Radix) 60 g, Guizhi (Cinnamomi Ramulus) 30 g, Xiebai (Allii Macrostemonis Bulbus) 30 g, Tianhuafen (Trichosanthis Radix) 30 g, Huangjing (Polygonati Rhizoma) 30 g, Dangshen (Codonopsis Radix) 60 g.

The above herbs were decocted twice and concentrated; then Xiyangshen (Panacis Quinquefolii Radix) 15 g ground into powder, Sanqi (Notoginseng Radix et Rhizoma) 15 g ground into powder, Ejiao (Asini Corii Colla) 30 g ground into powder, Zhenzhufen (Margarita) powder 10 g, Hupofen (Succinum) powder 5 g, and Lujiaojiao (Cervi Cornus Colla) 30 g ground into powder were added, together yielding 1000 ml of thick extract, sealed and stored in the refrigerator. Take 20 ml each time, 3–4 times daily, by dissolving the extract in water decocted with 3 slices of Shengjiang (fresh ginger) and 1 Dazao (jujube), or by swallowing the extract directly.

This formula combines Buyang Huanwu Tang, Tianma Gouteng Yin, Huangqi Fangji Tang, Erchen Tang, Taohong Siwu Tang, the "Four Kidney-Nourishing Herbs," Qiju Dihuang Tang, Huanglian Jiedu Tang, Shanzhi Dandouchi Tang, Guizhi Xiebai Tang, Shengjiang San, Zhijing San, Haifu San, and Shanzhi Dandouchi Tang, etc., together exerting the actions of supporting the healthy root and fortifying the foundation, activating blood and resolving stasis, promoting diuresis and dispersing swelling, and opening the orifices and arousing the spirit. This formula looks as though it contains many herbs, but in fact the amount of any single herb taken at each dose is mostly less than 1 g, and there are no highly toxic herbs, so its safety is very high.

From a modern-medicine perspective, Huanglian Jiedu Tang in this formula (composed of Huanglian, Huangbo, Zhizi, Huangqin, etc.) has broad-spectrum anti-inflammatory and antibacterial action; Huangqi Fangji Tang (composed of Huangqi, Hanfangji, Baizhu, Fuling, etc.), modified with Cheqianzi, Niuxi, Yiyiren, etc., has a diuretic effect—the purpose of these herbs is to drain hydrocephalus; Buyang Huanwu Tang (composed of Huangqi, Danggui, Chishao, Dilong, Honghua, Taoren, etc.) is the classic famous formula of Wang Qingren of the Qing dynasty for treating stroke sequelae; Tianma Gouteng Yin (composed of Tianma, Gouteng, Shijueming, Zhizi, Huangqin, Sangjisheng, Yimucao, etc.) is a classic TCM formula for hypertension and vascular headache and dizziness; Haifu San (composed of Ruxiang and Moyao), modified with Yujin, activates blood and resolves stasis; Zhijing San (composed of Wugong and Quanxie) relieves spasm and alleviates excessive muscle tone; Guizhi Xiebai Tang (composed of Guizhi, Xiebai, Tianhuafen, etc.) improves the circulatory function of the cardiovascular system; Shengjiang San (composed of Jianghuang, Chanyi, Jiangcan, Dahuang) upbears the clear and downbears the turbid, and disperses and vents constrained heat; Erchen Tang (composed of Chenpi, Fabanxia, Fuling, Gancao, etc.), modified with Dannanxing, Baijili, Zhuru, Shidi, etc., resolves phlegm and regulates qi; Shanzhi Dandouchi Tang treats vexation and oppression in the chest; Qiju Dihuang Tang (composed with Dihuang, Shanzhuyu, Fuling, Mudanpi, etc.); the "Four Kidney-Nourishing Herbs" (composed of Nuzhenzi, Mohanlian, Shayuanzi, Tusizi, etc.), modified with Xiyangshen, Dangshen, Huangjing, Yinyanghuo, Duzhong, Xuduan, Ejiao, Gouqizi, Lujiaojiao, Lujiaoshuang, etc., supports the healthy root and fortifies the foundation. Manjingzi, Fangfeng, Jingjie, Qianghuo, Duhuo, Gegen, etc., were added to dispel wind and invigorate blood; Shenjincao, Weilingxian, Guizhi, etc., to relax the sinews and unblock the collaterals; and Shichangpu, Yuanzhi, etc., were added to intensify the action of opening the orifices and arousing the spirit.

My prescription-thinking, though complex, is not chaotic; it can be said to have comprehensively addressed every aspect of the patient's problems. Having studied both Chinese and Western medicine, I have seen that textbooks on both sides advocate that one must not look at disease problems one-sidedly, but must comprehensively and systematically resolve the patient's various problems. Unfortunately, in reality, physicians who truly put this theoretical viewpoint into practice are rare; the prescription-thinking of the great majority of doctors is relatively simple. This is no problem when handling simple disease problems, but it lacks efficacy when handling refractory diseases whose causes and pathology are intricately complex.

In the end, we all simply brush it off with the phrase "this is a medical problem," rather than exerting our utmost to find a solution for the patient—which is most regrettable. In modern medicine's terms, nervous system injury, myocardial injury, and osteoarticular cartilage tissue injury are the three major irreversible injuries. This patient's cerebral hemorrhage volume was extraordinarily large, and after successful rescue, the brain tissue injury was basically impossible to reverse. In reality, the drugs Western medicine could offer this patient were very limited, and those that should have been used had all been used by the previous doctors—and the fact was that they were ineffective.

My approach of using such large compound formulas to treat disease has always been criticized, but with all due respect, treating refractory diseases with simple approaches basically amounts to wasting the patient family's money and toiling the patient and the patient's family. The injury that refractory diseases inflict on the human body is multifaceted, and treatment ought to proceed with a complex approach, giving comprehensive therapy.

So how should a physician wield such a large formula? I believe that first of all, one must build a solid foundation of basic skills; these include the physiology and pathology of both Chinese and Western medicine, knowledge of formula studies, and knowledge of pharmacology. On this basis, one must also have breakthrough thinking, not be confined to the routine approach to treating disease, and must not use simplistic thinking to diagnose and treat complex patients.

Under treatment with this approach, the patient showed clear efficacy in the very first week: the movement ability of her upper and lower limbs increased and her dexterity improved; from the third to fourth week, signs of recovering consciousness began to appear; from the fifth to sixth week, the patient could speak. By June 26, the patient was already able to use a syringe herself to push the Chinese-medicine liquid into her own mouth. This patient had formerly been a Western doctor; after she awoke, she began trying to care for herself.

Why do I take such pains to explain this treatment approach? It is in the hope that readers, especially my colleagues in the medical community, will understand, through this actual case, the large-compound, multi-target therapeutic doctrine that I have consistently advocated. When treating refractory diseases such as cancer and stroke sequelae, it is precisely this therapeutic doctrine that I adhere to. This doctrine is consistent with the systems-theory thinking that Qian Xuesen mentioned, and is also very similar to the "cocktail therapy" that Professor David Ho uses to treat AIDS.

The human body is extremely complex, and the problems involved in refractory diseases are usually multifaceted. If we always dare not attempt a systematic, comprehensive approach to such diseases, and remain confined to seeking treatments that address a single factor, we may never be able to conquer them.