Appreciation of Professor Li Jiren's Case of Gastric Cancer Patient Zhang
The patient, Zhang, male, 45 years old, first consulted Professor Li Jiren on August 20, 1995. The patient stated that in January 1995, for acute abdominal pain, he had undergone exploratory laparotomy at a hospital in Nanjing, which showed a 2 cm x 1.5 cm acute perforation on the lesser curvature of the stomach; pathological section showed gastric adenocarcinoma. After the exploratory procedure, ascites rapidly developed, and chemotherapy was given, but was ineffective. He then sought out Professor Li and switched to conservative TCM treatment.
At the first visit, the patient's abdomen was distended and bloated, his body emaciated, his complexion sallow, he was fatigued and lacking in strength, light-headed, and low in spirit. His stools were dry and bound, his urine scanty, the tongue body pale with a thick greasy coating, and the pulse fine and moderate. He weighed only 49 kg, with an abdominal circumference of 68 cm; shifting dullness and fluid thrill were present in the abdomen. There were bean-sized enlarged lymph nodes above both clavicles and a walnut-sized enlarged lymph node in the left axilla, poorly mobile and non-tender.
Professor Li differentiated the pattern as mutual binding of water and dampness, with righteous deficiency and excess of pathogen, disease located in the middle burner. He therefore decided on a strategy of fortifying the spleen and draining dampness, resolving toxicity and dissipating nodules. The first prescription was: Baihuasheshecao (Hedyotidis Herba), Huangmaoercao (Oldenlandia? Hedyotis? specifically Oldenlandia chrysotricha), Xishugu (Camptothecae Fructus), Yiyiren (Coicis Semen), and Dangshen (Codonopsis Radix), each 30g; Banzhilian (Scutellariae Barbatae Herba) 60g; Chao Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried), Fuling (Poria), and Jixueteng (Spatholobi Caulis), each 20g; Zexie (Alismatis Rhizoma) and Zhiqiao (Aurantii Fructus), each 12g; Zhi Fuzi (Aconiti Radix Praeparata) 10g; Baqia (Smilacis Chinae Rhizoma) 30g.
Several herbs in this formula—Huangmaoercao, Xishugu, and Baqia—are not common medicinal materials; most hospitals and pharmacies do not stock them, so they must be Professor Li's commonly used herbs, and his hospital must purchase them.
Huangmaoercao is a perennial herb of the Rubiaceae family, genus Hedyotis (Oldenlandia); because the whole plant is covered with yellow-green slender soft hairs, it is called "yellow-haired ear-grass." The whole plant may be used as medicine. TCM holds that itis acrid and bitter in taste and neutral in nature, with the actions of clearing heat and disinhibiting urine, and pacifying the liver; it may be used for summer-heat dysentery, damp-heat jaundice, acute nephritis in children, and tumors presenting damp-heat symptoms. Its function is roughly similar to that of Yinchen (Artemisiae Scopariae Herba).
Xishugu (Camptotheca fruit) is a Chinese medicinal with anti-cancer action. The camptothecin contained in Xishugu is one of the commonly used chemotherapy drugs. Xishugu has the effect of inhibiting tumor growth and promoting tumor-cell apoptosis in gastric cancer, intestinal cancer, lymphosarcoma, choriocarcinoma, and many other tumors. TCM holds that Xishugu breaks blood and dispels stasis, resolves phlegm and dissipates nodules, and may be used for various tumor diseases. Baqia dispels wind-dampness, disinhibits urination, and disperses swelling and toxin; the author previously wrote a dedicated article introducing this herb, see "Baqia's Anti-Cancer and Treatment of Diabetes and Skin Diseases". In addition, Banzhilian and Baihuasheshecao are also commonly used TCM herbs for clearing heat, resolving toxicity, anti-cancer, and dispersing swelling.
Thus, Professor Li's prescription was primarily disease-differentiation-based treatment, supplemented by pattern-differentiation treatment, addressing both root and manifestation. Dangshen, Baizhu, and Fuling are all spleen-fortifying, qi-boosting herbs; Fuzi supports yang. Adding an appropriate amount of Fuzi among a large group of heat-clearing, toxicity-resolving herbs avoids excessive cold and coolness that would damage stomach qi. Zhiqiao regulates qi and removes fullness; Zexie drains water and disperses swelling; these are used to relieve the abdominal distension and fullness caused by the patient's ascites.
The patient persisted in treatment along this approach, with the prescription essentially unchanged. After more than four years of treatment, symptoms gradually lessened, strength increased, ascites disappeared, abdominal circumference fell from 68 cm to 62 cm, abdominal ultrasound showed no further ascites, the cervical and axillary lymph nodes disappeared, and body weight rose from 49 kg to 54 kg. He continued taking Chinese medicine under observation; up to the day Professor Li published the case, he had survived for 7 years and 4 months.
What is most commendable in this case is that both doctor and patient adhered to the principle "when effective, do not change the formula," and held to it for years. In clinical practice, what we see most often is patients always asking doctors to keep adjusting the formula; most doctors, lacking their own conviction, readily comply and keep changing the prescription, which in the end does not yield good results. Cancer is a chronic disease; when treatment is effective, one should long hold to the unchanged formula and not lightly adjust it, adding feet to a snake and spoiling the result.