The Tumor- and Cancer-Treating Thought of Li Zhongzi, a Ming-Dynasty TCM Physician

Li Zhongzi (style name Shicai, hao Nian'e), a TCM physician of the Ming dynasty, showed unusual talent from youth and was exceptionally bright. Born into a scholarly family—his father was a jinshi of the Wanli era, 17th year—Li Zhongzi received a good education from childhood. In his teens he read widely. As a young man he sat for the civil service examinations, but after bitterly experiencing the deaths of both parents at the hands of quack doctors and his own early ill health, he turned to the study of medicine. Throughout his life he attached great importance to TCM theory, drawing on the strengths of many schools. His exposition of medical principles was able to go deep yet remain simple and accessible. Most of his books were easy to understand and became the shortest path for beginners to enter the inner chambers; at the time they could be called the most complete set of TCM teaching materials. They were therefore widely read in the Wu medical circle, making him a great physician and grand master of the Jiangnan region between the Ming and Qing, and he made a major contribution to the popularization of TCM. After middle age, Li Zhongzi devoted himself to studying the works of famous medical masters, grasped their essence, repeatedly researched the medicinal properties of Chinese herbs, and applied them in clinical practice. In practice he created his own medical theory and became a famous physician of his generation.

Li Zhongzi's Accumulation and Gathering: Essential Clinical Reading (Jiju Linzheng Bidu) set an important standard for later TCM treatment of tumors. The idea he advocated—treating tumors in three stages—remains a golden principle that clinical doctors of both Chinese and Western oncology must follow today. Some of the tumor-treatment formulas recorded and created by Li Zhongzi have high clinical value. Below is Li Zhongzi's Accumulation and Gathering: Essential Clinical Reading; because it is so excellent, I quote it at length, then offer my commentary.

The formation of an accumulation is due to insufficiency of healthy qi, after which evil qi occupies it—like petty men at court, because the gentleman's influence has waned. Healthy qi and evil qi are irreconcilable; they stand as high and low, one prevailing and the other declining. If evil qi daily prospers while healthy qi daily wanes, and one does not attack and remove it, death will soon follow. But if one attacks too urgently, healthy qi is instead injured. The three methods—initial, middle, and final—must be carefully considered. In the initial stage, the evil has just arisen, healthy qi is still strong, and the evil is still shallow; then the patient can endure attack. In the middle stage, the illness has gradually lasted longer, the evil is deeper, and healthy qi is weaker; then the patient can endure both attack and supplementation. In the final stage, the evil has long lingered, the evil qi invades and overbears, and healthy qi is consumed and depleted; then the patient can only endure supplementation. For accumulation, by nature, is the product of long days and months, not of a single morning or evening; therefore removing it must also be gradual. If too urgent, healthy qi is injured; when healthy qi is injured, it cannot transport and transform, and the evil becomes instead entrenched.

Zhiyuan's commentary: The above passage is almost the general outline of treating cancer in both Chinese and Western medicine today. Li Zhongzi already fully recognized that cancer arises not in a day, and that it is mostly caused by the body's long-standing weakness and low immunity. This understanding has not been surpassed by contemporary Chinese or Western medicine. Moreover, Li Zhongzi advocated staging cancer treatment; this idea is also highly consistent with today's Chinese and Western approach to cancer. For early-stage cancer patients, one may take a more forceful treatment plan; for mid-stage patients, one can only use attack combined with supplementation; for late-stage patients, heavy supplementation should outweigh attack, to prolong life as much as possible and improve quality of life.

But there is a point worth raising: TCM's division of cancer into early, middle, and late stages is actually not entirely the same as Western medicine's. Western medicine determines early/middle/late by the distance of tumor spread; TCM determines early/middle/late by the patient's overall physical condition. For example, a late-stage patient with T4N5M2, who already has lymph-node (N) and distant (M) metastasis, would be classified in Western medicine as a late-stage cancer patient. But in TCM, if this patient eats normally and is in decent physical condition, he would be classified as an early-to-mid-stage patient.

In fact, in the clinic there are many patients whom Western medicine regards as late-stage but whom TCM regards as early-to-mid-stage, because many cancer patients diagnosed with distant metastasis have quite good stamina. In such cases, TCM still has ways to treat them with attack combined with supplementation.

Tumor patients whom TCM cannot cure mostly belong to what we today call end-stage cancer patients; by then the patient already has cachexia and a very poor constitution, and treatment becomes truly difficult. This is why we often encounter or hear of certain late-stage cancer patients who, after some TCM treatment, miraculously lived a long time or recovered. For TCM, although a patient is late-stage, as long as the patient's stamina and appetite are still good, there is great treatment value.

I personally tend to encourage some patients diagnosed by Western medicine as late-stage to give up Western surgery and chemoradiotherapy and first try TCM for a while. Because, from my own observation, many late-stage patients deteriorate rapidly after surgery and chemoradiotherapy and die quickly. For early-to-mid-stage patients, do not take this risk; surgery still has a higher success rate.

Let us look at the next passage of Li Zhongzi's Accumulation and Gathering: Essential Clinical Reading.

I have often prepared formulas for yin and yang accumulations; the herbs are somewhat harsh, but used with measure. I supplement and tonify for several days, then attack; regardless of how much of the accumulation is removed, I again supplement and tonify, and when the patient's spirit is robust, I attack again. Repeatedly attacking and repeatedly supplementing, until balance is achieved. This is the secret I alone have obtained, hitting the mark a hundred times out of a hundred. The Classic (here referring to the Huangdi Neijing, the same below) says: Of great accumulations and gatherings, one may attack them, but only until they are half reduced. Therefore, once the accumulation is half removed, give only sweet-warm nourishment, so that the spleen-earth transports vigorously; then the broken remnants of the accumulation will depart without being attacked. If one insists on attacking until none remains, rarely will one not leave the person to an early death. The Classic says: In the robust, qi moves and the illness resolves; in the timid, it lodges and becomes disease. Jiegu said: Robust people have no accumulations; the deficient have them. Therefore one should nourish the upright, and the evil will of itself be removed. It is like a hall full of gentlemen: one or two petty men naturally have no place to stand. That said, this is spoken of the light and shallow. As for great accumulations and gatherings, if one does not search them out and drive them away, taking tonic soup every day is of no use. Once one clearly knows which channel is afflicted and what substance forms the accumulation, and the diagnosis is certain, send in the direct-entry troops to punish it; what fear is there that it will not be cured? The Art of War says: The one who is good at attacking makes the enemy not know what to defend. Such is also a good general in medicine!

Zhiyuan's note: This passage can be called the essential secret of TCM cancer treatment! Here Li Zhongzi presents his own unique secret for treating cancer. He first supplements the patient for a period, then attacks for a period; after attacking for a period, he again supplements for a period; finally he uses sweet-warm herbs to fortify the spleen, raise immunity, and let the patient's body slowly recover. Writing this, I should give a special warning: some patients think that, when they find a TCM doctor, one prescription can be taken continuously and, just by taking it, the cancer will be cured. This idea is absurd. TCM cancer treatment requires the physician to be extremely dedicated, to be with the patient over the long term, and to constantly adjust the strategy—attacking or supplementing—according to the patient's specific condition. Only in this way can relatively ideal results be obtained. This is the so-called nanny-style treatment.

I once emulated this method on a liver-cancer patient. The patient was diagnosed at the Cancer Hospital of the Chinese Academy of Medical Sciences as late-stage liver cancer; the doctors thought he would not live past that year's Spring Festival. He sought help everywhere, and later came to me. By the time he came, he already had ascites and a dark, murky complexion; the prognosis was indeed poor. Luckily, he was then living long-term in Beijing at his son's home and could come to see me once a week. The approach I took was Li Zhongzi's: attack one week, supplement one week, attack one week, supplement one week. Treating week by week, the patient's ascites cleared after more than twenty days, and the relevant cancer markers returned to normal after a month-plus. But the liver tumor was still slowly developing. He got through that year's Spring Festival safely, and the next year's Spring Festival safely too.

After the next Spring Festival, once the patient learned his true condition, he had a nervous breakdown (a wordy aside: hiding the condition from the patient is actually not helpful for treatment; it often causes the patient to collapse mentally when he inadvertently learns the truth mid-treatment). Eager to find a better treatment plan for his tumor problem, he switched to a famous integrated Chinese-Western medicine professor in Beijing, whose herbs were extremely harsh. After taking them for half a month, the patient had ascites, nausea, vomiting, and obstruction of urination and defecation. After breaking off with me for a while, feeling embarrassed to come back, he switched again to a famous TCM professor in Beijing. That professor used Shizao Tang (Ten-Jujube Decoction) to treat his ascites, which made things even worse. The illness reached a point beyond control, and only then did he seek treatment from me. When I saw the patient again, his hands and feet were already swollen. The whole family deeply regretted changing doctors. After that I was powerless; I adjusted several formulas without effect, and on June 1 of that year the patient died at the 302 Hospital.

For such late-stage cancer patients, if one lacks patience and attacks vigorously, the patient's body cannot bear it, and as Li Zhongzi put it, one "leaves the person to an early death." By the way, there is actually a very important principle in treating cancer: when a treatment is effective, do not change doctors. If one doctor's treatment is working well, do not lightly switch; the risk is too great.

The second point Li Zhongzi raises here is precisely the one I want to emphasize: cancer cannot be cured by peaceful formulas that merely raise immunity and support the patient's healthy qi. As Li Zhongzi said, "For great accumulations and gatherings, if one does not search them out and drive them away, taking tonic soup every day is of no use." In treating cancer, one must seize the opportunity to suppress the tumor; do not wait for it to grow. Although the tumor may not kill the patient immediately, one day it will. When treating cancer, we should, while ensuring safe medication, boldly use some harsh herbs to attack the cancer.

There is now a foul wind in TCM circles that loves to peddle the nonsense that raising the patient's immunity can cure his cancer. There is a logic that easily demolishes this heresy: before the patient had cancer, his immunity was so strong—why did it not stop the cancer from arising? After getting cancer, no matter how much you supplement, the balance of power between immunity and the cancer is weaker than before the illness. Without attack, how can cancer possibly be cured?

Li Zhongzi's cancer approach is factual and extremely practical. His cancer thought is not at all outdated today; on the contrary, he was far more serious and rigorous than today's risk-averse, peace-loving doctors. That is why Li Zhongzi's cancer results were so good and are well worth our study. I will write more articles in the future to further dig into Li Zhongzi's experience. For now, this article stops here.