Appreciation of Two Cases of Lymphoma Treated by Professor Liang Yijun
Professor Liang Yijun was born in 1927 into a TCM family in Beijing. She served as director of the TCM Internal Medicine Department at China-Japan Friendship Hospital and was a national-level expert. In 1990 she was named by the two ministries and one bureau as one of the first cohort of nationally renowned veteran TCM physicians, a state-designated mentor for inheriting academic experience, and a recipient of the State Council special allowance. She specialized in treating blood diseases, difficult internal-medicine conditions, and gynecological diseases with Chinese medicine. This article excerpts two of her cases of lymphoma (phlegm-toxin type), from which we may learn her approach.
Case One
Xu, female, 52. First visit May 14, 1988. The patient had had upper abdominal pain for a year. In May 1987, for no clear reason, she developed upper abdominal pain; in June an abdominal mass was found, and abdominal ultrasound showed a space-occupying lesion in the peritoneal cavity. On July 5 she underwent exploratory laparotomy at China-Japan Friendship Hospital; because the tumor was at the root of the small-intestine mesentery it could not be resected. A biopsy confirmed non-Hodgkin's lymphoma, stage 4B. After COAP chemotherapy from the hematology department and local abdominal radiotherapy, the intra-abdominal mass disappeared by December 1987; she received two consolidations. Since early 1988, because of fatigue and weakness, she sought Professor Liang's care.
At the visit her complexion was dull and lusterless; she was short of breath and listless, with numb hands and feet and weak legs when walking. Her mouth tasted bland, she had no appetite, her stool was dry, and urination was normal. The tongue was pale with a white coating; the pulse was deep, slippery, and fine. Professor Liang diagnosed phlegm-toxin nodules, differentiated as long-standing concrete accumulation with damaged upright qi and residual stasis-toxin; the treatment principle was to boost qi and support upright, nourish yin and detoxify, and resolve stasis.
First-visit prescription: Taizishen (Pseudostellariae Radix) 20 g, Maidong (Ophiopogonis Radix) 15 g, Wuweizi (Schisandrae Chinensis Fructus) 10 g, Danggui (Angelicae Sinensis Radix) 15 g, Baishao (Paeoniae Radix Alba) 20 g, Shouwu (Polygoni Multiflori Radix) 30 g, Shihu (Dendrobii Caulis) 15 g, Banzhilian (Scutellariae Barbatae Herba) 30 g, Baihua She She Cao (Hedyotidis Diffusae Herba) 30 g, Longkui (Solanum Nigri Herba) 20 g, Wangbuliuxing (Vaccariae Semen) 20 g, Chishao (Paeoniae Rubra Radix) 10 g.
On her second visit the patient reported that after the above formula her general condition had improved and palpitations, shortness of breath, and numbness of hands and feet had resolved. In July and December 1988 she completed two more rounds of COAP chemotherapy while taking TCM to support upright. From 1989 onward she persisted with TCM treatment, following the principles of fortifying the spleen and boosting qi, tonifying the kidney and engendering blood, and detoxifying and scattering nodulation.
Basic formula: Huangqi (Astragali Radix) 40 g, Danggui 15 g, Baishao 15 g, Dangshen (Codonopsis Radix) 20 g, Nüzhenzi (Ligustri Lucidi Fructus) 25 g, Mohanlian (Ecliptae Herba) 20 g, Xiangfu (Cyperi Rhizoma) 10 g, Qingpi (Citri Reticulatae Pericarpium Viride) 15 g, Tubeimu (Bolbostemmatis Rhizoma) 20 g, Maozhaocao (Ranunculi Ternati Radix) 25 g, Sheng Muli (raw oyster shell) 25 g (decoct first), Shanzha (Crataegi Fructus) 20 g, Zhiqiao (Aurantii Fructus) 10 g, Chenpi (Citri Reticulatae Pericarpium) 15 g, Baihua She She Cao 20 g.
On July 5, 1991, a recheck showed a slightly enlarged spleen; bone marrow aspiration showed "4% prolymphocytes," diagnosed as mild infiltration by non-Hodgkin's lymphoma. She continued TCM to fortify the spleen and kidney (supporting upright) and to detoxify and scatter nodulation (dispelling evil).
Prescription: Dangshen 20 g, Danggui 15 g, Baishao 15 g, Shouwu 30 g, Jixueteng (Spatholobi Caulis) 15 g, Huangqin (Scutellariae Radix) 6 g, Sheng Huangqi (raw astragalus) 15 g, Tusizi (Cuscutae Semen) 20 g, Shudi (Rehmanniae Radix Praeparata) 15 g, Ziheche (Placenta Hominis) 15 g, Niuxi (Achyranthis Bidentatae Radix) 15 g, Kushen (Sophorae Flavescentis Radix) 20 g, Banzhilian 30 g, Baihua She She Cao 60 g, Xiakucao (Prunellae Spica) 20 g.
She also took Xiaojin Dan (Little Gold Pill), 3 pills each time, three times daily.
After several months of treatment, a recheck showed the marrow picture was normal and abdominal CT was normal. By April 1992 her general condition was good with no positive findings on exam. The decoction was stopped and she was switched to alternating Liuwei Dihuang Wan, Xihuang Wan, and Xiaojin Dan to consolidate. At the end of 1993 she stopped the medicines and was rechecked annually; ten years of follow-up showed everything normal.
In this case the patient had stage 4B non-Hodgkin's lymphoma, i.e., late-stage disease, which requires integrated Chinese-Western treatment. Western chemo- and radiotherapy damage upright qi, so TCM was used to support upright and root while also combating cancer; relying on TCM alone would have been too risky, and the China-Japan Friendship Hospital team designed an integrated plan.
Professor Liang began with modified Shengmai San (Generate the Pulse Powder), then switched to a combination of Erzhi Wan (Two-to-Powder) and Xiaoluo Wan (Scatter Scrofula Powder) with modifications, using both upright-supporting and evil-expelling measures and applying both pattern- and disease-based treatment. She used symptomatic TCM formulas while also incorporating anticancer herbs widely used in TCM oncology—Baihua She She Cao, Banzhilian, Tubeimu, Maozhaocao, Xiakucao, Kushen—at relatively high doses. She also used the famous Qing dynasty Wang Hongxu family anticancer formulas Xihuang Wan and Xiaojin Wan.
This composure fully reflects Professor Liang's holistic view of tumor treatment and her emphasis on integrating Chinese and Western medicine. Although the patient improved after chemo- and radiotherapy, she later relapsed with bone metastases; afterward, treated purely with TCM, she did well. This is related to the fact that she had been under Professor Liang's care for a long time, so Liang knew her constitution well and her approach was mature. Mutual trust between doctor and patient, long-term persistence, and careful problem-solving are themselves important guarantees of efficacy.
Case Two
Yin, female, 18. First visit to Professor Liang on November 27, 2004. She had had swollen lymph nodes in the neck, subclavian region, and axillae for three months. Since August 26, 2004, those nodes had swelled and become painful for no clear reason, followed by high fever up to 40°C. On September 5 she was admitted to Peking Union Medical College Hospital; discharge diagnosis was "lymph node enlargement, likely viral infection." No lymph node biopsy was done, the specific treatment is unknown, and after the fever subsided she was not treated further.
But afterward the cervical and other nodes continued to swell and hurt, worsening with fatigue or anger. Her voice was faint. At the visit, enlarged nodes were palpable in all the areas, the largest pigeon-egg-sized, of medium consistency and tender. The tongue was pale red with a white coating; the pulse was fine and slippery. Professor Liang diagnosed phlegm-toxin nodules, differentiated as qi stagnation with phlegm congelation, dual deficiency of qi and yin, and interior binding of toxin-heat; the treatment principle was to move qi and scatter nodulation, detoxify, and boost qi and nourish yin.
First-visit prescription: Danggui 10 g, Baishao 10 g, Chaihu 6 g, Qinghao (Artemisiae Annuae Herba) 15 g, Xuanshen (Scrophulariae Radix) 15 g, Sheng Muli (decoct first) 30 g, Maozhaocao 20 g, Xiangfu 10 g, Taizishen 20 g, Shashen (Glehniae/Adenophorae Radix) 20 g, Baibu (Stemonae Radix) 10 g, Lianqiao (Forsythiae Fructus) 20 g.
On December 4, 2004 (second visit), nodules remained in the neck and subclavian region and were painful; the previous day she had a low fever of 37.3°C and was listless and fatigued. Tongue and pulse were as before; the principle was unchanged with minor additions.
Second-visit prescription: Chaihu 10 g, Huangqin 10 g, Banxia 10 g, Xuanshen 20 g, Sheng Muli (decoct first) 40 g, Shancigu (Cremastrae/Pleiones Pseudobulbus) 10 g, Banzhilian 15 g, Dangshen 20 g, Lianqiao 20 g, Maozhaocao 20 g, Huangqi 20 g.
On December 18, 2004 (third visit), the patient reported that after taking the medicine her strength had improved and appetite increased; the cervical and subclavian nodes were still swollen and painful but the fever had resolved. Tongue and pulse as before; principle as before, adding Xiakucao 10 g, Juhe (Citri Reticulatae Semen) 10 g, Haizao (Sargassum) 15 g, and Kunbu (Eckloniae Thallus) 15 g.
On December 23, 2024 (fourth visit—likely a typo for 2004), the patient reported that swelling and pain in the cervical, submandibular, subclavian, and axillary nodes had lessened and fever was gone, but she remained fatigued and drowsy; the tongue was red with scant coating and the pulse fine and slippery.
On January 8, 2005 (fifth visit), node pain and swelling had lessened and her irritability had improved; tongue and pulse as before, adding Chishao 20 g.
On February 19, 2005 (sixth visit), the cervical and submandibular nodes were no longer palpable, pain had resolved, strength increased, complexion improved, and weight had gained 2 kg. The tongue had a slight coating and the pulse was wiry and slippery. She continued the formula for 14 doses and then stopped; one year of follow-up showed no relapse.
This patient had no biopsy, so the benign or malignant nature of the lymphadenopathy could not be determined. She was young with prominent symptoms; noting the relation between her condition and her emotions, Professor Liang's first-visit combined Chaihu Shugan San (Bupleurum Powder to Spread the Liver) with Xiaoluo Wan—an integration of pattern- and disease-based treatment. At the second visit, with low fever present, she combined Xiao Chaihu Tang (Minor Bupleurum Decoction) with Xiaoluo Wan, still following the same integrated principle.
After the patient's symptoms improved, Professor Liang, holding that an effective formula should not be changed, kept the base formula and adjusted the herbs according to specific symptoms, resolving the patient's problems one by one. Throughout, the medication was light, correct, and moderate—ensuring safety while achieving good results. It fully displays an old master's steadiness in prescribing and unhurried approach to disease, which is well worth our learning.