A TCM Case Commentary: Late-Stage Cervical Cancer Treated by Ling Yunpeng

Doctor zhou
Patient Yan, female, 64, from Wenling County, Zhejiang Province.
First visit August 5, 1970. For several years the patient had frequently had vaginal bleeding, heavy in amount and foul in odor. Examination at the hospital's gynecology and obstetrics department confirmed late-stage cervical cancer. For days she had suffered nausea, poor appetite, and inability to rise from bed; palpation of the lower abdomen revealed a hard mass the size of a palm, tender to pressure, with a foul, putrid odor. The pulse was deep, fine, and slow; the tip and edges of the tongue were purplish-brown with a thick, greasy coating; the vaginal discharge was sauce-purple.
Following the principle of pattern differentiation, Venerable Ling Yunpeng considered that damp-heat had accumulated, with turbid, foul qi ascending and causing stomach decline and vomiting. The spleen and stomach are the acquired root: those who retain stomach qi live, those who lose it die. Although the patient suffered the serious disease of cervical cancer, Ling felt that the first priority was to restore her stomach qi. So the first prescription focused on aromatically transforming turbidity, fortifying the spleen and draining dampness, and downbearing counterflow to quiet the stomach.
Prescription: Huoxiang (Patchouli) 9 g, Peilan (Eupatorium) 9 g, Cangzhu (Atractylodes) 6 g, Houpo (Magnolia bark) 4.5 g, Fabanxia (processed Pinellia) 6 g, Jiao Shenqu (charred Massa) 12 g, Chenpi (tangerine peel) 6 g, Muxiang (Aucklandia) 9 g, Shagao Ke (Amomum and Cardamom shells) 3 g, Yiyiren (Coix seed) 12 g, Zhuru (bamboo shavings) 12 g, Fuling (Poria) 12 g. Five doses.
After five doses, the nausea and foul odor resolved, the vaginal bleeding decreased and its color turned pale red; the pulse was fine and slow, the tongue dark red with a white greasy coating. Seeing that the first visit had worked and that the patient had gained confidence, Ling decided to treat the root.
TCM generally regards late-stage cervical cancer as崩漏 (metrorrhagia and metrostaxis). Fu Qingzhu considered that the root of崩漏 lies in chronic spleen deficiency causing the Chong and Conception vessels to fail in securing the blood; he therefore advocated fortifying the spleen as the main treatment for崩漏. Later physicians followed his view. On this theoretical basis, Zhang Xichun created Gushen Tang (Securing the Chong Decoction), composed of stir-fried Atractylodes, raw Astragalus, dragon bone and oyster shell (calcined), Cornus fruit, Hangzhou White Peony, cuttlefish bone, madder, palm bark charcoal, and gallnut, to treat崩漏. Ling Yunpeng therefore modified Zhang Xichun's Gushen Tang.
Second-visit prescription: Sheng Huangqi (raw Astragalus) 18 g, Chao Baizhu (stir-fried Atractylodes) 12 g, Huaishanyao (Chinese yam) 30 g, Chao Baishao (stir-fried White Peony) 12 g, Sheng Muli (raw oyster shell) 24 g, Sheng Longgu (raw dragon bone) 24 g, Shanzhuyu (Cornus fruit) 12 g, Wuzeigu (cuttlefish bone) 12 g, Xuduan (Dipsacus) 12 g, Baiying (Solanum lyratum) 30 g, Qiancao (madder) 6 g. Take one dose every other day.
Note here: Ling prescribed one dose every other day, not daily. I greatly appreciate this method: cancer patients have a long course, and taking decoction daily injures the spleen and stomach, easily producing the opposite of the desired haste. Chronic disease need not be treated urgently; one should follow the principle of slow treatment for chronic disease. By having the patient take a dose every other day, Ling preserved her stomach qi. This prescribing method is well worth emulating.
One month after the second visit, the patient returned: after ten doses, the vaginal bleeding had stopped, she could walk several li, and her appetite had much improved. But because she had recently eaten rather more chicken, which she could not digest, her appetite again worsened and she had no desire to eat, and vaginal bleeding recurred. This time there was no foul odor and the amount was not large.
Note also: many cancer patients and their families are eager to strengthen nutrition and believe food supplements help cancer patients; in fact this is not always so. Improper food supplementation often backfires, and this patient is a typical example. She had achieved good results, but because she ate chicken and drank chicken soup, the condition relapsed. Other patients should take warning.
Seeing the patient once again had spleen-stomach disharmony, Ling adjusted the prescription once more, this time focusing on digesting food and resolving stagnation, and harmonizing the spleen and stomach. Third-visit formula: Huoxiang (Patchouli) 9 g, Houpo (Magnolia bark) 3 g, Jiao Shenqu (charred Massa) 12 g, Fabanxia (processed Pinellia) 6 g, Qingpi (green tangerine peel) 9 g, Chenpi (tangerine peel) 9 g, Jiao Shanzha (charred hawthorn) 12 g, Muxiang (Aucklandia) 9 g, Chao Zhiqiao (stir-fried bitter orange) 6 g, Dafupi (areca pericarp) 12 g, Jineijin (chicken gizzard lining) 9 g, Gualouren (Trichosanthes seed) 9 g, Guya (germinated rice) 12 g. Three doses.
After three doses, the abdominal distention resolved and the bowels moved, but the vaginal bleeding had not stopped. Ling again prescribed the second-visit formula, and instructed the patient henceforth to avoid all "fa wu" (foods traditionally avoided during illness), eat a bland diet, and take one dose every other day. Follow-up until 1978 showed the patient still alive. Later, because she returned to her hometown too far away to maintain contact, follow-up was discontinued.
How should cancer patients be treated? This is a matter on which benevolent and wise people may differ. Ling Yunpeng treated this patient with cautious, gentle herbs; the prescribing approach looks unremarkable, yet the results were remarkably good. Ling followed Fu Qingzhu's doctrine that崩漏 chiefly arises from spleen deficiency and insecurity of the Chong and Conception vessels, and drew on contemporary TCM research by including Baiying, an herb with anticancer and diuretic effects. In treatment he skillfully combined pattern differentiation with disease differentiation, prescribing different formulas according to the patient's symptoms at different stages, with notable results.
A final note: Ling Yunpeng was a late master of TCM external medicine in China; this case is one he treated during his lifetime, and he passed away many years ago. Although I almost always note in my articles that these venerable physicians have died, many readers with poor comprehension still ask me for their contact information, hoping to visit them for treatment, which is both laughable and vexing. Let it be stated clearly: this case is for reference only; please do not ask me for Ling's contact information.

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