Liu Fengwu on TCM Treatment of Gastrointestinal Reactions After Chemotherapy for Gynecological Tumors

As a renowned gynecologist, the elder physician Liu Fengwu also treated patients with gynecological tumors during his lifetime, though mainly by regulating the after-effects of radiotherapy and chemotherapy. He wrote an article summarizing some of his own experience and insights in treating gastrointestinal reactions after chemotherapy. In brief, there are the following two points:

First, treatment should proceed from the holistic concept, pay attention to regulating the function of the spleen and stomach, emphasize prevention, and combine prevention with treatment.

The elder physician Liu Fengwu believed that when different patients receive chemotherapy, or when the same patient receives different chemotherapy regimens, the gastrointestinal reactions are not entirely the same; they vary in severity and in when they appear. In mild cases there are only nausea and loss of appetite, which resolve on their own after chemotherapy ends; in severe cases the nausea and poor appetite are not only present but severe, and do not easily recover even after chemotherapy ends.

Proceeding from the TCM concepts of “treating before disease arises” and “treating disease while it is still mild,” it is best to begin regulating and treating before gastrointestinal reactions occur or at the very onset of symptoms, rather than waiting until the reaction becomes severe before adding Chinese medicine.

Judging from the patients' symptoms, post-chemotherapy gastrointestinal reactions most often present as spleen-stomach weakness with stomach qi counterflowing upward; some are complicated by cold-damp and others by damp-heat, causing obstruction of the middle jiao, derangement of the spleen and stomach, and disorder of their upbearing and downbearing functions. The main treatment principle should therefore be to regulate the upbearing and downbearing function of the spleen and stomach, using herbs such as Huoxiang (Agastachis Herba), Sugeng (Perillae Caulis), Houpo (Magnoliae Officinalis Cortex), Sharen (Amomi Fructus), Chenpi (Citri Reticulatae Pericarpium), Banxia (Pinelliae Rhizoma), Zhuru (Bambusae Caulis in Taeniam), Chao Guya (dry-fried Setariae Fructus Germinatus), Chao Maiya (dry-fried Hordei Fructus Germinatus), and Pipaye (Eriobotryae Folium).

Chemotherapy is usually combined with surgery and radiotherapy. The elder physician Liu believed that treatment history should be taken into account and patients treated holistically according to pattern differentiation. Chemotherapy following surgery alone generally presents as yin deficiency and blood deficiency; if radiotherapy is also combined, there are additionally patterns such as scorching and depletion of fluids, dual injury of qi and yin, and heat accumulating in the stomach and intestines. Besides the routine regulation of qi movement, supplementation of qi, and nourishment of blood, treatment should also clear heat and nourish yin, adding herbs such as Shihu (Dendrobii Caulis), Huangqin (Scutellariae Radix), and Huanglian (Coptidis Rhizoma).

Second, one should value treatment based on pattern differentiation. Each patient's underlying physical condition differs, their constitutions vary, and during treatment their reactions are not entirely the same; one cannot simply apply a universal formula but must judge according to each patient's specific situation and adopt an individualized medication plan.

Although the elder physician Liu's views may sound like commonplaces, they all strike to the heart of the matter. If these principles are followed, the treatment process will be steady and safe, which is beneficial and without drawback for both the patient and the attending physician.