Medical Case of Liu Fengwu Treating Vulvar Leukoplakia (Precancerous Lesion of Vulvar Cancer)

Vulvar leukoplakia is a chronic disease in which abnormal changes appear in the skin of the female external genitalia. It has a long course and is difficult to cure. Most cases of vulvar leukoplakia are benign lesions, but leukoplakia that lingers and is hard to cure carries a risk of malignant transformation.

The most common form of vulvar leukoplakia is vulvar lichen sclerosus, whose main symptoms are thinning and whitening of the vulvar skin together with itching. Uncomplicated lichen sclerosus is a benign lesion, but if it is not treated properly for a long time, or if, despite treatment, it lingers and recurs, it may progress to vulvar intraepithelial neoplasia. About 3%-5% of long-term uncontrolled cases develop into vulvar cancer, so this disease is regarded as a precancerous lesion of vulvar cancer.

Those with a course exceeding five years and repeated recurrence, complicated by HPV infection (especially types HPV16 or HPV18), with ulcers, indurated nodules, or abnormal growths at the lesion site, and with moderate-to-severe dysplasia confirmed by pathological examination, should be on guard against the risk of cancerous transformation.

TCM has no specific disease name for vulvar leukoplakia, but its clinical symptoms resemble those of the TCM conditions of vulvar leukoplakia (nv yin bai ban), vulvar dryness (yin zao), genital itching (yin yang), and vulvar sores (yin chuang).

There are very few published medical cases treating this disease. Recently, after encountering a patient whose vulvar leukoplakia had progressed to vulvar cancer, I consulted the monographs of renowned contemporary gynecological specialists Liu Fengwu and Ban Xiuwen, as well as the famous dermatological surgeon Zhao Bingnan, among other distinguished senior TCM physicians. Only in the book Experiences of Liu Fengwu in Gynecology by the elder physician Liu Fengwu did I find a single medical case treating vulvar leukoplakia. I now excerpt this case for everyone's reference.

The patient, a woman named Yin, aged 35, first consulted the elder physician Liu Fengwu on September 2, 1972. At the visit she reported an eight-year history of itching and pain in the vulvar region.

At the age of five the patient had suffered severe vulvitis, which improved after treatment. In 1964 she began to experience vulvar itching and pain, which were not relieved by treatments sought from many quarters. She married in 1965 and, up to 1967, remained childless; the vulvar itching and pain persisted, and there was little discharge. Her menstrual cycle was normal, but she had abdominal pain during menstruation, heavy menses with clots. The local vulvar skin gradually turned white; the patient was easily irritable and prone to dizziness, had very little vaginal discharge, and experienced pain during intercourse. Her tongue was red and her pulse deep and fine. Western medicine diagnosed vulvar leukoplakia, but medication had no effect.

The elder physician Liu Fengwu diagnosed the pattern as yin deficiency of the liver and kidneys, which should be treated by nourishing and tonifying the liver and kidneys. Given also her infertility, he decided to treat her with a modified Wuzi Yanzong Wan (Five-Seed Ancestor-Gathering Pill).

First-visit prescription: Fupenzi (Rubi Fructus) 4 qian, Tusizi (Cuscutae Semen) 4 qian, Gouqizi (Lycii Fructus) 3 qian, Cheqianzi (Plantaginis Semen) 3 qian, Wuweizi (Schisandrae Chinensis Fructus) 3 qian, Chaihu (Bupleuri Radix) 1.5 qian, Muxiang (Aucklandiae Radix) 1 qian, Danggui (Angelicae Sinensis Radix) 3 qian, Yimucao (Leonuri Herba) 3 qian, Puhuang (Typhae Pollen) 3 qian, Wulingzhi (Trogopterorum Faeces) 3 qian. (Note: in the elder physician Liu Fengwu's formulas, 1 qian may be converted to 3 grams.)

After taking 12 doses of the first-visit prescription, the patient conceived, but unfortunately miscarried, and treatment was suspended for a time after the miscarriage. At the end of 1973, because the vulvar itching and pain had become unbearable, she again came to the elder physician Liu Fengwu for treatment. He continued his previous approach, adjusting the prescription slightly.

Second-visit prescription: Fupenzi (Rubi Fructus) 4 qian, Tusizi (Cuscutae Semen) 4 qian, Gouqizi (Lycii Fructus) 3 qian, Cheqianzi (Plantaginis Semen) 3 qian, Wuweizi (Schisandrae Chinensis Fructus) 3 qian, Sangjisheng (Taxilli Herba) 5 qian, Chao Shanyao (dry-fried Dioscoreae Rhizoma) 5 qian, Xianlingpi (Epimedii Herba) 4 qian, Xianmao (Curculiginis Rhizoma) 3 qian, Niuxi (Achyranthis Bidentatae Radix) 3 qian. This formula still followed the approach of nourishing yin and supplementing the kidneys, quickening the blood and draining dampness.

After taking 5 doses of the above formula, the patient's vulvar dryness improved, vaginal discharge increased, the vulvar skin began to soften, and the itching and pain were greatly reduced; she therefore continued taking the formula long-term. It was not until February 20, 1974, when she conceived again and developed lower-back and abdominal pain, that she sought out the elder physician Liu to adjust the prescription. Given her history of miscarriage, he adjusted the formula, adding herbs to fortify the spleen and prevent miscarriage.

Third-visit prescription: Huangqi (Astragali Radix) 5 qian, Chao Baizhu (dry-fried Atractylodis Rhizoma) 4 qian, Huai Shanyao (Dioscoreae Rhizoma) 5 qian, Sangjisheng (Taxilli Herba) 3 qian, Duzhong (Eucommiae Cortex) 4 qian, Chuan Xuduan (Dipsaci Radix) 4 qian, Zhi Gancao (Glycyrrhizae Radix preparata) 2 qian, Tusizi (Cuscutae Semen) 2 qian, Chao Suanzaoren (dry-fried Ziziphi Spinosae Semen) 3 qian, Wuweizi (Schisandrae Chinensis Fructus) 3 qian, Huoxiang (Agastachis Herba) 3 qian, Chenpi (Citri Reticulatae Pericarpium) 2 qian, Dangshen (Codonopsis Radix) 3 qian.

By the way, the elder physician Liu was a towering authority in contemporary Chinese TCM gynecology, and was highly skilled in treating the common menstrual, vaginal-discharge, and childbearing disorders of gynecology. His third-visit prescription is an excellent miscarriage-prevention formula, well worth collecting by those interested in TCM obstetrics and gynecology.

The patient took more than 30 doses of this miscarriage-prevention formula, and on November 8, 1974, delivered a baby boy by cesarean section. Follow-up through December 24, 1974, found that her vulvar dryness had improved further compared with before pregnancy, and the vulvar leukoplakia had not progressed.

Medical cases of vulvar leukoplakia are few. The elder physician Liu's case records the whole course of the patient's treatment in full and is of some reference value. However, although this patient's symptoms were controlled and the leukoplakia did not progress, it was not eliminated; therefore this therapeutic approach can offer us some inspiration, but further study is still necessary.