A Case Study of Professor Liu Jiaxiang Treating Lung Cancer with Brain Metastasis with Modified Buyang Huanwu Tang
Professor Liu Jiaxiang of Shanghai Longhua Hospital is a famous TCM expert in fighting cancer. He once treated a patient with lung cancer and brain metastasis, using Modified Buyang Huanwu Tang created by the famous Qing-d physician Wang Qingren, and obtained good results.
The patient, Shu, was a 73-year-old male. Since October 1981 he had frequently experienced convulsions of the left limbs accompanied by brief loss of consciousness, urinary incontinence, and deviation of the mouth and eye. In February 1982, a CT scan at a certain hospital showed a large low-density area in the temporal region, compressing and shifting the ventricular system to the left; after contrast enhancement, a high-density shadow was seen in the parietal region, containing a cystic cavity. Conclusion: space-occupying lesion in the right parietal region, possibly a malignant tumor (metastasis?).
The patient first visited Professor Liu Jiaxiang at Longhua Hospital on February 18, 1982. At the visit he limped on the left leg, his left hand sometimes convulsed and had limited elevation, the pulse was fine and weak, the tongue coating was thin, slippery and greasy, the tongue was pale red, and the tongue body was enlarged. Professor Liu judged the patient's pattern to be middle-qi deficiency, mutual accumulation of phlegm and stasis, disturbance of clear yang, and obstruction of the collaterals. Treatment was planned to boost qi and resolve stasis, and to soften hardness and reduce swelling.
The initial prescription was as follows: Sheng Huangqi (raw Astragalus) 30 g, Danggui (Angelica sinensis) 9 g, Chishao (Paeonia rubra) 12 g, Baishao (Paeonia alba) 12 g, Gualoupi (Trichosanthes peel) 15 g, Wangbuliuxing (Vaccaria) 15 g, Xiakucao (Prunella) 15 g, Haizao (Sargassum) 15 g, Sheng Muli (raw oyster shell) 30 g, Sheng Nanxing (raw Arisaema) 30 g, Sheliugu (Amorphophallus) 30 g (decoct first), Fengfang (wasp nest) 12 g, Baizhi (Angelica dahurica) 12 g, Buguzhi (Psoralea) 12 g, Bilibiguo (Ficus pumila fruit) 15 g. 9 doses; additionally the hospital's preparation No. 7011 liquid to be taken orally.
After taking the above herbs, all the patient's symptoms eased, but nocturia became frequent, so Professor Liu added Tusizi (Cuscuta) 30 g to the original formula to improve the frequent urination. At the second visit, a chest X-ray was taken and a relatively large, deep-density, clearly-bordered but not smooth shadow was found near the left hilum. Western-medicine diagnosis: left lung cancer with intracranial metastasis.
After taking the above herbs for a little over a year, the patient's convulsions markedly decreased, he could walk more than a thousand meters on his own, and his appetite improved. On December 16, 1982, an EEG at a certain hospital showed marked asymmetry between the two hemispheres, the right slower than the left, with abundant delta waves, most marked in the right central-posterior temporal region. When he came for a visit on December 3, 1983, he reported walking like a normal person and being able to raise his left hand over his head. The pulse was fine, the coating thin, and the tongue pale red with teeth marks.
Modified Buyang Huanwu Tang was then prescribed.
Prescription: Sheng Huangqi (raw Astragalus) 60 g, Danggui (Angelica sinensis) 9 g, Baishao (Paeonia alba) 12 g, Wangbuliuxing (Vaccaria) 15 g, Chuanxiong (Ligusticum) 9 g, Dilong (earthworm) 30 g, Fengfang (wasp nest) 12 g, Qiyeyizhihua (Paris polyphylla) 15 g, Guijianyu (Euonymus) 15 g, Tusizi (Cuscuta) 30 g, Suoyang (Cynomorium) 15 g, Bilibiguo (Ficus pumila fruit) 30 g, Paoshanjia (processed pangolin scale) 12 g, Bailili (Tribulus terrestris) 15 g, Baizhi (Angelica dahurica) 12 g.
On October 9, 1984, the family reported on the patient's behalf: after taking the medicine, the patient's complexion was ruddy, his strength had clearly improved, and he could now practice tai chi for 25 minutes. Follow-up of 3 years and 10 months showed the patient still in good condition.
Professor Liu Jiaxiang designed the formula according to Wang Qingren's approach in the Qing-dynasty book Yilin Gaicuo (Correction of Errors Among Medical Writings) for treating pianku (i.e., what modern medicine calls hemiplegia). Wang Qingren was a great master of TCM treatment of "blood syndromes," best at using qi-boosting and blood-activating stasis-resolving methods; his "Buyang Huanwu Tang" is a famous TCM formula for hemiplegia.
But generally speaking, Buyang Huanwu Tang is used to treat sequelae of stroke, and it has a marked effect on ischemic cerebral infarction. It is just that the clinical symptoms caused by stroke sequelae and by brain tumors are very similar—both typically present with paralysis and disuse of one side of the limbs—so according to the TCM principle of "treating different diseases with the same method," Buyang Huanwu Tang can also be used to relieve the patient's clinical symptoms.
The original Buyang Huanwu Tang consists of: Huangqi (Astragalus) 4 liang (120 g), Dangguiwei (Angelica tail) 2 qian (6 g), Chishao (Paeonia rubra) 2 qian (6 g), Dilong (earthworm) 2 qian (6 g), Chuanxiong (Ligusticum) 2 qian (6 g), Honghua (Carthamus) 2 qian (6 g), Taoren (Peach kernel) 2 qian (6 g).
Wang Qingren used a very large amount of Huangqi. Professor Liu Jiaxiang drew on Wang Qingren but was not bound by Wang's original formula, making some adjustments to both the herbal composition and the dosages. Taking Buyang Huanwu Tang as the base, he removed Honghua and Taoren and added some Chinese medicines with the actions of softening hardness, dispersing nodules, fighting cancer, reducing swelling, and using toxin to attack toxin—so as to fight cancer and reduce swelling. This can be said to combine pattern differentiation with disease differentiation in formula design. Such an approach both draws on the wisdom of traditional TCM and borrows from the results of modern Chinese-medicine pharmacology research, and is worth learning from.