Appreciating a Medical Case: Professor Liu Yaxian Treating Hemoptysis in Lung Cancer
The patient was a 56-year-old man surnamed Li, who first visited Professor Liu Yaxian on November 24, 1995.
Chief complaint and history: He had undergone radiotherapy for lung cancer. Even before radiotherapy he had intermittent hemoptysis; after radiotherapy the cough became frequent, with difficult expectoration accompanied by hemoptysis and chest pain, dry throat, fatigue, and poor appetite. Western medication had not been clearly effective, so he came to Professor Liu. At the visit the patient coughed frequently with difficult expectoration, hemoptysis from time to time, chest pain and fatigue, a dry mouth and poor appetite, lassitude and shortness of breath, a dull complexion, and occasional low afternoon fever; the pulse was fine, the tongue was pale red with a thin white coating.
Professor Liu Yaxian differentiated the pattern as phlegm-stasis obstruction with qi counterflow injuring the collaterals, and planned treatment with the method of resolving phlegm and moving blood, downbearing counterflow and calming the collaterals. The first-visit prescription: Qiancao (Rubiae Radix) 10 g, Zicao (Arnebiae Radix) 10 g, Taoren (Persicae Semen) 10 g, Sheng Yiyiren (raw Coicis Semen) 15 g, Zhimu (Anemarrhenae Rhizoma) 10 g, Zhebeimu (Fritillariae Thunbergii Bulbus) 10 g, Jiangxiang (Dalbergiae Odoriferae Lignum) 10 g, Lugen (Phragmitis Rhizoma) 10 g, Ziwan (Asteris Radix) 10 g, Shanyao (Dioscoreae Rhizoma) 15 g, Digupi (Lycii Cortex) 10 g. Decoct in water, one dose daily, taken in two divided doses morning and evening.
On November 26 the patient reported that after taking 2 doses, the frequency of hemoptysis had decreased. Following the ancient maxim that "when effective, do not change the formula," Professor Liu told him to take 5 more doses. By December 3, after taking the above formula for 5 days, there had been no hemoptysis for 2 consecutive days, and radiotherapy was continuing. But symptoms of low afternoon fever, shortness of breath, and fatigue remained, so he was told to add Tianhuafen (Trichosanthis Radix) 15 g and Pugongying (Taraxaci Herba) 10 g to the first-visit prescription and continue for another 2 weeks. After taking the medicine, all symptoms improved and hemoptysis did not recur. Follow-up through the end of January 1996 found the general condition improved with no relapse of symptoms.
The patient in this case was treated by integrated Chinese and Western medicine. He already had hemoptysis before radiotherapy, which did not relieve his symptoms, and Western internal treatment was also ineffective, so integrated Chinese-Western treatment was needed. Professor Liu Yaxian's prescription was concise and effective; it relieved the patient's clinical symptoms and allowed radiotherapy to continue, fully bringing out the respective strengths of Chinese and Western medicine and raising the probability of successful treatment, which is of positive significance.
The patient in this case had dry throat, fatigue, chest pain, poor appetite, low fever, frequent cough, and inability to expectorate normally; this cluster of symptoms was caused both by the cancer and by the side effects of radiotherapy, and is a common problem in the course of treating lung cancer. In this formula, Professor Liu used Qiancao and Zicao to stop bleeding, Taoren to invigorate blood, Jiangxiang to regulate qi, Yiyiren to fight cancer and seep dampness, Zhimu, Digupi, and Lugen to clear lung heat, Zhebeimu to dissipate phlegm and nodules while also combating cancer, Ziwan to stop cough, and Shanyao to support the righteous and secure the root; later he added Tianhuafen and Pugongying to strengthen the heat-clearing force. Overall, the compositional approach was orthodox and steady, yet the efficacy was good, showing that the herbs were used with exact appropriateness.
In integrated Chinese-Western treatment of cancer, getting the measure of medication right is the key. Radiotherapy, chemotherapy, and surgery all have severe side effects. When TCM enters the treatment of such patients, one must carefully assess the medication risks. One should avoid taking too many anti-cancer Chinese herbs with toxic side effects at the same time, lest the side effects be superimposed and the body be unable to bear them. One should also avoid excessive or indiscriminate tonification, because indiscriminate tonification can easily promote tumor progression. Professor Liu's treatment followed these principles: the formula was simple and the herbs mild, effective, economical, and safe—something worth learning from.