Appreciating a Medical Case: Professor Liu Yaxian's Modified Qianjin Weijing Decoction for Postoperative Metastasis of Lung Cancer

Professor Liu Yaxian is a renowned TCM physician in Hebei Province. He formerly served as director of the TCM Department of the Fourth Hospital of Hebei Medical University and as a doctoral supervisor, and concurrently as a committee member of the Internal Medicine Society and the Oncology Society of the China Association of Chinese Medicine. In clinical practice he has treated many tumor patients.

On December 10, 1992, a 66-year-old retired patient surnamed Qin, who had undergone surgery for squamous cell lung cancer with postoperative metastasis, was referred. Radiotherapy had been ineffective and had even caused liver-function impairment with jaundice; a follow-up examination after treatment showed obvious enlargement of the mediastinal lymph nodes, considered to be postoperative metastasis of lung cancer. He then turned to Professor Liu for TCM treatment.

At the visit the patient coughed frequently, expectorated yellow sticky sputum, had a dry mouth and thirst, chest oppression and shortness of breath, and fatigue and weakness; the pulse was slippery, and the tongue was red with a white coating. Ultrasound showed pericardial effusion, and the patient had a prior history of diabetes.

After pattern differentiation, Professor Liu considered the patient to have insufficiency of qi and yin, with phlegm obstructing the qi dynamic, injuring the lung and disturbing the heart. He planned to treat with a modified Qianjin Weijing Tang (composed of Lugen, Yiyiren, Taoren, and Dongguaren).

The prescription was as follows: Lugen (Phragmitis Rhizoma) 10 g, Taoren (Persicae Semen) 10 g, Yiyiren (Coicis Semen) 15 g, Zhebeimu (Fritillariae Thunbergii Bulbus) 10 g, Pipaye (Eriobotryae Folium) 10 g, Baibu (Stemonae Radix) 10 g, Ziwan (Asteris Radix) 12 g, Jiegeng (Platycodi Radix) 10 g, Chenpi (Citri Reticulatae Pericarpium) 10 g, Xingren (Armeniacae Semen) 10 g, Sheng Gancao (raw Glycyrrhizae Radix) 10 g. One decoction per day, decocted in water and taken in two divided doses.

After taking 4 doses, the patient's cough lessened; the other symptoms were basically unchanged. On returning to see Professor Liu, he considered that the initial prescription had already shown preliminary effect and should not be changed, so he told the patient to continue the original formula for a period.

The patient continued taking the medicine until January 7, 1993, when he returned again. He reported that after taking the medicine, the cough and the expectoration of thick yellow sputum had clearly lessened, but he still had a dry mouth, fatigue, chest oppression, and shortness of breath. The pulse was the same as before, and the tongue had improved to a pale red with a white coating.

Professor Liu then added Sheng Shanyao (raw Dioscoreae Rhizoma) 15 g and Jineijin (Galli Gigerii Endothelium Corneum) 10 g to the initial prescription. After the adjustment, the patient took the medicine until February 4, 1993; the cough and sputum had basically improved, appetite increased, and chest pain did not recur, though he still had a dry mouth, shortness of breath, chest oppression, and fatigue. He returned once more. Professor Liu added Tianhuafen (Trichosanthis Radix) 10 g and Sheng Huangqi (raw Astragali Radix) 10 g to the third-visit prescription, and over the following half month gradually increased Tianhuafen to 20 g and Sheng Huangqi to 20 g.

The patient then continued treatment along these lines, and the various symptoms gradually disappeared; a follow-up ultrasound showed that the pericardial effusion had also resolved. At the follow-up visit on September 2, 1993, a chest X-ray showed that the mediastinal lymph nodes were no longer enlarged. The patient continued taking medicine until early December 1994; follow-up through December 1997 found everything as usual and his health good. By then, five years had passed since his first visit.

Qianjin Weijing Tang originates from Sun Simiao's Qianjin Yi Fang in the Tang dynasty. It is an important TCM formula for treating lung abscess (fei yong), with the effects of clearing zang-fu heat, clearing the lung and resolving phlegm, and expelling stasis and discharging pus. It principally treats the pattern of lung abscess with accumulation of heat-toxin and binding of phlegm and stasis, manifesting as mild fever, cough with profuse sputum, even coughing up foul-smelling pus and blood, dull pain in the chest, a red tongue with yellow greasy coating, and a slippery rapid pulse. Modern clinical practice often uses Weijing Tang for lung abscess, lobar pneumonia, and bronchitis presenting as binding of lung heat with phlegm and stasis. The modification principles are: if pus has not yet formed, Jinyinhua (Lonicerae Flos) and Yuxingcao (Houttuyniae Herba) should be added to strengthen heat-clearing and detoxifying; if pus has already formed, Jiegeng, Sheng Gancao, and Beimu can be added to enhance phlegm-resolving and pus-discharging.

The patient's symptoms at the first visit were exactly the typical indications for Weijing Tang. Professor Liu used Weijing Tang as the core of the formula, replacing Dongguaren with Xingren; after this modification, the cough-suppressing, wheezing-calming, and anti-tumor effects were more pronounced. Adding Jiegeng, Sheng Gancao, and Zhebeimu followed the modification rules of Weijing Tang, while adding Pipaye, Baibu, Ziwan, and Chenpi made the phlegm-resolving and cough-stopping effects more marked. Later additions of Sheng Huangqi, Shanyao, Jineijin, and Tianhuafen were also adjustments targeting the dry mouth and fatigue caused by the patient's diabetes.

In this case, the compositional rationale is clear and rigorous; the herbs used are essential rather than superfluous, and every herb is used with a precise target, following the principle of "when this pattern is present, use this medicine." Such prescribing is truly the work of a master.