My Medical Thoughts 2

What Is the "Large-Formula Multi-Target Specialty Therapy"? (Part 1)

Before introducing this self-created "Large-Formula Multi-Target Specialty Therapy," I would like to recount two past events.

The first event goes back to my sophomore year in high school, when I solved a combinatorics problem. The problem was as follows: There are five balls labeled 1, 2, 3, 4, and 5, and five boxes labeled 1, 2, 3, 4, and 5. The requirement is that no ball can be placed into the box with the matching number (e.g., ball 1 cannot go into box 1). The question is: how many ways are there to place the balls?

This problem looked simple but was quite tricky to solve. Perhaps many children today could solve it quickly, but back when I was in high school, even the math teachers found it challenging.

I tried multiple approaches and eventually solved it using a composite method that combined enumeration, formula-based calculation, and the exclusion principle. My reasoning was: first calculate the total number of ways to place all five balls into the five boxes, then subtract all arrangements that violated the condition. Since directly computing for five balls was too cumbersome, I started with two balls and three balls, identified and summarized the patterns, and then generalized from there.

Not only did I solve the original problem, but I also derived some formulas of my own to solve similar problems. For instance, using these formulas, one could easily solve the same problem with 100 balls and 100 boxes. However, after so many years, I can no longer recall the exact formulas I derived back then.

When my math teacher finished reading my solution process and the formulas I had summarized, he was both surprised and delighted. He sent my work to a mathematics journal in the hope of getting it published. The editor replied that my solution was essentially a rediscovery of the inclusion–exclusion principle, which was not a new mathematical finding, and thus not worth publishing. Although publication was not warranted, it was still quite remarkable for a 16-year-old country boy to independently derive the inclusion–exclusion principle—a concept from advanced mathematics.

In solving this problem, I used a method of thinking that I call "exhausting all possibilities." By considering every possible scenario and employing a combination of exclusion, enumeration, induction–deduction, and formula-based approaches, I could not only solve a single problem but also tackle an entire class of problems.

My math teacher greatly appreciated my work at the time. Now that I am 47, I gradually understand why he valued it so much. If I were a teacher and my student could not only solve complex problems but also independently derive rules and formulas, drawing inferences to solve a broader range of difficult problems, I too would hold that student in high regard. Such self-directed learning ability and innovative thinking are truly rare and valuable.

The second event concerns my mother's illness and our journey seeking medical help for her. In the last few years of her life, she suffered from two diseases—cancer and post-stroke sequelae—which made her final years extremely difficult.

At that time, I was a full-time businessman with a decent income, and I was willing to spare no expense to find the best doctors to cure my mother. Unfortunately, despite our family's efforts in visiting numerous hospitals and consulting many physicians, we could not resolve her problems.

Driven by this experience, I devoted myself to studying medicine, covering traditional Chinese medicine, psychiatry, and Western medicine comprehensively. The reason I now primarily focus on cancer and post-stroke sequelae is simply because these were the diseases that troubled my mother during her lifetime.

In retrospect, we did exhaust all possibilities in seeking treatment for my mother. However, during the actual course of her treatment, each doctor's approach remained fairly limited. This is understandable, as physicians' thinking is constrained by their own medical training and knowledge, staying within the boundaries of what they know.

I often wonder: if any of the doctors my mother had seen had adopted this "exhausting all possibilities" mindset and used a comprehensive rather than single-dimensional treatment strategy, might the outcome have been different?

Regrettably, there are not many doctors who are capable, willing, and daring enough to make such attempts. This requires not only courage and a broad knowledge base but also strong reasoning skills and a spirit of innovation.

In the final days of my mother's life, when she had been abandoned by hospitals and doctors, I did try such an approach. However, my knowledge and experience were insufficient at that time, and my mother was already in the terminal stage, so I did not achieve significant results—only managed to improve her quality of life somewhat.

Since then, I have been making steady progress in this direction, step by step. Over more than a decade of exploration, this line of thinking has matured. In clinical practice, it has resolved many complex medical problems that other physicians could not address. I have named it "Traditional Chinese Medicine Large-Formula Multi-Target Specialty Therapy," because this name adequately captures its main characteristics.

The core idea of this therapy is: when facing diseases with highly complex etiologies and pathologies—such as cancer, post-stroke sequelae, and Alzheimer's disease—we abandon simplistic approaches and instead choose a comprehensive strategy that exhausts all possibilities. We construct a large, targeted prescription that can address the various pathophysiological responses involved in such diseases.

Logically speaking, the above reasoning is sound. However, managing such a large prescription is extremely challenging. How does one formulate it? How does one ensure its safety and efficacy? There are no existing textbooks to guide us, and very few peers in the medical field have explored this path.

Most doctors would not even dare to think in this direction; they stick strictly to clinical guidelines. Yet a minority are willing to be the first to try. One such pioneer is Dr. David Ho, the Chinese-American physician who developed the AIDS "cocktail therapy."

Dr. Ho used a combination regimen rather than a single drug to tackle HIV/AIDS. His cocktail therapy dramatically reduced mortality rates among AIDS patients, earning him recognition as Timemagazine's Person of the Year and election to the U.S. National Academy of Sciences.

The large-formula multi-target therapy I advocate is essentially consistent with Dr. Ho's cocktail therapy in principle. Both represent a multi-pronged, unconventional approach to medication. However, on the surface, my method may appear more radical, as I often use up to a hundred herbs, whereas Dr. Ho's cocktail therapy uses far fewer drugs.

Within the field of Chinese medicine, there is also a senior figure who advocated a similar treatment philosophy—National Master of Traditional Chinese Medicine Qiu Peiran. He proposed a distinctive therapy for complex and critical illnesses, which he named the "Large-Formula Complex Treatment Method," also using large prescriptions for difficult diseases. Professor Qiu pointed out that in response to complex and variable pathogeneses, one may combine in a single formula herbs of cold and hot nature, qi and blood actions, and attacking and tonifying effects, integrating multiple methods and addressing multiple organ systems simultaneously—concentrating all efforts in one prescription.

Unfortunately, although Professor Qiu applied this method in practice and achieved good results, he wrote very little on this topic. He did not develop a systematic theory or specific operational guidelines, making it difficult for later generations to study and advance his work.

In my practice, I have occasionally encountered other physicians who use similar approaches. However, they often lack the ability to summarize and write systematically, and their personal influence is too limited to publish relevant articles on the subject. Even though they achieved some therapeutic effects, their methods were so unconventional that they were often dismissed by others, leaving many regrets.

For example, I once encountered a lung cancer patient who had been treated by a traditional Chinese medicine practitioner in Chengdu. Over more than three years, his condition remained stable with no progression—the tumor did not shrink, but neither did it grow, and the patient enjoyed a good quality of life. However, the prescription contained over 200 herbs, which was so astonishing that onlookers criticized it, shaking the confidence of the patient's family.

Moreover, a classmate of the patient's son worked at a top-tier tertiary hospital in Beijing. This doctor had an impressive résumé—graduated from a top domestic medical school and had studied in a top U.S. medical institution. He did not approve of the Chengdu doctor's prescription and recommended advanced PD-1 immunotherapy instead, suggesting that the patient might even be completely cured under his plan.

The family was persuaded and followed the advice of this familiar doctor. Unfortunately, less than three months after treatment, the patient's condition deteriorated rapidly, with a severe immune storm and persistent high fever that did not subside. Shortly before his death, the family asked me to help reduce his fever, but I could do little at that point, and he passed away soon after.

When I visited this patient, the entire family was filled with regret and recounted the whole story to me. Whenever I think back to this case, I cannot help but wonder: if this kind of large-formula multi-target therapy—akin to cocktail therapy—had been widely recognized, promoted, and popularized, might such tragedies have been avoided?

I hold a deeper aspiration. I hope to use modern medical methods and tools to advance this large-formula multi-target therapy toward greater scientific rigor and effectiveness.

We can certainly use animal experiments to screen for optimal drug combinations and then apply them in human clinical practice. This would not only ensure safety and efficacy but also accelerate the technological iteration and refinement of this therapeutic approach.

Therefore, for the rest of my life, I will not only continue to pursue this research direction but also do my utmost to promote laboratory studies on this therapeutic method.

What Is the "Large-Formula Multi-Target Specialty Therapy"? (Part 2)

Here I would like to offer my own definition of the large-formula multi-target therapy I advocate: It is a comprehensive treatment strategy for refractory diseases with complex etiologies and pathologies. Based on a thorough consideration of the known etiological and pathophysiological features of the disease, it designs a targeted therapeutic approach that addresses all relevant aspects. Because this approach strives for comprehensiveness, it requires a large number of medicinal ingredients and hence a large prescription. It relies on the synergistic action of various drugs to achieve more desirable clinical outcomes.

In my personal experience, although prescriptions formulated under this approach are large, the actual dosage of each individual ingredient is very small. When I treat diseases with large prescriptions, I do not use decoctions (soups) but rather adopt the forms of pills, powders, ointments, and pellets. This not only conserves medicinal materials and keeps safety doses well-controlled, ensuring side effects remain within a manageable range, but also significantly reduces the financial burden on patients. In fact, the cost of large-formula pills, powders, ointments, and pellets is often much lower than that of ordinary small prescriptions.

Theoretically, the large-formula multi-target therapy holds the greatest promise for improving clinical outcomes in refractory diseases and potentially creating therapeutic miracles. Moreover, this treatment philosophy does not reject the combination of Chinese and Western medicines; they can work together synergistically.

Thus, the characteristics of the large-formula multi-target therapy I advocate are: large prescription size, comprehensive formulation thinking, micro-dosing, and reliance on drug synergy to enhance efficacy.

How micro are the doses? For most herbs, the daily dose is less than 1 gram; for toxic herbs, the daily dose is below 0.1 gram; and for highly toxic herbs, the daily dose is below 0.01 gram. I generally keep all drug doses below 1/100 of the median lethal dose (LD50), and for toxic herbs, even below 1/1000 of the LD50.

Two well-known Chinese pharmacology and formula professors—Zhang Tingmo and Wang Mianzhi—have both noted that when Chinese herbs are combined in formulas, their effects are enhanced while the actual required dosages can be drastically reduced.

For instance, the antispasmodic powder consists of scorpion and centipede. A combination of 0.5 g of centipede and 0.5 g of scorpion produces a greater effect than using 10 g of centipede or 10 g of scorpion alone. Meanwhile, due to the body's daily absorptive capacity, the combination of 10 g of centipede and 10 g of scorpion does not produce a stronger effect than the 0.5 g + 0.5 g combination. Using higher doses merely wastes medicinal materials and increases the patient's financial burden.

If synergistic effects in Chinese medicine can reduce dosages so significantly, the advantages of this approach become self-evident. The more herbs we combine in a single prescription, the smaller the required dose of each individual herb. This has major implications for reducing the dosage of toxic herbs, lowering the risks of lethality, disability, and teratogenicity, and enhancing overall safety. Furthermore, the large-formula multi-target therapy can largely avoid the use of toxic herbs altogether, relying on the synergistic action of safe herbs to treat refractory diseases.

In my practice, I have witnessed the real-world efficacy and safety of this approach. My large-formula protocol for post-stroke sequelae has achieved an effective rate of over 80%, and has even shown benefits in some particularly difficult cases, including vegetative patients. Yet the daily dose of each herb for these patients is measured in milligrams.

During the COVID-19 pandemic, I developed the "Chai Gui Jie Du Pill." In clinical use, despite the large number of herbs in the formula, the total single dose was only 3–6 grams. When averaged out, the actual amount of each herb was only in the milligram range. Nevertheless, many patients resolved their symptoms after just one dose. The pill also treated some severe viral pneumonia cases effectively. For some patients, the entire course of treatment cost only a few tens to a couple of hundred yuan (RMB).

Thus, despite its large formula, the large-formula multi-target therapy retains the traditional Chinese medicine virtues of being "inexpensive and convenient." I have always opposed long-term use of decoctions for cancer patients, reserving them only for short-term use in acute complications, and I still hold this view.

In ancient times, traditional Chinese medicine practitioners seldom used decoctions for chronic diseases; they primarily used pills, powders, ointments, and pellets for gradual treatment. Although described as "gradual," this approach often resulted in shorter overall treatment courses than decoctions.

The renowned modern master of warm-disease medicine, Professor Zhao Shaogin, once recounted a saying from his father, Zhao Wenkui, who served as the last Imperial Hospital Director (equivalent to the highest health authority) in the Qing Dynasty.

Zhao Wenkui told his son that treating disease is like finding the key to a lock—the key is to pinpoint the right direction, not to force the lock open with brute strength. If the direction is correct, the lock opens easily. If the direction is wrong, large doses are useless. Accordingly, Zhao Shaogin always used light dosages, yet his clinical efficacy was renowned throughout Beijing.

Therefore, within the large-formula multi-target therapy I advocate lies a crucial "smallness"—small dosage. This therapy relies on comprehensiveness, precision, and rigor in formulation to achieve efficacy, rather than on large doses—using finesse rather than brute force.

In the following sections, I will gradually introduce the principles and techniques for formulating prescriptions in this therapy, and present case studies treated with this approach. My goal is that clinicians with a background in traditional Chinese medicine who are interested in this therapy will, after reading this book, fully grasp its essence and become capable of designing their own prescriptions based on this approach.

This book will be divided into two parts. The first part is the general introduction, covering the relevant theoretical foundations. The second part consists of disease-specific discussions, detailing my large-formula multi-target formulation strategies for each condition I am familiar with. Through this structure, I hope readers will develop the ability to draw inferences and make similar attempts in other diseases, thereby benefiting the patients they serve.

The completion of this book will take considerable time, and I plan to revise it ten years later, incorporating further thoughts gained from new knowledge. I intend to spend my entire life patiently polishing a truly valuable medical text.