Medical Case: A Patient (Xiao Mi) with Uterine Leiomyosarcoma
Xiao Mi, female, 45 years old, a resident of Meihekou City, Jilin Province, a patient with leiomyosarcoma; first visit on November 22, 2015.
The patient had already undergone multiple surgeries for leiomyosarcoma and had received three years of Western surgical treatment, but her condition could not be controlled. Now, due to recurrence and multiple metastases, she was referred by a fellow patient to consult the author in Beijing.
On November 16, 2015, B-ultrasound showed a 90x75 mm mass in the right upper abdomen and a 37x27 mm mass in the left upper abdomen, with clear boundaries, internal hypoechoicity, and CDFI showing blood flow signals within the tumors. Three masses were seen in the pelvis, the largest measuring 20x14 mm, with clear boundaries, internal hypoechoicity, and CDFI-detectable blood flow. The MRI report of October 27, 2015 showed multiple metastatic carcinomas in the posterior segment of the right hepatic lobe, the bilateral mid-to-lower abdomen, and both lungs (the lesions were enlarged compared with the MRI of September 24, 2015), and a cyst in the lower pole of the right kidney. A cystic-solid lesion posterior to the right side of the bladder in the pelvis was considered recurrent uterine leiomyosarcoma, showing no significant change compared with the MRI of September 24, 2015. Abnormal signals at the right margin of the L5 vertebra and the S2 vertebra were considered bone metastases.
Initial impression: The patient was in fair general condition; activity was not restricted, and she could live and function normally. Both left and right pulses were deep, thin, and forceless; the tongue was pale with a thin coating. She used to have cold hands and feet and stiff ear cartilages, and the skin over the tumor was cooler than elsewhere on the body surface; the tumor was palpable and hard in consistency. The patient recalled that the earliest symptom had been stomach pain, followed thereafter by intestinal discomfort, loose stools, stiff limbs, aching of the lower back, disorder of the small joints, and bones that were especially prone to dislocation. It gradually progressed to abdominal pain, and examination revealed uterine leiomyosarcoma, for which she underwent resection.
On comprehensive pattern differentiation, the author considered the tumor to belong to yin ju (yin abscess). The treatment approach should be to warm yang and unblock the interstitial spaces. Using Yanghe Tang as the base formula and modifying it according to the patient's specific condition, the prescription was drafted as follows:
Shudi (Rehmanniae Radix Praeparata) 40 g, Baijiezi (Sinapis Semen) 8 g, Lujiaojiao (Cervi Cornus Colla) 12 g (melted separately), Sheng Mahuang (Ephedrae Herba) 2 g, Paojiang (Zingiberis Rhizoma Praeparatum) 2 g, Sheng Gancao (Glycyrrhizae Radix) 4 g, Rougui (Cinnamomi Cortex) 4 g (ground, swallowed in suspension), Jiangcan (Bombyx Batryticatus) 12 g, Fuling (Poria) 12 g, Fabanxia (Pinelliae Rhizoma Praeparatum) 12 g, Hutaorou (Juglandis Semen) 15 g
One dose per day, taken in the morning.
Take Xihuang Wan in the evening: 6 g on day 1, 9 g on day 2, and 12 g from day 3 to day 7, taken with warm yellow wine; cover with a blanket after taking to induce sweating.
Take the medicine for seven days, then pause for seven days.
The patient later added that the illness had arisen from anger and frustration caused by troubled family relations; in the early stage her shoulders, back, lower back, and legs were all aching.
She was additionally instructed to take Jiawei Xiaoyao Wan.
On December 15, 2015, B-ultrasound showed tumor enlargement: the right upper abdominal tumor had enlarged to 134x84 mm and the left upper abdominal tumor to 43x32 mm, indicating that the above treatment had failed.