My Experience Treating Various Effusions in Cancer Patients with Modified Fangji Huangqi Tang (Stephania-Astragalus Decoction)

Fangji Huangqi Tang (Stephania and Astragalus Decoction) comes from Zhang Zhongjing's Jin Gui Yao Lue (Essential Prescriptions from the Golden Cabinet). It treats "wind-dampness with a floating pulse, heaviness of the body, sweating and aversion to wind." The original formula is: Fangji (Stephaniae Radix) 1 liang, Gancao (Glycyrrhizae Radix, fried) half a liang, Baizhu (Atractylodis Macrocephalae Rhizoma) 7 qian and 5 fen, Huangqi (Astragali Radix) 1 liang and 1 fen, with several slices of Shengjiang (Zingiberis Rhizoma recens) and Dazao (Jujubae Fructus) added as conduits as appropriate when decocting.

This is a classic famous formula for wind-damp bi-pain, indicated for generalized aching and heaviness, a floating pulse, sweating and aversion to wind.

I often modify this formula and use it to treat various effusions in cancer patients—such as pleural effusion (hydrothorax), pericardial effusion, ascites (abdominal effusion), pelvic effusion and hydrocephalus—and it is frequently effective.

The basic formula I commonly use is:

Sheng Huangqi (raw Astragalus) 30g, Han Fangji (Han Stephania) 30g, Fuling (Poria) 30g, Zhuling (Polyporus) 10-30g, Cheqianzi (Plantaginis Semen) 10-30g, Cheqiancao (Plantaginis Herba) 10-30g, Huanniuxi (Achyranthis Bidentatae Radix) 10-15g, Chao Baizhu (fried Atractylodes) 10-30g, Daji (Cirsii Japonici Radix) 20g, Xiaoji (Cirsii Herba) 20g, Yiyi (Coicis Semen) 60g, Tengligen (Actinidiae Root) 30g, Shiwei (Pyrrosiae Folium) 30g, Mohanlian (Ecliptae Herba) 6g, Nüzhenzi (Ligustri Lucidi Fructus) 6g, Shayuanzi (Astragali Complani Semen) 6g, Tusizi (Cuscutae Semen) 6g, Huangjing (Polygonati Rhizoma) 15g, Houpo (Magnoliae Officinalis Cortex) 15g, Dangshen (Codonopsis) 30g, Fabanxia (processed Pinellia) 6g, Zhigancao (honey-fried Licorice) 6g, Shengjiang (fresh Ginger) 7 slices, Dazao (Jujube) 7 pieces, Jiao Sanxian (scorched three digestives) 10g each; in addition, for yang-deficient patients, Guizhi (Cinnamomi Ramulus) or Rougui (Cinnamomi Cortex) 10-15g may be added.

Why compose the formula this way?

This formula is built on Fangji Huangqi Tang; most of the herbs in it have a water-disinhibiting action. But compared with formulas such as Shizao Tang, which contain drastic water-expelling herbs like Gansui (Kansui) and Daji (Euphorbiae Kansui Radix), its nature is far milder.

Besides the water-disinhibiting herbs, my empirical formula also adds quite a few tonifying herbs, such as Dangshen, Huangjing, Mohanlian, Nüzhenzi, Shayuanzi and Tusizi. In addition, this formula incorporates Renshen Banxia Houpo Shengjiang Gancao Tang, which has an excellent effect on reducing abdominal distension.

It should be noted that when using this formula, Han Fangji must not be replaced by Guang Fangji, because the latter belongs to the birthwort family (Aristolochiaceae) and causes considerable kidney damage.

Based on my many years of experience, when cancer patients develop effusions, most are already very weak and should not be given drastic herbs. Moreover, while disinhibiting water, one should also supplement qi and tonify the kidneys; otherwise one commits the error of "weakening the weak."

According to TCM theory, most water-disinhibiting herbs are spleen-strengthening, and strengthening the spleen tends to damage the kidneys. So when water-expelling herbs are overused, patients often develop weak, limp legs and dry, loose skin.

Therefore, when using water-expelling herbs, one should appropriately add kidney-tonifying herbs—such as the four mild herbs in this formula, Mohanlian, Nüzhenzi, Shayuanzi and Tusizi, which tonify both kidney yin and yang—so that the patient is usually spared the aftereffect of weak, limp legs after the water is dispelled.

One should also add some fortifying and strengthening herbs. In my empirical formula I have added tonics such as Dangshen and Huangjing, and incorporated the classic Renshen Houpo Banxia Shengjiang Gancao Tang, a "three-tonify, seven-disperse" famous formula, which both relieves the abdominal distension caused by pleural and ascitic fluid, pericardial effusion and pelvic effusion, and raises the patient's strength.

Adding a small amount of the digesting Jiao Sanxian improves the patient's appetite, enabling him to absorb more nutrition from food. By making use of the spleen and stomach—the acquired root—we raise the patient's upright qi to resist the pathogenic evil.

Daji and Xiaoji both disinhibit water and reduce swelling and stop pain; they are fine anti-cancer herbs. The herb pair Tengligen and Shiwei likewise both disinhibit water and fight cancer. Both pairs are folk-use experiences I have drawn on.

I once saw a patient who, simply by stewing meat with Daji and Xiaoji and eating it, achieved the resolution of ascites and pelvic effusion, and whose cancer marker CA125 dropped sharply afterward.

Tengligen and Shiwei were folk herbs used on their own by a cancer patient in Hubei; that patient, using only these two herbs, achieved the effect of dispelling ascites and fighting cancer.

Fuling and Zhuling in this formula are common water-disinhibiting herbs. Fangji paired with Fuling is also a common water-expelling pair; the Jin Gui Yao Lue has a dedicated Fangji Fuling Tang for treating "skin edema."

As for adding Niuxi, Cheqianzi and Cheqiancao, this is a medication experience borrowed from the composing logic of Jisheng Shenqi Wan.

Jisheng Shenqi Wan is simply Jingui Shenqi Wan with Niuxi and Cheqianzi added, for treating kidney-deficiency edema in the elderly.

Both the Jingui Shenqi Wan produced today by Tong Ren Tang and the Niuchi Shenqi Wan in Japanese kampo medicine use the Jisheng Shenqi Wan formula. Niuchi Shenqi Wan is listed by Japan's Ministry of Health as an adjuvant drug for cancer patients, mainly used to treat various effusions.

Below I append a few cases of cancer patients with various effusions whom I treated using this line of thought, for readers' reference.

Case 1: A patient with pleural mesothelioma

A patient surnamed Jiang, a worker at the Huabei Oilfield, had pleural mesothelioma with a history of asbestos exposure. He had mediastinal lymph nodes and stubborn, recurrent pleural effusion. Multiple treatments had failed. On February 21, 2018, he came to me for consultation, pushed in a wheelchair by his family.

The left pulse was slippery and the right pulse wiry. The patient had previously suffered constipation, with dry stools most of the time, relieved by laxatives. Sleep was fair, about five hours a night. He had intercostal pain and ear pain. Recently he felt fatigued, with dry mouth, cough, wheezing, chest tightness (left side) and chest pain.

The patient had been treated by other TCM doctors and had even taken Shizao Tang on his own. At the time of consultation his urine output was high. He had been taking Xihuang Wan (3g twice a day), and after reading my articles had gradually increased the dose to 6g. He felt uncomfortable in cool wind and often sweated spontaneously, breaking into sweats after morning activity. He had abdominal distension.

Prescription: Huangqi Fangji Tang combined with Guizhi Tang combined with Jiangjiang San, modified.

Sheng Huangqi 30g, Han Fangji 30g, Dangshen 30g, Fuling 30g, Zhuling 30g, Guizhi 15g, Baishao (Paeonia Alba) 15g, Zhigancao 10g, Shengjiang 10g, Dazao 7 pieces, Cheqiancao 15g, Cheqianzi 15g, Huanniuxi 15g, Mohanlian 20g, Nüzhenzi 20g, Shayuanzi 20g, Tusizi 20g, Tengligen 30g, Shiwei 30g, Chao Jineijin (fried Chickene Gizzard Lining) 30g, Jiao Sanxian 20g each, Banzhilian (Scutellaria Barbata) 30g, Sheshecao (Oldenlandia) 30g, Xianhecao (Agrimonia) 50g, Pianjianghuang (Curcuma Longa Slice) 6g, Chao Jiangcan (fried Batryticated Silkworm) 10g, Chantui (Cicada Slough) 6g, Pugongying (Dandelion) 30g, Rendongteng (Honeysuckle Stem) 30g, Xingren (Apricot Kernel) 10g, Houpo 20g.

I also gave Xihuang Wan, Neixiao Sanjie Wan (a self-designed pill formula for dispersing nodules), and norcantharidin tablets as ready-made medicines to assist anti-cancer treatment.

Two months after taking this formula, the patient's pleural effusion dropped sharply, the cancer marker CA125 fell markedly, and his strength recovered rapidly; in just over a month he was walking briskly, exercising on his own every day and able to walk more than ten thousand steps.

Afterward I used this as the base formula, modifying it according to his specific condition, and treated him for over a year. At his best, the tumor shrank from over 4 cm to 0.65 cm. Though his condition fluctuated along the way, he has remained well to this day and is still under treatment.

Case 2: A patient with advanced breast cancer and pleural effusion who could not lie flat

A patient surnamed Dai, female, born 1984, from Hunan, who had long worked in Dongguan, Guangdong. After radiotherapy for advanced breast cancer, she had multiple metastases.

In late 2018, pleural effusion left her with chest tightness, cough, inability to lie flat, sleeplessness day and night, hoarseness, and almost no ability to speak. She saw a doctor at a Guangdong hospital, paying 600 yuan for a specialist's appointment; after examining her, the doctor felt she could barely survive the year-end. So she turned to me.

Based on her symptoms, I prescribed modified Fangji Huangqi Tang: Sheng Huangqi 30g, Chao Baizhu 30g, Fuling 30g, Dangshen 30g, Han Fangji 30g, Cheqianzi 15g, Cheqiancao 15g.

After taking it, her edema lessened and she gradually could sleep a little at night. Thereafter I kept adjusting and modifying the formula based on her symptoms. Because her skin was red, swollen, painful and itchy after chemoradiation, I had her alternate this formula with Niubang Jieji Tang. The edema improved and the red bumps on her skin also markedly improved.

On top of this I added my self-designed Duoying Wan and other pill formulas; after taking them, her strength improved day by day. She has now recovered to nearly normal and is recently preparing to return to work.

Case 3: An ovarian-cancer patient with ascites

A patient surnamed Li, female, from Beijing, with ovarian cancer. She had consulted me over a year before, and I had suggested she first try Chinese medicine, and consider chemotherapy only if Chinese medicine failed.

Worried that her condition could not be controlled, she underwent chemotherapy. Afterward she declined steadily, gradually developing multiple metastases along with severe ascites and abdominal distension.

On March 17, 2019, she sought my help. Based on her symptoms, I prescribed the following:

Sheng Huangqi 30g, Han Fangji 30g, Fuling 30g, Zhuling 30g, Chao Baizhu 30g, Dangshen 30g, Cheqianzi 15g, Cheqiancao 15g, Huanniuxi 10g, Daji 20g, Xiaoji 20g, Yiyiren (Coix) 60g, Mohanlian 6g, Nüzhenzi 6g, Shayuanzi 6g, Tusizi 6g, Huangjing 15g, Houpo 15g, Fabanxia 6g, Zhigancao 6g, Shengjiang 7 slices, Dazao 7 pieces (broken up), Jiao Sanxian 10g each, Tengligen 30g, Shiwei 30g.

After about a week of medication, her abdominal distension markedly lessened and the ascites decreased; I told her to continue. She is still under treatment.

Case 4: A lung-cancer patient with pericardial effusion

A patient surnamed Li, from Nanyang, Henan, whose lung cancer had caused pericardial effusion with extreme chest tightness, dry cough without sputum, fatigue and weakness, and who was bedridden. He had previously undergone repeated drainage at a hospital in Zhengzhou and been on targeted therapy, which gave brief relief before the chest tightness returned. On March 25, 2019, his family sought my help; based on his condition, I used my empirical formula:

Sheng Huangqi 30g, Han Fangji 30g, Fuling 30g, Zhuling 30g, Chao Baizhu 30g, Dangshen 30g, Cheqianzi 15g, Cheqiancao 15g, Huanniuxi 10g, Daji 20g, Xiaoji 20g, Yiyiren 60g, Mohanlian 6g, Nüzhenzi 6g, Shayuanzi 6g, Tusizi 6g, Huangjing 15g, Houpo 15g, Fabanxia 6g, Zhigancao 6g, Shengjiang 7 slices, Dazao 7 pieces (broken up), Jiao Sanxian 10g each, Tengligen 30g, Shiwei 30g.

I also gave my self-designed anti-cancer pills Huanyuan Dan and Qisheng Dan to assist.

After about a week, his chest tightness markedly eased, he could cough up phlegm, his spirit improved, he got out of bed often, and the fatigue was gone. He is still under further treatment.

Case 5: An ovarian-cancer patient with pleural and ascitic fluid and pericardial effusion

A patient surnamed Zhang, female, 75, from Xingtai, Hebei. On May 30, 2018, she came to me with ovarian cancer. At her local hospital a multiloculated cystic-solid mass had been found in the pelvis, measuring 10.3 x 9.4 x 7.0 cm.

Because of the ovarian cancer she had developed ascites, pericardial effusion and left-sided pleural effusion.

She had a dry cough without sputum, with violent coughing whenever her posture changed, and chest tightness. Urination and defecation were normal. Over the recent one or two months she had lost weight rapidly, and her face had turned dark.

The pulse was wiry, slippery, rapid and forceful.

I prescribed based on her symptoms:

Dietary-therapy formula:

Daji 50-150g, Xiaoji 50-150g, Chenpi (Tangerine Peel) 30g, one white radish, stewed together with meat; eat the meat and drink the soup.

Decoction formula:

Sheng Huangqi 30g, Sheng Baizhu (raw Atractylodes) 30g, Han Fangji 30g, Fuling 30g, Zhuling 30g, Cheqianzi 15g, Cheqiancao 15g, Jiao Shanzha (scorched Hawthorn) 15g, Chao Maiya (fried Barley Sprout) 30g, Sheng Maiya (raw Barley Sprout) 30g, Chao Guya (fried Rice Sprout) 30g, Zhigancao 10g, Pianjianghuang 6g, Chao Jiangcan 10g, Chantui 6g, Huanniuxi 10g.

I also gave Xihuang Wan and Duoying Wan (my self-designed anti-cancer pill formula) for anti-cancer treatment.

One month after taking the above, her strength clearly improved; the chest tightness and cough were gone, and after several months the ovarian mass had shrunk by nearly half.

In late 2018, she caught influenza A, developed a high fever and was admitted to a local hospital for IV infusions, suspending the Chinese medicine for a while. Her condition rebounded and the cold did not clear.

I then advised her to stop using antibiotics and instead treat the cold with New Contac; the cold then cleared. This cold had lasted nearly two months, sharply reducing her strength, and pleural effusion, chest tightness, tumor rebound and cough had recurred. After the cold resolved she came back for a follow-up visit.

I again used the initial prescription as the main basis, with appropriate modifications. Recently the pleural effusion was brought under control again; the chest tightness and cough markedly lessened, her strength improved, and she could now do housework. She is still under treatment.

Case 6: A patient with squamous-cell lung cancer

A patient surnamed Li, from Inner Mongolia, with squamous-cell lung cancer; male, 69. First visit at 7:11 PM on February 12, 2019. The right pulse was slippery, rapid, and somewhat weak and soft; the left pulse was fine, soft and forceless. He coughed with much sputum, did not sweat, and felt neither cold nor hot. For many years he could only sleep on his side; he had coughed with much sputum since his early teens.

He had coughed up blood over the last three months. He had a cracked tongue with a white greasy coating. His cough caused chest pain, a history of over twenty years. He used to drink a lot of water, most of it before bed.

Recent hemoptysis; examinations at several hospitals showed: carcinoma of the left lung, multiple old lesions in both lungs, and inflammatory enlargement of mediastinal and bilateral hilar lymph nodes.

He occasionally had a fever and sometimes felt a bloating sensation around the orbits. Blood pressure was on the high side. Stool was normal, usually every other day, occasionally every two days. Urination was abnormal. He had acid regurgitation when eating sweets. He had underlying reflux esophagitis and chronic gastritis, a cyst in the middle pole of the left kidney, and prostatic hyperplasia with punctate calcification.

TCM pattern differentiation: lung heat forming an abscess, with chronic disease causing upright qi deficiency.

Decoction:

Sheng Shigao (raw Gypsum) 30g (decoct first), Zhigancao 10g, Xingren 6g, Zhi Mahuang (honey-fried Ephedra) 6g, Huangjing 30g, Danggui (Angelica) 15g, Yiyi 60g, Sheng Huangqi 30, Han Fangji 30g, Fuling 30g, Zhuling 15g, Cheqianzi 15g, Huanniuxi 10g, Yuxingcao (Houttuynia) 30g, Xiakucao (Selfheal) 10g, Lianqiao (Forsythia) 10g, Jinyinhua (Honeysuckle) 30g, Jinqiaomai (Fagopyrum Cymosum) 30g, Maozhuaacao (Ranunculus Ternatus) 30g, Ziwan (Aster) 10g, Kuandonghua (Tussilago) 10g, Dongsangye (Mulberry Leaf) 15g, Yejuhua (Wild Chrysanthemum) 10g, Xianhecao 50g.

I also gave the ready-made Sanjin Pian, Duoying Wan (self-designed pill formula) and Hualiu Wan (self-designed pill formula) for symptom relief and anti-tumor treatment.

After a week the effect was poor; he still coughed and had diarrhea. So I switched to my empirical formula:

Sheng Huangqi 30g, Han Fangji 30g, Fuling 30g, Zhuling 30g, Chao Baizhu 30g, Dangshen 30g, Cheqianzi 15g, Cheqiancao 15g, Huanniuxi 10g, Daji 20g, Xiaoji 20g, Yiyiren 60g, Mohanlian 6g, Nüzhenzi 6g, Shayuanzi 6g, Tusizi 6g, Huangjing 15g, Houpo 15g, Fabanxia 6g, Zhigancao 6g, Shengjiang 7 slices, Dazao 7 pieces (broken up), Jiao Sanxian 10g each, Tengligen 30g, Shiwei 30g, Xianhecao 50g.

Among the ready-made medicines, I added Fuzheng Guben Wan (my self-designed pill formula) to the original regimen.

After taking it, all symptoms improved immediately. After more than ten days he could again do farm work normally, with a good appetite and good strength.

These patients had different complaints and different kinds of cancer, but under the guiding idea of TCM pattern differentiation and treatment, they all belonged to the same pattern type with the same disease mechanism, so the medication logic was the same, and the results were all effective. The decoctions for three of the patients were even essentially identical—this is the charm of TCM's "treating different diseases with the same method."