Experience Treating an Old Fracture in a Cancer Patient with Modified Xiaxueyu Tang
Patient Ms. Li, female, 73, sought care at the end of 2023 for lung cancer. She had a history of old fractures. She reported that after a fall in her twenties, she had persistent pain in the left hip, now worsening; her lower back felt broken, unable to bear any weight, and turning was difficult. She was bedridden most of the time. Previously, rest after fatigue gave slight relief, but now the pain persisted after onset, and she lacked even the strength to bend over to put on shoes. Walking or sitting for long periods was excruciating; she took Maren Wan for bowel movements, and urination was normal. Recently the condition had worsened: even coughing or passing gas triggered severe lower-back pain, so she dared not cough or fart, and could barely function. Western medicine recommended surgery, but the patient and family could not decide.
On March 7, 2024, her family asked me to help relieve her lower-back pain. She had previously used Zhonghua Dieda Wan, Shaoyao Gancao Tang, Duhuo Jisheng Wan, Zhuanggu Jianshen Wan, and Western analgesics, all without effect—showing that routine methods failed. The pain had lasted from her twenties into her seventies. According to TCM theory, prolonged illness necessarily involves stasis; her lower-back pain should be caused by static and dead blood. But she had already tried blood-activating stasis-resolving herbs such as Zhonghua Dieda Wan without effect, suggesting the stasis-resolving force was insufficient.
After consideration, I suggested trying modified Xiaxueyu Tang. The prescription: Taoren (Peach kernel) 10 g, Honghua (Safflower) 6 g, raw Dahuang (Rhubarb) 6 g, Tubiechong (Eupolyphaga) 15 g, Sumu (Sappanwood) 10 g, Zirantong (Pyrite) 10 g (wrapped), Shuizhi (Leech) 6 g, Dilong (Earthworm) 10 g, Renshen (Ginseng) 6 g, Baizhu (Atractylodes) 6 g, Fuling (Poria) 6 g, Wuzhuyu (Evodia) 3 g, Zhi Gancao (honey-fried Licorice) 6 g, Mugua (Chaenomeles) 30 g, Yiyiren (Coix) 30 g, Cangzhu (Atractylodes) 6 g, Niuxi (Achyranthes) 6 g, Dangguiwei (Angelica tail) 6 g, Chishao (Red Paeonia) 10 g.
Three doses, decocted in water, morning and evening. If the response was good, continue to 7 doses and report back.
Xiaxueyu Tang comes from the Jingui Yaolue, composed of Dahuang (Rhubarb), Taoren (Peach kernel), and Tubiechong (Eupolyphaga). TCM uses it for "postpartum abdominal pain due to stasis, dry blood adhering below the umbilicus, and obstructed menstruation (amenorrhea)." This formula already has strong stasis-resolving power; I added Honghua, Shuizhi, Dilong, Dangguiwei, and Chishao, plus Sumu and Zirantong—blood-activating pain-relieving herbs commonly used for fractures.
The patient had prolonged illness with qi deficiency, so while activating blood and resolving stasis, qi must be supported. The formula therefore also combines the famous qi-tonifying Sijunzi Tang (Renshen, Baizhu, Fuling, Zhi Gancao), plus Simiao Wan (Cangzhu, Niuxi, Yiyiren, Huangbai) for lower-limb pain due to damp-heat pouring downward—here Huangbai was replaced by Mugua, which specifically treats lower-back and leg pain. Wuzhuyu was added because the patient had slight acid regurgitation.
This formula addresses both root and manifestation, with strong blood-activating power, so caution and close observation were needed. After the first dose, pain lessened and she dared to pass gas. After the second, she no longer needed to prop her left hip to turn over. By days 3-5 she was willing to get up and move, no longer bedridden. Per the TCM principle that an effective formula should not be changed, I kept the prescription unchanged.
This patient had about 50 years of old fracture history, with many prior treatments failing. For such deep, stubborn disease, one must dare use strong herbs, while closely observing the patient's response and ensuring safety.