My Medical Philosophy: Escalate Medication Gradually, Withdraw Slowly, and Prevent Relapse Scientifically
I advocate the large-formula multi-target special therapy and have practiced it clinically for over ten years, witnessing its results firsthand and working out some prescribing rules. Though I cannot yet, as I wish, speed up research through large-scale animal and human trials, that does not prevent TCM clinicians from using the method, because TCM has always treated disease mainly with formulas; a large formula is just a bigger one.
To further refine the theory of the large-formula multi-target special therapy, I will next explain its dosing and withdrawal rules and the follow-up principles after treatment. These can be summed up in the three phrases in this title: escalate medication gradually, withdraw slowly, and prevent relapse scientifically.
First, escalating medication gradually.
When treating patients, we follow the principle of increasing the number of herbs and the dosage step by step. Of course, once one is sufficiently proficient and a given large formula has proven highly safe in practice, this process can be simplified.
But when first learning and using the large-formula multi-target special therapy, one must strictly follow this principle. It is the bottom line for both patient safety and physician safety. Gradual dosing, careful observation of the patient's response, close attention to bloodwork and biochemical markers based on feedback, and adjusting dosage at any time are what prevent serious side effects.
During my apprenticeship, a retired-but-rehired TCM teacher repeatedly emphasized: when the patient is safe, the doctor is safe; prescribing must be doubly cautious. To train my caution, she even punished me severely for the smallest slip and required me to memorize the codes of conduct for various specialties to strengthen my safety awareness. I remain deeply grateful for that intensive training.
As I mentioned in earlier chapters, when using the large-formula multi-target special therapy for refractory disease, I advocate pills, powders, pastes, and pellets rather than decoctions. Their dosage is easier to control, they are safer clinically, and they are more economical for patients.
Pills are pellets made from Chinese herbs; powders are herbs ground into fine particles—formerly taken by stirring into water, now patients can fill empty capsules themselves; pastes are concentrated herbal extracts; "dan" (pellets) is essentially the same as pills, except that pellets historically underwent additional roasting and refining.
Even with pills, powders, pastes, and pellets, patients must start at low doses and build up.
It is also essential to tell patients to stop the drug for a few days after each period of use. Generally, for diseases like cancer and stroke sequelae, I instruct patients to take medicine for 5 days and stop for 2 days, with regular liver and kidney function checks, to ensure safety.
Now, withdrawing slowly.
Because patients who need the TCM large-formula multi-target special therapy all have refractory disease, their courses are generally long—months to years. Once effect is achieved, withdrawal principles must be considered.
Whether such diseases (especially cancer) are "cured" is hard to determine. All we can detect is disappearance of the tumor and normalization of tumor markers; we cannot yet tell whether the cancer cells are merely dormant or truly eliminated. Cancer is prone to relapse and metastasis. To reduce relapse, my personal recommendation is that after the tumor disappears and markers normalize, patients continue medication for a while to consolidate the effect.
During consolidation, dosing frequency and amount can be tapered gradually. For example, if the patient previously took the drug three times a day, consolidation can reduce that to twice; after three to six months of consolidation, taper to once, with a modest reduction in dosage.
After a period of consolidation, the drug can be stopped and the patient followed up. During follow-up, instruct the patient to recheck regularly. Watch markers closely; at the first sign of rebound, restart medication for a period.
Some of my cancer patients have been off medication for over five years, some for ten, without relapse. Others have had tumor markers suddenly rise during the off period; resuming their previous regimen brought the markers back down, and they returned to observation.
Of course these are the fortunate few; most patients do not achieve such outcomes. But the success rate for improving quality of life and extending survival through TCM is still high. This relates both to the special nature of cancer and to the fact that most cancer patients seek TCM only in late or terminal stages, when cure rates are inherently low.
To learn my TCM large-formula multi-target special therapy, one must absorb the whole philosophy. Without the patience to understand it fully, clinical treatment may carry unpredictable risks.