Appreciation of Three Medical Cases of Professor Pang Panchi Treating Radiation Enteritis in Cervical Cancer
Professor Pang Panchi (1918–1999) was, during his lifetime, a chief physician at Shuguang Hospital of Shanghai University of Traditional Chinese Medicine. He had extensive experience in using TCM to support Western medicine in treating cancer, and he held distinctive views on treating radiation enteritis.
Professor Pang believed that patients with delayed rectal reactions after radiotherapy mostly present deficiency syndromes, of which there are three types: qi deficiency, yin deficiency, and dual deficiency of qi and yin—the last being the most common. Such patients are also frequently complicated by damp-toxin.
In treatment, in addition to supplementing qi and nourishing yin and other methods to support the righteous (zheng) qi, the formula should be modified according to the patient's particular constitution and symptoms. For example, add Huaijiao (Sophorae Fructus), Cebaiye (Platycladi Cacumen), and Ejiao (Asini Corii Colla) for blood in the stool; add Paojiang (Zingiberis Rhizoma preparata), Buguzhi (Psoraleae Fructus), and Shanyao (Dioscoreae Rhizoma) for loose stools with yang deficiency; add Biyu San and Chifuling (Poria Rubra) for scanty, dark urine; add Huangqi (Astragali Radix), Yiyiren (Coicis Semen), Baitouweng (Pulsatillae Radix), and Zanglian Wan for damp-heat; add Guya (Setariae Fructus Germinatus), Maiya (Hordei Fructus Germinatus), and Sharen (Amomi Fructus) for poor appetite; and add Tufuling (Smilacis Glabrae Rhizoma), Baihuasheshecao (Hedyotidis Diffusae Herba), and Shuyangquan (Solanani Nigri Herba) when damp-toxin is present.
From the following medical cases published by Professor Pang, we can gain a deeper understanding of his therapeutic approach.
Case 1: A woman, Chen, aged 51.
First visit on December 14, 1978. Four months earlier, the patient had undergone radiotherapy for stage III cervical cancer. After radiotherapy ended, she felt dizzy, had a sore lower back, was fatigued and lacking in strength, and had a poor appetite; recently she had begun passing bright-red blood in the stool, in large amounts, two or three times a day, with anal pain. When she returned to the hospital after radiotherapy, she was diagnosed with a delayed rectal reaction. Her pulse was fine and rapid, her coating thin and yellow, and her tongue red. The pattern was heat-toxin scorching fluids after radiotherapy, forcing blood to move recklessly; blood loss had weakened qi, and both qi and yin were injured. Treatment should supplement qi and nourish yin to support the righteous, while clearing heat, resolving toxin, cooling the blood, and stopping bleeding.
Prescription: Dangshen (Codonopsis Radix) 9 g, Shengdi (raw Rehmanniae Radix) 9 g, Chuan Shihu (Dendrobii Caulis) 9 g, Tianhuafen (Trichosanthis Radix) 15 g, Danpi (Moutan Cortex) 9 g, Sharen (Amomi Fructus) 3 g, Tufuling (Smilacis Glabrae Rhizoma) 30 g, Shuyangquan (Solanani Nigri Herba) 30 g, Baihuasheshecao (Hedyotidis Diffusae Herba) 30 g, Yiyiren (Coicis Semen) 12 g, Huangbai (Phellodendri Cortex) 9 g, Guya (Setariae Fructus Germinatus) 9 g, Maiya (Hordei Fructus Germinatus) 9 g.
Second visit (December 21, 1978): after 7 doses, the blood in the stool had decreased to twice a day, and her appetite was gradually improving; however, she felt dizzy and thirsty, had spontaneous sweating and fatigue, a sore lower back, and vaginal discharge that was yellow in color and fishy in odor, with abdominal pain during defecation—damp-heat pouring downward into the belt vessel. The previous formula was modified by adding Zanglian Wan 3 g (swallowed), for 14 doses.
Third visit (January 4, 1979): after the medication, the bleeding had stopped, but she had abdominal pain and borborygmus, dizziness, thirst, and cracked lips; her pulse was fine and somewhat rapid, her coating thin, and her tongue red. The prolonged illness had weakened qi and injured yin. Qi weakness caused the spleen to fail in transportation, with qi stagnation and damp obstruction; yin injury caused fluids to wither and generate internal heat. Treatment should supplement qi and nourish yin, transform dampness, and fortify the spleen.
Prescription: Dangshen (Codonopsis Radix) 9 g, Shengdi (raw Rehmanniae Radix) 9 g, Chuan Shihu (Dendrobii Caulis) 9 g, Tianhuafen (Trichosanthis Radix) 15 g, Danpi (Moutan Cortex) 15 g, Tufuling (Smilacis Glabrae Rhizoma) 30 g, Sheng Yiyiren (raw Coicis Semen) 30 g, Huangbai (Phellodendri Cortex) 9 g, Shuyangquan (Solanani Nigri Herba) 30 g, Baihuasheshecao (Hedyotidis Diffusae Herba) 30 g, Guya (Setariae Fructus Germinatus) 9 g, Maiya (Hordei Fructus Germinatus) 9 g, Sharen (Amomi Fructus) 3 g, Xianglian Wan 3 g (swallowed). 14 doses.
The above formula proved effective; it was continued for 77 doses, and the bleeding was resolved.
Case 2: A woman, Cui, aged 18.
First visit on January 23, 1979. The previous autumn she had suffered stage II cervical cancer, which was cured by radiotherapy. Over the past month she had passed a good deal of bright-red blood in the stool, two to three times a day, with a heaviness and blockage in the anus, a sore lower back, and fatigue. Her pulse was fine and small, her coating partially peeled, and her tongue pale. The pattern was excessive blood loss, with weakened qi and a deficiency of the construction (ying); over time the spleen and kidneys were damaged and failed to govern and contain the blood. Treatment should fortify the spleen and supplement the kidneys, supplement qi and nourish the blood.
A modified Huangtu Decoction (Yellow Earth Decoction) was prescribed: Dangshen (Codonopsis Radix) 9 g, Chao Baizhu (Atractylodis Macrocephalae Rhizoma preparata) 9 g, Chao Baishao (Paeoniae Alba Radix preparata) 9 g, Fuling (Poria) 9 g, Paojiang (Zingiberis Rhizoma preparata) 3 g, Zhi Gancao (Glycyrrhizae Radix preparata) 3 g, Shanyao (Dioscoreae Rhizoma) 9 g, Buguzhi (Psoraleae Fructus) 9 g, Huaihua (Sophorae Flos) 9 g, Shoudi (processed Rehmanniae Radix) 9 g, Ejiao (Asini Corii Colla) 9 g (melted and infused), Zaoxintu (Fullo Terrae, earth from an oven hearth) 30 g (wrapped).
Second visit (February 12, 1979): after 7 doses the bleeding had not stopped; the blood was bright red, the stool unformed, and she felt dizzy, with a sore lower back and fatigue; pulse and tongue were as before. On pattern differentiation and pulse analysis, this was dual injury of qi and blood, with spleen disease reaching the kidneys, failure to govern and contain, and blood struggling to return to the vessels. Treatment should warm kidney yang and support the spleen earth; once yang returns, blood will of itself return to the vessels. The previous formula was kept, adding Shufu (processed Aconiti Radix) 9 g, Huangqi (Astragali Radix) 12 g, and Xianhecao (Agrimoniae Herba) 15 g. 7 doses.
Third visit (February 20, 1979): after adding the yang-warming herbs, the bleeding had markedly decreased; the stool was formed and passed twice a day; pulse fine, coating thin, tongue dim and pale. The same formula was continued, 7 doses.
Fourth visit (March 2, 1979): the bleeding had stopped and the blood had returned to the vessels, but the body was not yet recovered; to prevent renewed bleeding and consolidate the result, the original formula was given for 14 doses.
Fifth visit (March 22, 1979): the bleeding was cured and the appetite was good, though fatigue had not fully resolved; pulse fine, coating thin. Treatment should supplement qi and nourish the blood to consolidate the outcome. Prescription: Dangshen (Codonopsis Radix) 9 g, Huangqi (Astragali Radix) 9 g, Baizhu (Atractylodis Rhizoma) 9 g, Baishao (Paeoniae Alba Radix) 9 g, Fuling (Poria) 9 g, Shanyao (Dioscoreae Rhizoma) 9 g, Chenpi (Citri Reticulatae Pericarpium) 6 g, Shengma (Cimicifugae Rhizoma) 3 g, Zhi Gancao (Glycyrrhizae Radix preparata) 3 g, Ejiao (Asini Corii Colla) 9 g (melted and infused).
Case 3: A woman, Lu, aged 46.
First visit on October 7, 1978.
In April of that year the patient had undergone radiotherapy for cervical cancer, with a strong reaction: nausea and loss of appetite, a lower back as if broken, weak and aching legs, and a continuous clear vaginal discharge. She had been treated with Chinese medicine for three to four months and had gradually improved. Since the beginning of this month she had again begun passing bright-red blood in the stool, in large amounts, with a dry mouth and sore throat, numb limbs, and lassitude; her pulse was fine and rapid, her coating thin and white. This was heat-toxin scorching fluids after radiotherapy, forcing blood to move recklessly, with excessive blood consumption and dual deficiency of qi and yin. Treatment should supplement qi and nourish yin, clear heat, and resolve toxin.
Prescription: Dangshen (Codonopsis Radix) 9 g, Huangqi (Astragali Radix) 9 g, Shengdi (raw Rehmanniae Radix) 9 g, Xuanshen (Scrophulariae Radix) 9 g, Tiandong (Asparagi Radix) 9 g, Maidong (Ophiopogonis Radix) 9 g, Tianhuafen (Trichosanthis Radix) 12 g, Danggui (Angelicae Sinensis Radix) 9 g, Jixueteng (Spatholobi Caulis) 30 g, Qinjiao (Gentianae Macrophyllae Radix) 9 g, Baihuasheshecao (Hedyotidis Diffusae Herba) 30 g, Shuyangquan (Solanani Nigri Herba) 30 g, Huaihua Tan (charred Sophorae Flos) 9 g.
Second visit (November 6, 1978): after 14 doses, the bleeding had lessened and was bright red. Recently she had contracted an external pathogen. The exterior was treated first, tentatively by clearing heat and resolving toxin.
Prescription: Jingjie (Schizonepetae Herba) 5 g, Fangfeng (Saposhnikoviae Radix) 5 g, Yinhua (Lonicerae Flos) 9 g, Juhua (Chrysanthemi Flos) 6 g, Huangqin (Scutellariae Radix) 9 g, Tianhuafen (Trichosanthis Radix) 9 g, Xingren (Armeniacae Semen) 9 g, Chuanbei tablets (Fritillariae Cirrhosae Bulbus) 10 tablets (swallowed), Niubangzi (Arctii Fructus) 9 g, Diyu (Sanguisorbae Radix) 12 g, Huaihua Tan (charred Sophorae Flos) 12 g.
Third visit (November 27, 1978): after 4 doses, the exterior was resolved but the bleeding continued, now dark red, with anal pain, aching joints, and numb limbs; pulse fine and rapid, coating thin. Both qi and blood were depleted; qi deficiency could not contain the blood, and blood deficiency could not nourish the sinews. Treatment continued to supplement qi and nourish the blood, cool the blood, and stop bleeding.
Prescription: Dangshen (Codonopsis Radix) 9 g, Huangqi (Astragali Radix) 9 g, Tianhuafen (Trichosanthis Radix) 15 g, Tiandong (Asparagi Radix) 9 g, Maidong (Ophiopogonis Radix) 9 g, Shengdi (raw Rehmanniae Radix) 9 g, Xuanshen (Scrophulariae Radix) 9 g, Danggui (Angelicae Sinensis Radix) 9 g, Jixueteng (Spatholobi Caulis) 15 g, Sangzhi (Mori Ramulus) 15 g, Baishao (Paeoniae Alba Radix) 9 g, Baihuasheshecao (Hedyotidis Diffusae Herba) 30 g, Shuyangquan (Solanani Nigri Herba) 30 g, Diyu Tan (charred Sanguisorbae Radix) 12 g, Huaihua Tan (charred Sophorae Flos) 12 g.
Fourth visit (December 1, 1978): after 4 doses, the bleeding had lessened but not stopped; the limbs were numb and aching; pulse fine and rapid, coating thin, tongue red. The previous method was continued, assisted by clearing heat and resolving toxin.
Prescription: Dangshen (Codonopsis Radix) 9 g, Shengdi (raw Rehmanniae Radix) 9 g, Danpi (Moutan Cortex) 9 g, Danggui (Angelicae Sinensis Radix) 9 g, Baishao (Paeoniae Alba Radix) 9 g, Huangqin (Scutellariae Radix) 9 g, Niuxi (Achyranthis Bidentatae Radix) 9 g, Chuan Duan (Dipsaci Radix) 9 g, Jixueteng (Spatholobi Caulis) 30 g, Diyu (Sanguisorbae Radix) 9 g, Huaihua (Sophorae Flos) 9 g. Zanglian Wan 3 g (swallowed).
Fifth visit (December 8, 1978): after 7 doses. The previous formula had worked and the bleeding was reduced; continue for 14 doses.
Sixth visit (January 12, 1979): after stopping the medication for half a month, the bleeding recurred, again in large amounts and bright red, with unformed stools, anal pain, poor appetite, and fatigue; pulse fine, coating white and greasy. Repeated use of yin-nourishing herbs had restrained spleen yang, so the spleen could not govern the blood, and dampness obstructed the middle jiao. The approach was changed to emphasize supporting the earth (spleen).
Prescription: Dangshen (Codonopsis Radix) 9 g, Baizhu (Atractylodis Rhizoma) 9 g, Baishao (Paeoniae Alba Radix) 9 g, Paojiang (Zingiberis Rhizoma preparata) 3 g, Shanyao (Dioscoreae Rhizoma) 9 g, Zhi Gancao (Glycyrrhizae Radix preparata) 3 g, Huaihua (Sophorae Flos) 9 g, Juecha 9 g, Shoudi (processed Rehmanniae Radix) 9 g, Sharen (Amomi Fructus) 3 g (added later), Jiao Daqu (darkened Massa Medicata Fermentata) 9 g. Zanglian Wan 3 g (swallowed).
Seventh visit (January 19, 1979): after 7 doses the bleeding had lessened and the anal pain had ceased; appetite improved, but the stool remained unformed; pulse fine. The spleen had slightly recovered, but yin damage was again evident. The method was kept, adding heat-clearing and yin-nourishing herbs: Shengdi (raw Rehmanniae Radix) 9 g and Huangqin (Scutellariae Radix) 9 g were added to the previous formula.
Eighth visit (February 9, 1979): after 7 doses the bleeding had stopped, but after stopping the medication for two weeks the stool frequency increased to two or three times a day, with mucus and blood, and anal pain recurred; pulse fine, coating thin yellow. Spleen deficiency with damp-heat obstructing the center. Treatment should fortify the spleen, transform dampness, clear heat, and stop bleeding.
Prescription: Dangshen (Codonopsis Radix) 9 g, Chao Baizhu (Atractylodis Macrocephalae Rhizoma preparata) 9 g, Baishao (Paeoniae Alba Radix) 9 g, Danggui (Angelicae Sinensis Radix) 9 g, Zhi Gancao (Glycyrrhizae Radix preparata) 3 g, Paojiang (Zingiberis Rhizoma preparata) 3 g, Huangqin (Scutellariae Radix) 9 g, Baitouweng (Pulsatillae Radix) 9 g, Fuling (Poria) 9 g, Diyu (Sanguisorbae Radix) 9 g, Huaihua (Sophorae Flos) 9 g. Zanglian Wan 3 g (swallowed).
Ninth visit (February 21, 1979): after 7 doses the bleeding had instead increased, the stool was unformed and passed three to four times a day, with tenesmus during defecation and a bearing-down pain in the anus; the arms and lips were numb; pulse fine, coating thin. Spleen yang was slack and the center qi was sagging. The method was changed to supplement qi and lift the sinking, cultivating the earth to contain the blood.
Prescription: Dangshen (Codonopsis Radix) 9 g, Huangqi (Astragali Radix) 9 g, Baizhu (Atractylodis Rhizoma) 9 g, Baishao (Paeoniae Alba Radix) 9 g, Shengma (Cimicifugae Rhizoma) 3 g, Chaihu (Bupleuri Radix) 5 g, Paojiang (Zingiberis Rhizoma preparata) 3 g, Zhi Gancao (Glycyrrhizae Radix preparata) 3 g, Shanyao (Dioscoreae Rhizoma) 9 g, Jiegeng (Platycodi Radix) 6 g, Danggui (Angelicae Sinensis Radix) 9 g, Huaihua (Sophorae Flos) 9 g, Cebaiye (Platycladi Cacumen) 9 g.
Tenth visit (March 6, 1979): after 7 doses the bleeding was greatly reduced and the anal bearing-down also lessened; the stool was initially dry then loose; coating thin, tongue turning pale. The spleen damage had reached the kidneys, so both spleen and kidneys should be supplemented to complete the work. The formula was kept, adding Buguzhi (Psoraleae Fructus) 9 g, Wuweizi (Schisandrae Chinensis Fructus) 5 g, and Zaoxintu (Fullo Terrae) 30 g (decocted in a cloth bag).
Follow-up on April 3, 1979: she had taken the spleen- and kidney-supplementing formula up to the present; the bleeding had decreased and then stopped, the stool gradually normalized, and her strength was returning. Over several months of medication the approach was changed several times, yet the key was not grasped and the bleeding would not stop. Later, because of her unformed stools and the bearing-down blockage in the anus—signs of spleen deficiency with qi sinking—and because her aching lower back and legs clearly indicated kidney deficiency, which had not been considered at the outset, there was only slight, fleeting effect. Once she took the spleen- and kidney-supplementing medicine, the result was consolidated.
These three complete cases of Professor Pang treating cervical cancer show that his basic approach to radiation enteritis was to emphasize supporting the righteous and securing the root, while also addressing the branch, sticking to effective formulas, and gradually and steadily regulating the patient. This method is very prudent, but it requires both physician and patient to have sufficient patience.