Professor Zhu Chenyu's Experience in Treating Radiotherapy and Chemotherapy Syndrome

Doctor zhou May 25, 2020

Professor Zhu Chenyu (deceased) was a disciple of Shi Jinmo, one of the four famous physicians of Beijing. After graduating from high school, Zhu Chenyu studied TCM under Shi Jinmo for six years, and was then sent by his teacher to Japan to study modern medicine for four years. He thus received both Shi Jinmo's true transmission, laying a solid TCM foundation, and a systematic education in modern medicine, integrating Chinese and Western medicine, with a very high clinical level. Before his passing, Professor Zhu served as director of the TCM Department at Peking Union Medical College Hospital and also taught in advanced "Western medicine learning TCM" classes, training many talents who integrate Chinese and Western medicine.

Professor Zhu also treated many malignant tumor patients during his lifetime, and he had unique insights in treating radiotherapy and chemotherapy syndrome in malignant tumor patients. After malignant tumor patients undergo radiotherapy and chemotherapy, a series of toxic side effects appear (targeted therapy drugs also cause these reactions), such as inflammatory reactions, digestive tract dysfunction, liver function damage, myelosuppression, and bodily weakness. Professor Zhu called these collectively "radiotherapy and chemotherapy syndrome."

Radiotherapy and chemotherapy syndrome is related to modern medicine and belongs to modern iatrogenic diseases; it is a problem that ancient TCM never encountered. So in treatment, contemporary TCM physicians need to boldly innovate and practice clinically using TCM theory to explore effective treatment regimens.

Professor Zhu believed that radiotherapy damages the body's normal tissues and the zheng qi (upright qi). Clinically, patterns of heat evil damaging yin are commonly seen, resembling the ancient "fire evil" or "toxic heat evil." Chemotherapy, being highly toxic, mainly damages the body's spleen and stomach and hematopoietic function, belonging to "medicinal evil" or "medicinal toxin."

Malignant tumors inherently belong to patterns of zheng deficiency and excess evil. The damage caused by radiotherapy and chemotherapy makes the patient's condition more complex, so treatment must be based on the different patterns of zang-fu organs and qi and blood damage, using pattern differentiation to select medications.

Professor Zhu summarized the treatment principles for radiotherapy and chemotherapy syndrome as four types: boosting qi and nourishing blood, enriching yin and clearing heat, harmonizing the stomach and directing counterflow downward, and harmonizing the spleen and stomach. Commonly used formulas include Shengxian Tang (Yang-Qi-Extracting Decoction), Buzhong Yiqi Tang (Middle-Rooting and Qi-Boosting Decoction), Shengyu Tang (Holy Healing Decoction), Shashen Maidong Tang (Glehnia and Ophiopogon Decoction), Yiguan Jian (Threading Pipe Decoction), Zhibai Dihuang Wan (Anemarrhena, Phellodendron and Rehmannia Pill), Baitouweng Tang combined with Gegen Huangqin Huanglian Tang, Xiangsha Liujunzi Tang, Bixie Fenqing Yin combined with Zhuling Tang, Xiaoyao San (Free Wanderer Powder), and Danggui Shaoyao San (Angelica and Peony Powder), modified as appropriate.

Here the author will organize Professor Zhu's commonly used approaches according to TCM "formula-pattern" and "medication-pattern" theory, selecting the essentials for the reader's reference.

Shengxian Tang (Yang-Qi-Extracting Decoction)

Shengxian Tang is an empirical formula of Zhang Xichun, a famous physician of the Republican era. Zhang Xichun used it to treat "the great qi of the chest falling downward," hence the name. The pattern presents with shortness of breath and wheezing, chest tightness and chest pain that worsen after activity, dry cough with little sputum, dry throat and mouth, fatigue and spontaneous sweating, a pale enlarged tongue, and a deep, fine, wiry, and slippery pulse.

These symptoms are commonly seen in patients with cancers of the upper body such as lung cancer, breast cancer, and cardia cancer; in treatment, Shengxian Tang should be considered as the main formula. Shengxian Tang consists of: raw Huangqi (Astragalus membranaceus) 30g, Zhimu (Anemarrhena asphodeloides) 10g, Chaihu (Bupleurum chinense) 3g, Shengma (Cimicifuga foetida) 3g. According to TCM theory, Shengxian Tang has the effect of tonifying lung qi and lifting the fallen middle qi.

Professor Zhu commonly modified this formula with Baihuasheshecao (Oldenlandia diffusa) 30g, Banzhilian (Scutellaria barbata) 15g, Tengligen (Actinidia arguta root) 15g, Sangbaipi (Morus alba root bark) 10g, and Zhipipa Ye (processed Eriobotrya japonica leaf) 10g to treat cancer patients who develop the above symptoms after radiotherapy and chemotherapy. For sore throat, add Jinyinhua (Lonicera japonica) 10g, Lianqiao (Forsythia suspensa) 15g, Pugongying (Taraxacum mongolicum) 20g, Jiegeng (Platycodon grandiflorus) 10g; for dry mouth, add Maidong (Ophiopogon japonicus) 10g, Tianhuafen (Trichosanthes kirilowii root) 20g; for severe cough, add Qianhu (Peucedanum praeruptorum) 10g, Baiqian (Cynanchum glaucescens) 10g; for abundant sputum, add Chenpi (Citrus reticulata peel) 10g, Yuanzhi (Polygala tenuifolia) 10g; for constipation, add Danggui (Angelica sinensis) 15g, Baishao (Paeonia lactiflora) 30g.

In addition to these medicines Professor Zhu commonly used, the author also likes to add Shandougen (Sophora tonkinensis) 10-30g, Chonglou (Paris polyphylla) 10-30g, Jiaogulan (Gynostemma pentaphyllum) 10-30g, Huangjing (Polygonatum sibiricum) 10-30g, and Mabo (Lycoperdon bovista) 10g on this basis to strengthen the anti-cancer and right-supporting effects.

Buzhong Yiqi Tang (Middle-Rooting and Qi-Boosting Decoction)

Buzhong Yiqi Tang was created by Li Dongyuan, one of the four great physicians of the Jin-Yuan period. It is a famous warming and tonifying formula in TCM, with the actions of tonifying the middle and boosting qi, and raising yang and lifting prolapse. Its clinical application is very broad; it has good efficacy in treating bodily weakness and fatigue caused by various chronic diseases, shortness of breath and reluctance to speak, sallow complexion, loose stools, and a weak, faint pulse.

Professor Zhu commonly used Buzhong Yiqi Tang when treating digestive tract or gynecological tumors. He mainly applied it to patients with fatigue and dizziness, lassitude and spontaneous sweating, shortness of breath and steaming heat, poor appetite and loose stools, a pale dark tongue, and a fine, weak pulse.

Buzhong Yiqi Tang consists of: raw Huangqi (Astragalus) 15g, Renshen (Panax ginseng) 6g (or Dangshen, Codonopsis pilosula, 15g), Baizhu (Atractylodes macrocephala) 10g, Zhi Gancao (processed Glycyrrhiza uralensis) 15g, Danggui (Angelica) 10g, Chenpi (Citrus reticulata peel) 6g, Shengma (Cimicifuga) 6g, Chaihu (Bupleurum) 12g, Shengjiang (fresh Zingiber officinale) 9 slices, Dazao (Ziziphus jujuba) 6 pieces.

Buzhong Yiqi Tang is one of the most commonly used formulas by contemporary TCM physicians for treating tumor patients with bodily weakness after radiotherapy and chemotherapy. The author has also written a separate article introducing this formula; those interested can look it up and read it. The Chinese patent medicine Buzhong Yiqi Wan is made based on the Buzhong Yiqi Tang formula and is produced by many manufacturers, making it very easy to buy.

Professor Zhu also often added Maidong (Ophiopogon) and Wuweizi (Schisandra chinensis) to this formula; adding these two transforms it into a combination with Shengmai Yin (Generating Pulse Drink, consisting of Renshen, Wuweizi, and Maidong). In addition, Professor Zhu liked to add Gouqizi (Lycium barbarum fruit) and Nüzhenzi (Ligustrum lucidum fruit). If the patient has symptoms such as loose stools, add Sugeng (Perilla stem) and Huogeng (Agastache stem) each 10g, Baizhi (Angelica dahurica) 10g, and Sheng Yiyiren (raw Coix lacryma-jobi) 30g; for patients with weakness in the lower limbs, add Jixueteng (Spatholobus suberectus) 30g, Sangjisheng (Taxillus chinensis) 20g—the author personally prefers to add Bajitian (Morinda officinalis) and Yinyanghuo (Epimedium brevicornum); for patients with low white blood cell count, add Shiwei (Pyrrosia lingua) 15g, Xianhecao (Agrimonia pilosa) 30g.

Shengyu Tang (Holy Healing Decoction)

Shengyu Tang comes from "Lan Shi Mi Cang" (Orchid Chamber Secret Records). It is a formula for treating excessive blood loss caused by ulcerated sores and swellings, with vexation and thirst, hot and restless sensations, and inability to sleep peacefully. Its ingredients are: Shengdi (unprocessed Rehmannia glutinosa) 20g, Shudi (processed Rehmannia) 20g, Baishao (Paeonia lactiflora) 15g, Chuanxiong (Ligusticum chuanxiong) 10g, Renshen (Panax ginseng) 10g (or Dangshen, Codonopsis, 30g), Danggui (Angelica) 15g, Huangqi (Astragalus) 18g. Shengyu Tang is a formula formed by combining three famous blood-tonifying formulas: Siwu Tang (Four Substances Decoction), Danggui Buxue Tang (Angelica Blood-Tonifying Decoction), and Dushen Tang (Single Ginseng Decoction). So its emphasis is on tonifying blood and calming the spirit for cancer patients; it is suitable for patients with dual deficiency of qi and blood and insufficiency of kidney essence.

When using Shengyu Tang, Professor Zhu also often added Heshouwu (processed Polygonum multiflorum) 15g, Nüzhenzi (Ligustrum lucidum) 15g, Sangshenzi (Morus alba fruit) 10g, Gouqizi (Lycium barbarum) 10g, Jixueteng (Spatholobus) 30g, Shiwei (Pyrrosia) 15g, and Xianhecao (Agrimonia) 30g. For patients with hair loss, add Sangye (Morus alba leaf) 10g, Heizhima (Sesamum indicum, black) 15g, and Huoxiang (Agastache rugosa) 10g. For patients with a burning-hot sensation of the skin, add Huangqin (Scutellaria baicalensis) 10g, Huanglian (Coptis chinensis) 5g. For patients with poor appetite, add Changpu (Acorus gramineus) 10g, Peilan (Eupatorium fortunei) 10g. For patients with abdominal distension, add Chenpi (Citrus peel) 10g, Sharen (Amomum villosum) 3g. For patients with loose stools, add Baizhu (Atractylodes) 10g, Huaishanyao (Dioscorea opposita) 10g.

Shengyu Tang is suitable for various late-stage cancer patients presenting with poor blood counts, with both red and white blood cells and platelets on the low side. After radiotherapy and chemotherapy, most patients develop poor blood counts due to myelosuppression; some patients find it difficult to continue radiotherapy and chemotherapy because their blood counts are too poor. Western medicine generally uses white-cell-boosting injections and transfusions of platelets and whole blood, while TCM mostly uses Shengyu Tang as the base formula, modified according to the patient's clinical symptoms.

Shashen Maidong Tang (Glehnia and Ophiopogon Decoction)

Shashen Maidong Tang comes from "Wen Bing Tiao Bian" (Systematic Identification of Warm Diseases). It is an essence-moistening formula in TCM. It is mainly used for dryness evil causing dry throat and thirst, generalized heat, dry cough with little sputum, and other patterns of dryness damaging the lung and stomach or insufficiency of lung and stomach yin fluids. These are very common in nasopharyngeal cancer and thyroid cancer patients after radiotherapy; Western medicine's radiation pneumonitis mostly presents with these symptoms. Patients often drink compulsively out of thirst; some drink more than three liters of water a day without relief. For such patients, Shashen Maidong Tang is quite suitable.

Professor Zhu's empirical formula: Shashen (Glehnia littoralis) 15g, Maidong (Ophiopogon) 15g, Yuzhu (Polygonatum odoratum) 10g, Sangye (Morus alba leaf) 10g, Baibiandou (Dolichos lablab) 15g, Tianhuafen (Trichosanthes root) 20g, Gancao (Glycyrrhiza) 5g, Baihuasheshecao (Oldenlandia) 30g, Jiegeng (Platycodon) 10g, Shengma (Cimicifuga) 10g, Lianqiao (Forsythia) 15g, Pugongying (Taraxacum) 20g.

In the author's personal experience, adding Jiaogulan (Gynostemma) 10-30g and Lingzhi (Ganoderma lucidum) 10-30g to this formula works even better. In addition, the author often, while using this formula, advises patients to combine it with Chinese patent medicines such as Yangyin Qingfei Keli (Yin-Nourishing and Lung-Clearing Granules) to support the medicinal effect, or to combine it with Qingzao Jiufei Tang (Dryness-Clearing and Lung-Rescuing Decoction).

For liver and kidney yin deficiency patterns with dry throat and mouth, Professor Zhu mostly used Zhibai Dihuang Tang or Yiguan Jian modified with Huangqin (Scutellaria), Huanglian (Coptis), Danpi (Moutan cortex), and Baishao (Paeonia).

Baitouweng Tang combined with Gegen Qinlian Tang

Both Baitouweng Tang and Gegen Qinlian Tang are classic famous formulas from Zhang Zhongjing's canon for treating diarrhea. Professor Zhu often combined these two formulas into one to treat patients with radiation enteritis. Radiation enteritis patients not only frequently have diarrhea but, more seriously, often have bloody stools. Some cervical cancer and intestinal cancer patients have long-term bloody stools after radiotherapy, to the point where they must regularly receive transfusions to address the anemia caused by excessive blood loss.

Professor Zhu's empirical formula: Baitouweng (Pulsatilla chinensis) 30g, Huangqin (Scutellaria) 10g, Huanglian (Coptis) 10g, Qinpi (Fraxinus chinensis bark) 10g, Gegen (Pueraria lobata) 15g, Machixian (Portulaca oleracea) 30g, Xueyu tan (charred human hair) 10g, Sheng Diyu (unprocessed Sanguisorba officinalis) 15g, Gancao (Glycyrrhiza) 6g.

In the author's own experience, this formula is slightly insufficient in strength. The author himself often combines this combined formula with Huaihua San (Sophora Flower Powder) and Shihui San (Ten-Ingredient Ash Powder) to strengthen the hemostatic effect, and also often adds Chunshupi (Ailanthus altissima bark) and Huangbai (Phellodendron chinense) to strengthen the antidiarrheal effect. For patients with excessive bloody stools, it is still necessary to combine it with the Shengyu Tang introduced above to tonify the patient's qi and blood.

Bixie Fenqing Yin combined with Zhuling Tang

Besides radiation enteritis caused by radiotherapy, which leads to bloody stools, chemotherapy or interventional therapy also frequently causes hemorrhagic cystitis presenting with bloody urine, burning urethra, and other symptoms. When treating such patients, Professor Zhu mostly applied pattern differentiation according to the pattern of damp-heat pouring downward into the bladder.

The formula used is Bixie Fenqing Yin combined with Zhuling Tang: Bixie (Dioscorea hypoglauca) 10g, Wuyao (Lindera aggregata) 10g, Changpu (Acorus gramineus) 10g, Yizhiren (Alpinia oxyphylla) 10g, Zhuling (Polyporus umbellatus) 15g, Fuling (Poria cocos) 15g, Zexie (Alisma orientalis) 10g, Huashi (talcum) 15g, Ejiao (Colla corii asini, melted) 10g, Cheqianzi (Plantago asiatica seeds, wrapped) 10g, Shiwei (Pyrrosia) 15g, Daji (Cirsium japonicum) 15g, Baimaogen (Imperata cylindrica) 30g.

When using Professor Zhu's empirical formula, the author often adds Yimucao (Leonurus japonicus) 30g and Xiaoji (Cephalanoplos segetum) 15g on this basis to strengthen the efficacy.

Whether the bleeding is in the stool or the urine, when the author personally uses the above formulas, he always adds two herbs—Xianhecao (Agrimonia) and Fengweicao (Pteris multifida)—in relatively heavy doses, 30-60g each. Both Fengweicao and Xianhecao are excellent hemostatic medicines and additionally have anti-cancer effects; they are inexpensive, and Fengweicao also has a very good analgesic effect.

In addition, when chemotherapy drugs irritate the stomach and intestines, causing adverse digestive reactions—patients presenting with nausea and vomiting, acid regurgitation and belching, frequent hiccups, and other symptoms—Professor Zhu mostly treated them with Liujunzi Tang combined with Xuanfu Daizhe Shi Tang, modified with Huoxiang (Agastache) and Zhuru (Bambusa tuldoides shavings). This approach is the most common treatment approach in the TCM community; the author has previously introduced the approach to treating chemotherapy-induced digestive side effects on multiple occasions and will not repeat it here.

Most of the formulas Professor Zhu used are famous historical formulas, and the herbs he often added are mostly found in the book "Shi Jinmo's Paired Herbs." Professor Zhu's medication approach is an extension of Shi Jinmo's clinical experience; from his prescriptions one can see the imprint of Shi Jinmo. The greatest characteristic of Shi's prescription and medication was the combination of multiple formulas and the fond use of "paired herbs" (a group of herbs with similar effects used together, also called "herb pairs").

Cancer is indeed difficult to treat, but Chinese medicine can improve patients' quality of life and alleviate their suffering. A small number of lucky patients can even survive long-term after taking Chinese medicine. TCM cancer treatment still holds great promise.

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