Pu Fuzhou's Experiential Formula for Cervical Scrofula and Hodgkin's Disease
Cervical scrofula (lymph node tuberculosis) belongs to "luoli" in TCM external medicine. The venerable physician Pu Fuzhou considered this a disease of the liver and gallbladder channels, to be treated as qi depression combined with phlegm-fire. He used Xiaoyao San (Bupleurum, Angelica, Chuanxiong, White Peony, Atractylodes, Poria, honey-fried Licorice) plus Xiakucao (Prunella), Beimu (Fritillaria), Xuanshen (Scrophularia), Haigefen (clam shell powder), Bailili (Tribulus), Baijiezi (white mustard seed), Sanleng (Sparganium), Ezhu (Curcuma zedoaria), Kunbu (Ecklonia), and Haizao (Sargassum).
Hodgkin's disease is Hodgkin lymphoma, a malignancy of the lymphatic system. Patients often have masses in the neck, axillae, and groin. Pu Fuzhou regarded it as TCM "jinjie" (sinew knots) and "tanhe" (phlegm nodules). He considered it likewise caused by liver-gallbladder qi depression, and because the course is long and difficult to resolve quickly, treatment should mainly use harmonizing and dispersing methods, regulating the liver and gallbladder while resolving depression and transforming phlegm—again with modified Xiaoyao San. Because the course is long, Pu did not favor decoctions; instead he used powders for gradual effect.
Pu Fuzhou's experiential formula is: Chaihu (Bupleurum) 2 liang, Baishao (White Peony) 2 liang, Danggui (Angelica sinensis) 1 liang, Chuanxiong (Chuanxiong rhizome) 7 qian, Baizhu (Atractylodes) 1 liang, Fuling (Poria) 2 liang, Xiangfu (Cyperus) 1 liang, Yujin (Curcuma) 1 liang, Xiang Beimu (Fritillaria thunbergii) 1 liang, Haigefen (clam shell powder) 2 liang, Qingpi (green tangerine peel) 7 qian, Baijiezi (white mustard seed) 1 liang, Kunbu (Ecklonia) 1 liang, Haizao (Sargassum) 1 liang. Grind all herbs into coarse powder and divide into 30 packets; decoct one packet daily in gauze, adding two jujubes. Here one liang is converted to the modern 50 g. Pu did not specify the number of daily doses; by general convention, powders are taken 2-3 times a day after meals.
In TCM external medicine, luoli, tanhe, and jinjie are difficult to distinguish clinically; from a modern medical perspective they are all lymphatic-system diseases. Pu Fuzhou treated them with similar pattern differentiation and herbs: liver-gallbladder qi depression with phlegm-fire, using liver-soothing, depression-resolving, phlegm-dispersing, and nodule-resolving herbs.
In my own clinical practice, I have also found that most lymphoma patients have liver depression and qi binding; in some patients the tumor visibly waxes and wanes with their emotional state. Therefore liver-soothing and depression-resolving treatment is very important. Pu's choice of Xiaoyao San as the base formula precisely strikes the key point.
Pu also noted that this disease has a very long course; large-dose decoctions over the long term easily damage the spleen and stomach, so he advocated powders for gradual effect. TCM is particular about dosage forms. The traditional saying is: "Decoctions sweep; powders disperse; pills slow." Diseases are acute or chronic: acute diseases should be urgently treated with decoctions, chronic ones gradually with powders and pills.
This experience of using different dosage forms for different diseases arises from clinical practice; it shows that the ancients already recognized that long-term decoction use carries heavy side effects, and that chronic diseases are better treated with pills, powders, plasters, and pellets. However, many modern doctors have grown accustomed to prescribing decoctions, and patients have fixed ideas that only decoctions count as TCM treatment; some even demand decoctions from their doctors. This is inconsistent with the practical experience accumulated in TCM.