Veteran TCM Gynecologist Qian Boxuan's Approach to Uterine Fibroids

Professor Qian Boxuan was a renowned TCM gynecologist who treated many difficult gynecological conditions in his lifetime. Dr. Qian Boxuan's Gynecological Case Records preserves four cases of uterine fibroids treated by Dr. Qian, from which one can glimpse his general approach.

Case 1. Su had had uterine fibroids for over 10 years. Her periods came early, every 15 days, lasting five or six days each and heavy. In the past year the cycle had become disordered—either early by 15 days or delayed by 50–90 days, stopping after 3–4 days and heavy. Western examination revealed a fibroid the size of an 8-week pregnancy.

Dr. Qian found the pulse fine, slippery and rapid, with a thin yellow greasy tongue coating; the patient had dizziness and a bitter mouth, insomnia and constipation. Weighing the four examinations, Dr. Qian considered this a pattern of dual deficiency of qi and yin with phlegm-qi binding, and decided to supplement qi and nourish yin while resolving phlegm and softening hard masses. He used modified Shengmai San: Beishashen (Glehniae Radix) 12 g, Maidong (Ophiopogonis Radix) 9 g, Wuweizi (Schisandrae Fructus) 6 g, Fuling (Poria) 12 g, Yejiaoteng (Polygoni Multiflori Caulis) 12 g, Nüzhenzi (Ligustri Lucidi Fructus) 12 g, Kunbu (Eckloniae Thallus) 12 g, Haizao (Sargassum) 12 g, Sheng Muli (Ostreae Concha) 15 g, Tu Beimu (Bolbostemmatis Rhizoma) 12 g, Lianzirou (Nelumbinis Semen) 12 g.

After 14 months on this formula, the patient reached menopause, the uterine body shrank, and the fibroid also diminished—basically cured—and medication was stopped. In this formula, Beishashen, Maidong and Wuweizi are the Shengmai San; because the patient's yin deficiency was severe, the Renshen in Shengmai San was replaced by Beishashen, which supplements yin. Because the patient had insomnia and constipation, Fuling and Yejiaoteng were used to quiet the spirit. Yejiaoteng is the vine of Heshouwu; it both calms the spirit and aids sleep and moistens the intestines to move stool. Lianzirou clears heart fire and eliminates vexation; Nüzhenzi nourishes and supplements liver and kidney yin. Haizao, Kunbu, Sheng Muli and Tu Beimu are Xiaoluo Tang (Scrofula-Dissolving Decoction) minus Xuanshen.

Dr. Qian's prescribing here is a typical combination of supporting the righteous and dispelling the evil, and of disease differentiation with pattern differentiation. Shengmai San supports the righteous; Xiaoluo Tang dispels the evil. Combined, supporting the righteous does not retain the evil, and dispelling the evil does not damage the righteous. Only Dr. Qian used light, gentle medicinals over a very long course—14 months of medication, until menopause brought complete relief. (Gynecological fibroids also ease after menopause without treatment, and most patients would not have the patience to cooperate for so long.)

Case 2. Diao had had a fibroid for 6 years, with heavy menses and prolonged bleeding—over 10 days to stop. Before the visit she had already been menstruating for 12 days without stopping. She had abdominal pain and lower-back soreness, facial and limb edema, loose stools, frequent urination, a white greasy tongue coating, a purplish dark tongue with stasis spots, and a wiry pulse. Dr. Qian considered the pattern dual deficiency of liver and kidney with liver-qi binding and insecure Chong and Ren vessels. He decided to fortify the spleen and supplement the kidney, course the liver and resolve depression, and secure and contain the Chong and Ren.

The formula used: Dangshen (Codonopsis Radix), Fuling, Shanyao (Dioscoreae Rhizoma), Zhi Xiangfu (Cyperi Rhizoma), Sheng Muli, Chuanduan (Dipsaci Radix), Baishao (Paeoniae Alba Radix), Sangjisheng (Loranthi Herba), Nüzhenzi, Gouqizi (Lycii Fructus), Lianzirou, Sheng Longgu (Draconis Os), Tu Beimu, Wuzeigu (Sepiae Endoconcha), and others. This formula supports the righteous by fortifying the spleen and supplementing the kidney, while mainly using Xiaoluo Tang to soften hard masses and scatter nodules to remove the fibroid.

After four months, the fibroid had not enlarged, but the cycle had changed to once every 40–50 days, stopping after 5 days, and menstrual flow had dropped by two-thirds; the clinical picture was improving. Continuing along this line, the fibroid was gradually controlled. Dr. Qian's case records do not mention the fibroid being eliminated; presumably it ultimately was not.

Case 3. Xing had had a fibroid for half a year, with early periods on a 20–23 day cycle, stopping after 7 days, heavy and bright red with large clots; she had lower-back pain and soreness, fatigue, restless sleep, frequent urination, and profuse white discharge, with a fine, soft pulse. Gynecological exam showed a fibroid the size of a 12-week pregnancy. Dr. Qian considered the pattern dual deficiency of spleen and kidney with binding of phlegm and qi. He decided to fortify the spleen and supplement the kidney, regulate qi, and soften and scatter nodules.

The formula used Taizishen (Pseudostellariae Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Shanyao, Shayuanzi (Astragali Complanati Semen), Nüzhenzi, Sheng Muli, Haizao, Kunbu, Chuanduan, Ejiao (Asini Corii Colla), Wuzeigu, and others. Again, while fortifying the spleen and supplementing the kidney, Xiaoluo Tang was used to soften and scatter the fibroid. After four months, the fibroid had shrunk by half and the menstrual cycle normalized.

Case 4. After a spontaneous miscarriage, Hu was found to still have a uterus the size of a 10-week pregnancy; Western examination confirmed a uterine fibroid, and she sought TCM treatment. She reported lower-back pain, poor appetite, loose stools, a thin white tongue coating, and a deep, soft pulse.

Dr. Qian again considered dual deficiency of spleen and kidney, and decided on fortifying the spleen and harmonizing the stomach, supplementing the kidney and softening hard masses. The medicinals: Dangshen, Fuling, Gancao (Glycyrrhizae Radix), Shanyao, Sheng Muli, Biandou (Lablab Semen Album), Jupi (Citri Reticulatae Pericarpium), Kunbu, Chuanduan, Sangjisheng, Sanqi mo (Notoginseng powder), and others. This is a modified combination of Sijunzi Tang and Xiaoluo Tang.

After six doses, the patient improved and the uterine body had shrunk to the size of an 8-week pregnancy. But because taking decoctions was inconvenient, she asked Dr. Qian to make a pill formula. Dr. Qian prescribed: Dangshen 90 g, Baizhu 60 g, Fuling 120 g, Jupi 60 g, Sheng Muli 150 g, Haizao 90 g, Kunbu 90 g, Shanyao 90 g, Chuanduan 120 g, Sangjisheng 120 g. Grind all into powder, refine with honey into pills of 9 g each; take one pill morning and evening, without stopping during menstruation.

After three months on the pills, the fibroid had shrunk to the size of a 40-day pregnancy. After 11 months the uterus was normal. But she still felt discomfort during menstruation, so Dr. Qian prescribed another pill formula: Dangshen 90 g, Baizhu 90 g, Fuling 120 g, Jupi 60 g, Muxiang (Aucklandiae Radix) 60 g, Tusizi (Cuscutae Semen) 90 g, Shanyao 120 g, Sheng Muli 150 g, Gouji (Cibotii Rhizoma) 90 g, Sangjisheng 150 g. Grind all into powder, refine with honey into 9-g pills; take one morning and evening, without stopping during menstruation.

From these four cases we see that, except for the last, Dr. Qian's fibroid patients did not have the fibroids completely eliminated; the treatment improved symptoms and shrank the tumors. Running through all four cases is the logic of Xiaoluo Tang, a famous swelling-resolving, nodule-scattering formula from Yixue Xinwu (Medical Mind Awakened) by the Qing-dynasty physician Cheng Guopeng (Zhongling).

Common symptoms in fibroid patients include lower-back pain and irregular cycles. For the back pain, Dr. Qian often used kidney- and lower-back-strengthening herbs such as Sangjisheng, Chuanduan and Gouji to relieve symptoms. Then, through pattern differentiation, he judged the pattern and paired a corresponding formula to build a more targeted prescription.

Uterine fibroids are hard to eliminate; achieving removal by oral medicine alone is very difficult, and such outcomes are not to be counted on. If one can shrink the fibroid and improve symptoms, that is already quite good. Many patients must resort to surgery; if Chinese medicine can treat them and spare the knife, quite a few are willing.