Qige San (Obstruction-Opening Powder) for Esophagitis and Early Esophageal Cancer

Qige San (Obstruction-Opening Powder) comes from Yixue Xinwu (Medical Insights) by the Qing-dynasty physician Cheng Guopeng (courtesy name Zhongling). In the "dysphagia and choking" (ye ge) section of Yixue Xinwu, Qige San is described as a formula that "opens dysphagia and obstruction, and has repeatedly proved effective."

The original formula: Glehnia root (Shashen) 3 qian, Salvia (Danshen) 3 qian, Poria (Fuling) 1 qian, Fritillaria (Chuanbeimu, core removed) 1 qian 5 fen, Curcuma (Yujin) 5 fen, Amomum shell (Sharen Ke) 4 fen, lotus leaf stalks (Heyedi) 2, rice husk (Chutou Kang) 5 fen. Decoct in water.

Here chutou kang is rice bran, which is rich in vitamins and trace elements and very nutritious; in the countryside it is used to feed pigs. Rice bran can be used as medicine; it calms the spirit and treats insomnia. TCM also holds that it resolves constraint and phlegm, moistens dryness and downbears qi, which is why Qige San uses it.

Ye ge is a TCM disease name whose typical symptoms are inability to swallow food, or immediate vomiting after eating; it is seen in modern medicine in esophageal cancer, cardiac carcinoma, cardial spasm, esophageal diverticulum, esophageal neurosis and esophagitis. Radiation esophagitis after radiotherapy in cancer patients also belongs to ye ge.

Cheng Guopeng held that ye ge is a dryness syndrome requiring moistening herbs. Hence the formula uses Glehnia and Fritillaria, which moisten dryness. Cheng wrote: "Every case of ye ge comes down to the four words 'dryness of the stomach cavity.' When dryness is in the upper stomach, fluids can pass but food cannot enter. When dryness is in the lower stomach, food may enter but is soon vomited back. Since the stomach is already dry, treating it with drying herbs would only worsen the dryness; thus the Major and Minor Banxia Decoctions are contraindicated in ye ge. I have used Qige San to open the obstruction, supplemented by Four Gentlemen Decoction (Sijunzi Tang) to regulate the spleen and stomach. Cases with constraint are treated with Free Wanderer Powder (Xiaoyao San)."

From Cheng's original text, his purpose in using Qige San was to relieve the inability to swallow or immediate vomiting after eating in ye ge patients. In my experience, mild conditions such as esophagitis may be cured with Qige San alone, while serious diseases like esophageal or cardiac carcinoma cannot be treated by Qige San alone. But for early-stage esophageal and cardiac carcinoma patients, this formula can relieve clinical symptoms and enable them to eat.

Cheng himself listed modifications: for weakness, add ginseng. If ye ge is accompanied by worm accumulation, add Coptis-like Picrorhiza (Huanglian) and Ulmus macrocarpa (Yuyi), or even use Hezhou Realgar Powder (Xionghuang, Gualou stem, and Adzuki bean in equal parts as a powder) to induce vomiting. The "worm accumulation" Cheng describes resembles esophageal cancer. Realgar is an arsenic preparation and does indeed have anticancer effects. If blood accumulation is present, add Peach kernel (Taoren) and Safflower (Honghua), or drink raw Chinese chive juice separately. If phlegm accumulation is present, add Broad tangerine red (Guang Juhong). If food accumulation is present, add Radish seed (Laifuzi), malt (Maiya) and hawthorn (Shanzha).

Qige San has antitumor effects; modern pharmacology confirms it shows strong cytotoxic activity against tumor cell lines, with a clear dose-effect relationship. After 72 hours of Qige San treatment, some cells showed features of apoptosis such as cytoplasmic vacuolization, pyknosis, marginalization and fragmentation of the nucleus, and apoptotic body formation, and the induction of K562 cell apoptosis was time-dependent.

So clinically Qige San may serve as the base decoction, to which other herbs active against esophageal cancer are added to compose a decoction suited to the patient. Clinicians may follow this approach based on the patient's specific symptoms. But arsenic-containing herbs such as realgar are now mostly banned and hard to obtain.