Regulating the Spleen and Stomach in Cancer Patients: Gentle Rather Than Urgent, Mild Rather Than Heavy Doses

Many cancer patients suffer from digestive (spleen-stomach) complaints, with a wide range of causes. Some have always had a weak spleen and stomach; some develop digestive problems after anticancer treatment with severe side effects; and in others, digestive discomfort accumulates from long-term use of anticancer drugs with milder side effects.

All such patients can be helped with Chinese medicine. TCM's hallmark pattern-based treatment achieves the effect of "treating different diseases with the same method" for spleen-stomach weakness arising from various causes. But in my clinical experience, when addressing spleen-stomach weakness, the doctor should proceed gently rather than hastily, and use mild rather than heavy doses.

I will illustrate this view with one recent success and one failure of my own.

The successful case was a child with neuroblastoma, born in August 2012 and diagnosed at two and a half. From January 4, 2018 onward the child was treated by me purely with Chinese medicine. Before coming to me, the child had undergone Western surgery and chemotherapy and was very weak, with a low white-cell count; the treatment had not gone well, the tumor kept progressing, and by the time of the visit there were already multiple metastatic tumors in the body.

Then, under my TCM treatment using the method of "slow treatment with pills," I gave the child medicinal pills taken gradually. Before long the tumors decreased and shrank, so the parents trusted me enormously and refused any further Western treatment or any change of TCM doctor.

But since this summer, after taking the medicine the child developed pain and distending discomfort around the ribs, with nausea and vomiting. Stopping the pills made these reactions disappear. At first I suspected the child's liver function had been impaired from such prolonged medication, or that there was a gallbladder problem, so I told the parents to take the child for liver and kidney function tests and a hepatobiliary ultrasound; all were normal.

Since there was no liver or kidney damage and no gallbladder problem, the child's issue must have arisen from the very long course of medication damaging the spleen and stomach.

I therefore decided to prescribe a decoction to regulate the spleen and stomach: Chenpi (Citri Reticulatae Pericarpium) 3 g, Fabanxia (processed Pinelliae Rhizoma) 3 g, Zhuru (Bambusae Caulis in Taeniam) 3 g, Fuling (Poria) 3 g, Zhigancao (processed Glycyrrhizae Radix) 3 g, Dangshen (Codonopsis Radix) 3 g, Shengjiang (Zingiberis Rhizoma Recens) 1 slice, Dazao (Jujubae Fructus) 2 pieces.

This is a combination of Erchen Decoction and Jupi Zhuru Decoction, well suited to nausea and vomiting caused by spleen-stomach disharmony. The doses I used were all very light; after taking them the child's symptoms improved markedly and could continue on the anticancer pills.

Why did I use such tiny doses? For one thing, this was a pediatric patient; for another, patients with a weak spleen and stomach cannot tolerate strong medicinal force. Light doses work better, whereas large doses easily backfire and worsen the condition.

The failed case was a patient with extremely weak spleen and stomach after PD-1 therapy, whose symptoms worsened under my treatment.

This patient had undergone two gastric-cancer surgeries—the second being a total gastrectomy—and had been on PD-1 for almost a year. Recently the spleen and stomach became extremely weak.

The tongue coating was white and greasy, with a slight bitter taste in the mouth and poor taste sensation. There were bowel sounds after eating and drinking, pasty stools with blood, and abdominal distension. Urination was normal, though the urine was yellow in the morning and somewhat lighter during the day. The patient was averse to cold with cold hands and feet, no heartburn or acid regurgitation, and a constant sensation of qi rising upward while eating. Sweating was easy and there was back pain. There was no dizziness or headache; anemia was severe, and both legs were weak.

Taking the symptoms together, I judged the patient to present the Guizhi Jia Gegen Tang pattern and decided to treat with modified Guizhi Jia Gegen Tang: Guizhi (Cinnamomi Ramulus) 15 g, Baishao (Paeoniae Radix Alba) 15 g, Gegen (Puerariae Radix) 30 g, Dangshen 30 g, Houpo (Magnoliae Officinalis Cortex) 10 g, Fabanxia 10 g, Chenpi 10 g, Fuling 10 g, Zhigancao 10 g, Jiaomaiya (parched Hordei Fructus Germinatus) 30 g, Jiao Shenqu (parched Massa Medicata Fermentata) 6 g, Shengjiang 7 slices, Dazao 7 pieces. One dose daily, decocted in water, taken once in the morning and once in the evening after meals.

After taking the medicine just once, the patient contacted me to report excruciating pain around the navel. Far from relieving the suffering, the medication had intensified it, which filled me with shame. I quickly told the patient to stop and switched to Shenling Baizhu granules for gradual, gentle regulation.

Whether my pattern differentiation in this case was right or wrong, the doses were too large: a late-stage cancer patient with such a weak spleen and stomach immediately showed intolerance. Had the doses been light, even a formula not matching the pattern would not have provoked such a violent reaction.

Patients often develop clear discomfort after taking some decoctions, and bring me the prescription their doctor wrote, asking which herb has a severe side effect. In fact, most such formulas have no obvious side effects; it is simply that the doses are large and the patient's spleen and stomach cannot tolerate such heavy doses of Chinese medicine, which is why the discomfort appears.

Some patients and their families are also very impatient: the worse the condition, the more they want more herbs and larger doses to better control the cancer. But they do not realize that in late-stage treatment, especially once spleen-stomach weakness has appeared, the patient can no longer tolerate strong medicinal force. Taking more medicine then backfires: the body rapidly collapses, and the harm outweighs the benefit.

Hence the classic saying in medicine: sometimes doing nothing is better than doing something. Of course this is also a passive stance; careful, cautious treatment can not only relieve suffering but also give patients and families necessary psychological comfort. For late-stage cancer patients, giving up treatment entirely is not an option they and their families can accept.