Sanren Tang: A Common Summer Fever-Reducing Formula for Cancer Patients

In TCM, the formulas used to treat fever differ by season. TCM holds that the human body corresponds to the four seasons, and that spring, summer, autumn, and winter each have their own climatic characteristics, so the use of medicine must vary with these different climates. The general principle is: "do not use acrid-warming medicines in spring and summer, and do not use cooling medicines in autumn and winter."

It is now summer, and I will introduce to you in turn several fever-reducing formulas commonly used in summer.

Summer is hot and very damp, so patterns of damp-heat or damp-warmth are common, and many patients easily develop high fever. In TCM terms, this is dampness and heat jointly attacking; the warm-disease school describes dampness and heat mixed together as being "like oil mixed into flour"—clinging and hard to separate. So treatment must simultaneously drain dampness and clear heat; only thus can the fever be brought down. Representative formulas include Yinchen Wuling San and Sanren Tang.

Today I will introduce Sanren Tang.

Sanren Tang (Three-Seed Decoction) gets its name because three of its ingredients are "seeds"; in Chinese materia medica, "ren" generally refers to the kernels of plants. The main ingredients of Sanren Tang are: coix seed, cardamom kernel, apricot kernel, talc, bamboo leaf, magnolia bark, processed pinellia, tetrapanax medulla, and magnolia bark.

The dose I commonly use for adult patients is: coix seed 18g, talc 18g, apricot kernel 10g, processed pinellia 10g, tetrapanax 6g, white cardamom 6g, bamboo leaf 6g, magnolia bark 6g. Children may be reduced to two-thirds or half of the adult dose.

But this dose may be adjusted appropriately according to the patient's specific condition. If dampness clearly predominates over heat, with sticky stools and short, dark urine, the dampness-draining coix seed, talc, and tetrapanax may be moderately increased. If heat predominates over dampness, with restlessness, the heat-clearing bamboo leaf may be increased. If abdominal distension is marked, white cardamom and magnolia bark may be increased.

If it is the early stage of damp-warmth with aversion to cold and heaviness of the body, one may add huoxiang (agastache) and peilan (eupatorium), 6–10g each. If dampness is lurking in the pleural diaphragm with alternating chills and fever, add qinghao (artemisia annua, added later) and caoguo (tsaoko) to harmonize and transform dampness. If qi-phase heat is severe with high fever and vexed thirst, add raw gypsum to clear interior heat. For acute icteric hepatitis and cholecystitis flaring in summer with fever, jaundice, and hypochondriac pain, add yinchen (artemisia capillaris) and yanhusuo (corydalis). If appetite is poor and the stools are sticky and reluctant to pass, add shenqu (medicated leaven), maiya (germinated barley), binglang (areca), and jineijin (chicken gizzard lining). If a patient with pyelonephritis presents with severe damp-heat and eyelid edema, add cheqianzi (plantago seed), zhuling (polyporus), and huainiuxi (achyranthes) to this formula to promote urination and reduce swelling. If sinusitis presents with blocked nose, add cangerzi (xanthium) and xinyihua (magnolia flower) as appropriate to unblock the nasal orifices. If the upper jiao is hot with purulent yellow nasal discharge, add scutellaria and honeysuckle as appropriate to clear heat and remove turbidity.

I once saw Professor Pei Yongqing of Beijing University of Chinese Medicine use Sanren Tang to treat cancer fever. After Professor Pei's modifications and additions, not only was the stubborn cancer fever brought down, but some tumor patients' tumors also shrank along with it. I once referred several cancer-fever patients who had stumped me to Professor Pei, with excellent results.

Professor Pei often combines Sanren Tang with Jiangjiang San (Ascending-Descending Powder) and Didang Tang (Subdue-the-Flow Decoction) to treat cancer patients, using this approach whether or not there is cancer fever; some patients have responded well. I later learned Professor Pei's approach and used it on some cancer patients, with some effect, though I am not as skillful as he is.

Cancer fever in all four seasons is treated by Western doctors with a uniform approach, but in TCM terms, summer cancer fever is still mostly a damp-heat or damp-warmth pattern.

In addition, when using fever medicine, give a dose every two hours; two packets of medicine may be used in a day, each packet decocted twice and taken in two divided doses. This works better to reduce the fever. After the fever subsides, continue taking one packet a day, divided into 2–3 doses, gradually tapering off and maintaining it for a while; the effect is better.

Treating cancer fever requires patience; sometimes a patient needs 10–30 days of medication before the cancer fever is basically brought under control. So as soon as the patient's cancer fever eases and pain lessens, the patient and family must patiently adhere to the formula and not give up halfway.