Two Case Histories of Shen Shaogong Treating Esophageal Cancer
I previously wrote an article, "An Outline of Professor Shen Shaogong's Approach to Treating Malignant Tumors," introducing his main approach. Now I present his case records of treating malignant tumors, to learn how he treated them.
This article presents two of his cases of esophageal cancer.
Case One: A 58-year-old esophageal cancer patient, surnamed Wang.
The patient first consulted Professor Shen Shaogong on August 22, 2003. For the previous half year he had felt obstruction when eating and had sought care at many places without effect. Esophageal barium X-ray and CT scans diagnosed mid-esophageal cancer; esophageal exfoliative cytology diagnosed squamous carcinoma. Esophageal barium X-ray showed a 4.5-cm filling defect in the middle segment, loss of wall peristalsis, and disorganized mucosa; clinical stage was 2a. History taking revealed dysphagia, esophageal pain and poor appetite. The tongue was dark, the coating yellow and greasy, and the pulse wiry and fine. The patient was emaciated and haggard.
Professor Shen differentiated: this patient had disharmony of the spleen and stomach, with water and grain stagnating and transforming into phlegm-turbidity - hence the yellow greasy coating; phlegm-turbidity obstructed the qi dynamic, imbalance of yin-yang ascent and descent causing dysphagia; phlegm-toxin damaged the collaterals and qi stagnated, causing esophageal pain. The central earth was disharmonious and ascent-descent lost its command. Overall, this was the pattern of spleen-stomach disharmony with phlegm obstruction and upward counterflow. Treatment was to resolve phlegm and downbear counterflow, harmonize the spleen and stomach, using a modified Wendan Tang.
Initial prescription: Yinchen 15 g (added later), Zexie 10 g, Zhuru 10 g, Zhiqiao 10 g, Fuling 10 g, Chenpi 10 g, Shichangpu 10 g, Yujin 10 g, Xianhecao 10 g, Sheng Yiyiren 10 g, Gualou 30 g, Baihua Shegancao 30 g, Chuanlianzi (Toosendan Fructus) 10 g, Yuanhu (Corydalis Rhizoma) 10 g, Laifuzi 10 g, Danshen 30 g. Fourteen doses, one dose daily, decocted, divided into two doses.
After two weeks, dysphagia and pain lessened, but appetite remained poor, stools were unsatisfactory, and the coating was thick and greasy. At the second visit, Sheng Muli (raw Ostreae Concha), Sheng Longgu (raw Os Draconis) and Haigeqiao (Meretricis/Cyclinae Concha) were added to strengthen phlegm-resolving. After another two weeks, the yellow greasy coating improved. The three above herbs were then removed, and Sanqi Fen, Sheng Zheshi and Jiao Sanxian (fried three mature herbs) were added to strengthen stomach-harmonizing and counterflow-downbearing. After three consecutive months, the patient had no further dysphagia and esophageal pain had basically disappeared. Esophageal barium study showed the mid-segment filling defect had shortened by about 2.1 cm. He was then told to take the medicine once nightly to consolidate the effect, no longer twice daily. The patient continued treatment for two years; as of the publication of this case, he was still receiving Professor Shen's treatment.
Case Two: A 78-year-old male esophageal cancer patient, surnamed Zhang.
This patient presented in May 2002 to a major hospital with dry mouth, progressive dysphagia and chest pain. Esophageal barium X-ray showed irregular narrowing of the mid-esophageal lumen, a 5.4-cm filling defect, loss of wall peristalsis, and proximal barium retention; esophageal mucosal exfoliative cytology diagnosed squamous cell carcinoma. CT showed an indistinct boundary between the wall and surrounding tissues. Diagnosis was mid-esophageal squamous carcinoma, clinically staged as intermediate. After surgery he received six chemotherapy sessions, became frail, and could not continue Western treatment, so he came to Professor Shen.
At presentation the tongue was dark red with ecchymoses on the edges, the coating thin and yellow, and the pulse deep and fine. Professor Shen considered that, after surgery and chemotherapy, the patient's healthy qi had been damaged, with insufficient propulsion causing obstruction of the heart vessels; the dark red tongue with marginal ecchymoses indicated blood stasis obstruction; the heart and kidney were damaged, with heart-qi deficiency and kidney-yin insufficiency, hence palpitations, shortness of breath, poor sleep, sore lower back and weak legs, and a deep fine pulse. The disease location was the heart and kidney; the pattern was heart-kidney deficiency with heart-vessel stasis. Treatment was to supplement and boost the heart and kidney, resolve stasis and unblock the vessels, using a modified Qiju Dihuang Tang.
Initial prescription:
Gouqizi 10 g, Bai Juhua (white Chrysanthemum) 10 g, Sheng Duzhong 10 g, Sangjisheng 10 g, Shengdi 10 g, Danggui 10 g, Huangjing 10 g, Xianhecao 10 g, Sheng Yiyiren 10 g, Baihua Shegancao 30 g, Chishao 10 g, Mudanpi 10 g, Chuanxiong 10 g, Danshen 30 g, Shichangpu 10 g, Yujin 10 g, Sheng Jineijin (raw Galli Gigerii Endothelium Corneum) 30 g, Sheng Shanzha (raw Crataegi Fructus) 15 g.
One dose daily, decocted, divided into two doses. Additionally, Qiju Dihuang capsules, 5 capsules each time, twice daily, swallowed with water.
After two consecutive weeks, lower back soreness and palpitations lessened, with occasional belching and no dysphagia. Thereafter treatment continued along this basic approach, with occasional minor adjustments according to symptom changes, for nine months. The patient's mental state improved and symptoms basically disappeared; repeat esophageal barium study showed the mid-segment filling defect had shrunk to 3.1 cm. He was told to switch to taking the medicine once nightly and to persist long-term to consolidate the effect.
These two esophageal cancer patients treated by Professor Shen Shaogong both improved under his care and achieved survival with cancer. Professor Shen's dosing was very light, fully reflecting his characteristic of leading cancer treatment with pattern differentiation. Combining his empirical cancer formula with the symptomatic, pattern-based "unit" medications, he assembled formulas that integrated disease differentiation with pattern differentiation; seeking no quick success and valuing medication safety, this is a seasoned, prudent approach. In today's era of tense doctor-patient disputes, such medication achieves some efficacy while reducing disputes, and is also a lighter economic burden on patients - something worth learning from.