Shenxian Duoming Dan: Divine Life-Saving Pill for Esophageal and Cardiac Cancer

In the Ming-dynasty physician Fang Guang's work Danxi Xin Fa Fu Yu (Supplement to the Core Traditions of Danxi), there is a formula called "Shenxian Duoming Dan" (Divine Life-Saving Pill). It consists of 13 wumei (smoked plums, soaked in water, pit removed), naosha (sal ammoniac) 2 qian (6 g), xionghuang (realgar) 2 qian (6 g), ruxiang (frankincense) 1 qian (3 g), baicaoshuang (plant soot from the kitchen chimney) 5 qian (15 g), and 49 each of green mung beans and black soybeans. In use, mash the smoked plums, powder the other medicinals, and knead them together with the plum flesh into pills the size of a marble (about the size of a cooked egg yolk). Coat with a little frankincense and cinnabar as a dressing, and dry in the shade.

This formula accumulates and dissipates concretions, breaks stasis and disperses nodules. It is indicated for qi-binding dysphagia, vomiting, and regurgitation, with constipation or stool like sheep pellets. It is taken by slowly dissolving it in the mouth. During medication avoid greasy foods, anger, and sexual exertion, and avoid all fish, goose, chicken, mutton, raw/cold foods, and heat-generating foods.

Judging from its actions and indications, the disease treated by Shenxian Duoming Dan is what modern medicine calls esophageal or cardiac (gastric cardia) cancer. In TCM this is called "dysphagia and choking" (ye ge) or "regurgitation" (fan wei). Patients often develop dysphagia, vomiting, and regurgitation due to pyloric obstruction, and most also have constipation or stool like sheep droppings.

Both naosha and xionghuang in this formula are commonly used anti-cancer Chinese medicinals.

Naosha is the crystal (or artificial product) of sal ammoniac, molecular formula NH4Cl. It is highly corrosive. TCM holds that it softens hardness and dissipates nodules, transforms putrid flesh and generates new tissue, expels phlegm, and promotes diuresis. It is used for concretions and accumulations, dysphagia and regurgitation, throat impediment with swelling and pain, welling-abscesses, scrofula, eye nebula, polyps, and warts. The author has used naosha powder alone to treat esophageal cancer patients who could not swallow, or mixed naosha with mangxiao (mirabilite) in a 1:1 ratio into a powder for patients to hold in the mouth, to relieve the symptom of late-stage esophageal cancer in which even water is hard to swallow. This medicinal has some anti-tumor effect and can quickly improve clinical symptoms, but excessive use causes a burning sensation in the stomach.

Xionghuang (realgar) is an arsenic compound. Natural realgar is a mixture whose main component is arsenic disulfide (As2S2), but it contains impurities such as arsenic trioxide (As2O3, i.e., arsenic) and is quite toxic; it must be processed before use. Realgar must not be heated during processing; it can only be purified by the water-flying method. Grind realgar to powder in a mortar, then dissolve the natural realgar in water. Realgar is light and does not dissolve easily; it floats on the surface. Skim off the floating realgar and dry in the shade to obtain pure realgar; the impurities either dissolve in water or settle to the bottom. Pure realgar is less toxic than the natural mineral and safer to use. Pure realgar has anti-tumor effects.

This formula also uses the highly toxic zhusha (cinnabar), whose main component is mercury sulfide. It too has anti-tumor effects, but its side effects are considerable, and dosage must be carefully controlled with prolonged use.

The active components of these three medicinals are all compounds found in natural minerals, and they have been used in TCM since very early times (they belong to the "stone" category of Chinese materia medica). This shows that TCM has used chemical medicinals to treat disease since ancient times; not all Chinese medicines are low-toxicity, harmless herbs.

Baicaoshuang is kitchen soot; it stops bleeding, dissipates accumulations, and detoxifies. It treats vomiting of blood, nosebleed, bloody stool, uterine bleeding, vaginal discharge, dysentery due to food accumulation, jaundice, swollen and painful throat, mouth and tongue ulcers, and chronic lower-leg ulcers. A similar medicinal is ink carbon; both are common excipients in TCM pill formulas. The author suspects that ancients added baicaoshuang or ink carbon to such pill formulas also to prevent bleeding. Some TCM physicians also use huaruishi (os draconis / petrosilite), a hemostatic mineral, as an auxiliary hemostatic.

Ruxiang (frankincense) activates blood and reduces swelling; wumei (smoked plum) engenders fluids to stop thirst, astringes the intestines to stop diarrhea, and stops bleeding. Both cardiac cancer and esophageal cancer tend to bleed, so adding appropriate hemostatics to this formula makes sense. Mung beans and black soybeans both have some diuretic action; mung beans also clear summerheat and quench thirst, while black soybeans supplement the kidney and boost qi, supporting the zheng (righteous) qi and rooting the constitution.

After esophageal or cardiac cancer causes pyloric obstruction, patients often cannot even swallow water. Shenxian Duoming Dan can effectively improve these clinical symptoms and acts fairly quickly; usually within two or three days the patient can drink water and even take some liquid food. But this formula is also highly toxic; improper use easily causes mercury or arsenic poisoning. It should not be used long-term; once symptoms improve, the patient should switch to gentler follow-up treatment, or use it for only three to five days at a time and rest for one to two weeks between courses, to prevent cumulative poisoning. Moreover, treating esophageal and cardiac cancer with TCM alone has a low effective rate; where possible, patients should consider integrated Chinese-Western medicine.

This formula should not be used long-term; once symptoms improve, patients should switch to gentler follow-up treatment, or use it for three to five days then rest one to two weeks, to prevent cumulative poisoning. Treating esophageal and cardiac cancer with TCM alone has a low effective rate; where possible, patients should consider integrated Chinese-Western medicine. Pills made according to Shenxian Duoming Dan should be stored away from light in a cool place, kept in dark sealed bottles. Keep them out of children's reach to avoid accidental poisoning. Shenxian Duoming Dan also should not be stored long; use it up quickly after preparation. Because the realgar in the formula, if kept too long, readily oxidizes into the highly toxic arsenic trioxide, reusing it later can cause fatal poisoning.