Case Study: Shi Jinmo Treating a Lymphadenoma
The Shi Jinmo Linchuang Jingyan Ji (Collected Clinical Experience of Shi Jinmo—one of the late “Four Great Physicians of Beijing”) records a case of Shi treating a lymphadenoma in a woman surnamed Ding. Ms. Ding, 19, had developed a tumor on the left side of her neck in September of the year before her visit; it grew rapidly and did not respond to treatment. The pathology department of Shandong Medical College diagnosed cervical lymphadenoma. Her diet and excretions were essentially normal, but the tumor had ulcerated with slight bleeding; her menstrual period was irregular, the tongue coating was thin and white, and the pulse was deep and rough.
Shi Jinmo held that although the tumor had ulcerated, there was no suppuration, so it still needed swelling reduction and hardness-dissolving. The initial prescription: Gleditsiae Spina (Zaojiaoci, tip removed) 6 g, raw deer antler (Sheng Lujiao) 20 g, Cremastrae seu Pleionis (Shancigu) 10 g, processed pangolin scale (Pao Jiazhu) 10 g (note: Jiazhu is processed Manis squama, now strictly prohibited; it may be replaced by Polygoni orientalis Fructus (Shuihonghuazi) 10 g), Sargassum (Haizao) 10 g, Eckloniae (Kunbu) 10 g, Prunellae Spica (Xiakucao) 15 g, Sichuan Curcuma (Chuan Yujin) 10 g, Arctii Fructus (Dali Zi, i.e. Niubangzi) 6 g, Forsythia (Lianqiao) 10 g, Lonicerae Flos (Rendonghua, i.e. Jinyinhua) 10 g, bitter Platycodon 5 g, Thistle (Xiaoji) 10 g, Lonicerae Caulis (Rendongteng) 10 g. Decoct in water; in addition, take Sanqi powder 3 g washed down in two portions.
After six doses the patient’s tumor had shrunk. She wanted to return to Shandong for treatment and asked Shi for a formula she could use for a while; he adjusted the prescription as follows: Gleditsiae Spina 6 g (tip removed), Cremastra 10 g, processed pangolin scale 10 g (now replaced by Shuihonghuazi 10 g), Sargassum 10 g, Ecklonia 10 g, Prunellae Spica 15 g, Sichuan Curcuma 10 g, Arctii Fructus 6 g, Lonicerae Flos 10 g, bitter Platycodon 5 g, Thistle 10 g, Lonicerae Caulis 10 g, Sichuan Fritillaria (Chuanbeimu) 10 g (note: if Chuanbeimu is too expensive, use Zhejiang Fritillaria instead), Persicae Semen (Taoren) 6 g, fried Moutan 10 g, Scrophularia (Xuanshen) 12 g. Decoct in water; in addition, take Sanqi powder 3 g in two portions.
Two months on the second prescription, she also received physical therapy in Shandong. After two months the tumor had essentially disappeared and she was in good condition. Following the ancient maxim “if it works, do not change the formula,” Shi told her to keep taking the second prescription until the tumor was fully gone.
Lymphadenoma is a benign tumor, but treatment is still complex. Shi treated such cases by resolving swelling and softening hardness. The Gleditsia spine, deer antler, pangolin scale, Cremastra, Fritillaria, Prunella, Sargassum, and Ecklonia in the formula all reduce swelling and disperse nodules; they are commonly used in TCM for benign and malignant tumors.
Shi Jinmo was also fond of adding Sanqi powder to support the other herbs. In his lifetime, when treating benign or malignant tumors he always added a dose of Sanqi powder, with obvious effect. Sanqi stops bleeding, activates blood, relieves pain, and reduces swelling; it is a staple in oncology. But its dose must be controlled: too much may induce tumor emboli. As a rule, Sanqi powder should not exceed 3 g per dose washed down.
Shi’s formulas are simple and clear in logic, fully reflecting his principle of treating tumor-type disease by differentiating the disease first and the pattern second. The treatment logic boils down to clearing heat and detoxifying, softening hardness and dispersing nodules, and breaking blood and reducing swelling; in this case he used Forsythia, Moutan, Scrophularia, Lonicera flower, and Lonicera vine to clear heat and detoxify, supporting the nodule-dispersing herbs.
Tumors, benign or malignant, usually demand long courses; patients and families should adjust their expectations. Shi was famous for adhering to “if it works, do not change the formula,” and here too he told the patient or family not to alter the prescription casually but to observe the effect over time. Nowadays many patients or families want the physician to see the patient and adjust the formula frequently; changing prescriptions too often actually harms the patient.