Simplifying the Complex: Organizing My Approach to Treating Cancer

These days, under the guidance of a respected elder (a TCM chief physician), I have carefully reviewed my insights from treating cancer over the years and written an outline-style summary. Under his guidance, this manuscript went through more than a dozen revisions before it was finalized. It is not merely a simple document; it is also the essence of my approach to treating cancer. Through this closed-door summary, I have clarified my thinking on treating cancer, and my teacher has elevated my understanding of TCM cancer treatment to a new level. I have now slightly revised this manuscript into the present article.

I entered university in 1998. When I started college, my older brother was already in his third year; both of us attended key universities, so our family struggled to support us through school. But my mother, my brother, and I were all weak and prone to illness, and in 1998 my hometown was hit by floods, leaving the family in great difficulty. To ease the family's financial pressure, I dropped out of university and worked while studying TCM on my own. Later I also took apprenticeship under the vice president of our local TCM hospital; under my master's guidance I systematically studied TCM theory, and at the same time took online distance-learning apprenticeship courses issued by the State Administration of TCM—courses specifically designed for TCM apprentices like us preparing for the medical licensing exam.

My mother was a gastric cancer patient. While caring for her, I witnessed the suffering of cancer patients and resolved to make my mark in TCM treatment of cancer, thus embarking on the path of studying and exploring TCM anticancer therapy.

Cancer is a frequently occurring disease in contemporary society with a poor prognosis. Treating cancer requires multidisciplinary cooperation, including TCM. Although ancient China had no specific disease name of "cancer," the diseases recorded in ancient texts—such as jiju (accumulation), ru yan (breast rock), ye ge (dysphagia), shi rong (lost glory), luo li (scrofula), shen yan fan hua (kidney rock turned flower), xi ben (gathering binge), and jiao chang (crossed intestine)—have clinical symptoms similar to those of modern oncology. Ancient physicians accumulated rich experience in treating cancer through practice, with certain effects in improving patients' symptoms and prolonging survival. As the Ming-dynasty physician Chen Shigong said, treating these patients helps them "prolong life while carrying the disease."

Modern TCM has gone further than the ancients in cancer research. Contemporary TCM, borrowing research methods from modern pharmacology and biology, has discovered the anticancer mechanisms of certain Chinese herbs and formulas, providing a scientific basis for TCM cancer treatment. For example, it has been found that arsenic can induce apoptosis in leukemia cells, Xihuang Wan can inhibit tumor angiogenesis, Cinobufacin and Mylabris can inhibit cancer cell proliferation, and Spirobolus can block mitosis in cancer cells. These studies have contributed to improving the efficacy of TCM anticancer therapy.

But in treating cancer, TCM should still emphasize pattern differentiation and treatment (bian zheng lun zhi) and disease differentiation and treatment (bian bing lun zhi), with particular attention to "formula-pattern" (fang zheng) and "herb-pattern" (yao zheng) correspondences. Through comprehensive assessment of the four examinations, one determines which formula's and which herbs' indications the patient presents. Professor Hu Xishu said: "In TCM pattern differentiation, we do not merely differentiate the six channels and eight principles; more importantly, through them we differentiate the indications for formulas and herbs." Grasping the indications for formulas and herbs is the key to improving clinical efficacy. Therefore, in treating cancer I pay special attention to differentiating the patient's "formula-pattern." If the patient presents the Xihuang Wan pattern, use Xihuang Wan; if the patient presents the Guipi Tang pattern, use Guipi Tang; if multiple formulas' indications are present, combine several formulas.

I attach great importance to combining pattern differentiation with disease differentiation. Cancer is divided into early, middle, and late stages. In the early stage, healthy qi deficiency is not evident and excess pathogen predominates; in the middle stage, healthy qi deficiency gradually grows, and the tumor enlarges, hardens, and metastasizes; in the late stage, healthy qi is weak and pathogen hyperactive, often accompanied by complications such as cancer fever, cancer pain, ascites, and pleural effusion. The treatment principles and methods differ by stage: early stage primarily dispels pathogen with supporting healthy qi as secondary; middle stage balances both, giving equal weight; late stage primarily supports healthy qi, with moderate pathogen dispelling.

Each patient's age, sex, personality, constitution, habits, and living and working environment also differ. Therefore cancer treatment should follow the principle of "treating according to the person, the time, and the place" (san yin zhi yi), applying individualized treatment to different patients, embodying the spirit of TCM pattern differentiation and "treating the same disease differently." Moreover, modern patients have usually undergone Western treatment before seeking TCM, with many side effects; therefore TCM treatment of cancer patients should follow the principles of "treating according to the pattern" and "for this pattern, use this herb," prescribing according to the patient's specific situation.

But TCM holds that the basic pathogenesis of cancer is deficiency of healthy qi, dysfunction of zang-fu organs, stagnation of qi movement, and intertwining of phlegm and stasis, gradually forming a mass over time. Its pathological nature is deficiency of healthy qi and excess pathogen, an intermingling of deficiency and excess: deficiency systemically, excess locally. The main disease causes are qi stagnation, phlegm turbidity, damp obstruction, blood stasis, and toxin accumulation. In these respects, different patients also share common ground; therefore treating cancer must fully consider these commonalities. Following the principles of "disease differentiation and treatment" and "treating different diseases with the same method," one uses approaches such as supporting healthy qi and rooting it firmly (fu zheng gu ben), soothing the liver and regulating qi (shu gan li qi), activating blood and resolving stasis (huo xue hua yu), dissipating phlegm and dispersing nodules (xiao tan san jie), softening and dispersing hard masses (ruan jian san jie), promoting urination and percolating dampness (li shui shen shi), using poison to attack poison (yi du gong du), warming yang and dispersing nodules (wen yang san jie), or clearing heat and resolving toxin (qing re jie du), applying essentially the same therapeutic method to different patients.

Certain herbs are effective against many types of cancer. For example, Xihuang Wan's main functions are clearing heat and resolving toxin, activating blood and resolving stasis, reducing swelling and dispersing nodules, and anticancer analgesia. As long as the patient presents the pattern of intermingled stasis and heat, regardless of which cancer they have or whether their clinical symptoms differ, Xihuang Wan may be used alongside other medications.

For example, among the medical cases I have published, there are two mesothelioma patients: one is Li, with abdominal mesothelioma; the other is Jiang, with thoracic mesothelioma. At their visits, Li had ascites and Jiang Shufeng had pleural effusion; both had elevated tumor marker CA125, but their symptoms were not entirely the same.

Li had a hollow (kou) pulse, a purple tongue with thin coating, cold hands and feet, scanty urine, loose stools, and an abdomen distended like a pregnant woman. He had previously been treated by other TCM physicians with diuretic and edema-reducing herbs without effect, and taking Jinkui Shenqi Wan on his own had also failed. Through comprehensive four-examination assessment, I judged him to have yang deficiency and blood deficiency, corresponding to what the Qing-dynasty physician Wang Hongxu in Waike Zhengzhi Quansheng Ji called a "yin abscess" (yin ju)—an indication for Yanghe Tang. So I treated him primarily with Yanghe Tang. At the same time, I regularly adjusted the prescription based on changes in his clinical symptoms: as the pattern changed, the formula changed, rather than rigidly sticking to one formula.

Jiang, on the other hand, had a wiry and slippery pulse, a yellow, thick, greasy tongue coating, fatigue, dry mouth, cough, panting, lower limb edema, chest tightness, chest pain, aversion to wind, spontaneous sweating, and abdominal distension. She could no longer walk on her own and had to be brought in by family pushing her in a wheelchair. Judging from symptoms such as aversion to wind, spontaneous sweating, edema, and heaviness of the body, I considered this the Fangji Huangqi Tang pattern from the Jin Gui Yao Lue, so I treated her primarily with Fangji Huangqi Tang. Thereafter, as her condition changed, I continuously adjusted the medication approach to solve new problems.

Both patients also presented the intermingled cold-heat and intertwined phlegm-stasis pattern, so I put both on Xihuang Wan. As a result, both patients responded fairly well: the pleural effusion and ascites quickly resolved, the tumors shrank, and tumor marker CA125 fell to within normal range.

Li first came to me for treatment on August 8, 2013. At that time CA125 was 66 (reference 0–35), with multiple hepatic nodules, the largest measuring 1.2×0.8 cm. After two months of treatment, follow-up showed CA125 had dropped to 34, within normal range, and the largest hepatic nodule had shrunk to 0.8×0.8 cm. Thereafter, although the tumor had not completely resolved, it was controlled and stopped growing, and the patient could live and work normally. Li survived for more than six years after I began treating him. In 2017, believing he was safe, he stopped medication on his own, leading to tumor recurrence. After recurrence he came back to me for treatment, but his family felt the pace was too slow and used other treatment methods; the patient developed severe side effects under those other therapies and died in 2019.

Jiang began treatment with me on February 21, 2018. After two months of treatment, pleural effusion markedly decreased, CA125 dropped substantially, panting ceased, and she could walk more than ten thousand steps a day for exercise. During continued treatment, the tumor at one point shrank by about half, but because the condition was ultimately severe, she died in 2021. Most mesothelioma patients do not survive two years; these two patients survived longer than typical patients with the same disease and had a relatively good quality of life, and their families were satisfied with the efficacy.

The treatment of these two patients fully demonstrates the importance in cancer treatment of the TCM ideas of "formula-pattern," "pattern differentiation and treatment," and "disease differentiation and treatment."

Laozi said that governing a large state is like cooking small delicacies; a physician treating serious illness should likewise cook small delicacies. Cancer is hard to treat; to treat it safely and effectively, one must be especially careful and meticulous. Most anticancer drugs have certain side effects, the effective dose and the toxic dose are close, and the course of cancer treatment is long; long-term medication easily leads to cumulative poisoning. Therefore, when I prescribe for patients, I: first, start with a small dose and, if the patient has no discomfort, gradually increase to the effective dose; second, have them take liver-protective drugs at the same time; third, have them take medicine for four or five days and then rest for two or three days; fourth, have them regularly recheck liver and kidney function, and adjust the medication method immediately upon any abnormality to ensure safety.

Treating cancer relies not on "trick moves" but on the physician's basic skills and the ability to simplify the complex. Only through deep accumulation, diligent thinking, and constant summarization can a physician improve clinical efficacy. Late-stage cancer patients are mostly seriously ill with ever-changing symptoms, and some have no therapeutic value left; achieving results in such patients is no easy task. When a patient's condition is complex and there are too many difficult problems, a physician can easily become uncertain, doubting their own approach and ending up with no effect. Holding fast to the above treatment principles, reading and reviewing more in ordinary times, building solid basic skills, and simplifying complex problems in clinical practice—only thus can clinical efficacy be improved.