TCM Approaches to Stopping Bleeding and Enriching Blood in Cervical Cancer and Uterine Fibroids

The most typical clinical symptom of cervical cancer patients is vaginal bleeding. The bleeding volume in cervical cancer is very large; many patients, after bleeding, have hemoglobin falling below the critical point and require blood transfusions to sustain life. If not well controlled, some cervical cancer patients may even die from excessive bleeding. Uterine fibroids produce a similar situation.

Vaginal bleeding caused by cervical cancer or uterine fibroids is called "xue beng" (blood flooding) in TCM, a major gynecological emergency. When the bleeding is so heavy that the patient faints or falls unconscious, she needs emergency treatment with Du Shen Tang (Lone Ginseng Decoction): use 30–50 g of high-quality Renshen (Radix et Rhizoma Ginseng), decoct it thickly into a ginseng soup, and feed it to the patient. If financial circumstances are poor and the expensive price of ginseng cannot be afforded, one may consider substituting Huangqi Buxue Tang (Astragalus Blood-Enriching Decoction). The formula is as follows:

Huangqi Buxue Tang (Astragalus Blood-Enriching Decoction)

Huangqi (Radix Astragali) 60 g, Quan Danggui (whole Radix Angelicae Sinensis) 12 g.

In Huangqi Buxue Tang, the Huangqi may be either raw or honey-fried. If bleeding is excessive and the person is profoundly weak, consider using honey-fried Huangqi first and then raw Huangqi.

To stop bleeding, one should also urgently take Yunnan Baiyao—powder or capsules are both fine. During the bleeding period, 4 g may be taken at once, three times a day. After bleeding slows, the dose may be gradually reduced to 0.5–1 g each time.

After the emergency, routine bleeding control, bleeding prevention, and tumor-controlling treatment must follow. There are many approaches to treating cervical cancer. For cervical cancer patients with a bleeding tendency who cannot obtain effective treatment such as surgery, one may consider treating them according to TCM pattern differentiation, adopting corresponding formulas based on the patient's specific signs. Below I briefly introduce several prescriptions I commonly use in the clinic. When time permits, I will write more detailed articles comprehensively introducing my experience treating cervical cancer.

1. Gu Ben Zhi Beng Tang (Root-Strengthening Flood-Stopping Decoction)

Shudi (prepared Radix Rehmanniae) 30 g, Chao Baizhu (stir-fried Rhizoma Atractylodis Macrocephalae) 30 g, Renshen (Radix et Rhizoma Ginseng) 10 g, Sheng Huangqi (raw Radix Astragali) 10 g, Danggui (Radix Angelicae Sinensis) 15 g, Pao Jiang (blast-fried Rhizoma Zingiberis) 6 g.

Gu Ben Zhi Beng Tang comes from Fu Qingzhu's Gynecology. Its main actions are to boost qi and nourish blood, strengthen the root, and stop flooding. It is used for women with blood flooding presenting with dim and dark eyes, faintness and falling to the ground, loss of consciousness, a large but deficient pulse that becomes weak under heavy pressure—the pattern of blood loss with qi injury.

Gu Ben Zhi Beng Tang is a commonly used clinical formula for gynecological blood-collapse with qi deficiency. Bleeding caused by cervical cancer, uterine fibroids, or habitual abortion may all use it. If the patient's bleeding is profuse and urgent, Huangqi and Renshen should be used heavily; the Huangqi dose may sometimes be raised to 120 g and the Renshen dose to 30 g. One may even add processed Fuzi (Radix Aconiti Lateralis Praeparata) to rescue yang and boost qi to stem desertion. If the patient has a sallow complexion, fatigue and lassitude, shortness of breath with easy panting, and continuous menstrual leaking—attributable to central qi downward sinking—use heavy Huangqi and Renshen, and also follow the formula-building logic of Buzhong Yiqi Wan by adding Shengma (Rhizoma Cimicifugae) and Chaihu (Radix Bupleuri) to raise yang and lift the sinking; Chaihu should be used in a small dose, 1–6 g being sufficient. If the patient has sore and weak lower back and knees and continuous trickling menstrual blood, consider adding Tusizi (Semen Cuscutae), Chuan Xuduan (Radix Dipsaci), and Shanzhuyu (Fructus Corni) to supplement the kidney, benefit essence, and secure the Chong vessel.

One must also inspect the color of the bleeding. If the color is purplish-dark and deep red with clots, the patient has lower abdominal pain, the tongue body is dim or has stasis spots along the edges, and sublingual veins are engorged—this is lower abdominal blood stasis syndrome. One may consider adding herbs that resolve stasis and stop bleeding to the base formula, such as Sanqi Fen (powdered Radix et Rhizoma Notoginseng), Puhuang Tan (Pollen Typhae carbonisatum), and Taoren (Semen Persicae). If blood deficiency generates heat with thirst and a liking for fluids, add Shengdi (Radix Rehmanniae), Nüzhenzi (Fructus Ligustri Lucidi), Mohanlian (Herba Ecliptae), and Guijia (Carapax et Plastrum Testudinis) to nourish yin, subdue yang, cool blood, and stop bleeding. If blood loss has been prolonged, add Ejiao (Colla Corii Asini) and prepared Shouwu (Radix Polygoni Multiflori Praeparata) to nourish yin and enrich blood.

2. Qing Re Gu Jing Tang (Heat-Clearing Menses-Securing Decoction)

Shengdi (Radix Rehmanniae) 12 g, Digupi (Cortex Lycii) 12 g, Diyu (Radix Sanguisorbae) 12 g, Ejiao (Colla Corii Asini) 12 g, Oujie (Nodus Nelumbinis Rhizomatis) 12 g, Chen Zong Tan (Petiolus Trachycarpi carbonisatus) 12 g, Guijia (Carapax et Plastrum Testudinis) 20 g, Muli (Concha Ostreae) 20 g, Zhizi (Fructus Gardeniae) 10 g, Huangqin (Radix Scutellariae) 10 g, Gancao (Radix et Rhizoma Glycyrrhizae) 6 g.

This formula comes from the Concise TCM Gynecology. Its action is to clear heat and cool blood. Clinically it is used when bleeding comes at irregular times, in large amounts and of thick texture, dark red in color, with a red tongue, rapid pulse, and yellow greasy coating.

Clinically this formula is commonly used to treat irregular vaginal bleeding due to climacteric dysfunctional uterine bleeding, prolonged menstruation, uterine fibroids, corpus uteri cancer, cervical cancer, and the like—cases of flooding and spotting belonging to the pattern of heat causing chaotic blood movement. It may also be used for side effects caused by intrauterine devices.

If the patient belongs to heat scorching and yin injury, with dry throat and mouth, a red tongue with scant coating, add Shashen (Radix Glehniae/Adenophorae), Maidong (Radix Ophiopogonis), and Xuanshen (Radix Scrophulariae) to nourish yin and clear heat. If the patient has liver qi stagnation with chest and abdominal distending pain, irritability and easy anger, add Longdancao (Radix et Rhizoma Gentianae) and Chaihu (Radix Bupleuri) to soothe the liver and move qi. If the patient has pain in the lower or little abdomen, add Huangbai (Cortex Phellodendri Chinensis) and Yinchen (Herba Artemisiae Scopariae) to clear heat and drain dampness. The herbs in the formula may be modified according to the patient's specific situation. The Guijia and Muli in this formula should be decocted first.

3. Zeng Ye Tang with Additions (my own empirical formula)

Xuanshen (Radix Scrophulariae) 30 g, Shengdi (Radix Rehmanniae) 24 g, Maidong (Radix Ophiopogonis) 24 g, Baishao (Radix Paeoniae Alba) 12 g, Danggui (Radix Angelicae Sinensis) 12 g, Qiancao (Radix Rubiae) 20 g, Xianhecao (Herba Agrimoniae) 30 g, Puhuang Tan (Pollen Typhae carbonisatum) 12 g, Dahuang Tan (Radix et Rhizoma Rhei carbonisatus) 12 g.

This is my own empirical formula, used for cervical cancer and intestinal cancer presenting with constipation, bloody stool, and vaginal bleeding. When cervical cancer progresses to a certain degree, or after modern Western medical treatment, a considerable proportion of patients develop constipation. As soon as the patient strains at stool, fresh blood gushes from the vagina or anus; the sight is extremely frightening. In treatment, if the patient shows a red tongue with yellow coating, rapid pulse, and faint spots and rashes, this formula may be used to cool blood and stop bleeding, moisten the intestines and free the stool—treating the branch first.

In addition, among Chinese medicinal herbs with relatively strong anti-cervical-cancer effects are Kushen (Radix Sophorae Flavescentis), Shiwei (Folium Pyrrosiae), Tengligen (Radix Actinidiae Aristolochioideae), Shanqiaochong (Mylabris/Eupolyphaga-related insects), Banmao (Mylabris), Banzhilian (Herba Scutellariae Barbatae), and Baihuasheshecao (Herba Hedyotidis Diffusae). In formulas treating cervical cancer bleeding, corresponding anti-cancer herbs may be appropriately added to enhance the clinical effect.