TCM Cancer Treatment: "Dispersion Is Esteemed, Ulceration Is Feared"

In the book Waike Zhengzhi Quansheng Ji (Complete Collection of Surgery Patterns and Treatment), Wang Hongxu, in treating yong-ju (the swellings and abscesses of old surgery—i.e., what are today called tumors, both benign and malignant), states a principle: "dispersion is esteemed, support-drainage is feared." Previously, these eight words meant nothing to me personally.

But after seeing with my own eyes one breast-cancer patient and one penile-cancer patient with inguinal lymph-node metastasis whose tumors ulcerated, I deeply felt this. I also deeply understood why the ancients said, "Unless a physician's family has practiced medicine for three generations, do not take their medicine." An inexperienced TCM doctor with shallow learning truly harms people; medicine concerns life and death, and a physician's practical ability is far too important. These two patients, after the TCM doctors they found used highly corrosive Chinese herbs and purulent moxibustion and similar methods, both had their tumors ulcerate; the wounds were large and would not heal for a long time. No method could make the patients' wounds heal, and they kept spreading, leaving the patients with very poor quality of life in their final stage.

Observing the outside reveals the inside: from external tumors one can see that internal tumors, once ulcerated, are much the same. Once a tumor is treated to this degree, aftercare is extremely difficult. In treating yong-ju, ancient TCM spoke of the "seven evil signs" (qi e); one of them is "shape like a peeled eel." A "peeled eel" means an eel skinned alive; the everted flesh at the lesion looks exactly like an eel after its skin is removed. When this appears, the patient has nine deaths and one life, with almost no hope of cure.

Therefore Wang Hongxu, in treating tumors, especially emphasized using the dispersion method (xiaofa). The formulas handed down in Wang Hongxu's family—Yanghe Tang (Yang-Soaking Decoction), Xihuang Wan (Vitality-Restoring Pill), Xiaojin Dan (Little Golden Pill), Meihua Dianshe Dan (Plum-Blossom Tongue-Pointing Pill), and Xingxiao Wan (Awakening-Dissipating Pill) recorded in Waike Zhengzong—are all classic agents for the dispersion treatment of tumors, and remain widely used clinically today.

In late-stage cancer patients, what old medical books describe as "the root base firm and fixed, immovable" is in fact the tumor spreading to surrounding tissue and adhering to it. In such a situation, using the support-drainage method or large doses of blood-breaking herbs is quite dangerous. Once such a tumor ulcerates, aside from Western surgery, there is probably no other good strategy for aftercare. But such patients have often already lost the chance for surgery. Therefore, when TCM doctors treat such patients, they must be cautious and must not recklessly use herbs that cause the tumor to ulcerate.

The dispersion method is one of the eight TCM methods. It has two approaches. The first is clear dispersion (qing xiao), mainly heat-clearing and detoxifying, cooling the blood and reducing swelling; representative formulas include Xiao Luo Wan (Scrofula-Dispersing Pill), Wu Xiao Du Yin (Five-Toxin-Disinfecting Drink), and Xianfang Huoming Yin (Immortal's Life-Preserving Drink). The second is warm dispersion (wen xiao); representative formulas include Mahuang Xixin Fuzi Tang (Ephedra, Asarum, and Aconite Decoction) and Yanghe Tang.

I personally once saw a case of late-stage colorectal cancer treated by Kong Sibo, son of Kong Bohua—one of the four great famous physicians of old Beijing. Kong used modified Wu Xiao Du Yin to sustain this patient for over five years; the patient finally died at the age of eighty. Kong mostly used 6g doses and generally only a dozen or so herbs per formula. This patient had the typical pattern of intermingled cold and heat, half yin and half yang. By the time I saw the patient, she had already developed a bright-red tongue; because Kong Sibo himself had died of lung cancer, she had to switch to another famous physician at Beijing's Pingxin Tang, who used secret-formula medicines, and she died about three months later.

In the widely circulated case records of the late Sichuan old TCM doctor Yan Rongguang, almost uniformly clear-dispersion methods are used to treat cancer, with barely a formula without Xiao Luo Wan (composed of Xuanshen, Zhe Beimu, Sheng Muli, Haizao, Kunbu, etc.). The authenticity of Yan's case records is hard to verify, but in Zhongguo Dangdai Ming Zhongyi An Jingcui (Essence of Case Records of Contemporary Famous Chinese Medicine Doctors) one sees many successful cases similar to Yan's. This shows that the clear-dispersion method is indeed suitable for some yang-pattern cancer patients of heat-type constitution.

Few contemporary doctors are willing to use the warm-dispersion method. The main reason is that modern doctors generally consider tumors products of fire-toxin, so they lean toward heat-clearing and detoxifying. The theoretical basis of warm-dispersion is the theory, cited in the Huangdi Neijing (Yellow Emperor's Inner Canon), that "when cold congeals and blood congeals, yong-ju are born." The warm-dispersion school holds that ju (deep abscesses) mostly arise because the patient's constitution is cold, so that blood congeals in the cold and forms tumors; therefore treatment must warm and nourish the vessels, dispel cold and resolve phlegm, and disperse nodules and reduce swelling. In fact, if one carefully questions the patient's history, one finds that many patients indeed have cancer caused by cold. It is a pity that many doctors take histories hurriedly, cannot integrate pattern differentiation, and prescribe solely according to TCM textbooks that have already been somewhat Westernized.

The representative formulas of warm dispersion are Mahuang Xixin Fuzi Tang and Yanghe Tang, especially Yanghe Tang (composed of Shudihuang, Lujiaojiao, Mahuang, Baijiezi, Paojiang, Sheng Gancao, and Rougui). Modern physicians hold Yanghe Tang in the highest esteem, believing that for treating yin patterns, Yanghe Tang reaches the apex. The contemporary surgery master Duan Futing especially loved using Yanghe Tang; in treating yong-ju, his use rate of Yanghe Tang reached almost 50% or more.

Mahuang Xixin Fuzi Tang is a formula recorded in Zhang Zhongjing's Shanghan Lun. Clinically, when each herb is used at the doses Zhang Zhongjing used, the effect is extremely rapid. I have personally verified this myself: a classical-formula physician treated my intractable cough with modified Mahuang Xixin Fuzi Tang, and the effect was immediate; its phlegm-resolving and nodule-dispersing force was very strong.

However, this formula carries far greater risk than Yanghe Tang. Because Xixin (Asarum) belongs to the birthwort family (Aristolochiaceae), it is extremely toxic, and its damage to the kidneys and liver is irreversible. The course of tumor treatment is long; if asarum is used long-term in large doses, it is bound to leave the patient with the aftereffect of kidney failure. Modern toxicological experiments have shown that about 29% of experimental rats developed liver cancer after taking asarum. Therefore my personal opinion is that one should not lightly use this formula long-term. The ancients rarely followed up with patients; when patients fell ill from the toxic side effects of medicine, the ancients, because science and technology were not yet advanced, did not recognize it. We ought to recognize this problem.