A TCM Case: Gastric Cancer Complicated by Urticaria and Ulcerative Colitis—Patient Qi

The patient, Qi, male, 50, a forest ranger in Huanan County, Jiamusi, Heilongjiang. Gastric cancer diagnosed April 2018; before diagnosis 174 cm, 80 kg, normal BP and glucose. First online consult May 26, 2020, weighing 61 kg, normal BP and glucose.

Diagnosed with gastric cancer in 2018, he had surgery that April at the PLA General Hospital (admission 39422E, outpatient K0227495). Pathology (B1223652): ulcerated moderately-to-poorly differentiated adenocarcinoma at gastric angle and posterior antrum, partially signet-ring cell; 3.5x3x1 cm, invading subserosa, tumor emboli in local vessels; omentum and margins clear; nodes clear. IHC: HER-2 (+), Ki-67 20%, EGFR (+), Syn (-), CK (+). Six postoperative chemo cycles: oxaliplatin+S-1 x3, oxaliplatin+capecitabine x3. Rechecked every three months.

Family reported two recent blood tests showed falling WBC, with RBC and platelets borderline. Occasional burping when eating, bowel sounds, frequent foul gas, and buttock urticaria for years; recently short of breath and fatigued. Also gallstones, cholecystitis, and ulcerative coloproctitis for years. Introverted, quiet.

By video: cold aversion for years, stiff painful shoulders and neck, chronic urticaria unsolved locally. No sweating however hot; frequent diarrhea and bloody stools—gastroscopy after recurrent bleeding found the cancer. Reddish tongue with a central crack.

Before surgery he liked meat, spicy food, and alcohol; smoked but quit six years earlier. Post-surgery he ate bland food, avoiding irritants. Appetite fair, regular but frequent stools. He took decoctions at the provincial TCM hospital for about a year without resolving urticaria, then stopped. Now he drinks self-made lingzhi or ginseng water and eats jujubes/goji. Took Weifuchun for three months, just stopped; long on probiotics.

I saw a Taiyang-Yangming combined disease with both exterior and interior, presenting the 'stiff neck/back' and 'spontaneous diarrhea' of Gegen Tang. For convenience and reimbursement I used patent medicines, telling him to get them at a local insured hospital.

Prescription: 1. Gegen Tang granules (stiff neck, urticaria); 2. Compound Banmao Capsules (prevent recurrence); 3. Zhenqi Fuzheng Granules (raise WBC). Diet therapy: 30 g raw Huangqi, 6 g Danggui, some Coix seed, cooked as porridge. Avoid: pickles, salted vegetables, sweet potato, citrus, barbecue, hot pot, seafood, shrimp, crab, spicy food.

June 30, 2020: family reported neck no longer stiff or painful; urticaria much better, basically gone; he could sweat during exercise; cold aversion lessened.

July 5, 2020: blood count showed mild anemia. Since chemo he ate a varied vegetarian diet plus farm goose and chicken eggs, almost no fish/meat/milk/seafood, and insisted on it.

Two weeks earlier he had low blood sugar twice in a week; not since, and not for long before; glucose normal each time, though his voice still lacked strength.

With only debility and anemia remaining, I used Jiuzhuan Huangjing Paste and Huangqi Danggui Buxue Tang, made into pills to build blood. Afterward he stayed stable.

February 18, 2021: family contacted me again—over the Lunar New Year in Hainan, after eating seafood he developed diarrhea and bloody stools. He hid it for over two months, telling family only when worsening. But the pandemic was severe in Heilongjiang, so I had him first take Huaijiao Wan and report.

February 23, 2021: colonoscopy at Harbin Medical University Cancer Hospital (outpatient 02588903, scope Marror39) showed ulcerative coloproctitis and hemorrhoids. Local doctors could do nothing. At consult: occasional low blood sugar (palpitations, sweating), no pain. Frequent tenesmus, pain on defecation that resolves after, no pus. No cold drinks, prefers hot. No acid reflux/heartburn; occasional belching. Diyu Huaijiao Wan gave no clear improvement.

I judged it still a Taiyang-Yangming combined disease, but now a Guizhi Jia Gegen Tang pattern: previously anhidrotic, now sweating spontaneously, so no longer Gegen Tang but Guizhi Jia Gegen Tang. I combined it with Huaihua Powder, with additions.

Guizhi (Cinnamon twig) 10 g, Baishao 10 g, Zhi Gancao 6 g, Gegen 20 g, Baiji 10 g, Xianhecao 30 g, Huaihua 10 g, Ceyebai 10 g, Jingjiesui 10 g, ginger 5 slices, jujube 5 pieces, Huanglian 3 g, Huangbai 3 g. Three doses, decocted, morning and evening. Avoid raw/cold, greasy, slippery foods. If effective after three, buy five more and report after eight.

March 6, 2021: family reported marked improvement; stools from 3-4 daily to 1-2, occasionally 3. Morning stool still had dark red blood, only a fingernail-sized patch, little; no abdominal pain. To consolidate, I added antidiarrheal herbs.

Prescription: Guizhi 10 g, Baishao 10 g, Zhi Gancao 6 g, Gegen 20 g, Baiji 10 g, Xianhecao 30 g, Huaihua 10 g, Ceyebai 10 g, Jingjiesui 10 g, ginger 5 slices, jujube 5, Huanglian 6 g, Huangbai 6 g, Machixian 30 g, Qinpi 6 g. Seven doses; morning and evening. Instructions as before.

March 17: family reported stools normalized to once daily from the second dose, normal through March 17; limbs warmer. Occasional drop or two of blood, which stopped after self-administered Xilei Senemas. I then had him use Sini San for cold limbs and continue Compound Banmao Capsules, stopping decoctions. Stable after.

May 13, 2021: the patient reported ulcerative coloproctitis resolved after prior treatment, but after an asymptomatic period it recurred in early May. Xilei Senemas helped the bleeding; a week after stopping, colitis and hemorrhoids recurred. Blood during or after stool, dark red. Tenesmus, sometimes abdominal pain. Hemorrhoids worsened: anal heaviness, frequent urge but nothing passed, dark clots. Local hemorrhoid medicine gave slight relief. Cold limbs, cold aversion. Occasional urticaria. May 11 CBC and chemistry normal except low absolute lymphocytes. He requested Chinese medicine again.

He now sweats after exercise; I saw still a Guizhi Jia Gegen Tang pattern, so I kept that base and combined with Baitouweng Tang with modifications: Guizhi 10 g, Baishao 10 g, Gegen 20 g, Zhi Gancao 6 g, Baitouweng 15 g, Huanglian 6 g, Huangbai 12 g, Qinpi 12 g, Huaihua 30 g, Ceyebai 15 g, ginger 7 slices, jujube 7. Instructions as before.

May 17: after three doses, no blood in stool. But stool unformed, still tenesmus and abdominal pain, each bowel movement nearly 20 minutes. Hemorrhoids clearly better; cold hands/feet slightly better. He added a persistent post-surgery symptom: intermittent bowel sounds. No urticaria since medicine; more gas the last two days, strong odor.

He showed defensive yang and spleen-yang deficiency, so I tried modified Linggui Zhugan Tang: Fuling 30 g, Guizhi 15 g, fried Baizhu 15 g, Zhi Gancao 10 g, Huai Shanyao 30 g. Five doses, morning and evening.

May 22: after these five doses he was much better. Tenesmus, long/strained defecation, sticky unformed stools all improved. Now stools formed, defecation clearly shorter, cold hands/feet much better, bowel sounds and urticaria gone; only occasional abdominal pain and strong-smelling gas.

Per not changing an effective formula, I added Muxiang and Baishao: Fuling 30 g, Guizhi 15 g, Baizhu 15 g, Zhi Gancao 10 g, Shanyao 30 g, Muxiang 10 g, Baishao 30 g. Five more doses, instructions as before.

Note: Ulcerative coloproctitis is hard to treat and prone to recurrence; former Japanese PM Shinzo Abe resigned twice because of it, treated by both Western and Kampo doctors, yet it recurred often. Its cause is complex and treatment tricky. I treated this patient purely following the Shanghan Lun, staying within classic formula reasoning, with good results and resolving multiple complications. This shows the high clinical value of the Shanghan Lun.