A TCM Case of Neuroblastoma Cured in an Infant

Professor Jiang Yuren (1916-2003) was a famous TCM pediatric specialist in China; in his lifetime he was a professor at Nanjing University of Chinese Medicine.

Professor Jiang once treated an infant diagnosed at birth with neuroblastoma; after three years of medication he cured the child. Follow-up continued until the child reached adulthood, with no recurrence. Here I transcribe Professor Jiang's case record and offer some explanation of his medication logic, for the reference of neuroblastoma patients and their families, and of TCM colleagues interested in studying neuroblastoma.

The patient was an infant girl, Wang, aged 60 days. First visit May 25, 1978.

The infant was born in March of that year. Six days after birth her abdomen began to bulge, and it grew larger day by day; her face was emaciated, her stools were loose with curd-like milk fragments, and she fussed restlessly. Early this month she was admitted to a hospital; ultrasound found a space-occupying lesion in the liver, with a right upper abdominal mass whose boundary with the liver was unclear, and band-like waves. On May 18 an exploratory laparotomy was performed. Intraoperative findings: 1. The left and right lobes of the liver were diffusely enlarged, hard to grade 3, with an uneven surface and focal purplish-black necrotic areas; 2. The spleen was enlarged, hard to grade 2; 3. A 4cm x 6cm irregular hard mass with an uneven surface was palpated at the upper pole of the left kidney; 4. A small amount of ascites was present when the abdomen was opened. A wedge resection was taken from the edge of the right liver lobe for pathology; the report was malignant liver tumor, considered to be liver metastasis from neuroblastoma. Because it could not be resected, the abdomen was closed. Postoperative diagnosis: left retroperitoneal neuroblastoma with liver metastasis. Radiotherapy and chemotherapy were suggested, but the parents declined and left the hospital on their own. Today she came to our outpatient clinic.

At presentation the infant's face was pale and lustreless, she was emaciated to the bone, her abdomen was distended and board-hard, her abdominal wall showed exposed blue veins, and the abdominal zheng mass was hard as stone and immovable when pushed. "Zheng" (pronounced zheng, first tone) is a tangible accumulation, caused by the stagnation of qi and blood in the internal channels that over time condenses. Since the liver stores blood and the spleen governs blood, these two organs are the most prone to develop this disease. The disease location is in the internal organs, and the disease mechanism is stasis. Although the infant now shows signs of deficiency and her general condition is poor, she nurses as usual, indicating that stomach qi is still present. Therefore I resolutely adopted the method of attacking and breaking up the accumulation, in order to dispel her zheng.

Pao Jianpian (processed pangolin scales) 10g, Danshen 10g, Ezhu 10g, Sanleng 10g, Baihua Sheshicao 10g, one dose daily.

This formula was taken continuously for over a month. The abdominal zheng mass, though still hard, was already slightly softer on the abdominal wall; she slept peacefully at night, her stools were normal, and her appetite improved. On July 12, scleral and skin jaundice appeared, with scanty dark urine, reduced appetite, and irregular fever. Liver-function tests: icterus index 20 units, thymol turbidity 14 units, zinc turbidity 13 units, ALT normal. The formula was changed to one that clears and drains liver-gallbladder damp-heat.

Yinchen 15g, Huangbo 10g, Yujin 10g, Jinqiancao 15g, one dose daily.

After ten days of the above, the jaundice resolved, spirit and appetite improved, and repeat liver function was normal. Ultrasound: liver 4.2 cm below the costal margin, 4 cm below the xiphoid, with band-like waves in the liver region. The condition was trending toward improvement; he again gave softening-hardness and stasis-resolving herbs.

Formula: Jianpian powder, Danshen powder, Yujin powder, equal parts, mixed well; take 1 g each time, twice daily.

The above was taken continuously for over a year. The infant's abdomen gradually loosened, the zheng mass shrank, her weight increased, and her face grew ruddy. Repeat ultrasound on January 9, 1980: liver 3 cm below the costal margin, 4 cm below the xiphoid, 9 cm in vertical diameter, still with band-like waves in the liver region. The original formula was continued, changed to once daily.

Ultrasound on March 12, 1981: upper liver border at the 6th intercostal space, 4 cm below the xiphoid, 1 cm below the costal margin, 5 cm in vertical diameter, sparse micro-waves, no band-like waves in the liver region; spleen lateral view (-). The infant was lively, with normal physical and intellectual development. Medication was stopped. Follow-up to the present: the child has reached adulthood and is entirely like a normal person.

Professor Jiang's case record is very precious; it completely records the child's three-year treatment course, and under Professor Jiang's treatment the child achieved a cure. This is a great advantage of pediatric tumors: childhood tumors are easier to cure than adult tumors, and childhood tumors have the possibility of radical cure.

From my own experience treating childhood tumors, the younger the child, the better the treatment result. In pediatrics, not only tumors are easier to cure than in adults; stubborn illnesses such as asthma, which are hard to cure in adults, are also much easier to cure in children.

I have treated two cases of infantile asthma, both with extremely simple medication. In one case, only ginger juice and honey in a 1:1 ratio were mixed into a ginger-honey tea, and after about half a month it was cured. In the other, only two herbs—Gouteng and Bohe—were used, and after just over a week it was also cured.

In treating this infant, Professor Jiang also used few herbs. Each formula had only a few herbs, and the later treatment even used only a very light powder and still achieved a cure. So medication for young infants is entirely different from medication for adults or older children.

In this case treated by Professor Jiang, no highly damaging radiotherapy or chemotherapy was done; this was also an important reason he could achieve such good results with Chinese medicine. If this infant had undergone excessive chemoradiotherapy, it would probably not have been possible to achieve such good results so easily.

Pediatrics has since antiquity been called the "silent specialty." In TCM, diagnosis in pediatrics should rely mainly on inspection, with other diagnostic methods as adjuncts. When asking, young children cannot speak, and slightly older children's words are not to be fully trusted. When taking the pulse, many infants do not cooperate, so pulse diagnosis is extremely prone to error. Professor Jiang's diagnosis of this child embodied the pediatric emphasis on inspection.

Pediatric medication and diagnosis both have their unique characteristics; TCM physicians treating pediatric tumors should note this and study more TCM pediatric works.

Medication for newborns must be light and simple, so as not to cause irreversible harm to the infant's tender yin and tender yang. Medication for slightly older children may be moderately more complex, but the dosages should still be small.

TCM has great promise in treating childhood tumors. Unfortunately, because pediatric patients present so many difficulties, everyone avoids pediatrics as much as possible; as a result TCM has achieved little in the study of childhood tumors. This is truly a regret!

The pediatric patients I myself treat are still young and have not yet reached adulthood. By transcribing such infants' case records, I also hope that parents will build up confidence. As long as doctor and patient trust each other and the medication is effective, some childhood-tumor patients have the hope of being cured.