A TCM Case of Rash Caused by Targeted Therapy

Patient Shi, female, from Laoshan District, Qingdao, Shandong Province. She was diagnosed with lung cancer in 2021. On October 16, 2021, a PET/CT at local Zhouxin Medical Imaging (exam no. PET00001894) showed: 1. A left thoracic mass with unevenly elevated FDG uptake, considered malignant with left lung atelectasis and multiple lymph node metastases (bilateral supraclavicular, left axillary, mediastinal, bilateral internal mammary, left hilum, retroperitoneal, bilateral diaphragmatic); extensive left pleural metastases; bilateral pulmonary metastases; multiple liver metastases; bilateral adrenal metastases; multiple bone metastases; uneven density and metabolism in the left temporal lobe, suggesting MR evaluation; 2. Calcified foci in the right upper lobe and pericardial effusion; 3. Diverticulum in the descending duodenum; 4. Uterine fibroid; 5. Uneven thyroid density without abnormal FDG metabolism; 6. Spinal degeneration with a left erector-spinae lipoma at L2.

The patient had previously come to me for treatment of years of intractable insomnia, which I treated with Gui Zhi Jia Ge Gen Tang. After taking it, her insomnia improved greatly (for the case of treating her insomnia, see my earlier article "Experience Treating a Lung Cancer Patient's Insomnia with Gui Zhi Jia Ge Gen Tang"). Recently, after starting targeted therapy, she developed a generalized rash worst on the scalp and lower limbs, bright red in color, unbearably itchy, and worse at night.

Because her insomnia had resisted decades of seeking treatment everywhere yet was well resolved by me, the patient's family trusted me deeply. So after the drug rash appeared, they turned to me again.

Rash, and even skin ulceration, as a side effect of targeted therapy is very common. In this patient, symptoms were worse at night than by day. From the TCM perspective this is due to yin deficiency with blood heat, so treatment should nourish yin and cool blood, clear heat and drain dampness. I first suggested she try the patent medicine Pi Fu Bing Xue Du Wan. After three days the effect was unclear, and she came back to me.

I then decided on a combined internal and external approach: calamine lotion to wash the affected areas, plus a modified Si Wu Tang combined with Er Zhi Wan taken internally.

Internal formula: Jin Yin Hua (Lonicerae Flos) 15 g, Chi Shao (Paeoniae Rubra Radix) 10 g, Sheng Di Huang 10 g, Mu Dan Pi 10 g, Chuan Xiong 10 g, Dang Gui 10 g, Huang Bai 10 g, Zi Cao (Arnebiae Lithospermi Radix) 10 g, Fu Ping (Spirodelae Herba) 10 g, Han Lian Cao (Ecliptae Herba) 20 g, Nv Zhen Zi (Ligustri Lucidi Fructus) 20 g, Sheng Di Yu (raw Sanguisorbae Radix) 15 g, Di Gu Pi (Lycii Cortex) 10 g, Chan Yi 6 g, Fu Ling 10 g, Zhu Ling (Polyporus) 10 g, Yi Yi Ren 30 g, Xuan Shen 15 g, Bai Tou Weng (Pulsatillae Radix) 15 g. Three doses, one per day, decocted and divided into two takes—after breakfast and after dinner.

After three days of combined internal and external treatment, the rash was essentially resolved: about 80% had cleared and itching stopped. I told her to continue for another three days to consolidate the effect.

This formula is built on Si Wu Tang plus Jin Yin Hua, Huang Bai, Xuan Shen, Sheng Di Yu, Bai Tou Weng, Di Gu Pi, Mu Dan Pi and Zi Cao to cool blood and clear heat; Han Lian Cao and Nv Zhen Zi to nourish yin; Zhu Ling, Fu Ling and Yi Yi Ren to drain dampness; and Chan Yi and Fu Ping to expel wind and stop itching. Addressing both root and branch, it worked very quickly.

This regimen may serve as a reference for others who develop similar symptoms after targeted therapy.