TCM Emergency Management of Gastric Bleeding in Cancer Patients
Cancer patients, whether with gastric cancer or other cancers, may develop gastric bleeding due to gastric ulcer or gastric perforation caused by various factors. Gastric bleeding is an emergency requiring immediate management; if not handled properly, the patient's life is at risk. Especially in advanced cancer patients, the onset of gastric bleeding may well mean that life is approaching its end. At such times some first-aid measures are needed.
How is gastric bleeding diagnosed? Generally, the stool of a patient with gastric bleeding is very black, like the color of stool passed after eating pig or duck blood. Many Chinese medicines can also cause black stools in cancer patients—for example, Eclipta prostrata (mohanlian) has the side effect of darkening stool color—so sometimes one must rule out black stool caused by herbs.
When the bleeding volume is within 500 ml, there is generally only black stool. But when bleeding exceeds 500 ml, the patient also vomits blood, or the vomitus is black in color. Some patients develop hard-to-stop diarrhea after gastric bleeding, passing black watery stool.
After gastric bleeding, the patient rapidly becomes weak, with aversion to cold, cold limbs, and a fatigued expression. Patients losing more than 500 ml appear fragile, bedridden, and can hardly even stand. When helped to stand up, they feel dizzy and black out. This is the reaction after excessive blood loss.
If a patient passes unexplained black stool, it is convenient, if possible, to go to a local hospital for a routine stool test; if occult blood is present in the stool, it confirms that the patient has indeed had gastric bleeding.
Treating gastric bleeding requires stopping bleeding and greatly supplementing qi and blood simultaneously. For hemostasis, Yunnan Baiyao may be used, either powder or capsules, 1–2 g per dose, 4–6 doses a day; there is no need to follow the dosage on the package insert. One may also powder Bletilla striata (baiji) and take 1–6 g infused in warm water per dose, 3–6 doses a day. Bletilla powder is very effective for gastric bleeding.
If the patient has diarrhea, an antidiarrheal should be combined. Western medicines such as Zhengchangsheng (live Bacillus licheniformis) and montmorillonite powder may be used; Chinese medicines such as Shenling Baizhu granules and compound berberine tablets may also be used.
When the patient becomes very weak due to gastric bleeding, Dangshen Decoction of One Ginseng (Dushen Tang) should be used for emergency without hesitation. Dushen Tang formula: 6–30 g ginseng (Renshen), decocted for 30–90 minutes; this is the daily dose. When weakness is very severe, the ginseng dose may be increased to 30 g (one liang). If the patient's family cannot afford ginseng, rehmannia prepared (Shudi) and astragalus (Huangqi) may be substituted, though they are not as effective as ginseng.
Note that Dushen Tang uses only the single herb ginseng, with no other drugs combined. Because this is for emergency, ginseng is used directly to save life; no other herbs should be added that might interfere with ginseng's effect.
Patients who can afford it should, after taking emergency measures, be sent to hospital as soon as possible. Those who choose hospice care at home should keep taking Yunnan Baiyao or Bletilla powder for several days until the stool returns to a normal yellow, banana-like appearance.