TCM Formulas for Pyloric Obstruction in Esophageal and Cardiac Carcinoma

Pyloric obstruction is common in patients with esophageal and cardiac carcinoma. Once pyloric obstruction occurs, the patient has difficulty swallowing and cannot eat. Without solving this problem, the patient not only can hardly undergo the next stage of treatment but also struggles to maintain nutrition, so such patients often ultimately starve to death from malnutrition.

Western medicine generally solves the dysphagia of esophageal cancer mainly through chemotherapy, radiotherapy, and pyloric stent placement. TCM solves this problem through orally administered medicine.

Pyloric obstruction belongs to the TCM category of dysphagia (ye-ge). Common TCM drugs effective against pyloric obstruction include Shifu (woodlouse), Naosha (halite), Daizheshi (hematite), Weilingxian (Clematis root), Shidi (persimmon calyx), Shishuang (persimmon frost), Dingxiang (clove), Qingmengshi (chlorite schist), Mangxiao (Glauber's salt), Jixingzi (Impatient seed), Shifuchong (woodlouse), Banxia (Pinellia), and Danxing (bile Arisaema). When some patients have pyloric obstruction, they also usually develop constipation with stool as hard as sheep dung; for such patients, intestine-moistening laxatives such as Roucongrong (Cistanche), Huomaren (Cannabis seed), Dahuang (rhubarb), and Luhui (aloe) are also needed.

Zhang Xichun, a famous TCM physician of the late Qing and early Republican period, had a formula called Shen Zhe Pei Qi Tang (Ginseng-Hematite Qi-Supporting Decoction), a representative formula for pyloric obstruction. It consists of “Lutang Dangshen 6 qian, Tiandong (Asparagus) 4 qian, raw Daizheshi (hematite) 8 qian (ground fine), Qing Banxia (clear Pinellia) 3 qian, Roucongrong (Cistanche) 4 qian, Zhimu (Anemarrhena) 5 qian, Danggui (Angelica body) 3 qian, Shishuang Bing (persimmon frost cake) 5 qian (allowed to dissolve slowly in the mouth after taking the medicine).” Zhang believed that dysphagia-food obstruction is caused by weak central qi, with stomach qi unable to descend continuously and instead ascending on the empty path, causing phlegm-rheum to rise together with counterflow qi and block the cardia. I have previously written about Zhang Xichun's formula; see my articles A Case of Modified Shen Zhe Pei Qi Tang Treating Late-Stage Esophageal and Hypopharyngeal Cancer Patient Han and Zhang Xichun's “Shen Zheshi Pei Qi Tang” for Treating Dysphagia-Food Obstruction, so I will not repeat them here.

Among the medical cases of an old TCM physician from my hometown, Mr. Chen Mojin, treating esophageal cancer, there is a formula he often used called “Qiankou Yibeigeng” (Thousand Sips, One Cup): purple Naosha (halite) 6 g, Pengsha (borax) 6 g, Eguanshi (pipe stone) 10 g, Qingmengshi (chlorite schist) 5 g, Daizheshi (hematite) 10 g, Shishuang (persimmon frost) 10 g. These six ingredients are all ground into a fine powder; then Jixingzi (Impatient seed) 10 g, Chuanniuxi (Sichuan Achyranthes) 10 g, and Weilingxian (Clematis) 10 g are decocted in water for juice, which is combined while hot with the above powder, and an appropriate amount of lotus-root starch and honey is added and stirred into a paste. Each time, take a small spoonful into the mouth and swallow slowly, finishing the dose over three hours.

The Yixue Zhengzhi also contains a formula called “Runchang Gao” (Intestine-Moistening Paste) for treating “dysphagia, dry bound stool, food returning after a long time, and morning food vomited at evening or evening food vomited at morning.” This formula is simpler: take 120 g of fresh Weilingxian (pounded for juice; use those flowering separately in April–May), 120 g of fresh ginger (pounded for juice), 60 g of real sesame oil, and 120 g of white crystalline honey (boiled and skimmed of surface foam). Put the four together in a silver or earthenware vessel, stir well, and simmer slowly until the consistency of maltose; taste it from time to time with chopsticks. If one batch does not cure, take another batch.

In addition, the Zhongyao Da Cidian (Comprehensive Dictionary of Chinese Materia Medica), under the entry “Shifu,” records a modern TCM formula called Kaiguan San (Tube-Opening Powder): equal amounts of Shifu (woodlouse) and Qingmengshi (chlorite schist), ground together into a fine powder. Take 1–2 g each time, 4–6 times a day, placed at the base of the tongue to dissolve, not washed down with water. According to statistics, treating 48 patients with pyloric obstruction caused by esophageal or cardiac cancer with Kaiguan San, 37 had marked relief (complete obstruction improved to allowing semi-liquid food, lasting over 2 weeks), including 22 esophageal cancer and 15 cardiac cancer; 6 had partial relief (complete obstruction changed to allowing liquid diet), including 4 esophageal cancer and 2 cardiac cancer; 5 had no effect, including 3 esophageal cancer and 2 cardiac cancer.

The Bencao Gangmu quotes the Zhaiyuan Fang, a single-subject formula for treating “dysphagia with inability to swallow food:” take Fengxianhuazi (i.e., the herb Jixingzi, Impatient seed), soak in liquor for three nights, dry in the sun and grind into powder, and make into pills the size of mung beans with liquor. Take eight pills each time with warm liquor.

The Kangai Bencao (Anticancer Materia Medica) contains a formula for gastric cardiac cancer obstruction: “Jixingzi (Impatient seed) 9 g, Haifushi (pumice) 9 g, Huaruishi (orchid stone) 9 g, Haipiaoxiao (cuttlebone) 30 g, Daizheshi (calcined hematite) 6 g. Grind together into a fine powder, mix with water into pills the size of mung beans, take 6 pills each time, morning and evening.”

All the above formulas have a certain effect, but some are ineffective for severe obstruction. I myself treated two esophageal cancer patients with severe obstruction who could barely swallow even water. I used only Mangxiao (Glauber's salt), having the patient take a small spoonful and dissolve it slowly in the mouth; after taking Mangxiao, both patients' symptoms eased and they could take liquids and semi-liquids. On this basis, I then used Chinese herbs with anticancer and swelling-dispersing effects to treat them slowly.

However, although pyloric obstruction in esophageal and cardiac cancer can be briefly relieved, the tumor itself is not easily shrunk, so these temporary measures can only delay the patient's condition for a time. If subsequent anticancer treatment is ineffective, the patient will usually develop obstruction again after a few weeks, and the above methods may no longer work. If an integrated Chinese-Western approach can be taken to give the patient comprehensive treatment, the effect will be better.