The Advantage of TCM Large-Compound Multi-Target Formulas Shown Again in Severe Stroke Sequelae

Midway last month, the daughter of a Beijing patient contacted me, hoping I would see her mother when I returned to the capital on a weekend. Because she was referred by a colleague, and because the patient had already sought treatment everywhere without effect, I set aside some time to see her.

The elderly patient had suffered a cerebral hemorrhage a year earlier, with an extraordinarily large bleed of over 100 ml. Because Beijing has good medical resources, such a severe hemorrhage was still rescued. But after rescue the patient was essentially in a near-vegetative state: unable to speak, not fully conscious, with excessively high muscle tone in the upper limbs and no proper movement in the lower limbs—completely bedridden and requiring round-the-clock care.

The family had sought care at every major Beijing hospital and done rehabilitation at specialized facilities, with basically no effect. Brain MRI showed that cerebral edema had never subsided.

I looked at the prescriptions written by previous TCM physicians; they were all simple modifications of formulas for stroke sequelae such as Buyang Huanwu Tang and Tianma Gouteng Yin. Such an approach is certainly within the rules, but regrettably it was entirely ineffective; the herbs were wasted. Talking with the family, I said that treating this kind of refractory severe condition with a simple approach offered little hope; I could only try a comprehensive large prescription, with perhaps nearly a hundred herbs.

I explained that such an experiment might not work, but it was better than doing nothing. The family agreed; after all, they had already tried every method worth trying, the conventional approach had genuinely failed, and clinging to the old ways offered little hope of a breakthrough.

First-visit prescription: raw Huangqi (Astragalus) 120 g; Dangguiwei (angelica tail) 30 g; Chishao (red peony) 30 g; Chuanxiong (Sichuan lovage) 15 g; Tianma (gastrodia) 30 g; Yuanzhi (Polygala) 15 g; Shichangpu (Acorus) 15 g; Hanfangji (Stephania) 60 g; Chao Baizhu (stir-fried Atractylodes) 30 g; Fulin (Poria) 30 g; Zhuling (Polyporus) 30 g; Yiyiren (coix) 30 g; Zexie (Alisma) 15 g; Yimucao (motherwort) 30 g; Nüzhenzi (Ligustrum) 30 g; Mohanlian (Eclipta) 30 g; Baizhi (Angelica dahurica) 30 g; Fangfeng (Saposhnikovia) 30 g; Jingjie (Schizonepeta) 30 g; Manjingzi (vitex) 60 g; Bajitian (Morinda) 30 g; Wushaoshe (Zaocys) 10 g; Dilong (earthworm) 30 g; 20 Wugong (centipedes); 15 Quanxie (scorpions); Weilingxian (Clematis) 30 g; Ruxiang (frankincense) 15 g; Moyao (myrrh) 15 g; Danshen (Salvia) 30 g; Honghua (safflower) 10 g; Taoren (peach kernel) 15 g; Cheqianzi (plantago seed) 15 g; Yujin (curcuma) 30 g; Qianghuo (Notopterygium) 15 g; Duhuo (Angelica pubescens) 15 g; Shengma (Cimicifuga) 15 g; Niuxi (achyranthes) 30 g; Gouteng (uncaria) 30 g; Shidi (persimmon calyx) 15 g; Chenpi (tangerine peel) 15 g; Zhuru (bamboo shavings) 15 g; Fabanxia (processed Pinellia) 30 g; Xianhecao (agrimony) 50 g; Huanglian (Coptis) 10 g; Huangqin (Scutellaria) 15 g; Zhizi (gardenia) 15 g; Huangbai (phellodendron) 10 g; Dan douchi (fermented soybean) 15 g; Tianzhuhuang (bamboo sap) 15 g; Dannanxing (bamboo-processed Arisaema) 15 g; Baishao (white peony) 30 g; Zhi Gancao (honey-fried licorice) 30 g; Shenjincao (Lycopodium) 30 g; Baijili (Tribulus) 30 g; Pianjianghuang (curcuma zedoaria slice) 15 g; Chantui (cicada slough) 15 g; Baijiangcan (white stiff silkworm) 15 g; Cangzhu (Atractylodes lancea) 30 g; Shudi (processed rehmannia) 90 g; Shanzhuyu (cornus) 30 g; Rougui (cinnamon bark) 30 g; Yinyanghuo (epimedium) 30 g; Duzhong (eucommia) 30 g; Xuduan (dipsacus) 30 g; Lujiaoshuang (deer antler dross) 90 g; Shengdi (raw rehmannia) 30 g; Mudanpi (moutan) 15 g; Hangjuhua (chrysanthemum) 15 g; Gouqizi (lycium) 30 g; Shayuanzi (Astragalus complanatus) 30 g; Tusizi (cuscuta) 30 g; Gegen (pueraria) 60 g; Guizhi (cinnamon twig) 30 g; Xiebai (allium macrostemon) 30 g; Tianhuafen (trichosanthes root) 30 g; Huangjing (polygonatum) 30 g; Dangshen (codonopsis) 60 g.

Boil all the above twice, reduce to a concentrate, and add Xiyangshen (American ginseng) 15 g (powdered), Sanqi (panax notoginseng) 15 g (powdered), Ejiao (donkey-hide gelatin) 30 g (powdered), Zhenzhufen (pearl powder) 10 g, Hupofen (amber powder) 5 g, and Lujiaojiao (deer antler glue) 30 g (powdered). This yields 1000 ml of thick extract. Seal and store in the refrigerator. Take 20 ml three to four times daily, stirred into water boiled with 3 slices of ginger and 1 jujube, or swallowed directly.

This formula combines Buyang Huanwu Tang, Huangqi Fangji Tang, Erchen Tang, Taohong Siwu Tang, the "four kidney herbs," Huanglian Jiedu Tang, and Shengjiang San, jointly exerting blood-activating stasis-resolving, diuretic detumescent, and spirit-opening orifice-unblocking actions. The formula looks large, but in practice each herb is taken at under 1 g per dose, and there are no highly toxic herbs, so safety is high.

The patient followed this prescribing approach. Because the pharmacy's outsourced preparation was slow, she sometimes used similar pill forms as a substitute. By the first week results began to show: she was turning toward awareness. By the second and third weeks improvement was more obvious. By the fourth week her muscle tone had markedly diminished; she could make some voluntary movements and even interact with the young children in the family. This result not only thrilled the family but surprised me as well.

This kind of large-compound approach has always drawn criticism, but with respect, treating refractory diseases with simple theories basically wastes the patient's family's money and torments both patient and family. Refractory diseases damage the body in many ways, and treatment should likewise be comprehensive and complex. My prescription looks complicated, but anyone with a TCM foundation who studies it carefully will see that the formula is organized methodically and is well targeted to this patient's condition, and so can produce unexpected results.

In modern medical terms, such a patient would be considered beyond hope of improvement. By modern medicine's reckoning, damage to the nervous system, to the myocardium, and to bone-and-joint cartilage are the three irreversible injuries; this patient's hemorrhage was extraordinarily large, and after rescue the brain-tissue damage was basically irreversible.

I myself now study Western medicine and know that, by the Western approach, the drugs available for this patient are very limited—and the previous doctors had already used all the right ones, to no effect. A year of various treatments had also worn down the family's confidence; they came to me only because a leader at her workplace, who knew me well, thought I might create a small miracle. Expecting a long shot, they tried this large-compound multi-target approach.

I originally developed this approach for cancer, because cancer is too complex and multi-causal for simple formulas to work. Later, during the COVID outbreak, when rescuing severe COVID patients, I used the same idea to draft "Chai Gui Jiedu Wan" (I have published the formula; interested readers can find it in my older articles). Still later I used this approach for stroke sequelae and early dementia, with some success.

It is clear that this large-compound, multi-target (cocktail-like) approach can be applied across many refractory diseases. But composing such formulas requires deep TCM grounding; if one knows too few formulas and herbs and understands their toxic side effects too little, it is hard to safely and effectively steer such a large compound.