A Case of TCM Treatment for Lower-Limb Edema After Radiotherapy for Cervical Cancer

Patient: a woman, surname Zuo, 68 years old. She had previously been treated with radiotherapy for cervical cancer at a hospital in Guangdong province. After radiotherapy she developed a series of radiation sequelae: radiation enteritis causing bloody stools, mild anemia, and edema of the perineum and lower limbs. The local hospital could not relieve these complex symptoms, and her attending physician (a radiologist trained in Chinese medicine) turned to me for help.

I initially recommended taking powdered Baiji (Bletillae Rhizoma) mixed in water to relieve the rectal bleeding caused by radiation enteritis, and it worked very well for her. But the perineal and lower-limb edema remained difficult to resolve. After the summer vacation began this year, her attending physician again sought my help to relieve the patient's edema.

After questioning the attending physician and reviewing the patient's examination reports, I found she also had abdominal distension, constipation, and lymph-node metastasis. She had previously tried externally applied Chinese herbs for perineal and lymphatic edema, but without effect. Because the disease was uncontrolled, she had recently developed difficulty walking and progressive wasting.

I considered that the patient's current state was a pattern of righteous deficiency and replete evil, so the main approach should be supporting the righteous and securing the root, fortifying the spleen and reducing edema, while also addressing anticancer and detumescence. I treated her with modified Huangqi Fangji Tang combined with Erzhi Wan. I gave the attending physician the following medication recommendations.

Decoction: raw Huangqi (Astragali Radix) 30g, Hanfangji (Stephaniae Tetrandrae Radix) 30g, stir-fried Baizhu (Atractylodis Macrocephalae Rhizoma) 15g, Fuling (Poria) 30g, Zhuling (Polyporus) 10g, Yimucao (Leonuri Herba) 30g, Xianhecao (Agrimoniae Herba) 50g, Muxiang (Aucklandiae Radix) 10g, Houpo (Magnoliae Cortex) 15g, Cheqiancao (Plantaginis Herba) 15g, Nuzhenzi (Ligustri Lucidi Fructus) 10g, Mohanlian (Ecliptae Herba) 30g, Sheng Maiya (raw Hordei Fructus) 30g, Jiao Shanzha (char-fried Crataegi Fructus) 10g, Dangshen (Codonopsis Radix) 15g, Huangjing (Polygonati Rhizoma) 15g. One dose daily, decocted in water.

Patent medicines: Pingxiao Jiaonang (Pingxiao Capsules) plus Fufang Banmao Jiaonang (Compound Cantharis Capsules).

One week after starting the medication, the lower-limb edema had markedly subsided, and the perineal swelling was also significantly reduced. Her attending physician reported that the patient also had vaginal adhesion and stenosis after radiotherapy, and asked me to adjust the prescription to further address this. I therefore suggested adding a few blood-activating and stasis-resolving herbs to the above formula.

Second-visit prescription: raw Huangqi 30g, Hanfangji 30g, stir-fried Baizhu 15g, Fuling 30g, Zhuling 10g, Yimucao 30g, Xianhecao 50g, Muxiang 10g, Houpo 15g, Cheqiancao 15g, Nuzhenzi 10g, Mohanlian 30g, Sheng Maiya 30g, Jiao Shanzha 10g, Dangshen 15g, Huangjing 15g, Taoren (Persicae Semen) 6g, Honghua (Carthami Flos) 6g, Liujinu (Artemisiae Anomalae Herba) 10g, Wangbuliuxing (Vaccariae Semen) 10g. One dose daily, decocted in water. Patent medicines as before.

The patient is currently continuing TCM treatment.

The formula I devised is based on Huangqi Fangji Tang (composed of Huangqi, Fangji, Fuling, and Baizhu) and Erzhi Wan (composed of Mohanlian and Nuzhenzi), adding the paired herbs Muxiang and Houpo to regulate qi and promote diuresis, plus Zhuling to promote urination and reduce edema, Yimucao to activate blood and promote diuresis, Xianhecao to stop bleeding and support the righteous, Sheng Maiya and Jiao Shanzha to aid digestion, and Dangshen and Huangjing to boost qi.

Huangqi Fangji Tang has some efficacy in treating ascites and edema in cancer patients, with few side effects. I have repeatedly achieved results by combining Huangqi Fangji Tang with other formulas to treat ascites or edema; this formula is mild in nature and safer than Shizao Tang (Ten Jujube Decoction). Erzhi Wan nourishes yin and stops bleeding, also moistening the intestines to ease constipation, and has some anti-anxiety and estrogen-regulating effects. These two formulas established the basic treatment direction of this prescription, which was highly targeted to this patient's symptoms, hence the rapid and marked effect.