TCM Symptomatic Management of Chemotherapy-Induced Vasculitis

A small number of cancer patients develop vasculitis during chemotherapy because of the irritation of blood vessels by chemotherapeutic drugs. Vasculitis causes patients great suffering; when severe, it can destroy the limbs, with unbearable pain that makes it hard even to walk, leaving the patient bedridden and groaning. This severe pain makes patients despondent and deeply affects their quality of life and treatment outcome.

The key to vasculitis is prevention. Patients who have the means may choose to have a PICC line placed or a deep-vein puncture performed during chemotherapy to prevent vasculitis. At the same time, when infusing chemotherapeutic drugs, the medication should be fully diluted; once diluted, the concentration drops, reducing irritation to the blood vessels and preventing vasculitis. A patient I am currently treating—a Sichuan woman with double cancers of the breast and thyroid—was, during chemotherapy, given a chemo infusion in which the hospital, by mistake, multiplied the dosage several times over; as a result, after the infusion she could barely walk and took a very long time to recover. This side effect left her fearful of Western medicine ever afterward, and she has never dared try Western treatment again. So oncologists writing medical orders, and nurses carrying them out, should all pay attention to this.

But patients differ individually, and medicine has an inherent uncertainty; even with the above protective measures, some patients may still develop vasculitis during chemotherapy. Rescue measures must then be taken promptly to minimize the side effects of chemotherapy. From the perspective of TCM pattern differentiation and treatment, I will introduce the TCM approach to chemotherapy-induced vasculitis.

Vasculitis is an ancient disease; it is not as though only chemotherapy patients develop it. In ancient TCM texts there is a disease name related to vasculitis—duju (gangrene/decaying ulcer). Duju is a severe condition in TCM external medicine; in its early stage it usually occurs along the vessels of the knee and shin of the lower limb, especially the great toe of the foot, and sometimes also the fingers. The course of vasculitis in chemotherapy patients is basically similar, so cancer patients should pay attention if toe or finger pain appears during chemotherapy. When severe, the disease causes ulceration of the toes, fingers or limbs; chemotherapeutic drugs are strongly corrosive, and once ulceration occurs, the patient's subsequent quality of life is quite poor.

Treating vasculitis cannot be delayed. Chen Shigong, a renowned Ming-dynasty expert in external medicine, described the course of duju thus: “The onset is like boiling red dates; the form shows bones weak and sinews slack; the filth has a strange odor hard to dispel; its life is hard to save even with immortal formulas.” This shows that vasculitis progresses rapidly and easily causes deterioration. Ancient treatment of duju, it is said, “amputates when it is on the fingers, and cuts away when it is in the flesh,” showing that the disease was hard to treat and, in severe cases, required even surgery in antiquity.

Incidentally, it is not only chemotherapeutic drugs that cause vasculitis; some TCM “using poison to attack poison” herbs, such as arsenic (pishuang) and Chinese blister beetle (banmao), when used improperly or in excessive doses, can also readily irritate the patient's blood vessels and, in severe cases, likewise cause vasculitis. So clinical TCM physicians who use the “poison attacking poison” method should also pay attention to medication safety.

I often advise cancer patients during chemotherapy to take TCM formulas that supplement qi and blood, such as Bazhen Tang (Eight-Treasure Decoction), Shiquan Dabu Tang (All-Inclusive Great Tonifying Decoction), Guipi Tang (Spleen-Returning Decoction) and Buzhong Yiqi Tang (Middle-Supplementing Qi-Boosting Decoction). These formulas not only help patients maintain a good blood picture but also have a good effect on preventing vasculitis. Unfortunately, quite a few patients are prejudiced against TCM and will not take such advice; this is beyond help.

Most vasculitis patients can only lock the stable door after the horse has bolted, trying to rescue the situation only after chemotherapeutic drugs have damaged the blood vessels. But by then half the effort yields half the result, and treatment is far more laborious. Moreover, many doctors are unwilling to take on such patients at this hour of crisis, fearing that if treatment fails and the patient's condition rapidly worsens, the family will make trouble. So some patients can only spend the rest of their lives crying out in pain.

Traditional TCM holds that this disease is caused by obstruction of the vessels and collaterals, or by accumulation of fire-toxin and heat; so treatment is, by and large, to unblock the meridians, clear heat and detoxify, or nourish yin and downbear fire. Famous TCM formulas such as Simiao Tang, Simiao Yong'an Tang, Xianfang Huoming Yin (Immortal Life-Saving Formula), Wuwei Xiaoyin Yin (Five-Ingredient Detoxification Drink), Gubu Tang (Step-Taking Decoction), Shaoyao Gancao Tang (Peony-Licorice Decoction), Lianqiao Baidu Tang, Duhuo Jisheng Tang (Angelica-Loranthus Decoction), Danggui Sini Tang (Angelica Four-Miner Decoction), Yanghe Tang (Yang-Harmonizing Decoction), Zhibai Dihuang Tang (Anemarrhena-Phellodendron Rehmannia Decoction), Ziyin Jianghuo Tang, and Qinghao Biejia Tang (Sweet Wormwood-Turtle Shell Decoction) are all effective formulas for treating vasculitis. Those who study TCM anti-cancer work should remember the indications of these formulas; treating according to the pattern can often relieve the patient's suffering. If treatment is patiently continued for some time, there is hope of helping the patient escape the vasculitis.

Post-chemotherapy patients also have deficiency of qi and blood; their white blood cells, red blood cells, hemoglobin and platelets are low. Such patients, when complicated by vasculitis, are the hardest to treat. For them, on the one hand one must support the vital qi and root, and supplement qi and blood; on the other hand, one must manage the symptoms. One may use qi-and-blood-supplementing formulas such as Renshen Yangrong Tang (Ginseng Nourishing-Nature Decoction), Guipi Tang, Shiquan Dabu Tang, Bazhen Tang and Baoyuan Tang, combined with the above formulas.

If the patient's liver and kidney function are impaired, medication must also take into account the recovery of liver and kidney function; besides using some TCM herbs that protect the liver and gallbladder, and fortify the spleen and kidney, treatment should be combined with Western liver-protective drugs.