Two Case Reports: TCM Purgation Relieving Cancer Pain More Effectively Than Morphine
Originally written June 13, 2013.
The two case reports below are from two patients I have recently been treating. The patients are still under treatment, and final results remain to be seen, but after applying the purgation method, the cancer pain in both cases was greatly reduced. In treating these two patients, I uniformly used the purgation method—a treatment I would not have dared use at all when treating cancer patients last year. But this year, in clinical practice, I decided to be bolder and step forward; the results were very satisfactory. This suffices to prove that the purgation method is not as frightening as imagined.
Case 1: A cervical cancer patient with lung metastasis
First visit, June 7, 2013. A 37-year-old single woman, referred by a friend from the Sina cancer circle. In February this year she was hospitalized for massive hemorrhage; examination revealed advanced cervical adenocarcinoma, inoperable, and doctors advised prompt radiotherapy and chemotherapy at a higher-level hospital. Because of poverty she declined and sought TCM conservative treatment. At the end of May she again suffered massive hemorrhage, this time more violent. Admitted to Sichuan Provincial Cancer Hospital, examination showed cervical cancer with lung metastasis: multiple diffuse metastatic lesions in both lungs, the largest 1.1 cm; two cervical tumors, the larger 4.2 × 3.1 cm and the smaller 2.6 × 2.1 cm; enlarged abdominal and pelvic lymph nodes. Gallstones with cholecystitis; cysts and nodules in the left breast.
On first examination, the patient had an old yellow tongue coating with a cracked center; her skin showed red rashes (though she later said these were marks left from previous beauty treatments; since I could not examine her in person, I cannot confirm whether the old marks she described were what I saw; recorded as such), suggesting possible subcutaneous bleeding, and she had purpura on her body. Pain in the ribs, located in the upper buttocks and the outer right thigh; the left leg was also beginning to hurt, though not obviously. The pain lasted longer each day, roughly two or three hours daily, and she could only sleep on her side. Bleeding occurred intermittently; after the last massive hemorrhage was stopped in hospital with gauze packing, on the night of June 6 she again showed slight bleeding. On the 7th she began taking Yunnan Baiyao, and the bleeding temporarily stopped. But on the evening of the 7th, straining at stool caused another massive hemorrhage. Urination and defecation were obstructed. On comprehensive analysis, the preliminary judgment was blood-dryness with bound-up stool, an excess-heat type malignant-tumor constitution.
First-visit prescription: Zengye Chengqi Tang combined with Xiao Luo Wan and Shaoyao Gancao Tang, modified.
Rationale: cool the blood and stop bleeding, dissipate nodules and reduce swelling, resolve stasis and stop pain, and unblock the viscera.
Xuanshen (Scrophulariae Radix) 30g, Maidong (Ophiopogonis Radix) 30g, Shengdi (Rehmanniae Radix recens) 30g, Mangxiao (Natrii Sulfas) 30g, Sheng Dahuang (raw Rhei Radix) 20g (added later), Diyu Tan (carbonized Sanguisorbae Radix) 30g, Daji (Cirsii Japonici Herba) 15g, Xiaoji (Cirsii Herba) 15g, Baishao (Paeoniae Radix alba) 30g, Chishao (Paeoniae Radix rubra) 15g, Sheng Gancao (Glycyrrhizae Radix) 9g, Danggui (Angelicae Sinensis Radix) 15g, Xianhecao (Agrimoniae Herba) 30g, Haizao (Sargassum) 30g, Kunbu (Eckloniae Thallus) 30g, Zhe Beimu (Fritillariae thunbergii Bulbus) 15g, Sheng Muli (Ostrea Concha) 30g (decocted first), Laifuzi (Raphani Semen) 30g, Cheqianzi (Plantaginis Semen) 15g, Yiyiren (Coicis Semen) 30g, Chixiaodou (Phaseoli Semen) 30g, Banzhilian (Scutellariae Barbatae Herba) 30g
On June 8, after one dose, the patient reported bowel movements became regular, the purpura began to disappear, and pain basically vanished, though there was still slight stabbing pain at the cervical os. I instructed adding Kushen (Sophorae Flavescentis Radix) 15g and Tu Fuling (Smilacis Glabrae Rhizoma) 30g to the original formula and continuing.
On June 9, after an adjusted prescription, the patient reported the analgesic effect was not as good as the previous day; bleeding had stopped, and the abdomen began to show signs of impending diarrhea. I told her that after the diarrhea she should moderately reduce the Dahuang dose, decoct more medicine, and take it four or five times a day to maintain continuous medicinal effect. At the same time I instructed her to take Guipi Wan (Spleen-Returning Pill) to prevent excessive damage to the healthy qi. By video call I saw the patient's condition was acceptable. Because taking Chinese medicine can weaken the body, I told her to strengthen nutrition and eat more kelp stewed with pork ribs, but to separate meals from medicine by more than an hour.
On June 10, the patient had a local TCM doctor feel her pulse; the local doctor differentiated qi and blood deficiency with a white greasy tongue coating, unlike the old yellow coating of the first visit. The right thigh pain eased, but the area around the buttock corresponding to the mass hurt a lot. Her mouth and tongue were dry, especially after waking. Later, seeing a photo of her tongue, I found the coating was still yellow and greasy, the tongue tip red, and the edges tooth-marked; I suspected the local TCM diagnosis was wrong. The massive hemorrhage had completely stopped. On the afternoon of June 10 the patient began to have diarrhea; after the diarrhea, almost all pain disappeared. I told her to reduce the Dahuang dose but keep Dahuang at home on hand. The Dahuang dose should be such that the stool is moderate and does not require straining. I especially warned her not to strain at stool, to prevent another massive hemorrhage. Considering moderate attack-and-dispersion. The dry mouth was suspected as a pre-symptom of cancer fever; Chaihu and Huangqin were added for prevention.
Xuanshen 20g, Maidong 20g, Shengdi 20g, Mangxiao 30g, Sheng Dahuang 10g (added later), Diyu Tan 20g, Daji 15g, Xiaoji 15g, Baishao 30g, Sheng Gancao 10g, Zhishi (Aurantii Immaturus Fructus) 20g, Chaihu (Bupleuri Radix) 10g, Huangqin (Scutellariae Radix) 10g, Xianhecao 30g, Ezhu (Curcumae Rhizoma) 12g, Moyao (Myrrha) 9g, Ruxiang (Olibanum) 9g, Haizao 30g, Kunbu 30g, Zhe Beimu 15g, Sheng Muli 30g (decocted first half an hour), Duan Walengzi (calcined Arcae Concha) 15g (decocted first half an hour), Yiyiren 30g (decocted first half an hour), Banzhilian 30g, Kushen 15g, Tu Fuling 15g, Tianhuafen (Trichosanthis Radix) 15g, Shengjiang (Zingiberis Rhizoma recens) 10g sliced, Dazao (Jujubae Fructus) 5 pieces
At the same time take the patent medicine Guipi Wan. I instructed her not to take Chinese medicine during menstruation or a cold, and to abstain from sexual activity. If this formula's analgesic effect was not good enough, next time increase Baishao to 60g. I told her to stop for two days after every five days of medication.
On the evening of June 11, the patient reported the above formula gave a fairly good analgesic effect, and the diarrhea was within an acceptable range. Treatment advanced further. The prescription was slightly adjusted, adding the qi-supporting Dangshen and the poison-attacking-with-poison Lufengfang (Nidus Vespae).
Dangshen (Codonopsis Radix) 30g, Xuanshen 20g, Maidong 20g, Shengdi 20g, Mangxiao 30g, Sheng Dahuang 10g (added later), Diyu Tan 20g, Daji 15g, Xiaoji 15g, Baishao 30g, Sheng Gancao 10g, Zhishi 20g, Chaihu 10g, Huangqin 10g, Xianhecao 30g, Ezhu 12g, Moyao 9g, Ruxiang 9g, Haizao 30g, Kunbu 30g, Zhe Beimu 15g, Sheng Muli 30g (decocted first half an hour), Duan Walengzi 15g (decocted first half an hour), Yiyiren 30g (decocted first half an hour), Banzhilian 30g, Kushen 15g, Tu Fuling 15g, Tianhuafen 15g, Lufengfang (Nidus Vespae) 4g, Shengjiang 10g sliced, Dazao 5 pieces
On June 12, after taking the new prescription, the patient sweated easily, presumably due to Chaihu's diaphoretic action. If sweating reduced pain, Chaihu could continue next time; if not, remove Chaihu and Huangqin. The patient later reported that after sweating she felt better, so I told her to continue. The medicine cost was too high for her to bear long-term; I told her that after a while one dose could be stretched over two days. Now the Dangshen dose was reduced. Because the ureter was blocked by tumor, urination was still difficult.
Next time fill the following prescription:
Dangshen 15g, Xuanshen 20g, Maidong 20g, Shengdi 20g, Mangxiao 30g, Sheng Dahuang 10g (added later), Diyu Tan 20g, Daji 15g, Xiaoji 15g, Baishao 30g, Sheng Gancao 10g, Zhishi 20g, Chaihu 6g, Huangqin 6g, Xianhecao 30g, Ezhu 12g, Moyao 9g, Ruxiang 9g, Haizao 30g, Kunbu 30g, Zhe Beimu 15g, Sheng Muli 30g (decocted first half an hour), Duan Walengzi 15g (decocted first half an hour), Yiyiren 30g (decocted first half an hour), Banzhilian 30g, Kushen 15g, Tu Fuling 15g, Tianhuafen 15g, Lufengfang 4g, Niuxi (Achyranthis bidentatae Radix) 10g, Cheqianzi 15g, Fulin (Poria) 15g, Jineijin (Galli Gigerii Endothelium Corneum) 30g (added later together with Dahuang)
Continue Guipi Wan without interruption. The day after tomorrow and the day after that, stop the decoction for two days to reduce the burden on the liver and kidneys. During the decoction break, do not stop Guipi Wan. If cancer pain is severe during the break, take the patent medicine Yuanhu Zhitong Pian (Corydalis Pain-Relieving Tablets).
Both the TCM diaphoretic method and the purgation method can, to a certain extent, relieve cancer pain, as this patient's treatment course clearly shows.
Case 2: Terminal lung cancer with brain, liver, and bone metastases—hospice care
The patient was a 56-year-old Mongolian man, 178 cm tall, weighing 49 kg. In January 2013 he developed right lung pain and cough; a local hospital CT showed a shadow in the right lung and recommended examination elsewhere. On January 15, 2013, he went to Peking Union Medical College Hospital for a PET/CT scan.
The scan showed: in the upper lobe of the right lung, a mass with abnormally heterogeneous increased radiotracer uptake, adjacent to the dorsal pleura, measuring 6.9 × 6.3 × 6.9 cm, mean SUV 7.2, maximum 20.4, with a central area of reduced uptake; around the mass, in the adjacent lung lobe, interlobular septal thickening with mildly increased uptake, mean SUV 1.2. No definite foci of increased uptake or abnormal density were seen in the remaining lung lobes.
At the right hilum (station 10R) one lymph node showed abnormal increased uptake, short axis 1.4 cm, mean SUV 5.9, maximum 12.7. No definite abnormal increased or decreased uptake was seen in the remaining mediastinum, axilla, or chest wall soft tissue.
In the white matter of the left frontal lobe and left parietal lobe, one ring-shaped focus of increased uptake each, measuring 0.8 × 0.8 and 1.3 × 1.4 respectively, mean SUV 4.7 and 3.2, maximum 6.4, with reduced uptake in the surrounding left frontal and parietal cortex; the concurrent CT showed these foci had a central low-density area with extensive surrounding edema of the cerebral white matter. In the right cerebellum (near the vermis), one suspicious ring-shaped focus of mildly increased uptake, 0.7 × 0.8, mean SUV 5.1, maximum 7.0.
Peking Union Medical College Hospital's impression: a mass in the right upper lobe with abnormally heterogeneous metabolic increase, considered lung cancer; right hilar (10R) lymph node metastasis; multiple brain metastases (left frontal and parietal lobes) with extensive surrounding edema and secondary reduced metabolism in the adjacent frontal and parietal cortex following cerebral edema; a suspicious focus of increased metabolism in the right cerebellum, not excluding early metastasis.
PUMCH's treatment plan: the hospital would not admit him; if treated, radiotherapy and chemotherapy were recommended, not surgery. The patient's family decided against Western medicine; after the scan he took Chinese herbal decoctions from an old TCM doctor. After taking the medicine, cough, blood-streaked sputum, and right chest pain all eased, but the edema was poorly controlled. The edema pressed on nerves, causing disturbance of consciousness and loss of function of speech, the right hand, and the right foot—serious.
After his condition worsened, on February 16 he flew to Beijing, was admitted on the 17th, and underwent gamma knife on the brain on the 18th. Postoperatively, dehydrating treatment was given using mannitol (250 ml × 3 bottles), glycerol-fructose, furosemide, and hormones; his condition improved. On March 15 he underwent pulmonary gamma knife at Navy General Hospital, for a total of 12 sessions; his condition improved, and he was discharged on March 30.
After discharge from Navy General Hospital, he returned home to recuperate. Because large doses of hormones had been used during his Navy General Hospital stay, he developed a gastric ulcer. On April 13 he was admitted to our local hospital for treatment, mainly with lansoprazole, and improved slightly; discharged April 28. Thereafter he developed pain in the lumbar and cervical spine, each bout worse than the last. Treatment: plasters, painkillers, and the old TCM doctor's herbs—ineffective.
On May 13 he was again admitted to Navy General Hospital for examination and treatment. Head MRI showed: multiple abnormal signals in both frontal, parietal, and temporal lobes, the right centrum semiovale, and the posterior horn of the left lateral ventricle, considered metastases, with a small amount of cerebral edema and an old hemorrhage in the left parietal lobe. Enhanced chest CT showed: a mass with abnormal heterogeneous increased uptake in the right upper lobe, adjacent to the dorsal pleura, measuring 9.7 × 9.3 cm; a shadow in the thoracic vertebrae suspicious for bone metastasis.
Ultrasound of the liver, gallbladder, pancreas, and spleen showed: multiple hyperechoic nodules in the liver, the larger about 2.9 × 2.5 cm, with a surrounding hypoechoic halo; CDFI showed rich blood-flow signals. Navy General Hospital's diagnosis: advanced lung cancer, brain and liver metastases, bone metastasis? (Bone scan showed no abnormality; the nuclear medicine physician at Navy General Hospital explained that lytic bone metastases may appear normal on bone scan, and the attending physician must confirm in combination with symptoms and other imaging.)
Navy General Hospital recommended radiotherapy/chemotherapy or targeted therapy with Iressa or Tarceva for the bone metastasis.
The patient's family declined these plans and consulted a famous TCM doctor.
That TCM doctor's diagnosis: advanced lung cancer with brain and liver metastases, bone metastasis?; gastrointestinal tract extremely weak; avoid cold and spicy foods; avoid wind and cold.
Treatment: bloodletting at Weizhong (BL40);
Fourteen doses of Chinese medicine: Duan Haifushi (calcined Pumex) 50g (decocted first), Baiying (Solanum lyratum) 20g, Baihe (Lilii Bulbus) 30g, Zhimu (Anemarrhenae Rhizoma) 20g, Sharen (Amomi Fructus) 10g (added later), Ganjiang (Zingiberis Rhizoma) 10g, Wugong (Scolopendra) 3 pieces, Sheng Huangqi (Astragali Radix) 50g, Danggui (Angelicae Sinensis Radix) 30g, Shengma (Cimicifugae Rhizoma) 3g, Dilong (Pheretima) 10g, Shanzhuyu (Corni Fructus) 30g, Shudihuang (Rehmanniae Radix praeparata) 30g, Bihu (Gecko) 30g, Fulin (Poria) 30g, Guizhi (Cinnamomi Ramulus) 10g, Baishao (Paeoniae Radix alba) 30g, Chao Cangzhu (fried Atractylodis Rhizoma) 15g, Zexie (Alismatis Rhizoma) 20g, Huainiuxi (Achyranthis bidentatae Radix) 30g, Jineijin (Galli Gigerii Endothelium Corneum) 20g. One dose daily, divided into two doses, together with Jinlong Jiaonang (Golden Dragon Capsule).
Ineffective.
When seeking treatment, the patient's family described the current symptoms:
The body was extremely weak, weighing under 50 kg; hands and feet cold, aversion to cold. Bowel movement once every 4-5 days, requiring Kaiselu (glycerin enema), with little stool. Urination 5-6 times a day, small volume; prostatic disease. Cervical pain radiating to the head; unbearable lower back pain radiating to the right leg and foot; swelling and pain on the outer edge of the right foot, slight edema on the instep; that day he again felt generalized pain. Poor appetite, eating only congee and other liquids at each meal; smelling greasy food caused nausea and vomiting. Poor sleep.
Western medicine given daily: amino acid injection, Shenmai injection, lansoprazole injection; pain control with morphine tablets and pethidine. The family had previously emailed to consult about pain; I had suggested Shaoyao Gancao Tang and Xihuang Wan for pain, both briefly effective then ineffective. Western painkillers were the same. Severe constipation—no bowel movement for 4-5 days; impossible to defecate without medication.
The patient's son requested a prescription to ease his father's suffering.
This patient had lung cancer with brain, liver, and bone metastases, and the lung tumor was already massive; the spleen and stomach were already failing, with severe ulceration from hormones, and taking medicine or greasy food caused nausea and vomiting. There was little I could do. Only because the family begged bitterly for a prescription to save him, on June 1 I prescribed the following:
Ruxiang (Olibanum) 6g, Moyao (Myrrha) 6g, Qianghuo (Notopterygii Rhizoma) 6g, Duhuo (Angelicae Pubescentis Radix) 6g, Sangzhi (Mori Ramulus) 30g, Baiying (Solanum lyratum) 30g, Banzhilian (Scutellariae Barbatae Herba) 15g, Shufu (Armadillidium) 15g, Tubiechong (Eupolyphaga) 15g, Yuanhu (Corydalis Rhizoma) 6g, Chuanlianzi (Toosendan Fructus) 6g, Maidong (Ophiopogonis Radix) 15g, Tiandong (Asparagi Radix) 15g, Shengdi (Rehmanniae Radix recens) 15g, Taizishen (Pseudostellariae Radix) 15g, Dangshen (Codonopsis Radix) 15g, Baizhu (Atractylodis Macrocephalae Rhizoma) 6g, Cangzhu (Atractylodis Rhizoma) 6g, Chenpi (Citri Reticulatae Pericarpium) 6g, Qingpi (Citri Reticulatae Viride Pericarpium) 6g, Fabanxia (processed Pinelliae Rhizoma) 6g, Baishao 30g, Zhi Gancao (honey-fried Glycyrrhizae Radix) 10g, Danggui 10g, Baiji (Bletillae Rhizoma) 10g, Wuzeigu (Sepiae Endoconcha) 10g, Jiao Maiya (charred Hordei Fructus germinatus) 10g, Jiao Shanzha (charred Crataegi Fructus) 10g, Jineijin 15g, Zhe Beimu (Fritillariae thunbergii Bulbus) 15g, Chaihu (Bupleuri Radix) 6g, Huangqin (Scutellariae Radix) 6g, Huomaren (Cannabis Semen) 15g, Yuliren (Pruni Semen) 15g, Baiziren (Biotae Semen) 15g, Fulingpi (Poriae Cortex) 60g, Yiyiren (Coicis Semen) 60g
Patent medicine: Qiangli Pipaga (Strong Pear Syrup), three times daily.
Wuling Jiaonang (Five-Ingredient Poria Capsule), three times daily.
No analgesic effect was obtained, and the appetite did not improve; after taking the medicine urination increased somewhat. It was fine at first, but after a few days, taking the medicine caused vomiting. I already felt it was extremely hard to handle. The patient himself and his son both refused to give up, and earnestly invited me to make a house call to Inner Mongolia. Because my family worried about legal risk and disagreed, I refused to go.
The patient's immediate urgent problems included: vomiting after taking medicine, severe pain, difficult defecation, inability to eat, and sleeplessness through the night due to pain.
On June 10, from photos sent by the patient's son, I saw the tongue coating was dry and old yellow, the tongue body small and thin. The patient urgently needed urgent purgation to preserve yin, but the risk was too great. I again prescribed:
Laifuzi (Raphani Semen) 90g, Baishao 90g, Sheng Gancao 15g, Houpo (Magnoliae Cortex) 45g, Zhishi 30g, Sheng Dahuang (raw Rhei Radix) 20g (steeped for 5 minutes in the freshly poured hot decoction after it is done), Mangxiao 30g (dissolved in two portions in the decoction), Tubiechong 30g, Pugongying (Taraxaci Herba) 120g, Taoren (Persicae Semen) 20g (crushed, added later), Ezhu 15g, Sanleng 15g, Xuanshen 15g, Zhe Beimu 15g, Sheng Muli 30g (decocted first half an hour), Haizao 45g, Kunbu 45g, Haidai (Laminariae Thallus) 45g, Renshen (Ginseng Radix) 30g, Maidong 30g, Wuweizi (Schisandrae Fructus) 30g, Xuanfuhua (Inulae Flos) 10g, Daizheshi (Hematitum) 30g (added later), Baiji 20g, Duan Walengzi 15g (decocted first half an hour)
I told the patient's son to start the patient at one-third of the standard dose; if there was no discomfort, gradually increase to the standard dose next time. Observe for eight hours after taking; if no bowel movement, take again. If painful diarrhea occurs, call to determine the next dosing plan. For emergencies, communicate at any time.
On June 11, 40 minutes after taking the above medicine, the patient developed bodily heat and dryness, with no other discomfort and no further vomiting. This should be ginseng causing an upward rush; I told the family not to panic. If this side effect had not resolved after two hours, take strong concentrated white-radish soup frequently to counteract ginseng's upward rush. The ginseng dose was too large; I may have underestimated the patient's strength, and the family probably selected a high-quality, long-aged ginseng when buying it, hence this strength.
After this dose the patient no longer vomited—good—and the ginseng upward-rush signs resolved on their own.
I told the family that if no bowel movement occurred after 6-8 hours, go to the pharmacy and weigh out 10g of raw Dahuang; take one-third of the previously decocted liquid, decoct the 10g of raw Dahuang in it, strain after boiling, and keep the liquid. At the same time, take a large white radish, boil a thick half-bowl of soup, and give it together with the Dahuang-decocted liquid. If bowel movement has occurred but is not unobstructed, do the same. If there is painful diarrhea, do not decoct Dahuang; just take the white radish juice mixed in.
Fifty minutes after the patient took this, he had slight abdominal pain and one bowel movement, neither dry nor loose; then he felt the urge again, though it was all urine. The lower back pain was greatly relieved, and he was almost pain-free through the night—an effect morphine had never achieved. The next morning cancer pain returned. I told the patient to take the remaining medicine all at once using the previous method, still with 10g Dahuang plus 15g Mangxiao. The prescription had shown initial effect; the balance of attack and support needed adjustment, pending the patient finishing the remainder. This time he did not vomit; the stomach qi was recovering, and there was hope for treatment.
At 10 a.m. on June 12, the family reported the patient had twitching, not severe. I suspected it was due to an empty stomach and told them to give the patient appropriate white sugar in hot congee; if it did not resolve on its own, a local doctor should examine him. The family later reported it was just startle during sleep; after waking, the patient's spirits were much better than before medication. So I suspected it was not medical "convulsion" in the strict sense, but rather the family, lacking clinical knowledge, being overly nervous. This should be due to days of abnormal eating, urination, and defecation leading to spleen deficiency and spirit exhaustion. I considered subsequent conditioning with Guipi Tang combined with Xiao Liu Wei/Dissipating-Nodule Pill plus Xiexin Tang modifications to fortify the spleen, calm the spirit, and soften and disperse nodules, hoping to further improve the patient's quality of life and prolong survival.
I told the family to switch to the following prescription:
Renshen 15g, Baizhu 30g, Fushen (Poriae Pini) 30g, Longyanrou (Longan Arillus) 10g, Muxiang (Aucklandiae Radix) 6g, Yuanzhi (Polygalae Radix) 10g, Zhi Gancao 10g, Roucongrong (Cistanches Herba) 60g, Baishao 30g, Chuan Huanglian (Coptidis Rhizoma) 6g, Rougui (Cinnamomi Cortex) 6g, Huangbai (Phellodendri Cortex) 12g, Haizao 30g, Kunbu 30g, Xuanshen 15g, Zhe Beimu 15g, Sheng Muli 30g (decocted first half an hour), Duan Walengzi 15g (decocted first half an hour), Tubiechong 15g, Sanleng 12g, Ezhu 12g, Ruxiang 9g, Moyao 9g.
This patient was a critically ill, urgent case who could pass away at any time. Yet after using the purgation method, the patient not only did not become listless but showed improved spirits, improved appetite, and reduced cancer pain. This shows that the TCM purgation method need not be as frightening as imagined.