A TCM Case Relieving Cancer Pain in a Pancreatic Cancer Patient

Patient: Li, male, 58 years old, from Hubei province (my hometown). In May 2026 he developed abdominal pain without obvious cause—persistent epigastric pain below the xiphoid, of a distending nature. It was accompanied by nausea and vomiting, recurring repeatedly. He was seen by the gastroenterology department, where a gastroscopy was done, and oral gastric medications were prescribed without improvement. On the evening of May 21, 2026, he was admitted through the emergency department to the hepatobiliary and pancreatic ward.

During hospitalization, serum amylase was found slightly elevated; CT showed a mass in the pancreatic head, multiple secondary liver lesions, and a mesenteric mass. A liver biopsy showed poorly differentiated adenocarcinoma; combined with imaging and immunophenotyping, a malignant tumor of pancreatobiliary epithelial origin was suspected. Diagnosed: pancreatic cancer involving the root of the mesentery, with mesenteric lymph-node metastasis and multiple liver metastases.

The patient began chemotherapy after admission. After two cycles, the pain could not be relieved, and he required oral OxyContin for pain relief; after taking the analgesic he sweated profusely and became constipated. Chemotherapy caused myelosuppression, leaving him weak and fatigued. Urination was difficult; bowel movements came once every 2–3 days, in sheep-dung-like pellets, requiring Kaiselu (glycerin enema) to defecate. He had recently lost weight, with poor appetite, flatulence, and dull abdominal pain.

Past medical history: diabetes, and anxiety disorder diagnosed 20 years earlier; he had long taken hypoglycemic and anti-anxiety medications.

On June 13, 2026, the patient's family, introduced through an acquaintance, turned to me for help, hoping I could relieve his cancer pain, constipation, and other symptoms.

Based on the patient's complaints and examination reports, I judged him to have yin deficiency with effulgent fire, qi and blood deficiency, and exhaustion of fluids. I planned a combined formula of Danggui Buxue Tang, Zengye Tang, Shen Siwei (Four Kidney Herbs), Shengmai Yin, Yupingfeng San, and Shaoyao Gancao Tang, plus added Xianhecao, Xuchangqing, Huomaren, Huangjing, Baihuasheshecao, and Zhizi.

First-visit decoction:

Xuanshen (Scrophulariae Radix) 30g, Maidong (Ophiopogonis Radix) 24g, Shengdi (Rehmanniae Radix) 24g, Huomaren (Cannabis Semen) 30g, raw Huangqi (Astragali Radix) 50g, Danggui (Angelicae Sinensis Radix) 10g, Baizhu (Atractylodis Macrocephalae Rhizoma) 10g, Fangfeng (Saposhnikoviae Radix) 10g, Baishao (Paeoniae Alba Radix) 30g, raw Gancao (Glycyrrhizae Radix) 10g, Mohanlian (Ecliptae Herba) 30g, Nuzhenzi (Ligustri Lucidi Fructus) 10g, Shayuanzi (Astragali Complanati Semen) 10g, Tusizi (Cuscutae Semen) 10g, Dangshen (Codonopsis Radix) 30g, Wuweizi (Schisandrae Fructus) 10g, Huangjing (Polygonati Rhizoma) 15g, Xuchangqing (Cynanchi Paniculati Radix) 30g, Xianhecao (Agrimoniae Herba) 50g, Baihuasheshecao (Hedyotidis Diffusae Herba) 30g, Zhizi (Gardeniae Fructus) 10g.

Start with 1 dose; if no obvious side effects, then use 3 doses at a time. If effective, do not change the formula during chemotherapy, using it to support chemotherapy.

Patent medicine: Yuanhu Zhitong Pian (Corydalis Pain-Relieving Tablets), taken per the package insert. Try first cutting the OxyContin dose in half; if pain is relieved after using the Chinese medicine, continue trying to stop OxyContin completely.

The Danggui Buxue Tang above (composed of raw Huangqi and Danggui in a 5:1 ratio) supplements qi and blood; Zengye Tang (Xuanshen, Maidong, Shengdi) nourishes yin, moistens dryness, and loosens the bowels; Shen Siwei (Mohanlian, Nuzhenzi, Shayuanzi, Tusizi) supports the righteous, secures the root, and has an anti-anxiety effect; Shengmai Yin (Dangshen, Maidong, Wuweizi) boosts qi and nourishes yin; Yupingfeng San (Huangqi, Baizhu, Fangfeng) secures the exterior and stops sweating; Shaoyao Gancao Tang (Baishao, Gancao) relaxes spasm and relieves pain; Xianhecao supports the righteous, fights cancer, and stops bleeding; Xuchangqing relieves pain; Huomaren moistens the intestines and eases defecation; Huangjing boosts qi and nourishes yin; Baihuasheshecao clears heat, resolves toxin, and fights cancer; Zhizi clears heat and promotes diuresis; plus the patent medicine Yuanhu Zhitong Pian to invigorate blood and stop pain. This prescription took essentially all of the patient's symptoms into account.

After taking 2 doses, with OxyContin halved, the pain lessened. He continued the medication until June 18, when OxyContin was completely stopped, and the cancer pain did not recur. Bowel movements became regular, his spirit and strength recovered noticeably, and his overall condition improved markedly. The patient now continues the above formula alongside chemotherapy to support it.

How does one compose such a formula? I believe the first step is to build a solid foundation: one must have the indications of commonly used formulas and herbs clearly in mind. Only then can one compose formulas with ease. TCM treatment emphasizes pattern differentiation (treating the manifestation); the more formula indications we remember, the broader our thinking when prescribing. There is no shortcut; it requires day-after-day accumulation.