A Case Study: Telemedicine TCM Alleviating Clinical Symptoms in an Elderly Patient with Advanced Ovarian Cancer

A certain Chen, female, aged 84, presented with abdominal distension. On April 9, 2021, she underwent a CT examination at the radiology department of the Yunan County People's Hospital, Yunfu, Guangdong (CT no. 110818). The diagnosis was: 1. Occupying lesion posterosuperior to the uterus, considered a malignant tumor likely arising from the adnexa, with possible peritoneal implant metastasis beside the ascending colon in the right mid-abdomen; the lesion was partly ill-defined from the surrounding bowel, posterior uterine wall, and right external iliac artery and vein; MRI and contrast enema CT were recommended. 2. Abdominal and pelvic effusion; peritoneal thickening and exudation, possible peritoneal metastasis. 3. Suspected S3 hepatic cystic lesion. 4. Right pleural effusion with partial atelectasis of the right lower lobe. 5. Fibroproductive foci in the left upper lobe lower lingular segment and the medial segment of the right middle lobe. 6. Multiple enlarged mediastinal lymph nodes. 7. Cardiac enlargement; atherosclerosis of the aorta and coronary arteries. 8. Degenerative changes of the thoracic and lumbar spine; compression deformity of the T12 vertebral body, and Schmorl's nodes on the superior endplates of T11 and T12.

Laboratory results from the Guangzhou Jincheng Medical Laboratory Center (test no. 70563) showed the patient's human epididymis protein 4 (HE4) was 417.5 and CA125 was 1151; the ROMA index was elevated both before and after menopause. The local physician diagnosed advanced ovarian cancer.

Because the patient was elderly, the family did not consider more invasive treatments such as surgery or chemoradiation. After the patient's son read an empirical formula I had published on my website for treating ovarian cancer ascites, he prepared the medicine himself. The prescription was:

Sheng Huangqi (raw Astragalus) 50 g, Han Fangji (Stephania) 15 g, Baizhu (Atractylodes) 15 g, Zexie (Alisma) 15 g, Dafupi (Areca peel) 15 g, Fuling (Poria) 30 g, Banbianlian (Lobelia) 30 g, Shuihonghuazi (Polygonum orientale fruit) 30 g, Mabiancao (Verbena) 30 g, Yiyiren (Coix seed) 50 g, Longkui (Solanum nigrum) 20 g, Guizhi (Cinnamon twig) 10 g, Gancao (licorice) 10 g. Decoct the above in water, divide into two doses, one packet per day.

One day after taking this formula, the patient's symptoms improved and her shortness of breath lessened, but it was not yet enough to resolve all her problems. Seeking better efficacy, the family contacted me on May 3, 2021, hoping that I would help improve the patient's quality of life through a video consultation.

The remote consultation revealed: the patient had dry, bound stools; a dry and bitter mouth; toothache for one week; a slightly yellow, greasy tongue coating; severe shortness of breath when lying down or getting up; abdominal distension; a large amount of ascites; urine volume varying with water intake and colored yellow; poor appetite, able to eat only a bowl of congee per meal. Her hands and feet were neither cold nor hot; she had no aversion to cold or heat; she usually preferred warm drinks.

Since the above prescription was effective, it was by and large on the pattern for this patient. But because the family did not understand TCM and did not know how to modify the formula to address the patient's other problems, it could not yet resolve them. I therefore modified the formula on the basis of the patient's symptoms.

Prescription: Sheng Huangqi 40 g, Han Fangji 15 g, Baizhu 15 g, Zexie 15 g, Dafupi 15 g, Fuling 30 g, Banbianlian 30 g, Banzhilian (Scutellaria barbata) 30 g, Baihuasheshecao (Oldenlandia) 30 g, Xianhecao (Agrimonia) 30 g, Yumixu (corn silk) 30 g, Chao Zhizi (fried gardenia) 15 g, Yinchen (Artemisia capillaris) 10 g, Longkui 20 g, Yiyiren 60 g, Shuihonghuazi 30 g, Mabiancao 30 g, Guizhi 10 g, Gancao 10 g, Ezhu (Curcuma zedoaria) 10 g, Sheng Maiya (raw malt) 30 g, Chao Maiya (fried malt) 30 g, Jiao Shanzha (charred hawthorn) 6 g, Roucongrong (Cistanche) 30 g, Pian Jianghuang (Curcuma) 6 g, Chan Yi (cicada slough) 6 g, Chao Jiangchan (fried stiff silkworm) 10 g, Danggui 10 g, Baishao (white peony) 10 g, Xuanshen (Scrophularia) 12 g, Zhe Beimu (Zhejiang Fritillaria) 12 g, Sheng Muli (raw oyster shell) 30 g.

In this formula, corn silk, gardenia and yinchen were added to strengthen the water-disinhibiting, swelling-reducing effect, while also clearing heat and detoxifying; Banzhilian, Baihuasheshecao, Xianhecao, Ezhu, Pian Jianghuang, Chan Yi, Jiangchan, Xuanshen, Zhe Beimu and Sheng Muli were added to combat cancer and reduce swelling; raw malt, Danggui, Baishao and Roucongrong were added to soothe the liver and resolve depression, nourish yin and blood, and moisten the intestines to loosen the bowels; fried malt and charred hawthorn were added to improve the appetite.

After taking one packet of the modified prescription, the patient had a slight nausea, so I told the family to add Chenpi (tangerine peel) 6 g and Fabanxia (processed Pinellia) 6 g to the formula. After taking two more packets, the patient's bowel and urinary movements returned to normal, her appetite was good, her energy markedly improved, and she could do housework with her family. The family was overjoyed, and added that the patient had long had a rapid heart rate. I therefore advised her to take the patent medicine Wenxin Keli (Heart-Stabilizing Granules) alongside the decoction. After three more packets, her energy and appetite continued to improve, the abdominal distension was markedly reduced, and only the dry, bitter mouth remained. I advised her not to change the formula because it was effective; on top of the above medicines, she should take Shugan Hewei Wan (Liver-Soothing Stomach-Harmonizing Pill), and stop it once the dry, bitter mouth resolved.

The patient in this case was elderly and frail and certainly could not have tolerated the side effects of surgery and chemotherapy. The family sought TCM conservative treatment to relieve clinical symptoms and improve the patient's quality of life; this psychological expectation was reasonable. For such an elderly patient, conservative treatment is more meaningful, so when the family came to me, I felt there was mutual trust and the family's expectations were reasonable and would not impose too great a psychological burden on me; I therefore agreed to treat the patient with pure TCM.

The key to TCM relieving clinical symptoms in advanced cancer patients lies in the physician's familiarity with the indications of formulas and herbs. The diagnostic process and prescribing approach above are not complicated; the formula was constructed by modifying and combining Wuling San (Five-Ingredient Powder with Poria), Shengjiang San (Ascending-Dispersing Powder) and Xiaoluo Tang (Melt-Nodules Decoction). But the dosages are large, because cancer patients differ from ordinary patients; at too low a dose it is hard to achieve the desired effect.