Three Ancient Formulas Centered on Naosha (Sal Ammoniac) for Esophageal Cancer

China has long been a country with a heavy burden of esophageal cancer. According to the World Health Organization, China ranks first in the world in esophageal cancer incidence. This is closely related to two deeply ingrained dietary habits of the Chinese people: first, the fondness for eating food while it is very hot (scalding food); second, the love of various pickled foods—dried radish, fermented bean curd, cured fish, cured meat, cured chicken, Chinese sausage and so on. All of these are carcinogenic causes of esophageal cancer.

This dietary habit has a long history and remains widespread today. Ancient Chinese physicians also recognized esophageal cancer in clinical practice; in TCM classical texts it was called "ye ge" (dysphagia and globus). (Of course, the historical category of ye ge was broader than today's esophageal cancer, also covering benign lesions of the esophagus and mediastinum, as well as cardiac carcinoma and other diseases.)

Ye ge was counted among the four incurable diseases of TCM internal medicine. The celebrated Qing-dynasty physician Xu Lingtai once said that ye ge was basically a fatal disease, and that cases of ye ge that could be cured were not true ye ge. This shows that ancient TCM physicians also recognized the poor prognosis of esophageal cancer.

Even so, there have always been researchers who delved deeply into this disease. Some physicians created effective formulas that could relieve the patient's condition, prolong survival, and in a few fortunate cases even achieve cure. Here I select three ancient formulas to introduce how TCM treated ye ge using naosha (sal ammoniac, ammonium chloride) as the principal herb.

The first is "Hei Jin Wan" (Black Gold Pill) from the Shengji Zonglu (General Collection for Holy Relief). Its composition: Chenxiang (Aquilariae Lignum resinatum) half a qian (filed, 15 g), Fuzi (Aconiti lateralis Radix praeparata) half a qian (roasted until cracked, skin and navel removed, 15 g), Muxiang (Aucklandiae Radix) one fen (0.3 g), Qingpipi (unripe Citri Reticulatae Pericarpium) one fen (soaked in water to remove the white pith, dried, 0.3 g), Ganjiang (Zingiberis Rhizoma) one fen (roasted, 0.3 g), Ximo (fine ink) one fen (heated red, ground with vinegar, 0.3 g), Jing Sanleng (Sparganii Rhizoma) one fen (roasted, filed, 0.3 g), Ezhu (Curcumae Rhizoma) one fen (roasted, filed, 0.3 g), Gui (Cinnamomi Cortex) one fen (rough bark removed, 0.3 g), Dahuang (Rhei Radix et Rhizoma) half a fen (filed, 0.15 g), Ganqi (dry lacquer, Toxicodendri Resina) half a fen (stir-fried until smoke appears, 0.15 g), Shexiang (Moschus) half a fen (ground, 0.15 g), Naosha (sal ammoniac) one liang (ground, levigated with water, 30 g).

Preparation: pound and grind all thirteen ingredients into powder. Boil Jing Sanleng, Ezhu, Dahuang and Naosha together in rice vinegar until soft, then grind into a paste. Mix in the remaining herb powders and form into pills the size of a parasol tree seed. Take 10 to 15 pills each time, washed down with ginger decoction, at any time. This formula treats food-related zheng-jia and pi-ju (abdominal masses), and all kinds of blood-binding stabbing pain. The food-related zheng-jia pi-ju described here closely resembles today's esophageal cancer, cardiac carcinoma and gastric cancer, especially esophageal cancer.

This formula uses a heavy dose of naosha, also called purple naosha. It is the crystalline or artificial product of the chloride mineral sal ammoniac, produced naturally in Xinjiang, Gansu, Qinghai and other parts of China. TCM recognized its medicinal value very early, holding that it can "dissolve accumulation and soften hard masses, transform putrefaction and generate new tissue, expel phlegm and promote diuresis." It is used for zheng-jia masses, ye ge with regurgitation, throat bi with swelling and pain, welling abscesses, scrofula, eye nebulae, polyps and superfluous growths. Naosha is somewhat caustic; clinically it can indeed inhibit tumor progression, but its side effects are not trivial. Some patients develop excess gastric acid or loose stools after taking it, and in severe cases liver or kidney function may become abnormal, so it must be used with caution.

The ancient technique of "levigating with water" (shuifei) was mainly used to remove impurities from mineral medicines such as naosha. Some impurities in naosha carry even greater side effects and can be fatal in severe cases. Levigation works by dissolving naosha in water and allowing it to slowly crystallize out; harmful impurities, originally present only in tiny amounts, dissolve and remain in the water, so the precipitated naosha is less toxic. However, untrained people may find this procedure difficult to perform; ancient Chinese physicians actually mastered many primitive chemical methods.

In this formula, Chenxiang and Fuzi assist naosha, moderately reducing its side effects while also helping to relieve the symptoms caused by esophageal cancer. TCM holds that esophageal cancer belongs to qi stagnation, so descending-qi herbs are needed. The other herbs are used lightly; Sanleng, Ezhu, Ganqi and Shexiang are also anticancer herbs used by modern TCM physicians, but because naosha is the main agent relieving the patient's symptoms, the other herbs must not overshadow it and interfere with efficacy.

The Yangshi Jiacang Fang (Yang Family's House-hold Formulas) contains a related formula called Nao Fu Bingzi (Sal-Ammoniac and Aconite Cakes). One whole Fuzi is hollowed out, the hollow filled with 1 fen of finely ground naosha, the opening plugged with ground Fuzi, and the aconite wrapped in raw dough in two layers, then roasted slowly in a fire until the aconite turns yellow-brown. The dough is removed, and 3 qian each of Muxiang and Dingxiang are added; the whole is ground into powder and made into pills of about 1.5 g each. Chew slowly and swallow, taking them at any time of day without limit. This formula likewise combines naosha with aconite and aromatic qi-regulating herbs, treating regurgitation of food, ye ge, vomiting and abdominal pain.

The Yifang Leiju (A Complete Collection of Medical Formulas), compiled by the ancient Korean physician Kim Ye-mun, also contains a Naosha Wan. Its composition: large Fuzi one fen (core removed, to be ground separately with the other herbs), naosha half a qian (levigated with water), Dingxiang half a qian, Qingpipi one fen (white pith removed), Muxiang one fen, Roudoukou one fen, Binglang (Arecae Semen) three fen (used raw). Its preparation is basically similar to the Naosha Wan in the Yangshi Jiacang Fang. It treats the five ge with qi obstruction and oppression, or vomiting and inability to eat—symptoms essentially corresponding to esophageal or cardiac cancer.

In addition, naosha mixed with mirabilite (mangxiao) or purged mirabilite (xuanmingfen) in a 1:1 ratio and held in the mouth as a powder can also relieve symptoms related to esophageal cancer; I have used this method myself. However, naosha must not be used long-term. When using naosha, the patient's response must be closely monitored; if side effects are significant, stop promptly and switch to another regimen.