Three Cases of Remote TCM Treatment of Cancer (Liver Cancer, Leukemia, and Lung Cancer)

Because of the pandemic, many patients have had no choice but to seek remote treatment. In TCM, by tradition, diagnosis requires combining the four examinations—inspection, listening/smelling, inquiry, and palpation—but my years of conditioning cancer patients have given me fairly rich experience, so even without taking the pulse I can roughly judge a cancer patient's situation at different stages. Thus, after a detailed video consultation, treatment results are not inferior to in-person consultations.

Moreover, because I serve fewer than half as many patients, I have more spare time. After the consultation I need not write a prescription immediately as in person, but can look up more material and think the prescription through more thoroughly. So for some patients the results are even better than face-to-face visits—an unexpected bonus.

Of course, conditioning late-stage cancer is always difficult, so the success rate remains unsatisfactory; I still need further study to improve effectiveness. In future I plan periodically to write up selected cases for patients, their families, and colleagues to criticize.

Case 1: Late-stage liver cancer with tumor thrombus, patient Dai

Dai, a middle-aged to elderly man from Yueyang, Hunan, was first consulted by video on March 25, 2021, at the invitation of a local chief physician, Dr. Liu.

The patient's examinations at Hunan Provincial People's Hospital showed: masses in liver segments S7 and S8 and abnormal enhancement in S5 and S6, highly suspicious of liver cancer with daughter nodules; lesions supplied mainly by the right hepatic artery and branches; multiple tumor thrombi in the intrahepatic, infradiaphragmatic, and atrial segments of the inferior vena cava, bilateral common iliac, internal iliac, and external iliac veins, with involvement of the middle and right hepatic veins; multiple enlarged retroperitoneal lymph nodes suggesting metastasis. Also present were liver cirrhosis, splenomegaly, portal hypertension, a small amount of abdominopelvic effusion, multiple gallstones with cholecystitis, a small calcified focus in liver segment S2 or a small intrahepatic bile duct stone, tortuous and dilated vessels in the lower rectum of undetermined nature (hemorrhoids? please correlate clinically), bilateral pulmonary emphysema, slight inflammation in both lower lungs, and slight thickening of both peritonea.

Blood tests (report no. 52243687) showed hepatitis B surface antigen above 130; routine liver function (report no. 52236233) showed abnormal liver function, alpha-fetoprotein 1184.23 (reference 0–20 ng/ml), CA125 69.30 (reference 0–35), and hepatitis B big three positives. The patient also had low platelets and low white blood cells.

The patient had a dark face, abdominal distension, and an uncomfortable feeling of the stomach being pushed up. He had a bitter and dry mouth, a yellow-black tongue, dark urine of not too small volume, and normal bowel movements with black stool. There was no needle-like pain under the right rib, no distension under either rib, and no back pain. His entire epigastrium felt uncomfortable on belching, as if gas could not escape; his limbs were weak. He had hiccups every ten-plus minutes. He was dizzy and faint, especially on getting up. His eyes were yellow but his skin was not itchy. He reported no obvious prior symptoms and had suddenly gone to hospital for left lower abdominal distending pain, where late-stage liver cancer was found.

Based on his condition, I decided to combine and modify Chaihu Shugan San, Shengmai Yin, Xuanfu Daizhe Tang, and Xiaoluo Wan, and prescribed:

Chaihu (Bupleuri Radix) 10 g, Huangqin (Scutellariae Radix) 10 g, Shashen (Glehniae/Adenophorae Radix) 10 g, Maidong (Ophiopogonis Radix) 10 g, Wuweizi (Schisandrae Fructus) 10 g, Xuanfuhua (Inulae Flos) 10 g (wrapped), Daizheshi (Haematitum) 10 g (wrapped), Pipaye (Eriobotryae Folium) 6 g, Chao Xiangfu (processed Cyperi Rhizoma) 10 g, Banzhilian (Scutellariae Barbatae Herba) 30 g, Baihua Shebicao (Hedyotidis Diffusae Herba) 30 g, Chao Zhizi (Gardeniae Fructus) 10 g, Danshen (Salviae Miltiorrhizae Radix) 30 g, Lianqiao (Forsythiae Fructus) 10 g, Sheng Huangqi (Astragali Radix) 20 g, Yinchen (Artemisiae Scopariae Herba) 20 g, Sanleng (Sparganii Rhizoma) 10 g, Ezhu (Curcumae Rhizoma) 10 g, Xianhecao (Agrimoniae Herba) 50 g, Zhi Biejia (processed Carapax Trionycis) 24 g (decoct first for half an hour), Taoren (Persicae Semen) 10 g, Honghua (Carthami Flos) 6 g, Shengdi (Rehmanniae Radix) 10 g, Mudanpi (Moutan Cortex) 10 g, Chishao (Paeoniae Rubra Radix) 10 g, Xuanshen (Scrophulariae Radix) 12 g, Zhebeimu (Fritillariae Thunbergii Bulbus) 12 g, Duan Muli (calcined Ostreae Concha) 30 g (decoct first for half an hour), Baitouweng (Pulsatillae Radix) 10 g, Shandougen (Sophorae Tonkinensis Radix) 10 g.

On April 14, at Dr. Liu's invitation, I conducted another video consultation.

After about twenty doses, white blood cells were still low but platelets had returned to normal. The tongue was reddish and moist. All symptoms had completely relieved, with no obvious discomfort. The previous formula worked, confirming the basic approach; but the symptoms had changed—hiccups were gone, so Xuanfuhua and Daizheshi could be dropped. I strengthened the supporting and anticancer powers to buy the patient more survival time. New formula:

Chaihu 10 g, Huangqin 10 g, Dangshen (Codonopsis Radix) 30 g, Huangjing (Polygonati Rhizoma) 30 g, Maidong 10 g, Wuweizi 10 g, Chao Xiangfu 10 g, Banzhilian 30 g, Baihua Shebicao 30 g, Chao Zhizi 10 g, Danshen 30 g, Lianqiao 10 g, Sheng Huangqi 30 g, Yinchen 20 g, Sanleng 10 g, Ezhu 10 g, Ruxiang (Olibanum) 6 g, Moyao (Myrrha) 6 g, Tubiechong (Eupolyphaga/Steleophaga) 15 g, Xianhecao 50 g, Zhi Biejia 24 g (decoct first half hour), Taoren 10 g, Honghua 6 g, Shengdi 10 g, Mudanpi 10 g, Chishao 10 g, Xuanshen 12 g, Zhebeimu 12 g, Duan Muli 30 g (decoct first half hour), Baitouweng 15 g, Jinqiancao (Lysimachiae Herba) 30 g, Shandougen 10 g, Shayuanzi (Astragali Complanati Semen) 10 g, Tusizi (Cuscutae Semen) 10 g, Mohanlian (Ecliptae Herba) 10 g, Nüzhenzi (Ligustri Lucidi Fructus) 10 g, Lingzhi (Ganoderma) 30 g, Tiankuizi (Semiaquilegiae Radix) 10 g.

Patent medicines: demethylcantharidin tablets twice daily, 5–15 mg each; additionally, pills/powder made from Wugong (Scolopendra), Quanxie (Scorpio), Bihu (Gecko), Sanqi (Notoginseng), and Chansu (Bufonis Venenum), twice daily, 1–2 g each.

This patient already had late-stage liver cancer with many comorbidities, making treatment difficult; Western medicine had little to offer, and targeted drugs caused severe side effects the patient refused. He hoped TCM would relieve his clinical symptoms and slow progression. His psychological expectations were reasonable. Although I could not see him in person or take his pulse, his clinical symptoms were enough to determine the formula pattern, so remote prescribing worked.

Case 2: Elderly leukemia patient Feng

This is a leukemia patient I have treated for one year and four and a half months. She lives in Xi'an, Shaanxi, and was discharged from Ward 1, Hematology Department, First Affiliated Hospital of Xi'an Jiaotong University on December 31, 2019 (inpatient no. 0001626203). Discharge diagnosis: acute non-lymphocytic leukemia M4; pulmonary infection. Since New Year's Day 2020 she has been under my TCM care, occasionally undergoing one or two chemotherapy cycles, but after chemotherapy her condition was poor and rebounded quickly, with very poor blood counts—platelets often dropped to levels Western doctors felt required transfusion. Because she was elderly and frail, her condition fluctuated, and chemo side effects were too severe, she rejected chemotherapy and has stayed on Chinese medicine. I have published parts of her case before; this continues it.

On March 7, 2021, after a cold resolved, she developed cough, expectoration, and nasal discharge, with yellow thick sputum, dry mouth, and profuse sweating. Her family asked for help. Judging the symptoms as a Mahuang Xingren Shigao Tang pattern, I prescribed a modified version: Zhi Mahuang (honey-fried Ephedra) 6 g, Xingren (Armeniacae Semen) 6 g, Zhi Gancao (honey-fried Licorice) 6 g, Sheng Shigao (Gypsum fibrosum) 30 g, Lugen (Phragmitis Rhizoma) 30 g.

After one dose symptoms were greatly reduced; after the second they had essentially resolved. I advised her to take Lianhua Qingwen capsules for 2–3 days to consolidate. She also took pills/powder made from Chansu, Xionghuang (Realgar), Danggui (Angelicae Sinensis Radix), Huangqi, Huangjing, and Yiyiren (Coicis Semen) against the leukemia.

On March 22, the family reported platelets had dropped from 230 to over 70, though the patient had no obvious clinical symptoms. They asked to strengthen the anticancer effort, so I prescribed a decoction:

Taizishen (Pseudostellariae Radix) 30 g, Chishao 12 g, Mudanpi 12 g, Shengdi 12 g, Danshen 30 g, Zicao (Arnebiae/Lithospermi Radix) 30 g, Huaihua (Sophorae Flos) 30 g, Xianhecao 100 g, Mohanlian 30 g, Nüzhenzi 10 g, Shayuanzi 10 g, Tusizi 10 g, Shandougen 10 g, Digupi (Lycii Cortex) 10 g, Pugongying (Taraxaci Herba) 30 g, Shihu (Dendrobii Caulis) 30 g, Daqingye (Isatidis Folium) 30 g, Jiao Maiya (charred Hordei Fructus germinatus) 30 g, Baitouweng 30 g, Machixian (Portulacae Herba) 40 g, Chao Maiya (stir-fried Hordei Fructus germinatus) 30 g, Jiao Shanzha (charred Crataegi Fructus) 10 g, Shudi (Rehmanniae Radix praeparata) 30 g, Banzhilian 30 g, Baihua Shebicao 30 g, Sanleng 10 g, Chonglou (Paridis Rhizoma) 10 g, Jinyinhua (Lonicerae Flos) 30 g, Diding (Violae Herba) 10 g, Tiankuizi 10 g, Yejuhua (Chrysanthemi Indici Flos) 6 g.

She also took pills such as Lishen Wan (Six Spirit Pills) against the leukemia.

Recheck on March 24 showed platelets rising markedly. Having long refused chemotherapy due to intolerance, she asked to strengthen the TCM antileukemia effort. The previous prescription was working, so I kept the approach and added Banlangen (Isatidis Radix), continuing Lishen Wan and other patent medicines.

Taizishen 30 g, Chishao 12 g, Mudanpi 12 g, Shengdi 12 g, Danshen 30 g, Zicao 30 g, Huaihua 30 g, Xianhecao 100 g, Mohanlian 30 g, Nüzhenzi 10 g, Shayuanzi 10 g, Tusizi 10 g, Shandougen 10 g, Digupi 10 g, Pugongying 30 g, Shihu 30 g, Daqingye 30 g, Jiao Maiya 30 g, Baitouweng 30 g, Machixian 40 g, Chao Maiya 30 g, Jiao Shanzha 10 g, Shudi 30 g, Banzhilian 30 g, Baihua Shebicao 30 g, Sanleng 10 g, Chonglou 10 g, Jinyinhua 30 g, Diding 10 g, Tiankuizi 10 g, Yejuhua 6 g, Banlangen 10 g.

On April 14 the patient's daughter reported she was doing well; blood counts rechecked at the Hongmiaopo Zhifang Village Community Health Station, Lianhu District, Xi'an (outpatient no. GH00029338) showed white cells, red cells, and platelets all normal. At 73, with stable counts and good condition, she did not want further chemotherapy. I decided to respect the wishes of the patient and family and continue treatment while observing.

Case 3: Lung adenocarcinoma with mental illness, patient He

First online consultation and prescribing on March 23, 2021.

Patient He, 67, a farmer from Longhua County, Chengde, Hebei, had over thirty years of mental illness: frequent episodes when young, especially in spring, gradually improving in old age so she could do housework. In recent years she had cough and chest tightness, which she dismissed as minor and ignored. During the 2021 Spring Festival the condition worsened; ultrasound at Longhua County Hospital, Hebei (ID 210323034) showed bilateral pleural effusion. She was transferred to the Affiliated Hospital of Chengde Medical University, where stage IV lung adenocarcinoma was diagnosed. The family declined chemoradiotherapy and asked me how to treat; I suggested first doing genetic testing to see if a targeted drug was available, and if so, combining targeted therapy with Chinese medicine. Testing showed no targeted drug available; the family wanted TCM to relieve symptoms, prolong survival, with reasonable expectations.

Considering the family's poor financial situation and limited rural cooperative medical reimbursement, and that decoctions would be too costly, I chose a combination of pills and powders: Jiuzhuan Huangjing Gao to support upright qi, Jinkui Shenqi Wan to drain water, and dry Chan Yi (toad skin), Shuizhi (Hirudo), Bihu (gecko), Sanqi, and Shanquchong (julid) to fight cancer.

Eight days after starting, the drainage tube stopped draining; the family suspected a blockage and went to the hospital, but the local hospital found the tube fine. A repeat chest CT showed the pleural effusion was gone, the lungs had improved, and clinical symptoms had essentially disappeared. The patient and family were satisfied.

All three patients remain under continued treatment and observation. TCM cure of cancer is very difficult, but using TCM to relieve clinical symptoms, reduce suffering, improve the body, and prolong life still has a certain success rate.