Three Enema Formulas for Treating Colorectal Cancer

TCM treatment of colorectal cancer may use oral decoctions, pills, powders, plasters or pellets, as well as external methods such as enema. Using Chinese herbal enema allows the medicine to reach the lesion directly without hepatic metabolism; the effect may be better and side effects smaller, though enema requires a certain skill.

This article introduces two enema formulas collected in the Zhongguo Waizhi Miaofang (Marvelous External Prescriptions of China) and one enema formula, Huaihua Tang, collected in the Quanguo Zhongyao Mishu Dacheng (Complete Compendium of Secret TCM Prescriptions for Tumors), for readers' reference.

Formula 1: Baihuasheshecao (Hedyotis diffusa) 30 g, Wumei (Mume) 30 g, Banzhilian (Scutellaria barbata) 30 g, Hongteng (Sargentodoxa) 30 g, Baitouweng (Pulsatilla) 30 g, Kushen (Sophora flavescens) 30 g, Tengligen (Actinidia root) 45 g, Longkui (Solanum nigrum) 15 g, Zaojiao (Gleditsia sinensis) 15 g, Diyu (Sanguisorba) 15 g. This formula has the actions of clearing heat and detoxifying, and dispersing stasis and reducing swelling, and mainly treats colorectal cancer.

When using, decoct the above herbs in water to obtain 100 ml of concentrated juice, one dose daily, as a retention enema; 4 weeks is one course, with a 1-week interval between courses. This enema may be used concurrently with chemotherapy: each time use fluorouracil 1 g and dexamethasone 5 mg added to 1000 ml of Ringer's solution for intraperitoneal drip, once weekly; mitomycin 5-8 mg by intravenous drip, once weekly, 5 times being one course. Each course is separated by 21 days.

Note: Judging from the herbal composition, this formula focuses on hemostasis and antidiarrhea, and on clearing heat and reducing swelling, so its precise indication should be colorectal cancer patients clinically presenting with bloody stool and diarrhea.

Both Baitouweng and Kushen in this formula are dampness-draining antidiarrheal herbs; Wumei astringes yin to stop diarrhea; Diyu stops bleeding and diarrhea; Tengligen, Longkui, Baihuasheshecao and Banzhilian are all commonly used anti-cancer Chinese medicines. Overall analysis shows that this formula has a hemostatic and antidiarrheal effect.

Formula 2: Pugongying (Taraxacum) 50 g, Rendongteng (Lonicera stem) 50 g, Xiakucao (Prunella) 50 g, Xianlingpi (Epimedium) 50 g, Gouqizi (Lycium) 50 g, Huaihua (Sophora flower) 50 g, Quanxie (scorpion) 50 g. This formula has the actions of clearing heat and detoxifying, and anti-cancer nodule-dispersing, and mainly treats rectal cancer.

When using, decoct the above herbs to obtain 500 ml of concentrated liquid, dispense into 7 bottles; each time take 1 bottle and add fluorouracil (calculated by body weight, 20 mg per kg body weight) for combined enema.

Note: Although this is an enema formula, it also integrates supporting zheng (vital qi) and dispelling xie (pathogen). In the formula, Xianlingpi and Gouqizi are both tonifying herbs; Huaihua stops bleeding; Pugongying, Rendongteng and Xiakucao clear heat and reduce swelling; Quanxie uses toxin to attack toxin and fights cancer to reduce swelling. Overall analysis shows this formula suits colorectal cancer patients with healthy-qi deficiency and excess pathogen.

Formula 3 (Huaihua Tang): Baihuasheshecao (Hedyotis diffusa), Sheng Dahuang (raw Rhubarb), and Baijiangcao (Patrinia), 40 g each; Huaihua (Sophora flower) and Yadanzi (Brucea javanica), 15 g each; Zaojiaoci (Gleditsia spine) and Xuejie (dragon's blood), 10 g each. This formula has the actions of clearing heat and detoxifying, cooling blood and stopping bleeding, softening hard nodules, and reducing swelling and relieving pain, and mainly treats rectal cancer. When using, decoct all the above herbs together to obtain 200 ml of concentrated juice, for retention enema of 1-2 hours, once daily, 7 days being one course.

Note: This formula uses a large amount of Sheng Dahuang, which has a strong purgative effect; it belongs to the purging category of TCM formulas. Hence this formula suits patients whose vital qi is still adequate but whose pathogen is rampant; it is more suitable for constipated colorectal cancer patients.

Enema formulas and oral decoctions differ greatly in dosage; enema formulas generally allow larger dosages. All three enema formulas above use relatively large amounts of each herb, and such formulas are not suitable for oral use. If taken orally at the above dosages, weak patients could not tolerate them; but with enema, the actual amount absorbed by the patient is limited, so even at these dosages it is quite safe.