A Case by Tu Kuixian: Thyroid Cancer with Bone Metastasis

Tu Kuixian (1916–2003) was, before his death, head of internal medicine at the Changzhou Municipal Hospital of Traditional Chinese Medicine. He once treated a patient with bone metastasis from follicular adenocarcinoma of the thyroid. The patient first came to Dr. Tu on August 25, 1981. At the first visit, she had pain in the left buttock; pelvic X-rays showed extensive metastatic foci in both iliac bones, especially prominent on the left. Large, irregular radiolucent areas and osteolytic destruction were seen in the left ilium, the upper end of the left femur, and the left side of the sacrum, and Western medicine diagnosed metastatic carcinoma of the pelvis.

The patient had undergone removal of a thyroid adenoma in 1961. On March 3, 1981, because of chest pain, she underwent resection of the sternum at a Shanghai hospital; postoperative pathology confirmed metastatic follicular adenocarcinoma of the thyroid to the sternum. She then received a total of 8 courses of chemotherapy, but by early July 1981 pain reappeared in the left buttock, and a follow-up scan found new bone metastatic lesions. She therefore abandoned Western treatment and sought TCM care.

At the first visit the patient could no longer walk normally. Both buttocks ached, the left more markedly, and the sacrum had a pulling pain. She had chest oppression and dry mouth, sticky sputum difficult to expectorate, poor sleep, irritability, and low spirits. The tongue was yellow and greasy, and the pulse slippery. Dr. Tu pattern-differentiated: spleen-qi insufficiency, phlegm-turbidity obstructing the collaterals, and blood stasis in the vessels. Treatment should fortify the spleen and boost qi, expel phlegm and transform the collaterals, and free the collaterals and disperse stasis.

First-visit formula: Tu Bei Mu (Bolbostemmatis Rhizoma) 10 g, Zhi Tian Nan Xing (processed Arisaematis Rhizoma) 10 g, Luo Shi Teng (Trachelospermi Caulis) 10 g, San Qi Pian (Notoginseng tablets) 10 g, Ren Zhong Bai (human grey, prepared) 10 g, Tao Ren (Persicae Semen) 10 g, Han Fang Ji (Stephaniae Tetrandrae Radix) 10 g, Xuan Shen (Scrophulariae Radix) 15 g, Mu Ling Zhi (wooden Ganoderma) 15 g, Fu Ling (Poria) 15 g, Wei Ling Xian (Clematidis Radix) 15 g, Zhu Ling (Polyporus) 30 g, Huang Qi (Astragali Radix) 20 g. Decoct in water; one dose daily.

After taking more than 20 doses, the left buttock pain eased, and her mobility and spirits improved. She continued the formula until November 1981, three months in all; the left buttock pain had stopped, and only dull pain remained in the right. By April 1982 her condition fluctuated, with severe sacral pain radiating to the buttocks, reduced appetite, irregular stools, chest discomfort, a wiry and thin pulse, and a slightly greasy tongue coating. Dr. Tu felt she should now continue fortifying the spleen and freeing the collaterals, supporting the righteous qi and transforming turbidity. He prescribed the following:

Huang Qi (Astragali Radix) 20 g, Cang Zhu (Atractylodis Rhizoma) 12 g, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 12 g, Tu Bie Chong (Eupolyphaga) 12 g, Xuan Mu Gua (Chaenomelis Fructus) 12 g, San Qi Pian (Notoginseng tablets) 10 g, Fu Ling (Poria) 10 g, Chuan Huang Lian (Coptidis Rhizoma) 4 g, Gan Jiang (Zingiberis Rhizoma) 4 g, Gong Ding Xiang (Caryophylli Flos) 5 g, Chuan Xiong (Chuanxiong Rhizoma) 8 g, Rou Gui (Cinnamomi Cortex) 6 g (added later), Zhu Ling (Polyporus) 30 g. Decoct in water; one dose daily.

After taking this for three months, the pain markedly lessened, appetite increased, and stools normalized. She continued until February 1983, by which time the pain was basically gone. By June 1983 her spirits, strength, and appetite had all improved markedly; she could walk independently and care for herself. In the spring of 1985 the patient died of pneumonia.

Once cancer has metastasized to bone, treatment is very difficult. Dr. Tu's case record is detailed. His methods look unremarkable; the first and return-visit formulas were mainly symptomatic, using the common TCM approach for rheumatic bi pain. Dr. Tu treated the patient chiefly to relieve her suffering, yet achieved quite good results. After taking the herbs, her clinical symptoms improved and her survival was extended; the effect was surprising.

So far, in TCM we have no particularly specific solution for bone metastasis in cancer patients, but the TCM principle of pattern differentiation and treatment is a good symptomatic approach. In Dr. Tu's formula, Luo Shi Teng, Han Fang Ji, Wei Ling Xian, Tao Ren, San Qi, Tu Bie Chong, Cang Zhu, Mu Gua, Chuan Xiong, Fu Ling, and Zhu Ling are all commonly used herbs for rheumatic bi pain and pain due to blood stasis.

The other herbs in the formula either support the righteous and secure the root (such as Huang Qi and Ling Zhi/Ganoderma) or are symptomatic herbs for the patient's current complaints. For example, Tu Bei Mu and processed Tian Nan Xing in the first formula were prescribed for the sticky sputum hard to expectorate; Ding Xiang, Rou Gui, Huang Lian, and Gan Jiang in the second visit were prescribed for the irregular stools.

Such a composing approach is understandable to anyone with a little TCM grounding. Yet it is just such an ordinary-looking prescription that achieved the effect of relieving pain and prolonging survival in a bone-metastasis patient. Pain from cancer bone metastasis is also a very intractable problem from the viewpoint of modern medicine; even the three-step analgesic ladder can only relieve suffering and is hard to prolong survival. So Dr. Tu's result is encouraging, and this approach is worth learning from.