Tuoli Xiaodu San for Cancer Patients with Non-Healing Ulcerations
Tuoli Xiaodu San (Interior-Supporting Toxin-Expelling Powder) comes from Waike Zhengzong (Orthodox Manual of External Medicine) by the Ming-dynasty surgical master Chen Shigong, volume 1. Its composition is: Renshen (Ginseng), Chuanxiong (Ligusticum), Baishao (white Paeonia), Huangqi (Astragalus), Danggui (Angelica), Baizhu (Atractylodes), Fuling (Poria), Jinyinhua (honeysuckle), each one qian; Baizhi (Angelica dahurica), Gancao (Licorice), Zaojiaozhen (Gleditsia thorn), Jiegeng (Platycodon), each five fen. Preparation and dose: “Two zhong of water, decoct to eight fen, take between meals.” Chen Shigong also notes: “For those with a weak spleen, remove Baizhi and double the Renshen.” Here one qian may now be used as 6 g and five fen as 3 g. Strictly, one qian should convert to 3–4 g, but given the potency of modern medicinal materials, 10 g is preferable. When decocting, use two bowls of water and simmer down to eight-tenths of a bowl to take. It may be decocted twice daily and taken twice, after the morning and evening meals.Chen Shigong used this formula for “carbuncles and swellings that have formed and cannot be dispersed internally.” Tuoli Xiaodu San is one of the representative formulas of the TCM “supporting [the upright] method” (tuofa). TCM holds that when disease is severe and the patient is weak from consumption of qi and blood, one should no longer use qi-venting or cold-cooling herbs, because these readily damage the patient's spleen and stomach; rather, for such patients, supplementing herbs should be used to push the toxin outward. Hence every supporting method emphasizes supplementation over attack. In Tuoli Xiaodu San, Renshen, Chuanxiong, Baishao, Huangqi, Danggui, Baizhu, Fuling, and Gancao are common TCM herbs that supplement qi and blood; Jinyinhua clears heat, resolves toxin, and dissipates carbuncles, but compared with other heat-clearing and toxin-resolving herbs, Jinyinhua is very mild and does not injure the spleen and stomach. Baizhi, Zaojiaoci, and Jiegeng have the action of penetrating toxins, reducing swelling, and draining pus, and are used in small doses.Thus this treatment is gentle and reliable, the herbs are very safe, and while improving the patient's quality of life and supplementing qi and blood, it slowly penetrates toxins and drains pus. TCM mostly uses it for patients with deficient upright qi, where pus has formed but the rotten flesh will not resolve, new flesh will not grow, the pus-water is clear and thin, and the wound long refuses to close. This formula is seven parts supporting the upright and three parts dispelling the evil. Modern use includes chronic osteomyelitis, suppurative otitis media, keratitis, mastitis, and other chronic diseases. It can also be used for cancer patients who, after multiple treatments, are weak yet have ulcerations on the body surface, or whose tumors are ulcerative and bleed chronically. When I use this formula for cancer patients, I often add Xianhecao (Agrimonia) and Baiji (Bletilla) to it.Once patients with breast cancer, skin cancer, melanoma, or lymphoma develop ulcerations, it is hard to find a good treatment. Some patients with less malignant tumors survive for a long time—measured in years—after surface tumors ulcerate. I have seen these patients try all sorts of methods, yet the wounds are hard to close. Some external applications even make the ulcerations larger, and nursing them is very difficult. For such patients, borrowing the logic of Tuoli Xiaodu San—seven parts supplementation, three parts dissipation—can instead improve quality of life and prolong survival. If combined with chemotherapy, some patients' ulcerations can shrink or even close. But this formula is unlikely to achieve ideal tumor-shrinking effects, so it can only serve as a palliative and adjunctive treatment.Some cancer patients, after chemotherapy or targeted therapy, have very poor blood counts and ulcerations of the skin and limbs; for them, one may also consider using Tuoli Xiaodu San as a base, slightly adjusted to the patient's specific condition.