Two Classic Formulas for Lymphoma and Lymphatic Metastases: Xiangbei Yangrong Tang and Herong Sanjian Wan

"Xiangbei Yangrong Tang" comes from the Yizong Jinjian (Golden Mirror of the Medical Lineage), and "Herong Sanjian Wan" comes from the Waike Zhengzong (Orthodox Manual of External Medicine). Both are classic famous formulas of TCM external medicine.

The reason I introduce these two formulas together is that in clinical use they are often applied to the same category of disease. Their main indication is various primary and secondary lymphomas. As long as one is good at modifying and adapting them, using them clinically for late-stage tumors of the lymphatic system can prolong the patient's survival.

The Waike Zhengzong is the medical work of Chen Shigong, a famous Ming-dynasty surgeon. Chen Shigong practiced clinical medicine all his life and compiled the Waike Zhengzong in his sixties. So this book is the crystallization of his lifelong treatment of tumor-type diseases. To write it, Chen Shigong poured out his heart's blood; by the time the book was completed, he says, "looking in the mirror, I saw that my beard and temples had turned white."

Chen Shigong is one of the rare great masters of TCM external medicine. He was not only skilled in treating tumor diseases with herbs but also expert in the "scalpel art," able to perform many surgeries for patients (incidentally, TCM external medicine has always had surgery; the fact that many modern TCM doctors oppose surgery is pure prejudice). His created "Orthodox school" is one of the three great schools of TCM external medicine.

The Yizong Jinjian was the imperially commissioned textbook of the Imperial Medical Academy during the Qianlong era. Its compilation drew on the efforts of famous specialists of all departments in the Qianlong period, and exerted a profound influence on later ages.

Even today, the Yizong Jinjian remains a classic of TCM clinical diagnosis and treatment; a TCM physician who can master it is a first-class clinical master. At present, there are not many TCM physicians in China who have read the Yizong Jinjian thoroughly.

So the sources of these two formulas are both highly authoritative.

In the Yizong Jinjian, "Xiangbei Yangrong Tang" is used to treat "upper stone-char" (shiju). To aid physicians' memory, the Yizong Jinjian put the symptoms of "upper stone-char" into a verse: "The stone-char grows beside the neck, hard as stone, color as usual. Liver depression congeals in the channels and network vessels; after ulcerating, treat by the method for luoli sores."

This "upper stone-char" is much like today's metastatic tumors of the cervical lymphatic system. The hallmark of "upper stone-char" is being "hard as stone, color as usual," which distinguishes it from infectious boils: it is neither red and swollen nor pus-forming, and looks more like a primary lymphoma or lymphatic metastasis in the neck from a tumor elsewhere.

Below this verse there is an annotation: "This char grows on both sides of the neck, shaped like a peach or plum, with skin color as usual, hard as stone, swollen and painful but not hot. It arises from binding depression of the liver channel, causing qi and blood to congeal in the channels. This disease starts small and gradually grows, hard to disperse and hard to ulcerate, and once ulcerated hard to close; it is a stubborn, chronic condition. At the outset, those with robust qi should take Shugan Kuijian Tang; those with qi deficiency should take Xiangbei Yangrong Tang. Externally apply scallion white and honey pounded into a paste."

According to the Yizong Jinjian, for a lymph node growth in the neck that at the early stage belongs to robust qi, one should use Shugan Kuijian Tang; if it belongs to qi deficiency at the progressive stage, one should use Xiangbei Yangrong Tang.

The Xiangbei Yangrong Tang formula is as follows: Chao Baizhu (stir-fried Atractylodes) 2 qian, Renshen (Ginseng) 1 qian, Fulin (Poria) 1 qian, Chenpi (tangerine peel) 1 qian, Shudihuang (prepared Rehmannia) 1 qian, Chuanxiong (Ligusticum) 1 qian, Danggui (Angelica) 1 qian, Beimu (Fritillaria, cored) 1 qian, Xiangfu (Cyperus, wine-fried) 1 qian, Baishao (white peony, wine-fried) 1 qian, Jiegeng (Platycodon) 5 fen, Gancao (Licorice) 5 fen.

Xiangbei Yangrong Tang has two mnemonic verses. The first: "Xiangbei Yangrong uses the Eight Treasures, plus tangerine peel and platycodon; it boosts qi and nourishes blood, moves qi and resolves phlegm, for luoli that after ulceration will not close." The second: "Xiangbei Yangrong uses the Four Gentlemen, the Four Substances, fritillary, platycodon, cyperus, and tangerine peel; for dual deficiency of qi and blood take it often, and it works like a god on neck luoli and stone-char."

This verse too is for the learner's memory. Xiangbei Yangrong Tang is built on the TCM Eight-Treasures Decoction (the Eight Treasures combine the Four Gentlemen Decoction and the Four Substances Decoction; the Four Gentlemen is the foremost qi-tonifying formula and the Four Substances the foremost blood-tonifying formula, so their combination, the Eight Treasures, is the famous qi-and-blood-tonifying formula), to which are added Chenpi, Jiegeng, Beimu, and Xiangfu.

This formula focuses on supplementing qi and blood. Generally, after a tumor metastasizes to the neck, signs of qi and blood insufficiency have usually already appeared. Modern patients with lymphoma or lymphatic metastasis who have reached the point of seeking TCM treatment are mostly already deficient in qi and blood. So there are many opportunities to use Xiangbei Yangrong Tang. I once wrote about an elderly lymphoma patient I treated, who was treated mainly with this formula, with fairly good results.

Xiangbei Yangrong Tang alone has limited effect on lymphoma or lymphatic metastasis. It can serve as the main formula in pattern-based treatment to regulate the patient's body and free the channels; on this basis some antitumor herbs must still be added before the patient's condition can be controlled.

Herong Sanjian Wan treats "shirong" (lost glory), and "shirong" is also what we today call lymphoma or lymphatic metastasis. Shirong means having lost one's former glory and prosperity. Ancient TCM held that shirong was mostly caused by frustrations in the patient's life, hence the name "shirong syndrome."

The Waike Zhengzong has a chapter specifically on treating shirong; interested readers can look it up themselves. This formula is also recorded in the Yizong Jinjian, and here I follow mainly the Yizong Jinjian record.

"Shirong syndrome" also has a verse: "Shirong beside the ear and on the neck and shoulder, begins like a phlegm nodule, unmoving and hard; skin color as usual, daily growing larger; grief, anxiety, anger, and depression congeal as fire. Over time qi wanes and the body wastes, more ulcerated and harder, showing purple patches, rotting and spreading, oozing watery blood; the sore mouth turns flower-like, always hard to treat."

This verse records in detail the course of lymphoma or lymphatic metastasis. A newly arisen lymphoma or metastatic lymph node generally shows nothing abnormal on the skin apart from a hard, stone-like lump. As it progresses, it tends to ulcerate. Once a metastatic lymph node ulcerates, it is extremely hard to treat. I have seen many such patients in my clinical years; in the late stage the patients suffer greatly and the families have great difficulty nursing them, which is deeply pitiable.

The Yizong Jinjian's annotation to the shirong verse is as follows: "Shirong arises in front of and behind the ear and on the shoulder and neck. At the outset it is like a phlegm nodule, unmovable when pushed, hard as stone, with skin color as usual, growing larger day by day. It is formed by the congelation of grief, anxiety, wrath, qi stagnation, rebellious blood, and fire. Over time it is hard to heal; the form and qi gradually decline, the muscles waste, the more it ulcerates the harder it becomes, the color shows purple patches, it rots and spreads, oozing bloody water, the sore mouth opens wide, fleshy granulations protrude high, resembling a flower-like tumor. Though from old to modern there have been treatments, it is ultimately a hopeless condition, yet one must not abandon it untreated. At first take Herong Sanjian Wan, and externally apply Ehua Huapi Plaster; yet this is only to prolong the years."

This annotation not only records in detail the symptoms of cervical lymphoma or lymphatic metastasis but also sums up the disease's course of development.

Beyond this, it makes clear that the prognosis of this disease is poor. Cure is already unlikely; the role of treatment is merely to "prolong the years"—what we moderns call prolonging survival.

The Herong Sanjian Wan prescription is as follows: "Chuanxiong 1 qian, Baishao 1 qian, Danggui 1 qian, Fulin 1 qian, Shudi 1 qian, Chenpi 1 qian, Jiegeng 1 qian, Xiangfu 1 qian, Chao Baizhu 1 qian, Renshen 5 qian, Zhi Gancao 5 qian, Haifen 5 qian, Kunbu 5 qian, Beimu (cored) 5 qian, Shengma 3 qian, Honghua 3 qian, Xiakucao (decocted, then add 4 liang red honey and boil again into an extract) 1 jin."

Grind all the above herbs into a fine powder, and with the Xiakucao extract form pills as large as a parasol seed; take 3 qian each time, washed down with plain water after a meal.

This formula is basically Xiangbei Yangrong Tang with added flavors. Such patients generally also have other symptoms, and the Yizong Jinjian gives the modifications for this formula.

"Fever: add Huangqin, Chaihu. Spontaneous sweating or night sweating: remove Shengma, double Renshen, add Huangqi. Food without flavor: add Huoxiang, Sharen. Food not transformed: add Shanzha, Maiya. Glomus and oppression in the chest and diaphragm: add Zexie, Muxiang. Cough with unclear phlegm-qi: add Xingren, Maidong. Dry mouth and thirst: add Zhimu, Wuweizi. Restless sleep: add Huangbai, Yuanzhi, Zaoren. Frightened palpitations and forgetfulness: add Fushen, Shichangpu. Sweating with aversion to cold: add Bohe, Banxia. No sweating with aversion to cold: add Cangzhu, Huoxiang. Irregular menstruation in women: add Yanhusuo, Danpi. Abdominal distension not relaxed: add Houpo, Dafupi."

An experienced oncology physician should know that these symptoms summarized in the Yizong Jinjian are very common in mid-to-late-stage lymphoma or lymphatic metastasis patients. Body heat is often cancer fever, also a typical symptom of lymphoma.

The verse for Herong Sanjian Wan is as follows: "Herong Sanjian Wan disperses depression, opens binding and supplements deficiency, regulates the liver and spleen; the Eight Treasures, fritillary, platycodon, tangerine peel, cyperus, kelp, sea-feather, cimicifuga, safflower, and prunella are fitting."

Modern radiotherapy and chemotherapy also have some effect on lymphoma and lymphatic metastasis, so using the above formulas as adjunctive treatment after radiotherapy and chemotherapy can prolong survival and improve quality of life. If the patient's constitution is reasonably good, one may also use this as the main formula, combined with other anticancer Chinese patent medicines, to achieve tumor shrinkage or even elimination, or survival with tumor.

In addition, from my experience, these two formulas can be used not only for lymphoma or lymphatic metastasis but also for other tumors such as breast cancer and thyroid cancer.

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