Two Remarkable Esophageal Cancer Cases Recorded in Selected Medical Records of Past and Present

Ancient Chinese medical writings, when discussing disease, mostly echoed received opinion; few offered independent views. Many texts were simply plagiarized from earlier authors, and the resulting errors multiplied endlessly, misleading later learners of medicine. But occasionally some authors are wonderfully candid, honestly recording what they saw and heard and questioning the words of predecessors — which is truly precious.

In Selected Readings from Annotations to Medical Cases Past and Present (Gujin Yi'an Xuan), the Qing-dynasty author Yu Zhen records a little-known Qing physician named Yang Supu and two cases of dysphagia (ye-ge) he mentioned — what we today call esophageal cancer. The passage reads: "In my hometown there was a man who treated this condition: in blazing sun he bound the patient to a pillar, pried open the mouth with an instrument, pressed down the tongue, and saw in the throat something like a polypoid tumor directly obstructing the esophagus. He cut it away with a sharp blade; there was much bleeding. The patient was weak for several days before recovering.... There was also a ne'er-do-well who in old age developed this; everyone hoped he would die. Full of hatred, he thrust the handle of a wisteria whip into his throat seeking a quick death. He vomited several pints of blood — and his illness was actually cured. Though these two cases cannot be taken as models, it is clear that something tangible was obstructing the esophagus, and that it was not narrow without cause!"

This passage is immeasurably superior to all the classical TCM literature that preceded it. One could say that over 90% of earlier TCM writings on the causes of dysphagia were nonsense. Ancient TCM basically held that dysphagia arose from qi binding due to excessive grief and brooding or to wine and sex, so among the treatments discussed in those texts, few were effective.

For example, the famous Ming physician Zhang Jingyue discussed the cause of dysphagia thus: "The syndrome of dysphagia necessarily arises from sorrow, anxiety, accumulated toil and repression, or excess wine and sex causing injury. Excessive grief and brooding bind qi, and bound qi fails to move and transform; excess wine and sex damage yin, and damaged yin leads to depletion of essence and blood. When qi does not move, dysphagia arises above; when essence and blood dry up, constipation arises below."

Because his understanding was purely speculative, Zhang Jingyue basically could not find a correct treatment for dysphagia. He was honest about outcomes, noting specifically: "In those elderly who develop this, it is mostly untreatable, because qi and blood are depleted. If the stool is like sheep droppings (note: many late-stage esophageal cancer patients have pellet-like stool), it is untreatable — the large intestine has no blood. If sputum is like crab foam, it is untreatable — spleen qi is scattered. If there is abdominal pain and gnawing like a knife cut, it is untreatable — the Ying is utterly deficient and blood exhausted within." Old Zhang threw up his hands: basically all untreatable.

The great Qing physician Ye Tianshi's discussion of dysphagia was especially absurd: he held it caused by exhaustion of yin fluids below and binding of yang qi above, narrowing the esophagus. On such a basis, of course, dysphagia could not be treated.

Today, with anatomy and imaging, we know that these master-class ancient physicians like Zhang Jingyue and Ye Tianshi held utterly presumptive views of esophageal cancer. By contrast, a little-known doctor like Yang Supu could faithfully record what he saw and heard, and his own thinking on the disease, which makes the two cases he reported invaluable.

Yang's account shows that even then, people in the folk were surgically removing esophageal tumors by very primitive methods. Crude as the method was, the patient's condition improved greatly. During the operation, prizing the mouth open and pressing down the tongue, one could see the "polypoid tumor" in the esophagus in bright light — far more insightful than the masters Zhang and Ye. His second case, too, treated rather brutally by a quasi-surgical method, unexpectedly achieved good results, breaking through the dogma that dysphagia is untreatable. But reading this today, we feel such primitive surgery — no anesthesia, no sterilization — was truly harrowing.

What point am I making with this article? I want to say we should disenchant the classics and the masters. I see many people studying TCM with an unquestioning devotion to "classics" and "masters," not realizing that these classics and masters are themselves full of errors — whereas among the rubble, pearls may be hidden.

For a disease like esophageal cancer, whose cure rate remains low to this day, how can blindly following the so-called classics and masters, passing errors down through the generations, and failing to explore new treatments possibly improve outcomes?