Appreciating a Qing-Dynasty Case by Wang Jiufeng Treating "Five-Colored Vaginal Discharge" (Today's Cervical Cancer)
Wang Jiufeng was a physician of generations-renowned family in Dantu (within present-day Jiangsu) during the Qianlong-Jiaqing period of the Qing dynasty. He was skilled in treating various internal and surgical diseases, and the case records of his clinical practice were compiled as Wang Jiufeng Yi'an (Medical Cases of Wang Jiufeng). That book records a case in which Wang Jiufeng treated "five-colored vaginal discharge" (i.e., cervical cancer in modern medicine). The case is as follows:
"The Classic (note: i.e., the Huangdi Neijing) states that disease of the Ren Channel causes vaginal discharge in women. Last autumn there was blood in the urine; after autumn, discharge of five colors appeared, with pain on urination, restless sleep at night, and tasteless eating. Heart heat was transferred to the Small Intestine, with damp-heat and internally depressed liver fire; the illness had lingered for half a year and was extremely difficult to resolve.
Shanzhizi (Gardeniae Fructus) 1.5 qian, Haijinsha (Lygodii Spora) 1 qian, Gancaojie (Glycyrrhizae Nodus) 1 qian, Bianzhu (Polygoni Avicularis Herba) 3 qian, Taizishen (Pseudostellariae Radix) 3 qian, Hudanpi (Moutan Cortex) 1 qian, Longdancao (Gentianae Radix) 1 qian, Lianzixin (Nelumbinis Plumula) 8 fen, Chifuling (Poria Rubra) 3 qian, Cebaiye (Platycladi Cacumen) 1 qian, Dengxincao (Medulla Junci) three cun.
After four doses, red discharge was still abundant and white discharge slightly reduced; chills and fever had lessened, dysuria slightly stopped, sleep somewhat improved, and eating became pleasant. The original formula was modified.
Qizheng San plus Shengdi (Rehmanniae Radix), Danpi (Moutan Cortex), and Dengxin (Medulla Junci).
Chills and fever resolved, discharge reduced, and dysuria settled; appetite gradually increased. The dosages of the original formula were slightly adjusted.
Repeatedly taking modified Qizheng San, the vaginal discharge was cured and dysuria resolved, and eating became pleasant. Only blood-deficiency headache and aching heaviness of both legs remained. This was qi and blood dual deficiency with uncleared damp-heat of liver and kidney; it was treated with modified Guishao Dihuang Tang.
Guishao Dihuang Tang, removing Shanzhuyu (Corni Fructus), adding Gancaoshao (Glycyrrhizae Radex et Rhizoma tip), Bianxu (Polygoni Avicularis Herba), Zhuye (Lophatheri Herba), and Dengxin (Medulla Junci).
Vaginal discharge and dysuria were both cured; only right hypochondrial fullness, blood-deficiency headache, and low spirits remained. It was appropriate to supplement the three yin, assisted by transforming damp-heat: Guishao Dihuang Wan, Sangpiaoxiao (Mantidis Oötheca), and Gancaoshao."
This case is a rare, comparatively complete ancient medical case with a fairly detailed treatment record. The "five-colored vaginal discharge" suffered by the woman in the text is cervical cancer in modern medicine. Five-colored discharge refers to a mixture of green, yellow, white, red, and black vaginal discharge in women; this symptom is mostly seen in the middle and late stages of cervical cancer.
The Qizheng San mentioned in the case comes from Volume 6 of Yifang Kao, and consists of seven herbs: Cheqianzi (Plantaginis Semen), Chifuling (Poria Rubra), Shanzhiren (Gardeniae Fructus), Sheng Gancaoshao (raw Glycyrrhizae radix tip), Mutong (Akebiae Caulis), Bianxu (Polygoni Avicularis Herba), and Longdancao (Gentianae Radix). It clears heat, resolves toxin, and drains dampness. It is indicated for difficult, painful urination and urinary retention attributable to exuberant heart and liver fire, and is now commonly used to treat acute cystitis, pyelonephritis, urethral syndrome, vaginitis, cervicitis, and cervical cancer.
The Guishao Dihuang Tang mentioned in the case comes from Volume 2 of Zheng Yin Mai Zhi; it is formed by adding Danggui (Angelicae Sinensis Radix) and Baishao (Paeoniae Radix Alba) to Liuwei Dihuang Tang (composed of Shudi (Rehmanniae Radix Praeparata), Shanzhuyu (Corni Fructus), Fuling (Poria), Zexie (Alismatis Rhizoma), Mudanpi (Moutan Cortex), and Shanyao (Dioscoreae Rhizoma)). It nourishes blood and enriches yin. It is indicated for hematemesis from external contraction with excessive blood loss and a hollow, rough pulse, or for insufficiency of true yin of liver and kidney that fails to nourish the construction and defense, leading to blurred vision, tinnitus, dry mouth and tongue, and exhaustion of fluids.
Guishao Dihuang Tang is a famous formula for enriching yin and nourishing blood. Besides the disease name "five-colored discharge," cervical cancer also carries the disease name "beng lou" (flooding and spotting), and is prone to massive hemorrhage; middle- and late-stage patients commonly become anemic from heavy bleeding. Hence in this case Wang Jiufeng first attacked and then supplemented, using Guishao Dihuang Tang to enrich yin and nourish blood as the supplementing phase. Viewed today, such treatment is also very scientific.
In Wang Jiufeng's era, Western medicine had not yet been introduced to China, and such patients were treated with Western medicine completely excluded. Wang Jiufeng's therapeutic strategy was first to clear heat and drain dampness, cool blood and stop bleeding, and afterward to enrich yin and nourish blood, supporting healthy qi and rooting the constitution. This can also be understood as first attacking and then supplementing; the emphasis of both attack and supplement was directed at the clinical syndromes the patient presented. While attacking there was also supplementation, and while supplementing attack was not forgotten—only the emphasis differed.
From this case, the patient's clinical symptoms all disappeared after Wang Jiufeng's treatment. But the case lacks follow-up, so we do not know whether the patient later relapsed, nor how long she survived. In any case, her quality of life was clearly improved, and her survival time should also have been prolonged. Wang Jiufeng's therapeutic thinking is worth our reference and study.