Professor Wang Yunqi's Empirical Formulas for Treating Radiation Therapy Side Effects in Cancer

Professor Wang Yunqi is a chief physician and department director in the TCM and Integrated Chinese-Western Medicine Department of Hunan Cancer Hospital. From his clinical practice he has worked out a set of formulas for treating (or preventing) the side effects or sequelae of radiotherapy according to different irradiated sites, which is quite worth learning from.

Professor Wang Yunqi believes that the side effects of radiotherapy for head tumors such as nasopharyngeal, oral, and throat cancers mostly belong to heat-toxin damaging yin, and should be treated following the principles of clearing heat and resolving toxin, and nourishing yin and generating fluids. His empirical formula is a modified combination of Wu Wei Xiao Yin (Five-Ingredient Decoction to Eliminate Toxin) and Shashen Maidong Tang (Glehnia and Ophiopogon Decoction).

The formula is as follows: Jinyinhua (Lonicerae Flos) 20-30 g, Lianqiao (Forsythiae Fructus) 15 g, Zihu Diding (Violae Herba) 20 g, Baizhi (Angelicae Dahuricae Radix) 12 g, Chishao (Paeoniae Rubrae Radix) 20-30 g, Mudanpi (Moutan Cortex) 15 g, Shengdihuang (unprocessed Rehmanniae Radix) 12 g, Shashen (Glehniae Radix) 15-20 g, Maidong (Ophiopogonis Radix) 15-20 g, Lugen (Phragmitis Rhizoma) 20-30 g, Yuzhu (Polygonati Odorati Rhizoma) 15-20 g, Baizhu (Atractylodis Macrocephalae Rhizoma) 15-20 g, Chenpi (Citri Reticulatae Pericarpium) 10 g, Gancao (Glycyrrhizae Radix) 6 g. If sore throat is relatively severe, remove Yuzhu and Lugen and add Shandougen (Sophorae Tonkinensis Radix) 10 g, Shegan (Belamcandae Rhizoma) 15 g, Jiangcan (Bombyx Batryticatus) 15 g, Chantui (Cicadae Periostracum) 10 g; for oral ulcers, add Shigao (Gypsum Fibrosum) 30-60 g (separately packaged and decocted first), Zhimu (Anemarrhenae Rhizoma) 20-30 g, Chuanniuxi (Achyranthis Bidentatae Radix) 20 g.

In this formula, Jinyinhua, Lianqiao, and Zihu Diding clear heat and resolve toxin; Lugen, Yuzhu, Shashen, and Maidong nourish yin, relieve thirst, generate fluids, and moisten dryness; Chishao, Mudanpi, and Shengdihuang clear heat and cool blood; Baizhi relieves pain; Baizhu strengthens the spleen; Chenpi regulates qi; Gancao both clears heat and reduces the irritation of bitter-cold herbs to the spleen and stomach. It has a certain relieving effect on dry throat and mouth and difficulty swallowing caused by radiotherapy for head tumors. Adding Shandougen and Shegan for sore throat gives symptomatic treatment; adding Jiangcan and Chantui combines with Shengjiang San (Ascending-Descending Powder) to clear stagnant heat in the triple burner. Adding Shigao, Zhimu, and Chuanniuxi for oral ulcers combines with Yunv Jian (Jade Woman Decoction) to clear stomach heat. In the author's experience, patients with radiation-induced oral ulcers should also supplement the trace element zinc and vitamin B2, and may consider using Kangfuxin Ye simultaneously, so that recovery may be faster.

Professor Wang Yunqi believes that after radiotherapy for lung cancer, the condition mostly belongs to lung yin deficiency caused by heat-toxin damaging yin, so it should be treated by the principles of nourishing yin and moistening the lung, and clearing heat and resolving toxin. His experience is to build the formula by modifying Baihe Gujin Tang (Lily Bulb Decoction to Preserve the Metal).

The formula uses: Baihe (Lilii Bulbus) 12-20 g, Shengdihuang 12 g, Chishao 20-30 g, Shashen 15 g, Maidong 15 g, Sangbaipi (Mori Cortex) 20-30 g, Gualouke (Trichosanthis Pericarpium) 15-20 g, Huangqin (Scutellariae Radix) 10-15 g, Chonglou (Paridis Rhizoma) 20 g, Dahuang (Rhei Radix) 5 g, Baizhu 12 g, Chenpi 10 g, Guya (Setariae Fructus Germinatus) 20-30 g, Maiya (Hordei Fructus Germinatus) 20-30 g, Yiyiren (Coicis Semen) 30 g. For radiation pneumonitis, add Zhi Pipaye (honey-fried Eriobotryae Folium) 15-20 g, Kuandonghua (Farfarae Flos) 15 g, Xiyangshen (Panacis Quinquefolii Radix) 6-10 g (separately packaged and steamed to mix), Huoxiang (Agastaches Herba) 15 g, Cangzhu (Atractylodis Rhizoma) 15 g; for hemoptysis, add Xianhecao (Agrimoniae Herba) 30 g, Baiji (Bletillae Rhizoma) 20-30 g, Puhuangtan (Typhae Pollen carbonisatum, in a cloth bag) 10-15 g, Qiancao (Rubiae Radix) 10 g, and additionally take 4 g of Yunnan Baiyao together with the decoction.

Baihe Gujin Tang is a classic TCM formula for nourishing yin and moistening dryness, mainly treating lung yin deficiency. The Tangtou Gejue (Verses on the Teachings of Formula Prescriptions) describes Baihe Gujin Tang as: "Lily Bulb Preserve-the-Metal uses two Rehmannias, with Scrophularia, Fritillaria, Platycodon, and Licorice; combined with Ophiopogon, Peony, and Angelica, it treats wheezing, cough, and blood from injured lung." So it has been the representative formula for treating lung disease since ancient times; the Baihe, Rehmannia, and Maidong in the formula all nourish yin and moisten dryness. Professor Wang's formula follows the meaning of Baihe Gujin Tang with modifications; Shashen is used to enlarge the yin-nourishing strength, because radiation damage to yin is very severe. Sangbaipi and Huangqin clear lung heat; Chonglou clears heat and resolves toxin while also anti-cancer; Gualou clears and discharges lung heat while also unblocking the bowels; Dahuang discharges heat and frees the stools; Baizhu strengthens the spleen; Chenpi regulates qi; Guya and Maiya strengthen the stomach and digest food; Yiyiren strengthens the spleen, percolates dampness, and also anti-cancer. Overall, this formula treats both the branch and the root for cancer patients after radiotherapy.

After radiotherapy for rectal and cervical cancer, the most common conditions are radiation proctitis, radiation cystitis, and radiation pelvic inflammation. Professor Wang believes this pattern should be treated in TCM as damp-heat pouring downward with impaired qi movement, using the approach of clearing and draining damp-heat and smoothing the qi movement.

Radiation enteritis is treated with modified Bai Tou Weng Tang (Pulsatilla Decoction) combined with Er Miao San (Two-Marvel Powder): Baitouweng (Pulsatillae Radix) 15 g, Huangbai (Phellodendri Cortex) 15 g, Cangzhu 15 g, Jinyinhua 30 g, Lianqiao 15 g, Kushen (Sophorae Flavescentis Radix) 15 g, Baijiangcao (Patriniae Herba) 30 g, Yiyiren 30 g, Jinqiancao (Lysimachiae Herba) 30 g, Dahuang 6 g, Wuyao (Linderae Radix) 15 g, Chenpi 15 g, Gancao 6 g. For hematochezia, add Xianhecao 30 g, Diyu tan (Sanguisorbae Radix carbonisatum) 30 g, Cebai tan (Platycladi Cacumen carbonisatum) 20-30 g, Qiancao gen tan (Rubiae Radix carbonisatum) 20-30 g; for severe diarrhea, add Huoxiang 10-15 g, Peilan (Eupatorii Herba) 10-15 g, Shenqu (Massa Medicata Fermentata) 20-30 g.

Radiation cystitis may be treated with modified Wu Wei Xiao Yin combined with Ba Zheng San (Eight-Correct Powder): Jinyinhua 15 g, Lianqiao 15 g, Zihu Diding 20 g, Cheqiancao (Plantaginis Herba) 30 g, Jinqiancao 30 g, Bianxu (Polygoni Avicularis Herba) 15-20 g, Qumai (Dianthi Herba) 15-20 g, Liu Yi San (six-one powder, wrapped for decoction) 1 packet, Danzhuye (Lophatheri Herba) 15 g, Kushen 15 g, Dahuang 6 g, Chuanniuxi 20 g, Baizhu 15-20 g, Gancao 6 g; for hematuria, add Da Ji tan and Xiao Ji tan (each 20-30 g), Puhuangtan (in a cloth bag) 15 g, Xianhecao 30 g.

Pelvic inflammation after radiotherapy for cervical cancer may be treated with modified Wu Wei Xiao Yin combined with Er Miao San: Jinyinhua 15 g, Lianqiao 15 g, Zihu Diding 20 g, Cangzhu 15 g, Huangbai 15 g, Hongteng (Sargentodoxae Caulis) 20 g, Baijiangcao 30 g, Yiyiren 30 g, Jinqiancao 30 g, Chuanniuxi 20-30 g, Chishao 20 g, Dilong (Pheretima) 20 g. Additionally, the following formula may be decocted for a sitz bath: Rendongteng (Lonicerae Caulis) 50 g, Lianqiao 30 g, Zihu Diding 30 g, Kushen 30 g, Huangbai 20 g, Baijiangcao 30 g, Jinqiancao 50 g, Cangzhu 20 g, Yiyiren 50 g, Dahuang 20-30 g, Mangxiao (Natrii Sulfas) 15-20 g. This is an external formula, so the doses are larger.

Overall, Professor Wang Yunqi believes that the side effects of radiotherapy mainly manifest in the two characters "heat evil." Whether targeting the head and neck (upper jiao), chest (middle jiao), or lower body (lower jiao), heat evil predominates. So when treating radiation side effects, Professor Wang mainly clears heat and resolves toxin, because clearing heat and resolving toxin is the method treating the root.

But the various radiation side effects are not entirely identical; different irradiated sites produce different clinical symptoms, so the branch must also be treated in a targeted manner. This is a treatment approach combining disease differentiation with pattern differentiation, and the whole with the local.

The author's note: radiation sequelae are very stubborn and prone to recurrence. In the author's experience, although TCM formulas have a certain therapeutic effect on radiation side effects, it is difficult to eradicate them completely. Moreover, treating radiation sequelae is quite tricky; sometimes a simple symptom plagues a patient who consults many doctors and tries many methods with little effect.

So the author suggests that when treatment has a certain effect, patients should firmly remember the regimen that worked for them and entrust the pharmacy to process the used formulas into pills for long-term taking. Or, when the next sign of recurrence appears, start medication to intercept it; this can consolidate the therapeutic effect, shorten the treatment course, and reduce the treatment burden.

Some patients' radiation sequelae appear late, for example years after radiotherapy; patients and doctors easily overlook them. Patients with a history of radiotherapy and their families should pay attention to this. If a patient develops dry mouth, fatigue, cough, hemoptysis, recurrent diarrhea, hematochezia, hematuria, scanty urine, or painful urination, radiation sequelae should be considered and treated as such.