Xiao Jianzhong Tang for Cancer Patients Disrupted by Excessive Cold, Cooling Herbs: Experience Report

Nowadays many TCM doctors like to prescribe heat-clearing, detoxifying herbs to cancer patients; I myself often use such formulas. But some patients, after overusing cold and cooling herbs, develop marked discomfort, and some develop severe side effects.

I have treated several patients whose spleen and stomach were upset or who developed unexplained pain after overusing cold herbs; I basically used Xiao Jianzhong Tang. I now write this up to share the experience for readers' reference.

Xiao Jianzhong Tang (Minor Center-Fortifying Decoction) is a classical formula from the Shanghan Lun. Its composition there is: "Guizhi three liang (peeled), Gancao two liang (honey-fried), Shaoyao six liang, Dazao twelve pieces (broken), Shengjiang two liang (sliced), Jiaoyi one sheng (maltose syrup)."

My usual dose is: "Guizhi 15g, Zhi Gancao 10g, Baishao 30g, Dazao 7 pieces, Shengjiang 5-7 slices, Jiaoyi (maltose) 60-90g." The Jiaoyi here is maltose, which is hard to buy these days; I usually have patients order it from Taobao.

The Japanese like Xiao Jianzhong Tang, so among Japanese Kampo products there are Xiao Jianzhong Tang granules and Huangqi Jianzhong Tang granules, both easy to buy in Japan.

Huangqi Jianzhong Tang adds Huangqi (Astragalus) to Xiao Jianzhong Tang and treats what classical TCM calls "deficiency-taxity with urgent interior." For patients who can afford it, I suggest buying Japanese Xiao Jianzhong or Huangqi Jianzhong granules online—for quality and convenience.

In the Shanghan Lun, two clauses address Xiao Jianzhong Tang:

"In cold damage, the yang pulse is rough and the yin pulse wiry; there should be urgent abdominal pain. First give Xiao Jianzhong Tang; if not cured, Xiao Chaihu Tang governs."

"On the second or third day of cold damage, if there is palpitations in the heart and irritability, Xiao Jianzhong Tang governs."

The formula verse for Xiao Jianzhong Tang goes:

Xiao Jianzhong Tang uses much Shaoyao, with Gui, Jiang, Gancao, and Dazao harmonized.

Adding Yitang supplements the center; deficiency-taxity with cold abdomen is cured by it.

Adding Huangqi gives it its name; exterior deficiency with body pain is unequaled.

There is also the fourteen-herb Jianzhong for yin sores and taxities, raising deep-rooted illness.

Shiquan Dabu plus Fuzi, with Mai, Xia, and Congrong—take careful note.

In fact, historically many famous formulas were built on Xiao Jianzhong Tang by adding herbs. Besides Huangqi Jianzhong Tang, there are Danggui Jianzhong Tang, Fuling Jianzhong Tang, and the fourteen-herb Jianzhong.

Danggui Jianzhong Tang adds Danggui (Angelica) to Xiao Jianzhong; Fuling Jianzhong Tang adds Fuling (Poria). Danggui Jianzhong treats postpartum blood-deficiency abdominal pain in women; Fuling Jianzhong treats urinary difficulty in postpartum or weak patients.

Xiao Jianzhong Tang can also be used without maltose. For diabetics or those allergic to sweets, remove the Yitang; Xiao Jianzhong minus maltose becomes Guizhi Jia Shaoyao Tang, also for deficiency-cold abdominal pain.

Xiao Jianzhong Tang treats not only various abdominal pains but also anemia and chronic liver/gallbladder deficiency patterns.

In modern medicine, gastric ulcer, duodenal ulcer, cholecystitis, and hepatitis all cause abdominal or generalized pain. Such patients, if their pulse is weak and forceless, can be treated with Xiao Jianzhong Tang.

Another use is for patients whose stomach has been damaged by various Chinese or Western drugs. It can even be combined with unavoidable gut-injuring medicines to protect the stomach.

Three of my cases follow.

Case 1: Critical condition after overusing cold herbs

Wen, from Guilin, had bladder cancer metastasized to the urethral epithelium. A local senior TCM doctor had treated him for many days with Longdan Xiegan Tang (Gentian Liver-Draining Decoction) and Yadanzi (Brucea). Since then his appetite worsened daily, until he could not even keep down a sip of broth.

His condition was critical: he could take neither food nor water, was bedridden, and survived only on local doctors coming to give nutrient IVs. On March 27, 2017, his daughter invited me to Guilin to see him.

On analysis, the urgent problem was spleen-stomach damage from overused cold herbs. TCM says: with stomach qi there is life, without stomach qi there is death. He could take neither food nor water; unless this changed, treatment could not begin. So I prescribed Xiao Jianzhong Tang and told his daughter to find maltose in Guilin.

After taking it, nausea stopped and he could drink and eat again. Because he had taken no food or water for a while, he was frail; plain Xiao Jianzhong could not quickly restore his strength, so I combined it with Guipi Tang (Spleen-Returning Decoction).

After a week he not only ate but rode his bicycle out for a stroll.

Case 2: Frequent severe pain in leiomyosarcoma

Zhang, male, born 1986, from Baoding, Hebei, had poorly differentiated retroperitoneal leiomyosarcoma. On March 5, 2019 he came to me for frequently recurring severe pain.

The tumor had been surgically removed; now he had abdominal bloating and fullness, dark yellow urine, unformed stool, cold aversion, and little sweating. Pulse: fine, wiry, weak. The tumor had metastasized to the gallbladder, which was removed; he had disliked greasy food since childhood and his hepatobiliary system had never been strong.

For the severe pain he had visited People's Hospital of Beijing, 301 Hospital, Cancer Hospital of CAMS, and Guang'anmen TCM Hospital, among many Grade-A tertiary centers. None could find the cause; they prescribed OxyContin, which worked poorly and had strong side effects.

He wanted Chinese medicine and came to me via a patient referral. He was thin and frail. Asking about his medication history, I learned he had long taken cold herbs prescribed by another TCM doctor, after which his appetite dropped and pain grew steadily worse. I judged this deficiency-cold pain and treated him with modified Xiao Jianzhong Tang:

Raw Huangqi 30g, Guizhi 15g, Baishao 60g, Zhi Gancao 10g, Shengjiang 30g, Dazao 7 pieces, maltose (in two divided doses), Jiao Sanxian each 15g, Fuling 30g, Danggui 10g.

Afterward, the intensity and frequency of pain clearly decreased; on some days he felt little pain at all. He gradually noticed that whenever his appetite improved, pain lessened markedly.

Case 3: Late breast cancer with weak, painful legs

Dai, late breast cancer. Surgery and radiotherapy had not controlled the disease; cancer had metastasized widely. Her skin was badly damaged by radiation, and she had taken gut-injuring herbs for a time.

In November 2018 she came to me for weak, painful legs. She was frail with poor appetite. Both legs were weak, painful, and hard to bend or straighten. I judged this weakness and pain to stem from overall frailty and prescribed Xiao Jianzhong Tang.

After three days she improved markedly and could walk her legs unimpeded.

These patients all had a history of spleen-stomach damage leading to various problems. Xiao Jianzhong Tang is an excellent formula for restoring spleen-stomach function. Clinically, when its indication is grasped and applied to the pattern, it can relieve patients' suffering.