Physician Yang Zhiyi's Experience in Treating Radiation Proctitis and Cystitis from Cervical Cancer Radiotherapy
Radiotherapy is a common and very effective treatment for cervical cancer, but it often induces sequelae, among which radiation proctitis and radiation cystitis are the most common.
Radiotherapy sequelae are quite distressing; some patients are tormented by them for the rest of their lives. I have treated several cervical-cancer patients tormented by radiation sequelae. Recently I read some of the experienced approaches of the veteran physician Yang Zhiyi for treating radiation proctitis and radiation cystitis induced by radiotherapy for cervical cancer, and I was greatly inspired. I now transcribe them with appropriate notes for readers' reference.
Using this set of pattern-differentiation methods, Dr. Yang Zhiyi achieved a success rate of over 90% in treating radiation proctitis and radiation cystitis induced by radiotherapy for cervical cancer.
Radiation Proctitis as Jueyin Heat Dysentery Pattern
Liver fire descends downward; excess heat damages yin. There is dysentery of red-and-white mucus, or bloody stool, tenesmus, burning sensation in the anus, yellow-red urine, thirst, and red lips. The pulse is wiry or fine and rapid; the tongue is red or has cracks, sometimes with yellow coating. Treatment should clear liver heat and nourish yin-blood.
The formula is modified Baitouweng Decoction plus Gancao Ejiao Decoction. Baitouweng plus Ejiao Gancao Decoction comes from the Jingui Yaolue; it clears heat and treats dysentery, boosts qi and nourishes blood. It is often used for postpartum dysentery with abdominal pain, tenesmus, pus and blood in the stool, and deficiency of qi and blood.
Baitouweng (Pulsatilla) 15 g, Huangbo (Phellodendron) 12 g, Qinpi (Ash Bark) 12 g, Huanglian (Coptis) 6 g, Gancao (Licorice) 3 g, Ejiao (Donkey-hide Gelatin) 9 g
Radiation Proctitis as Jueyin Painful Diarrhea Pattern
Liver-spleen disharmony with frequent diarrhea: at first a small amount of red-and-white mucus, later watery diarrhea, a bearing-down sensation in the anus, and abdominal distending pain. The pulse is wiry-soft, or wiry on the left and weak on the right; the tongue coating is thin white, or the tongue is slightly dark. Treatment should support earth to restrain wood, and use sour-bitter herbs to astringe the liver; use modified Tongxie Yaofang (Painful Diarrhea Essential Formula).
Tongxie Yaofang (harmonizing formula)
Chenpi (Tangerine Peel) 4.5 g, Baizhu (Atractylodes) 9 g, Baishao (White Peony) 6 g, Fangfeng (Saposhnikovia) 3 g
Radiation Proctitis as Jueyin Heat Diarrhea Pattern
True yin is depleted and liver heat descends. Diarrhea accompanied by dizziness, bitter mouth, and greenish-blue eyes; the pulse is wiry, and the center of the tongue is red and glossy with cracks. Treatment should nourish yin and clear heat; use Lianmei Decoction (Coptis-Mume Decoction) plus Shaoyao and Gancao.
Lianmei Decoction (from Wenbing Tiaobian) plus Shaoyao and Gancao
Huanglian 6 g, Wumei (Mume, pitted) 9 g, Maidong (Ophiopogon) 9 g, Shengdi (raw Rehmannia) 9 g, Ejiao 6 g, Baishao 6 g, Zhi Gancao 6 g
Radiation Proctitis as Taiyin Combined with Shaoyin Pattern
Cold diarrhea with spleen-kidney yang deficiency: loose, clear watery stools, occasionally with mucus, slight bearing-down in the anus, fatigue and lassitude, no desire to eat, no thirst, and normal urination. The pulse is fine and deep; the tongue is pale with a white moist coating. Treatment should warmly tonify the spleen and kidney; use Fuzi Lizhong Decoction (Aconite Regulate-the-Middle Decoction) plus Zhishi.
Fuzi Lizhong Decoction plus Zhishi
Fuzi (Aconite) 3 g, Renshen (Ginseng) 9 g, Ganjiang (Dried Ginger) 9 g, Zhi Gancao 9 g, Chao Baizhu (stir-fried Atractylodes) 9 g, Zhishi (Immature Bitter Orange) 6 g
Radiation Proctitis as Shaoyang Combined with Yangming Pattern
Heat dysentery with damp-heat pouring downward: red-and-white mucus in the stool, lower-abdominal bearing-down, tenesmus. The pulse is deep; the tongue coating is yellow, and there is a bitter mouth. Treatment should clear heat, regulate qi, and move blood; use Qinshao Decoction plus Danggui, Muxiang, Shanzha, Huaihua, or Shengma Gegen Decoction.
Qinshao Decoction (from Ye Shi Nü Ke, originally for women during pregnancy with abdominal pain, a restless fetus and rapid pulse due to heat)
Huangqin (Scutellaria) 3 g, Baishao 3 g, Baizhu (honey-fried) 3 g, Rougui (Cinnamon) 1.5 g
Shengma Gegen Decoction comes from Taiping Huimin Hejiju Fang; it has the effect of releasing the muscle layer and venting the exterior, and is mainly indicated for the early stage of measles: measles not emerging, fever and headache, cough, red eyes and tearing, thirst, a red tongue with thin dry coating, and a floating rapid pulse. (Besides measles, this formula also treats herpes zoster, herpes simplex, chickenpox, diarrhea, and acute bacillary dysentery belonging to pathogen constrained in the muscle layer with heat in the lung and stomach.)
Shengma (Cimicifuga) 10 g, Shaoyao (Peony) 10 g, Zhi Gancao 10 g, Gegen (Pueraria) 15 g
Radiation Cystitis, Taiyin Pattern
Urinary retention due to qi deficiency and sinking: the patient cannot urinate spontaneously, with a bearing-down sensation; only straining yields a little urine, with a burning sensation, and irregular bowel movements. The pulse is fine and moderate; the coating is thin white. Treatment should boost qi and raise the clear; use modified Shengxian Decoction (Raise-the-Sinking Decoction).
Shengxian Decoction (from Yixue Zhongzhong Canxilu)
Sheng Huangqi (raw Astragalus) 18 g, Zhimu (Anemarrhena) 9 g, Chaihu (Bupleurum) 4.5 g, Jiegeng (Platycodon) 4.5 g, Shengma (Cimicifuga) 3 g. Indications: boost qi and raise the fallen. For extreme qi deficiency and sinking, appropriately add a few qian of Renshen, or add a few qian of Shanzhurou (Cornus flesh, pitted) to astringe the scattered qi, so that what is raised does not sink again—this is even better. If the great qi sinks excessively, with the lower abdomen sagging or even painful, increase the Cimicifuga to one-and-a-half qian, or double it to two qian. For extreme spleen-lung deficiency, Renshen may be appropriately added to strengthen qi-boosting, or Shanyurou added to astringe the scattered qi.
Radiation Cystitis, Taiyin Pattern
Frequent urination or incontinence due to qi deficiency and sinking: frequent urination, lower-abdominal bearing-down, sometimes incontinence or hematuria. The pulse is fine and weak; the tongue is clean. Treatment should boost qi and raise the clear; modified Shengxian Decoction may also be used.
Radiation Cystitis, Taiyin Combined with Taiyang Pattern
Difficult urination due to heart-and-small-intestine fire descending: short, dark-red urine, frequent or bloody urination with burning pain on voiding, thirst, and constipation. The pulse is fine, wiry, and slightly rapid; the tongue is red with yellow coating. Treatment should clear fire and cool the blood; use modified Daochi Powder (Guide-the-Red Powder).
Daochi Powder (from Xiao'er Yaozheng Jue)
Shengdi (raw Rehmannia) 10 g, Mutong (Akebia) 10 g, Sheng Gancao (raw Licorice) 10 g. Grind together into coarse powder; take 10 g each time, add 3g of Zhuye (Lophatherum), and decoct in water for oral use.