Appreciating Professor Zhang Jiapeng's Case of Pleural Effusion due to Lung Adenocarcinoma
Zhang Jiapeng (1925–1992) was a researcher at the China Academy of Traditional Chinese Medicine (now the China Academy of Chinese Medical Sciences). He studied under famous TCM physicians Ran Xuefeng, Yue Meizhong, and Zhao Xiwu. With over forty years of clinical practice, he excelled at treating a variety of difficult, complicated diseases, and his prescribing was concise, effective, and distinctive. He was also an editorial board member of works such as the Pharmacopoeia of the People's Republic of China, A Compendium of TCM Internal Medicine, and a Handbook of Proven Formulas for Common TCM Diseases.
On June 3, 1988, Professor Zhang saw a patient with pleural effusion due to lung adenocarcinoma. The patient, surnamed Zhang, responded remarkably to Professor Zhang's small-formula treatment. Five months earlier, the patient had gone to hospital for shortness of breath, palpitations, and a slight, scant cough, and was diagnosed with lung adenocarcinoma. He was hospitalized because of pleural effusion, but after treatment the fluid did not resolve. Two months before the consultation, the fluid was tapped every 7–10 days, 500–1100ml each time, and quickly recurred. Hoping to try TCM for the effusion, he came to Professor Zhang.
At the first visit the patient had fullness and pain in the chest and rib-side, difficult urination, aversion to cold with cold limbs, an enlarged tongue with white coating, and a deep, wiry pulse—all signs of declining kidney yang. Professor Zhang planned treatment with yang-warming and fluid-dispelling principles.
Initial prescription: processed aconite (zhi fuzi) 10g, white peony root (baishao) 12g, Poria (fuling) 10g, toasted atractylodes (chao baizhu) 10g, whole trichosanthes fruit (gualou) 20g, ginger-processed pinellia (jiang banxia) 10g, descurainia seed (tinglizi) 15g, fresh ginger (shengjiang) 10g, 10 jujubes (dazao, broken). Ten doses, decocted in water.
After taking the medicine the patient improved, and on his own added four more doses; only after fourteen consecutive doses did he return. By then the fluid was tapped only once in half a month, amounting to 450ml; urination had increased and all symptoms had lessened. Following the ancient maxim "if it works, do not change the formula," Professor Zhang only added 10g of tangerine peel (chenpi) and had him continue. At follow-up half a year later, the patient had needed no further tapping; his strength had recovered enough for ordinary housework, and Western re-examination showed the pleural effusion had resolved.
Professor Zhang's prescriptions used few herbs but were exquisitely constructed. This formula incorporates three classical formulas—Zhenwu Tang (True Warrior Decoction), Tingli Dazao Xiefei Tang (Descurainia and Jujube Decoction to Drain the Lung), and Gualou Xiebai Banxia Tang (Trichosanthes, Allium, and Pinellia Decoction)—all from Zhang Zhongjing's Shanghan Lun and Jingui Yaolue of the Han dynasty. Zhenwu Tang warms yang and transforms fluid-rheum; Tingli Dazao Xiefei Tang drains the lung and expels rheum; Gualou Xiebai Banxia Tang broadens the chest and dissipates fullness. Used together, pattern differentiation and disease differentiation are combined, treating both root and manifestation and perfectly resolving the patient's problem. Few herbs, striking effect—showing fully the charm of classical formulas.
Note that, according to TCM's "eighteen incompatibilities" and "nineteen mutual antagonisms," pinellia and aconite should not be used together. But the eighteen incompatibilities and nineteen antagonisms are not scientific; they are fabricated prescribing taboos attached by certain physicians of the Jin-Yuan period. For example, aconite and pinellia were counted as incompatible simply because the former is dark and the latter light, and the ancients held that the two could not be used together—a rather absurd taboo. Zhang Zhongjing of the Han dynasty already used aconite and pinellia together, and modern pharmacology shows they are not lethally toxic when combined, so such taboos are no better than superstition. Professor Zhang was not bound by this pedantry, and obtained good results.
Whether to use them this way must still be individualized; if a patient is concerned about it, we should avoid the combination in clinic where possible, to prevent unnecessary medical disputes.