A Case History of Senior Physician Zhang Xijun Treating Gastric Cancer

The patient was a 60-year-old man surnamed Gao, who first consulted senior physician Zhang Xijun on February 5, 1978. The patient had suffered epigastric pain since he was 20 years old (40 years earlier); the pain often flared when he ate slightly too much or when he was hungry, accompanied by belching of putrid food and acid regurgitation. Twenty years earlier he had once had a massive gastric hemorrhage due to excessive drinking. Over the past seven years, because of his work he had frequently been in contact with acids, alkalis and other chemicals, and the epigastric pain had worsened, with vomiting and poor appetite; he had taken various Chinese and Western medicines without effect. In 1977 his condition worsened, and an abdominal mass about 3 cm × 4 cm could be felt in the upper abdomen, accompanied by progressive wasting. Western examination diagnosed ulcerative gastric cancer. The hospital urged immediate surgery; the patient was unwilling and instead sought out senior physician Zhang Xijun, who was at that time seeing patients at Chongqing First Hospital of TCM.

At the initial visit, palpation could detect a hard upper-abdominal mass with tenderness. The patient was listless, his limbs were fatigued, his body emaciated; his chest, epigastrium and abdomen often felt distended and painful, with occasional stabbing pain. He felt a foul-smelling fluid surging up from the stomach to the throat, unbearable; his appetite was poor, stomach pain worsened after meals, and his stools were black and small in amount. The tongue was purple-dark, sublingual veins were varicose, the tongue coating was white-greasy with a yellow tinge, and the pulse was wiry and fine.

Dr. Zhang differentiated the condition as deficiency of both qi and blood, dysfunction of the zang-fu organs, qi stagnation and blood stasis, and congelation of phlegm-dampness, gradually accumulating into a mass. The treatment principle was to support healthy qi and secure the root, move qi and resolve stasis, invigorate blood and dissipate the Zheng mass, and soften hardness and scatter nodulation.

Initial prescription: Taizishen (Pseudostellariae Radix) 30g, Dazao (Jujubae Fructus) 15g, Hetaozhi (Juglandis Ramulus) 30g, Gancao 6g, Yiyiren (Coicis Semen) 30g, Baihua Shegancao (Hedyotidis Herba) 30g, Banzhilian (Scutellariae Barbatae Herba) 30g, Shidachuan (Salviae Chinensis Herba) 30g, Tufuling (Smilacis Glabrae Rhizoma) 30g, Chao Maiya and Chao Guya (fried Hordei Fructus Germinatus, Oryzae Fructus Germinatus) 10g each, Duan Walengzi (calcined Meretricis/Cyclinae Concha) 18g, Wuzeigu (Sepiae Endoconcha) 18g; 7 doses, decocted in water.

At the same time, he took Aitongning and Liushen Wan orally, and was given Renshen (Ginseng) injection intramuscularly. Yanghe Gao was applied externally over the mass.

After taking the medicine, epigastric pain was markedly relieved, vomiting ceased, and no foul surge recurred. At the second visit on February 12, Dr. Zhang Xijun removed Walengzi, Wuzeigu and Tufuling from the initial prescription, added Yuqiushuan 15g and Jishiteng (Paederiae Herba) 30g, and prescribed 24 doses for continued use. The Renshen injection was changed to Hekui injection; Aitongning was changed to Yunnan Baiyao; Liushen Wan was changed to Zhongjiefeng tablets.

By March 3, after taking the medicine, the patient's condition had improved: epigastric pain had stopped and appetite had increased, but the stools were still black and the mass was unchanged. Dr. Zhang then revised the prescription as follows: Huangyaozi (Dioscoreae Bulbiferae Rhizoma) 15g (decocted first for one hour), Dangshen 30g, Dazao 15g, Yiyiren 30g, Longkui (Solanigri Nigri Herba) 30g, Shemei (Duchesneae Herba) 30g, Paifengteng 30g, Sanleng (Sparganii Rhizoma) 9g, Ezhu (Curcumae Rhizoma) 9g, Haizao (Sargassum, washed) 25g; decocted in water. Separately, Xuejianchou 30g and Sanqi 30g were ground together into fine powder, divided into 60 sachets, taken one sachet each time, three times a day, infused in warm water. Xiakucao Gao (Prunellae paste), 5 bottles, one tablespoon each time, three times a day. Yanghe Gao plus Shexiang (Moschus) was applied externally over the mass. Shanghai Zhongjiefeng injection, 5 boxes, 4 ml each time, twice a day, intramuscular injection.

After more than 20 days of treatment according to the above regimen, the mass had shrunk by about half and stool color had returned to normal. But he still felt very fatigued and weak, with reduced appetite. Therefore, on the basis of the above formula, Sanleng, Ezhu and Huangyaozi were removed, and Jishiteng 30g, Geshanqiao 30g and Dibiechong (Eupolyphaga) 9g were added; the patient continued taking 10 doses. At the same time, Renshen injection was given intramuscularly once a day, 4 ml each time. Yunnan Baiyao was taken internally, and Yanghe Gao plus Shexiang applied externally.

At the follow-up visit on April 7, the mass had basically disappeared, but the patient was still fatigued and weak with poor appetite. The prescription was then changed to: Dangshen 30g, Taizishen 30g, Hetaorou (walnut kernels) 10 pieces, Dazao 15g, Gancao 6g, Haizao 25g, Kunbu (Eckloniae/Algae) 15g, Banzhilian 30g, Shidachuan 30g, Baihua Shegancao 30g. Patent medicines Huazheng Huisheng Dan and Xiakucao Gao were also used.

At the follow-up on April 27, the mass had completely disappeared; the patient was in good spirits, had no epigastric pain, improved appetite, and normal urination and defecation. Re-examination at a Chongqing hospital showed that the cancerous lesion had disappeared. He was told to continue taking Chinese medicine and to return for re-examination after three months.

Prescription: Taizishen 30g, Baizhu 15g, Fuling 15g, Gancao 6g, Wuzeigu 18g, Duan Walengzi 18g, Jishiteng 30g, Yuqiushuan 30g, Longkui 30g. Additionally, Zhongjiefeng tablets orally, 4 tablets each time, three times a day; Jianpi Gao tablets, 4 tablets each time, three times a day; royal jelly, two vials daily. Separately, Wushaoshe (Zaocys) 60g and Chao Jiangcan (fried Bombyx Batryticatus) 60g were ground together into fine powder, refined honey added to form pills, to be slowly dissolved in the mouth as needed.

This patient was followed up for 6 years with no recurrence.

This case record of senior physician Zhang Xijun can be called a textbook of TCM external medicine. The range of herbs used is enormous, and it includes many famous formulas, such as Yanghe Gao and Huazheng Huisheng Dan. The former was a family-secret formula of the Qing Dynasty physician Wang Hongxu; the latter was an empirical formula of the warm-disease great master Wu Jutong. Only someone with broad learning could use such a wide array of medicines.

Dr. Zhang not only used these classic famous formulas, but also a large number of folk medicines common in the southwest region. Hetaozhi, Geshanqiao, Yuqiushuan, Shemei, Jishiteng and Xuejianchou in the formula are not standard commonly used Chinese medicines, but they are all folk herbs commonly used for treating gastric cancer and stopping bleeding; Dr. Zhang incorporated them all into his formulas.

In addition, combining Gancao and Haizao in the same prescription was a bold use. Gancao and Haizao are listed among the "eighteen incompatibilities" (shiba fan); pharmacies seeing such a prescription often dare not dispense it. Patients and their families who know a little TCM also recoil at the sight of such a prescription. But in fact, famous TCM external-medicine formulas such as Haizao Yuhu Tang simultaneously use Gancao and Haizao. This precious medication experience is worth learning from.

During treatment, Dr. Zhang also used many Chinese medicine injections, a characteristic of his era. Most of these injections are no longer used clinically today; the corresponding herbs can simply be added to the decoction.

This way of using medicines looks dazzling, but every herb is well-targeted. Cancer is hard to treat; one may exhaust every means and still find it hard to achieve good outcomes, so senior physician Zhang Xijun used medicines without rigid convention during treatment. This is a proactive, committed attitude. Compared with the practice of playing it safe because of fear of medical accidents, using only bland formulas, daring not to take risks for patients, and thereby delaying their treatment, Dr. Zhang's way of daring to explore ways of survival for his patients is far superior.