A Detailed Look at Professor Zhao Shaoqin's Experience Formula for Treating 'Jiju' (Late-Stage Pelvo-Abdominal Tumors)

In Professor Zhao Shaoqin's work Zhao Shaoqin's Inner-Canon Heart Methods there is an experience formula for treating "jiju" (accumulation, i.e., late-stage pelvo-abdominal tumors) in patients with qi-and-blood deficiency and long-standing stasis. It is a pill formula, a combination of "Gongji Wan" (Accumulation-Attacking Pill) and "Bazhen Wan" (Eight-Treasure Pill) with modifications.

Professor Zhao Shaoqin's formula is: Xuanfuhua (Inula) 5 qian, Danggui (Angelica) 1 liang, Chishao (Red Peony) and Baishao (White Peony) each 1 liang, Rougui (Cinnamon Bark) 5 qian, Yuanhu (Corydalis) 3 qian, Zhi Biejia (honey-processed Tortoise Shell) 3 qian, Dangshen (Codonopsis) 1 liang, Fuling (Poria) 1 liang, Baizhu (Atractylodes) 1 liang, Zhishi (Immature Bitter Orange) 5 qian, Huanglian (Coptis) 5 qian, Ezhu (Curcuma) 5 qian, Sanleng (Sparganium) 5 qian, Duhuo (Angelica Pubescens) 5 qian, Fangfeng (Saposhnikovia) 5 qian, Jiao Shanzha (charred Hawthorn) 2 liang, Qingpi (Unripe Tangerine Peel) and Chenpi (Aged Tangerine Peel) each 1 liang. Grind all the above into fine powder; refine with honey into pills the size of a parasol seed; take 2 qian each in the morning, noon and evening with plain water; suspend during a cold.

Professor Zhao used this formula for patients with hard, long-standing abdominal masses, progressively worsening pain, sallow emaciated complexion, uneven mottled pigmentation, a purple tongue with stasis spots, white slippery coating with teeth marks, poor appetite, difficult urination and defecation, subjective fatigue and weakness, and a thin weak pulse. Such signs often appear in patients with late-stage pelvo-abdominal tumors (such as gastric, liver, intestinal, or abdominal mesothelioma).

Professor Zhao Shaoqin inherited the medicine of the Qing imperial hospital. His father Zhao Wenkui was the last head of the Qing imperial hospital (equivalent to today's health minister), holding high rank in the Qing imperial medical office. Treating imperial nobles required exceptional caution; a single mistake could risk dismissal or even execution. Zhao Shaoqin's family medicine was therefore known for steadiness, and he was praised as "a physician of balanced, upright, clear and nimble method." He used no startling or risky drugs; his formulas look "uneventful" but work remarkably well.

I studied his case records and treated several cancer patients following his思路, with ideal results. I have also seen records of patients treated by many of his students; their formulas likewise look ordinary yet work remarkably. So imperial physicians' skill was not as contemptible as the TV drama "Miracle Doctor Xi Lai Lee" mocks; their tradition of emphasizing "safe and effective" is worth learning.

Gongji Wan comes from volume 7 of Yizong Bidu (Essentials of the Medical Sect) by the Ming physician Li Zhongzi; it is also called Yin-Yang Gongji Wan. Li Zhongzi says it "treats the five accumulations, six gatherings, seven zheng and eight jia, xuan-pi, worm accumulation, phlegm and food stagnation, regardless of yin or yang." The original formula: "Wuzhuyu (Evodia, soaked), Ganjiang (Dried Ginger, stir-fried), Guangui (Cinnamon Bark, peeled), Chuanwu (Aconite, processed) each 1 liang; Huanglian (Coptis, stir-fried), Banxia (Pinellia, washed), Juhong (Tangerine Red), Fuling (Poria), Binglang (Areca), Houpo (Magnolia, stir-fried), Zhishi (Immature Orange, stir-fried), Changpu (Acorus, avoid iron), Xuanhusuo (Corydalis, stir-fried), Renshen (Ginseng, root removed), Chenxiang (Aquilaria), Hupo (Amber, separately ground), Jiegeng (Platycodon) each 8 fen; Ba Bing (Croton Butter, separately ground) 5 qian. Grind finely; take 6 liang of Zaojiao (Honey Locust), decoct the juice and use to pan-form pills the size of a mung bean. Take 8 fen each time, gradually increasing to 1.5 qian, with ginger decoction.

Professor Zhao followed its intent without copying Li Zhongzi's original formula exactly: he removed the highly toxic Chuanwu (Aconite) and Badou Shuang (Croton Butter), did not use the hemolytic Zaojiao, and used qi-regulating, accumulation-dissolving herbs less drastically than Li Zhongzi. This is reasonable: late-stage tumor patients are mostly frail; following Li Zhongzi's formula exactly might help some but would certainly raise the rate of medical accidents. Zhao's adjustment was therefore for safety.

The Modern Rare TCM Books Collection contains another formula called "Gongji Wan," recorded as: "Gongji Wan, also called Qili San, treats qi-damp stagnation with abdominal distension; after taking it, much foul material is discharged and the distension gradually resolves. Take one pill, or two for the robust. For malaria chills and fever, take on an empty stomach with boiling water. For undigested food and strain injury, take with ginger decoction. For dysentery, take with licorice decoction. For food injury, take with coix decoction. Stir-fried Cangzhu (Atractylodes Lancea) 1 liang, stir-fried Qingpi (Unripe Tangerine) 1 liang, Nanmuxiang (Southern Aucklandia) 4 qian, Badou Rou (Croton meat, oil removed) 1 liang, Xionghuang (Realgar) 3 qian 6 fen, Baicaoshuang (plant soot) 7 qian, Fanmuie (Ma Qianzi, roasted in sesame oil) 3 qian, Chuan Jianghuang (Turmeric) 3 qian, stir-fried Gancao (Licorice) 3 qian 8 fen, Shijunzi (Rangoon Creeper) 3 qian, Yujin (Curcuma) 2 qian, raw Dahuang (Rhubarb) 3 qian 3 fen. Grind all finely; make a paste with half a sheng of aged rice flour and form pills the size of a soybean; coat externally with 60 sheets of true gold leaf."

This formula is also composed along Li Zhongzi's yin-yang accumulation-attacking logic. It uses the arsenic compound Xionghuang (Realgar), the toxic laxative Badou Shuang (Croton Butter), and the toxic Mubiezi (Nu Lou). Analyzed by modern pharmacology, it has anti-tumor effects, but its toxicity is hard to control. Inexperienced doctors cannot manage such a formula, and inexperienced patients and families even less. Once a patient develops arsenic poisoning or liver/kidney damage on this formula, aftermath is extremely difficult.

There is a famous TCM anti-cancer physician famous for "using poison to attack poison"; I have met patients he treated. According to one patient he treated successfully twenty years ago, when that patient saw this famous physician, many other patients died rapidly after taking his prescriptions. In today's medical environment that would produce countless disputes. So we must be extremely cautious when using poison-to-attack-poison drugs.

By comparison, Professor Zhao Shaoqin's formula is more prudent. He removed the more toxic herbs from the yin-yang accumulation-attacking formula and added relatively safe but genuinely anti-tumor herbs—Sanleng (Sparganium), Ezhu (Curcuma), Zhi Biejia (processed Tortoise Shell)—while combining in the Bazhen Wan formula, making it much safer. Bazhen Wan is a classic TCM formula that simultaneously supplements qi and blood; Gongji Wan emphasizes attack, while Bazhen Wan emphasizes supplementation; combining the two achieves simultaneous righteous-support and evil-dispelling.

Bazhen Wan consists of eight herbs: Renshen (Ginseng), Baizhu (Atractylodes), Fuling (Poria), Zhi Gancao (honey-fried Licorice), Shudi (Processed Rehmannia), Danggui (Angelica), Chuanxiong (Sichuan Lovage), and Baishao (White Peony). Professor Zhao removed the cloying Shudi and Zhi Gancao, which burden the diaphragm and impair appetite, also removed the somewhat acrid-dry Chuanxiong, and replaced Renshen with Dangshen (Codonopsis), consistent with the Zhao family's pursuit of steadiness. A warming-tonifying formula thus becomes a gently tonifying one, a much more robust approach.

So Professor Zhao's formula is very steady both in dispelling evil and supporting the righteous, fitting his "balanced, upright, clear and nimble" style. This attention to both safety and efficacy is worth learning.