A Case by Professor Zhao Shaoqin (Descendant of Three Generations of Imperial Physicians) Treating Gastric Cancer with Hepatic Metastasis, Using Shengjiang San as the Main Formula
Professor Zhao Shaoqin is a famous Chinese medical scholar, a descendant of three generations of imperial physicians and a renowned professor of the Warm-Disease (wenbing) school. His father Zhao Wenkuang was head of the Imperial Medical Academy in the Qing Dynasty (ranked first grade, the highest office of the Academy). Professor Zhao Shaoqin is renowned worldwide for the light, balanced and upright quality of his prescribing, and his therapeutic results are outstanding. This article presents a medical case of Professor Zhao Shaoqin treating a patient with gastric cancer accompanied by liver metastasis; from it we can learn Professor Zhao Shaoqin's basic approach to treating cancer.
The following is Professor Zhao Shaoqin's medical case:
Zhou, male, 40 years old.
【First visit】
On May 20, 1985, the patient had presented with a mass in the epigastrium together with pain and vomiting; in November 1984, examination at the affiliated hospital of a certain provincial medical college had confirmed gastric cancer, and he underwent total gastrectomy. In 1985, due to right upper quadrant pain he came to a Beijing hospital for examination; B-ultrasound suggested a space-occupying lesion in the liver, diagnosed as metastatic liver cancer.
On March 14, 1985, ultrasound findings: hypoechoic areas were seen in both the lateral segment and the medial margin of the left liver, measuring 2.0×2.1 cm and 3.0×2.9 cm respectively, with fairly clear borders. The right liver echo was uniform, with no obvious abnormal area. Suggestion: multiple space-occupying lesions (M) within the left liver.
The patient felt fullness and discomfort below the right rib, with intermittent pain, irritability and agitation, much dreaming at night, dry mouth and parched throat; the tongue was red and thin, with a white, dry coating; the right pulse was wiry, fine and slippery, the left pulse wiry and fine. This was liver heat with yin injury, stagnation of qi movement and disharmony of the connecting vessels. It arose because unfulfilled emotions caused long-standing liver depression that transformed into fire and damaged yin. First, soothe and regulate qi movement to resolve liver depression.
Inula (Xuanfuhua) 10 g, Wenyujin Turmeric (Pianjianghuang) 6 g, Cicada Slough (Chanyi) 6 g, Striated Silkworm (Jiangcan) 10 g, Cyperus (Xiangfu) 10 g, Auklandia (Muxiang) 6 g, Salvia (Danshen) 10 g, Jiao Sanxian (three calcined digestive herbs), each 10 g. 20 doses.
He was also told to avoid pungent, hot and rich-flavored foods, eat only light vegetarian food, and insist on walking exercise every day without interruption.
【Second visit】: June 10, 1985.
After the medicine, the area below the ribs gradually felt comfortable and the pain was greatly reduced. The pulse was still wiry and fine; the tongue was red with a white, dry coating; irritability and much dreaming remained. Qi movement was gradually harmonized, but the depressive heat had not cleared; continue the method of soothing and regulating qi movement.
Cicada Slough (Chanyi) 6 g, Striated Silkworm (Jiangcan) 10 g, Wenyujin Turmeric (Pianjianghuang) 6 g, Cyperus (Xiangfu) 10 g, Apricot Kernel (Xingren) 10 g, Loquat Leaf (Pipa Ye) 10 g, Jiao Sanxian, each 10 g. 6 doses.
【Third visit】: June 17, 1985.
The tongue was red and dry, the pulse wiry, fine and rapid, and night's rest was poor. This was still liver-channel depressive heat not yet cleared, with disharmony of the connecting vessels. Again soothe and regulate, adding cooling the blood and resolving stasis.
Scutellaria Barbata (Banzhilian) 10 g, Pulsatilla (Baitouweng) 10 g, Cicada Slough (Chanyi) 6 g, Striated Silkworm (Jiangcan) 10 g, Wenyujin Turmeric (Pianjianghuang) 6 g, Bamboo Shavings (Zhuru) 6 g, Immature Bitter Orange (Zhiqiao) 6 g, Jiao Sanxian, each 10 g. 6 doses.
【Fourth visit】: June 24, 1985.
Night's rest gradually improved and irritability lessened; the right pulse was wiry, fine and slippery, the left pulse soft and frail. The depressive heat was gradually abating; continue and advance the previous method.
Scutellaria Barbata (Banzhilian) 10 g, Red Peony (Chishao) 10 g, Madder Root (Qiancao) 10 g, Pinellia (Banxia) 10 g, Tangerine Peel (Chenpi) 6 g, Cicada Slough (Chanyi) 6 g, Striated Silkworm (Jiangcan) 10 g, Wenyujin Turmeric (Pianjianghuang) 6 g, Jiao Sanxian, each 10 g. 6 doses.
【Fifth visit】: July 1, 1985.
The pulse was slippery and soft, the tongue red with white coating; belching felt uncomfortable. Again use the method of cooling the blood, resolving stasis and unblocking the collaterals.
Scutellaria Barbata (Banzhilian) 10 g, Red Peony (Chishao) 10 g, Madder Root (Qiancao) 10 g, Tangerine Peel (Chenpi) 6 g, Wenyujin Turmeric (Pianjianghuang) 6 g, Cicada Slough (Chanyi) 6 g, Striated Silkworm (Jiangcan) 10 g, Jiaomaiya (calcined barley malt) 10 g. 6 doses.
【Sixth visit】: July 8, 1985.
The pulse was soft, frail and calm; the tongue had a white, greasy, moist coating; all symptoms had diminished. Continue the method of cooling the blood and resolving stasis.
Scutellaria Barbata (Banzhilian) 10 g, Lobelia (Banbianlian) 10 g, Pinellia (Banxia) 10 g, Tangerine Peel (Chenpi) 6 g, Cicada Slough (Chanyi) 6 g, Striated Silkworm (Jiangcan) 10 g, Wenyujin Turmeric (Pianjianghuang) 6 g, Jiao Sanxian, each 10 g. 12 doses.
【Seventh visit】: July 22, 1985.
The pulse was soft and frail; the tongue red and deep crimson. There was discomfort in the liver region; use the method of boosting qi and resolving stasis.
Raw Astragalus (Sheng Huangqi) 10 g, Glehnia (Shashen) 10 g, Poria (Fuling) 10 g, Red Peony (Chishao) 10 g, Madder Root (Qiancao) 10 g, Cicada Slough (Chanyi) 6 g, Striated Silkworm (Jiangcan) 10 g, Wenyujin Turmeric (Pianjianghuang) 6 g. 6 doses.
【Eighth visit】: July 29, 1985.
A repeat B-ultrasound had been done a few days earlier, with the following results:
Ultrasound findings of July 27, 1985: a hypoechoic mass of 1.3×1.2 cm was seen in the left medial lobe of the liver, with a clear, regular border; the rest of the echo was acceptable.
Ultrasound suggestion: nodular space-occupying lesion (M) in the left medial lobe of the liver.
The pulse was wiry, fine, slippery and rapid, with much dreaming at night. This was still depressive heat not cleared, heat located in the yin aspect. Continue the method of cooling the blood, resolving stasis, boosting qi and activating the collaterals.
Raw Astragalus (Sheng Huangqi) 20 g, Glehnia (Shashen) 10 g, Ophiopogon (Maidong) 10 g, Schisandra (Wuweizi) 10 g, Scutellaria Barbata (Banzhilian) 10 g, Red Peony (Chishao) 10 g, Madder Root (Qiancao) 10 g, Cicada Slough (Chanyi) 6 g, Jiao Sanxian, each 10 g, Polygonum orientale (Shuihonghua Zi) 10 g, Wenyujin Turmeric (Pianjianghuang) 6 g, Striated Silkworm (Jiangcan) 10 g. 30 doses.
The patient returned to his hometown in Shandong with the above formula and continued taking it for three months; all symptoms disappeared and his body grew steadily stronger. In September 1985 he returned to Beijing for a re-examination, with the following results.
Ultrasound findings of September 9, 1985: the echo within the liver was uniform, with no obvious abnormal echo mass and clear vessels. The pancreas was poorly visualized.
Ultrasound suggestion: no obvious abnormality within the liver.
In August 1986 the patient returned to Beijing again for re-examination, and again no abnormality was found.
【Commentary】: This case was postoperative gastric cancer that had metastasized to the liver, with a very high degree of malignancy; Master Zhao used TCM pattern differentiation to achieve satisfactory results. Looking at the whole course of treatment, it can broadly be divided into three stages.
The first stage, comprising the first and second visits, mainly soothed and regulated qi movement to resolve liver depression.
Although the patient, through cancerous consumption plus surgery and the long-standing subsequent dysfunction of spleen-stomach transportation, had sustained damage to both qi and yin, the principal contradiction in his disease mechanism was still liver-depression heat. Because the patient learned he had cancer and that it had recurred and metastasized after surgery, he believed it was untreatable and that death was near; he therefore felt heavy-hearted and low, depressed all day. This was one of the main factors causing liver depression and disordered qi movement. Long-standing liver depression necessarily transforms into heat, hence symptoms such as irritability and much dreaming at night. Depressive heat in the interior necessarily damages yin, hence also dry mouth, fine pulse and thin tongue. By comparison, liver depression was the primary, the first-order issue. Treatment therefore soothed and regulated qi movement to resolve liver-depression heat, using Shengjiang San as the base: Cicada Slough and Striated Silkworm, endowed with clear transforming qi, rise to ascend the clear yang; combined with Inula, Apricot Kernel and Loquat Leaf they diffuse the lung and downbear turbidity; Wenyujin Turmeric soothes and frees the stasis of qi and blood. Salvia assists in activating blood and resolving stasis; Auklandia assists in regulating qi; Jiao Sanxian removes food stagnation and frees the sanjiao. The patient was also taught to eat vegetarian food to preserve transportation, to exercise to move qi and blood, and to avoid pungent, hot, rich foods so that the fu-organs stay clean and depressive heat does not arise. With such comprehensive regulation, the liver's depressive heat was dispersed; although cancer itself was not directly treated, the root cause of the cancer was directly uprooted.
The second stage of treatment ran from the third to the sixth visit. After the first stage, qi movement gradually became smooth, symptoms gradually diminished, the patient was calmer than before and his confidence in treatment grew. At this point the treatment focus gradually shifted to cooling the blood and resolving stasis. Because the liver stores blood, long-standing liver-depression heat necessarily causes heat to enter the blood aspect and produce stasis; hence, although merely soothing qi movement was necessary, it was not targeted enough. It had to be combined with cooling the blood and resolving stasis, simultaneously regulating both qi and blood. Therefore, on the basis of Shengjiang San's soothing of qi movement, Scutellaria Barbata was added to clear heat and resolve toxin, and Pulsatilla, Red Peony and Madder Root to cool the blood and resolve stasis. After over a month of regulation, the patient felt his various symptoms gradually lessen, his mental state improved, he was full of confidence and cooperated actively. Repeat B-ultrasound showed that of the two original liver tumors, one had disappeared and the other had markedly shrunk.
The third stage of treatment began at the seventh visit. On the basis of the earlier soothing of qi movement and cooling the blood to resolve stasis, herbs that boost qi and support the righteous were added, because from the outset this disease involved deficiency of both qi and yin, a condition of righteous deficiency with excess evil. After the first two stages, the depressive heat evil had gradually dispersed; only now was it appropriate to support the righteous without the risk of retaining the evil. Moreover, his pulse was soft and frail, showing that the qi aspect was already insufficient; relying solely on the clearing-transforming method would not have been the best policy, so this was the most opportune moment to support the righteous and expel the evil. Therefore, on the basis of soothing qi movement and cooling the blood to resolve stasis, Raw Astragalus was added to boost qi and support the righteous, and Shengmai San (Pulse-Generating Powder) to boost qi and nourish yin. Before the patient returned home, Jiao Sanxian and Polygonum orientale were also added to the formula, since he would need to take it long-term after returning; adding them helped digestion. Thus the combination was comprehensive and the formula suitable for long-term use. The patient persisted with this formula for three months, and the liver mass completely disappeared, achieving a satisfactory therapeutic result.
Note by Zhou Zhiyuan: Shengjiang San is a famous Warm-Disease formula, from Shanghan Wenyi Tiaobian (Systematic Differentiation of Cold Damage and Warm Epidemics), vol. 4. Its composition is four herbs: Striated Silkworm (Jiangcan), Cicada Slough (Chantui), Turmeric (Jianghuang) and Rhubarb (Dahuang). The original text notes its action as treating great heat in the exterior, interior and sanjiao in warm disease when the symptoms are indescribably complex; its uses are very broad.
The name of the formula Shengjiang San (Ascending-Descending Powder) fully reflects TCM's emphasis on the balance of upbearing and downbearing of the body's qi movement. The herbs that compose it both ascend and descend: Striated Silkworm and Cicada Slough mainly ascend, upbearing the clear yang within yang; Turmeric and Rhubarb mainly descend, downbearing the turbid yin within yin. One ascending and one descending, interior and exterior communicate harmoniously, the function of the zang-fu organs is regulated, and perverse qi and toxic influence are instantly dispersed.
Professor Zhao Shaoqin built his formulas by modifying Shengjiang San, precisely inheriting this basic idea of adjusting the human body's function of upbearing the clear and downbearing the turbid. This is also the consistent idea behind Professor Zhao Shaoqin's treatment of tumors; in the many cancer cases he treated, he basically used Shengjiang San as the core formula.
Coincidentally, modern pharmacological research has also confirmed the antitumor effects of Striated Silkworm and Turmeric, but this is not the main point—because at the doses Professor Zhao Shaoqin used, from the standpoint of modern pharmacology, they could by no means achieve a cancer cure. The key here is that when treating cancer, Professor Zhao Shaoqin used TCM's zang-fu theory and the theory of the ascending and descending of qi movement to adjust the patient's imbalance of yin and yang and of the zang-fu organs, and so the tumor of itself disappeared.
Professor Zhao Shaoqin treated disease with few herbs and small doses—light, balanced and upright; his formulas were very safe, yet his therapeutic results were outstanding. This is precisely the highest realm that a clinical TCM physician should strive for.