Appreciating Professor Zhou Zhongying's Case: Complex Combined Formula for Elevated CA125 after Ovarian Cancer Surgery

Professor Zhou Zhongying is a renowned National Medical Master of China. Among his medical cases is one titled "Complex Combined Formula for Elevated Tumor Markers after Ovarian Cancer Surgery." In this case, Professor Zhou did not follow the usual TCM approach to disease; he boldly adopted a complex combined formula (fu fa da fang), using many herbs together, and employed both decoctions and pills. Under Master Zhou's treatment, the patient's CA125 was brought under control; Master Zhou followed up for two and a half years, and the condition remained stable.

The patient was a 51-year-old woman who first consulted Master Zhou on August 17, 2000. In mid-June 2000 she had undergone surgery for ovarian cancer; during surgery the tumor was found to have invaded the uterus and greater omentum, and pathology showed poorly differentiated adenocarcinoma. After surgery she received three intraperitoneal chemotherapy sessions and one intravenous chemotherapy session. Following chemotherapy she had a low white-cell count, fatigue and lassitude, palpitations and shortness of breath, dizziness and tinnitus, dry mouth and poor appetite, as well as pain in the liver area and to the right of the umbilicus, and she sought TCM treatment.

Master Zhou's initial pattern differentiation was liver-kidney yin deficiency with dual damage to qi and yin, internal accumulation of cancer toxin, and intermingled phlegm and stasis. He therefore decided to use a large prescription. The formula was: Zhi Biejia (processed Carapax Trionycis) 15 g, Tubiechong (Eupolyphaga) 6 g, Ezhu (Rhizoma Curcumae) 10 g, Shancigu (Pseudobulbus Cremastrae Seu Pleionis) 15 g, Haizao (Sargassum) 15 g, Jiangcan (Bombyx Batryticatus) 10 g, Baihuasheshecao (Herba Hedyotis Diffusae) 25 g, Lulu (Radix Rhapontici) 12 g, Banzhilian (Herba Scutellariae Barbatae) 25 g, Qingpi (Pericarpium Citri Reticulatae Viride) 6 g, Chenpi (Pericarpium Citri Reticulatae) 6 g, Fabanxia (processed Rhizoma Pinelliae) 10 g, Sheng Yiyiren (raw Semen Coicis) 15 g, Fengfang (Nidus Vespae) 12 g, Sheng Huangqi (raw Radix Astragali) 15 g, Gouqizi (Fructus Lycii) 12 g, Xianhecao (Herba Agrimoniae) 15 g, Zhi Wugong (processed Scolopendra) 2 pieces, Tiandong (Radix Asparagi) 12 g, Maidong (Radix Ophiopogonis) 12 g, Chao Yanhusuo (stir-fried Rhizoma Corydalis) 12 g, Chuanlianzi (Fructus Toosendan) 10 g, Jiuxiangchong (Aspongopus) 5 g.

In addition, Xihuang Wan was taken orally twice daily, one bottle each time.

The patient took the medicine for two weeks; on the second visit, September 14, 2000, she reported improved spirit, better constitution, and recovered appetite, but there was still dull pain in the liver area and gastric distension. Master Zhou therefore added Shixiao San (wrapped, 10 g) and Shijianchuan (Herba Salviae Chinensis) 20 g to the first formula.

Thereafter, based on the above formula, the patient was also given modifications using herbs such as Yuzhizi (Fructus Akebiae), Shuyangquan (Solanum Septemlobum), Tianhuafen (Radix Trichosanthis), Danggui (Radix Angelicae Sinensis), Jixueteng (Caulis Spatholobi), Sangjisheng (Herba Taxilli) and Tiannanxing (Rhizoma Arisaematis). By November 2001, CA125 had fallen from the postoperative 40-170 U/ml to 13.8 U/ml (reference range 0-35). The patient's general condition was good, and she had gained 5 kg in weight.

The patient continued taking the medicine until March 6, 2003, when she returned for consultation with no uncomfortable symptoms at all. A follow-up B-ultrasound showed only mild fatty liver, with no other obvious abnormalities. Master Zhou then adjusted her prescription as follows:

Zhi Biejia 15 g (decocted first), Sheng Huangqi 25 g, Danggui 10 g, Maidong 10 g, Shengdihuang (Radix Rehmanniae) 10 g, Zhi Nuzhenzi (processed Fructus Ligustri Lucidi) 10 g, Mohanlian (Herba Ecliptae) 10 g, Xianhecao 15 g, Jixueteng 15 g, Zhi Huangjing (processed Rhizoma Polygonati) 10 g, Shancigu 15 g, Zhi Jiangcan 10 g, Zeqi (Euphorbia Helioscopia) 12 g, Maozhaocao (Radix Ranunculi Ternati) 20 g, Fengfang 10 g, Shixiao San 10 g (wrapped), Tubiechong 6 g, Baihuasheshecao 25 g, Banzhilian 25 g, Lulu 12 g, Longkui (Solanum Nigrum) 20 g, Yuzhizi 10 g, Ezhu 10 g, Guiman tou (Fructus seu Radix Fici Pumilae) 15 g, Sheng Shanzha (raw Fructus Crataegi) 15 g, Gouqizi 12 g.

Master Zhou's writings do not record further follow-up of this patient, but after his treatment the condition had stabilized, and her subsequent survival time and quality of life should have been good. Compared with classical formulas (jing fang), Master Zhou's formulas contain more herbs; most of the herbs were chosen according to disease-based treatment, using Chinese medicines with anti-cancer effects, and he also used the famous anti-cancer formula Xihuang Wan-so the treatment was effective.

Looking over this case of Master Zhou's, there is both pattern-based treatment-for example, addressing the patient's liver-kidney yin deficiency with Erzhi Wan (Nuzhenzi, Mohanlian) and yin-nourishing/engendering herbs such as Maidong and Tiandong-and disease-based treatment-for example, using hard-mass-softening and nodule-dispersing herbs such as Zhi Biejia, Jiangcan, Haizao and Shancigu; heat-clearing, detoxifying, anti-cancer herbs such as Banzhilian, Baihuasheshecao, Shijianchuan and Lulu; "using poison to attack poison" herbs such as Fengfang and Wugong; blood-activating and stasis-resolving herbs such as Shixiao San, Jixueteng, Ezhu and Tubiechong; and he also used Xianhecao, which cools blood, stops bleeding and fights cancer-all of these being disease-based anti-cancer medications.

The Chinese patent medicine Xihuang Wan prescribed by Master Zhou is a famous anti-cancer formula, but it is now expensive and beyond the means of ordinary patients.

Overall, Master Zhou's prescribing does not depart from supporting the righteous qi and expelling the pathogen. Among a large battalion of pathogen-expelling herbs, he also added righteous-qi-supporting, root-strengthening herbs such as Sheng Huangqi, Huangjing, Mohanlian, Nuzhenzi, Danggui and Gouqizi. In this way he both addressed anti-cancer and supported the righteous, enhancing the patient's constitution while attacking cancer cells, embodying the characteristic of TCM holistic treatment.