Appreciating Zou Xuexi's Treatment of Severe Postoperative Pain in Liver Cancer
Zou Xuexi, born in 1931, was a native of Xindu county, Sichuan. He studied medicine from childhood under the famous physician Liao Deming and was a TCM physician who grew up through the apprenticeship model. In 1991 he was named by the National Personnel Department, the Ministry of Health, and the State Administration of TCM as one of the first 500 nationally renowned veteran TCM physicians, enjoying the State Council special government allowance. He taught for many years at the Chengdu TCM College (now Chengdu University of TCM), published over twenty medical monographs in his lifetime, and his works have been translated into foreign languages for publication abroad. Old Zou was skilled in treating difficult, complicated diseases.
On April 16, 1993, Old Zou saw a patient after liver-cancer surgery. The patient had been diagnosed with liver cancer six years earlier and had undergone liver-cancer resection; for years after surgery he had done well. But two months before, the right upper quadrant began to hurt, worsening day by day, radiating to the right scapula; each day from 2 p.m. to 4 a.m. the pain was severe and unbearable. At first morphine analgesics worked, but after half a month even larger doses no longer relieved the pain. The patient suffered greatly each day, so he sought Old Zou. At the visit he needed three people to support him; his face was pained, he panted and groaned, with stabbing pain under the right rib-side and in the back, epigastric fullness, and poor appetite. The tongue was purple-dark with thin white coating, and the pulse was string-like and slippery.
Old Zou considered the patient's pattern liver-stomach disharmony with qi stagnation and blood stasis, to be treated by soothing the liver and regulating qi, and moving qi and invigorating blood. He therefore treated with a combined, modified version of Sini San and Jinlingzi San.
First-visit prescription: Chaihu (Bupleuri Radix) 15 g, Baishao (Paeoniae Radix Alba) 15 g, Zhiqiao (Aurantii Fructus) 10 g, Chao Chuanlianzi (Toosendan Fructus, stir-fried) 15 g, Yanhusuo (Corydalidis Rhizoma) 15 g, Yujin (Curcumae Radix) 12 g, Houpo (Magnoliae Officinalis Cortex) 10 g, Binglang (Arecae Semen) 15 g, Wumei (Mume Fructus) 12 g, Zhigancao (Glycyrrhizae Radix Preparata) 6 g. Three doses, decocted in water.
On April 23 the patient came by bicycle alone, beaming, and gratefully reported that after one dose the pain had markedly lessened, and after finishing the three doses the pain had disappeared; only epigastric discomfort and poor appetite remained. On the basis of the above, Chuanlianzi and Wumei were removed, and Chenpi (Citri Reticulatae Pericarpium), Xiangfu (Cyperi Rhizoma), and Guya/Maiya (germinated barley) added to regulate the liver and spleen, digest food, and harmonize the stomach; after another four doses, all symptoms resolved.
This patient's severe pain must have arisen from some blockage between the gallbladder and pancreas caused by improper diet or bad routines. Such pain is only briefly relieved by pethidine or morphine and cannot be cured. Professor Zou's formula is a representative liver-soothing, qi-regulating prescription. I have noticed that such formulas dilate the bile duct. Some gallstone patients, after taking such formulas, also have their severe biliary colic relieved, and even some small gallstones can be expelled as the duct dilates.
After this patient took the Chinese medicine, the biliary blockage was cleared, so his pain was cured at its root. I have had similar experience: I once had a gallbladder-cancer patient in agonizing pain, unrelieved by various analgesics; I gave modified Xiaoyao Wan and the pain quickly vanished. Modified Xiaoyao Wan is also a Chaihu-series formula with liver-soothing, qi-regulating action.
Cancer patients' pain has various causes, and treatment should be chosen according to each patient's specific condition; there is no uniform method. Nor should one reach for analgesics whenever there is pain; such symptom-focused treatment cannot solve the root problem and, though it may give brief relief, cannot maintain long-term effect. Professor Zou's case is of much reference value.