Hu Xishu Classical Medicine
| Introduction: Cancer-related fatigue is one of the most common complications in patients with malignant tumors. The NCCN guidelines in the United States have published guidelines related to cancer-related fatigue. Currently, there are no specific drugs for this condition, and treatment mainly involves multidisciplinary interventions focusing on physiological and psychological aspects. Based on the clinical characteristics of cancer-related fatigue, it can be classified under the TCM category of “Xu Lao” (deficiency fatigue). The Shuyu Wan (Dioscorea Pill) is derived from the “Essentials of the Golden Coffer: Blood Stasis and Deficiency Fatigue Disease, Pulse Diagnosis and Treatment, Chapter Six”. This article introduces the application of Shuyu Wan in treating cancer-related fatigue.
Hu Xishu Classical Medicine
Cancer-related fatigue refers to a painful, persistent, subjective feeling of fatigue or exhaustion related to physical, emotional, or cognitive aspects. This condition can occur at any stage of cancer, with an incidence rate as high as 90% among patients who have undergone surgery, chemotherapy, or radiotherapy.Currently, most TCM scholars believe that the fundamental cause of cancer is “deficiency”. Based on this, phlegm, toxins, and blood stasis can create cancer toxins, which accumulate and deplete Qi and blood. Additionally, treatments such as surgery, radiotherapy, and chemotherapy further deplete Qi and blood, leading to weakness in the body. Therefore, cancer patients are more likely to experience fatigue, which TCM categorizes as “Xu Lao”.Discussion from the “Essentials of the Golden Coffer”In the sixteenth section of “Blood Stasis and Deficiency Fatigue Disease, Pulse Diagnosis and Treatment, Chapter Six”: For deficiency fatigue and insufficiency, with wind and Qi causing various diseases, Shuyu Wan is the main treatment.【Shuyu Wan】30g of Dioscorea, 10g each of Angelica, Cinnamon Twig, Rehmannia (dried), Fermented Rice, and Yellow Soybean Roll, 28g of Licorice, 6g each of Chuanxiong, Ophiopogon, Peony, Atractylodes, and Apricot Kernel, 7g of Ginseng, 5g each of Bupleurum, Platycodon, and Poria, 7g of Ejiao, 3g of Dried Ginger, 2g of White Peony, 6g of Siler, and 100 pieces of Jujube (for syrup). Grind these twenty-one ingredients into a powder, mix with honey to form pills the size of a marble, and take one pill on an empty stomach with wine. A total of one hundred pills constitutes one dose.Formula Explanation:This formula emphasizes Dioscorea as the monarch herb, which tonifies the spleen and stomach, balancing Yin and Yang. The “Shennong Bencao Jing” records that Dioscorea “treats injuries, replenishes deficiency, eliminates cold and heat evil Qi, tonifies the center, boosts Qi strength, and promotes muscle growth. Long-term use enhances hearing and vision and lightens the body.” Dried Ginger, Ginseng, Atractylodes, and Licorice are used to regulate the middle, supplemented by Jujube to strengthen the spleen and stomach while warming the center. The Four Substances Decoction is enhanced with Ophiopogon and Ejiao to nourish Yin and replenish blood, which also assists Dioscorea in regulating Qi and blood. In addition to supporting the body’s defenses, Cinnamon Twig, Siler, and Bupleurum are added to dispel evils and relieve the exterior. Poria, Fermented Rice, and Yellow Soybean Roll strengthen the spleen, transform dampness, and eliminate stagnation; while Apricot Kernel, White Peony, and Platycodon help to smooth Qi flow and relieve depression.Explanation by Mr. Hu Xishu:Deficiency fatigue means the entire body is weak and susceptible to wind evil. A person with deficiency is prone to external pathogens, leading to various diseases. Shuyu Wan is the main treatment. Dioscorea, which is sweet in flavor, combined with the regulating properties of the middle, has the function of strengthening the stomach; Poria promotes urination and eliminates dampness, aligning with the stomach’s preference for dryness and aversion to dampness, which is also a method to strengthen the stomach; the Four Substances Decoction, combined with Ophiopogon and Ejiao, nourishes Yin and replenishes blood, strengthens the stomach, regulates the middle, and treats deficiency fatigue. Cinnamon Twig, Fermented Rice, Yellow Soybean Roll, Apricot Kernel, Bupleurum, Platycodon, Siler, and Siler are used to treat exterior symptoms.Clinical Application of Shuyu Wan in Treating Cancer-Related FatigueCancer patients generally exhibit a chronic consumption constitution, and Western medical treatments can affect immune function, making patients more susceptible to external pathogens due to their weakened constitution. Therefore, Shuyu Wan can be used to nourish the righteous Qi and eliminate evils. Professor Huang Huang believes this formula is a tonic and a deficiency remedy, suitable only for diseases characterized by emaciation, fatigue, and anemia. Such as lung cancer, colorectal cancer, gastric cancer, and other malignant tumors that present with emaciation and poor appetite, or elderly cancer patients who require conservative treatment.Yang Guobin and others found through clinical research that Shuyu Wan is effective in treating cancer-related fatigue (the total effective rate of the Shuyu Wan group was 79.07%, while the chemotherapy group was 44.19%), and it has good safety, making it worthy of promotion. Xu Hong demonstrated through clinical research that Shuyu Wan can significantly alleviate fatigue in patients with colorectal cancer across four dimensions: behavior, emotion, perception, and cognition, improving physical condition, sleep quality, and quality of life. In animal experiments, this formula can increase the expression levels of CD4+ and CD4+/CD8+ cells in cancer mice after chemotherapy, while reducing the expression of CD4+, CD25+, Foxp3+, and Treg cells, thereby improving immune function after chemotherapy.Professor Huang Huang’s Case StudyWang, male, 60 years old. Date of consultation: 2012-7-16.Main complaint: Diagnosed with lung cancer for over 6 months. Medical history: The patient was diagnosed with lung cancer 6 months ago due to worsening cough and sputum. He has undergone chemotherapy four times, and the tumor has shrunk to about 1cm. However, due to significant side effects, he could not tolerate further chemotherapy, and tumor markers remain elevated. Current condition: The patient is thin, with a dark complexion, cough with little white sticky sputum, mild eyelid edema, aversion to wind, chills, occasional low fever, fatigue, lack of taste, poor appetite, and loose stools. The tongue is pale with a thin coating, and the pulse is floating, thin, and weak. The proposed treatment is Shuyu Wan with modifications:10g of fresh ginseng, 10g of Atractylodes, 10g of Poria, 5g of fresh Licorice, 10g of Angelica, 10g of Chuanxiong, 10g of White Peony, 15g of Rehmannia, 10g of Ophiopogon, 10g of Asparagus, 10g of Cinnamon, 10g of Ejiao, 15g of Bupleurum, 15g of Siler, 10g of Apricot Kernel, 5g of Platycodon, 15g of Fermented Rice, 10g of Yellow Soybean Roll, 10g of Dried Ginger, 30g of Dioscorea, 10g of Jujube, and 10g of Cornelian Cherry.Second consultation: After taking 15 doses of the medicine, the patient’s spirit improved significantly, cough decreased, aversion to wind and chills diminished, appetite improved, frequency of low fever decreased, bowel movements improved, and mild eyelid and foot edema were noted. The tongue remained pale with a thin coating, and the pulse was thin and weak. Continue with Shuyu Wan with modifications:10g of fresh ginseng, 10g of Atractylodes, 10g of Poria, 5g of fresh Licorice, 10g of Angelica, 10g of Chuanxiong, 10g of White Peony, 15g of Rehmannia, 10g of Ophiopogon, 10g of Ejiao, 15g of Bupleurum, 15g of Siler, 10g of Apricot Kernel, 5g of Platycodon, 15g of Fermented Rice, 10g of Yellow Soybean Roll, 10g of Dried Ginger, 30g of Dioscorea, 30g of Jujube, 10g of Cornelian Cherry, 20g of Astragalus, 15g of Alisma, 15g of Polyporus, 10g of Alpinia, 10g of Chenpi.Results: After 3 months of treatment, all symptoms improved. The patient was advised to continue taking this formula and to consume goji berry and Dioscorea porridge daily.(This case is excerpted from: Miao Tingting. Huang Huang’s Clinical Experience in Treating Lung Cancer After Chemotherapy with Shuyu Wan [J]. Journal of Nanjing University of Traditional Chinese Medicine, 2016, 32(2):198-200.)
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References:
[1] Feng Shilun. Hu Xishu on the Treatise on Cold Damage and Miscellaneous Diseases [M]. People’s Military Medical Publishing House, 2007.
[2] Zhang Chi, Guo Wei, Xia Jiangnan, et al. Examples of Treating Cancer-Related Fatigue with Formulas from the “Essentials of the Golden Coffer” [J]. Journal of Traditional Chinese Medicine Oncology, 2020, 2(05):6-10.
[3] Miao Tingting. Huang Huang’s Clinical Experience in Treating Lung Cancer After Chemotherapy with Shuyu Wan [J]. Journal of Nanjing University of Traditional Chinese Medicine, 2016, 32(2):198-200.
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