4. TCM Syndrome Differentiation and Formulas

4. TCM Syndrome Differentiation and Formulas

5. Spleen-Lung Qi Deficiency Symptoms: Poor appetite, fatigue, shortness of breath, cough with phlegm, spontaneous sweating, aversion to cold, pulse is deep and fine, cun and chi pulses are weak, tongue is plump, pale, and has tooth marks. Recommended formulas: Jianpi Bufei, Peitu Shengjin. Formulas: Shengmai San, Erchen Tang, Xingsu San with added ingredients. Formulas: Perilla leaf 10g, apricot kernel 10g, pinellia 6g, tangerine peel 6g, poria 12g, licorice 6g, citrus aurantium 10g, platycodon 10g, codonopsis 10g, ophiopogon 10g, schisandra 3g, atractylodes 10g, poria 12g. Decoct in water and take one dose daily.

6. Lung-Kidney Yin Deficiency Symptoms: Chest tightness, shortness of breath, cough with phlegm, sticky and difficult-to-expectorate phlegm, blood in the phlegm, bone-steaming heat, five-center vexation, night sweats, dizziness, lower back pain, tinnitus, leg fatigue, pulse is thin and rapid, chi pulse is weak, tongue is red and has little coating, with stasis spots. Recommended formulas: Sha Shen Mai Men Dong Tang, Wu Yu He Ji, Kang Ai Wu Wei Xiao Du Yin with added ingredients. Northern ginseng 15g, ophiopogon 10g, polygonatum 6g, dendrobium 6g, houttuynia 15g, sea cucumber 20g, panax notoginseng 3g (to be taken in two doses), raw ochre 20g (to be decocted first), zhimu 10g, zhebei mu 10g, schisandra 3g, baihua she shi cao 15g, ban zhi lian 15g, hu zhang 15g, zao xiu 15g, xia ku cao 15g. Decoct in water and take one dose daily.

7. Heat Invading the Lungs Symptoms: High fever, thirst, chest pain and tightness, cough with shortness of breath, blood in the phlegm, massive hemoptysis may occur, tongue is red and coating is yellow and greasy, pulse is string-like, slippery, and rapid. Recommended formulas: Ma Xing Shi Gan Tang, San Huang Xie Xin Tang, Liang Ge San, Xie Bai San, Zun Da Zao Xie Fei Tang with added ingredients. Medicinal ingredients: ephedra 10g, apricot kernel 10g, raw gypsum 30g (to be decocted first), licorice 6g, rhubarb 10g, scutellaria 10g, coptis 3g, mulberry bark 10g, wolfberry bark 10g, zi 10g, forsythia 15g, mint 6g, gardenia 10g, magnesia nitrate 10g (to be taken orally). Decoct in water and take one dose daily.

8. Long-term Disease Entering the Meridians Symptoms: Emaciation, dark complexion, chest pain and coughing, blood in the phlegm, lumps under the ribs, nodules in the neck. Pulse is deep and rapid, tongue is red and has little coating, with stasis spots. Recommended formulas: Lanzhou Fang, Fuyuan Huo Xue Tang, Xiang Sha Liu Jun Tang with added ingredients. Medicinal ingredients: prince ginseng 15g, northern ginseng 15g, ginseng roots 15g, codonopsis 15g, ophiopogon 10g, schisandra 3g, cinnamon 10g, white peony 15g, bupleurum 12g, angelica 10g, peach kernel 10g, safflower 6g, pangolin 3g, atractylodes 10g, poria 12g, licorice 6g, pinellia 6g, tangerine peel 6g, agarwood 3g, grass bean 3g, rehmannia 12g, cornelian cherry 6g, Chinese yam 10g, danpi 6g. Decoct in water and take one dose daily. The above four syndrome types summarize the clinical manifestations of lung cancer at different stages of development. The provided formulas are only suitable for symptomatic treatment at each stage. Type 1 mostly corresponds to the early stage of lung cancer, type 2 has reached the middle and late stages, accompanied by metastasis to multiple organs and autonomic nervous system dysfunction, type 3 involves concurrent infection and tumor infiltration, and type 4 represents widespread tumor metastasis. Traditional Chinese medicine plays a significant role in the treatment of lung cancer, especially when combined with radiotherapy, chemotherapy, and interventional therapy. Using TCM formulas to support righteous qi and strengthen the foundation can not only reduce the toxic side effects of radiotherapy, chemotherapy, and interventional therapy, but also enhance their therapeutic effects. In this regard, formulas such as Xiang Sha Liu Jun Tang, Gui Pi Tang, Bu Zhong Yi Qi Tang, and Xiao Chai Hu Tang can be used. As can be seen, Wu Yu He Ji, Kang Ai Wu Wei Xiao Du Yin, Ma Xing Gan Shi Tang, Liang Ge San, Xie Bai San, and Zun Da Zao Xie Fei Tang are all commonly used formulas by Professor Pei Zhengxue under syndrome differentiation and treatment. Among them, Wu Yu He Ji consists of black plum, houttuynia, panax notoginseng, raw ochre, zhimu, zhebei mu, codonopsis, ophiopogon, and schisandra. In addition, Da Qing Long Tang and Xiao Qing Long Tang are used for patients with wheezing, Xing Su San for those with phlegm, Wu Tan Zhi Sou San for those without phlegm, Gua Bai Bai Jiu Tang, Gua Bai Ban Xia Tang, Shi Bai Gui Zhi Tang, Fu Ling Apricot Kernel Licorice Tang, Zheng Fu Zi Tang, Wu Tou Chi Shi Zhi Wan, Ling Gui Shu Gan Tang, and Wu Ling San can also be used based on syndrome differentiation. Traditional Chinese medicine holds that cancer can only occur and develop when there is an imbalance of yin and yang in the body and a deficiency of righteous qi, as expressed in the saying, “If righteous qi is present within, evil cannot invade.” On the other hand, surgical trauma and chemotherapy indiscriminately kill both normal cells and tumor cells, further weakening righteous qi and creating a vicious cycle. In such cases, it is very important to use TCM to support righteous qi and strengthen the foundation. Professor Pei Zhengxue has therefore formulated the “Lanzhou Fang.” This formula takes prince ginseng, codonopsis, northern ginseng, ginseng roots, rehmannia, Chinese yam, and cornelian cherry as the main medicinal ingredients. Among them, prince ginseng, codonopsis, northern ginseng, and ginseng roots focus on strengthening the spleen; rehmannia, Chinese yam, and cornelian cherry focus on nourishing the kidneys, with cornelian cherry used in larger quantities, typically 15–30g. In the early 1970s, Professor Pei Zhengxue completely cured a patient with acute monocytic leukemia (M5) using this formula. In 1973, at the National Hematology Conference held in Suzhou, this formula was officially named “Lanzhou Fang.” Over the past 40-plus years, Professor Pei Zhengxue has expanded the application of this formula to all cancers in clinical practice and further improved it, achieving remarkable results in reducing the toxic side effects of radiotherapy, chemotherapy, and interventional therapy, extending the survival time of cancer patients, and improving their quality of life.

9. Analysis of Professor Pei Zhengxue’s Lung Cancer Formulas Basic formula: Ma Xing Shi Gan Tang: Ephedra 10g, apricot kernel 10g, gypsum 30g (to be decocted first), licorice 6g. Originating from “Shanghan Lun,” ephedra opens and disperses lung qi to relieve asthma and clears the exterior to dispel pathogenic factors; gypsum is pungent and cool, relieving muscle tension and clearing lung heat to generate fluids. One medicine is warm and pungent, the other is cool and pungent; one opens the lungs, the other clears them, and their combination embodies mutual complementarity. Four medicines are used together, combining exterior-clearing and lung-clearing, with lung-clearing as the main focus; opening the lungs and descending qi are combined, with opening as the main focus. Zhi Sou San: Platycodon 30g, jingjing 10g, zibei 10g, baibu 10g, baiqian 10g, licorice 10g, tangerine peel 10g. Originating from “Yixue Xinwu.” Functions: opening the lungs to disperse wind, stopping cough and resolving phlegm. Platycodon is slightly bitter and pungent, able to open lung qi, dissipate fire and cold, treat phlegm stagnation and asthma, nasal congestion and sore throat. Jingjing is pungent and warm, fragrant and dispersing, dispelling wind-dampness, clearing head and eyes, benefiting the throat, and effectively treating wind-cold headaches and coughs. Zibei is sweet and pungent, warming the lungs, alleviating deficiency and regulating the center, resolving phlegm and quenching thirst, treating cold-heat stagnation and reverse coughing. Baibu is slightly bitter and sweet, able to moisten the lungs and treat lung heat and choking cough. Baiqian is slightly bitter and sweet, good at resolving phlegm and stopping cough, especially for coughs caused by excessive lung qi. Tangerine peel regulates the center and speeds up digestion, helping to resolve phlegm. Licorice is fried to raise its temperature, replenishing the three jiaos’ original qi while dispelling exterior cold. Xing Su San: Apricot kernel 10g, perilla leaf 10g, pinellia 10g, tangerine peel 6g, qianhu 10g, zhike 10g, platycodon 30g, poria 10g, licorice 10g, ginger 6g, big date 6g. Originating from “Wenbing Tiaobian,” following “Suwen · Zhizhen Yaodalu” which says, “Dryness and excess inside should be treated with bitterness and warmth, supplemented by sweetness and spiciness,” the treatment should be to clear and disperse dryness, regulate qi and resolve phlegm. In this formula, perilla leaf disperses cold and opens lung qi, allowing dryness and cold to dissipate from the outside; apricot kernel is bitter and warm, lowering lung qi and moisturizing dryness to stop coughing; qianhu disperses wind and eliminates pathogenic factors, lowers qi and resolves phlegm; platycodon and zhike alternate between ascending and descending, assisting apricot kernel and perilla leaf in regulating lung qi and resolving phlegm; pinellia and tangerine peel regulate qi and resolve stagnation, dispelling dampness and resolving phlegm; poria strengthens the spleen and drains dampness to eliminate the source of phlegm; ginger and big date harmonize ying and wei to dispel exterior cold, while licorice harmonizes all the herbs, working with platycodon to open the lungs and benefit the throat.

10. Examples of Clinical Cases Treated by Professor Pei Zhengxue Case 1: Male patient, 70 years old, first visit on October 6, 2010. Chief complaint: Cough, phlegm, and blood in the phlegm for more than a month. Past medical history: The patient developed cough, phlegm, and blood in the phlegm about a month ago without any obvious cause, with bright red blood, gradually worsening, accompanied by chest tightness, shortness of breath, poor appetite, fatigue, five-center vexation, night sweats, dizziness, thin and rapid pulse, weak chi pulse, red tongue, swollen tongue with tooth marks, and little coating. Auxiliary examination: On September 10, 2010, a CT scan at Gansu Provincial Tumor Hospital showed a space-occupying lesion in the middle and lower lobe of the left lung; bronchoscopy biopsy pathology revealed squamous cell carcinoma. [Western medical diagnosis] Bronchial lung cancer. [Chinese medical diagnosis] Lung accumulation. TCM syndrome differentiation: Deficiency of lung, spleen, and kidney qi and yin. [Treatment principle] Cultivate earth to generate gold, nourish yin and reduce fire, resolve phlegm and stop bleeding. [Prescription] Xing Su San, Sha Shen Mai Men Dong Tang, Wu Yu He Ji. Northern ginseng 15g, ophiopogon 10g, polygonatum 6g, dendrobium 6g, perilla leaf 10g, apricot kernel 10g, pinellia 6g, tangerine peel 6g, poria 12g, licorice 6g, citrus aurantium 10g, platycodon 10g, codonopsis 10g, schisandra 3g, atractylodes 10g, poria 12g, licorice 6g, ginger 6g, big date 6g. Decoct in water and take one dose daily. After taking 10 doses, the patient no longer had blood in the phlegm, appetite and fatigue significantly improved, cough and phlegm decreased, five-center vexation, night sweats, and dizziness were greatly alleviated. Now the patient has a fever, red tongue, thin white coating, and weak chi pulse. The prescription was then adjusted to Xing Su San, plus Kang Ai Wu Wei Xiao Du Yin with added ingredients: white flower snake tongue herb 15g, half branch lotus 15g, tiger stick 15g, flea rest 15g, summer withered grass 15g. Perilla leaf 1g, apricot kernel 10g, pinellia 6g, tangerine peel 6g, qianhu 10g, citrus aurantium 10g, platycodon 10g, poria 12g, licorice 6g, decoct in water and take one dose daily. After taking 15 doses, the patient’s symptoms continued to improve. The prescription was then made 10 times stronger, ground into powder, mixed with honey to form pills, taking one pill twice a day, and after 3 months the condition remained stable, with the patient able to take care of himself. Comment: Professor Pei Zhengxue always uses Wu Yu He Ji (black plum, houttuynia, panax notoginseng, raw ochre, zhimu, zhebei mu, codonopsis, ophiopogon, and schisandra) as the main formula when treating lung cancer patients with hemoptysis, making adjustments based on individual cases and achieving remarkable results. Professor Pei Zhengxue says that the main cause of hemoptysis is often yin deficiency and excessive fire, with qi unable to control the blood. Houttuynia and zhimu can supplement yin and reduce fire; Shengmai San can nourish qi, yin, and control the blood; black plum and zhebei mu can guide the meridians, while black plum also has the effect of astringency and hemostasis; raw ochre can reverse and stop bleeding, and panax notoginseng can stop bleeding without leaving stasis. In addition, Liang Ge San can also be used, based on the idea that “the lungs and large intestine are mutually related.” Case 2: Female patient, 78 years old, first visit on March 15, 2011. Chief complaint: Chest pain, coughing, and high fever for a week. Past medical history: According to family members, the patient suddenly developed chest pain, coughing, and high fever a week ago, accompanied by thirst, shortness of breath, coughing up blood, nodules in the neck, red tongue with little coating, stasis spots, yellow and greasy coating, and string-like, slippery, and rapid pulse. Auxiliary examination: On March 11, 2011, a CT scan at Gansu Provincial Traditional Chinese Medicine Hospital showed a space-occupying lesion in the right lung, with two indicators related to lung cancer: neuron-specific enolase (NSE) 50.35ng/ml, and cytokeratin 19 fragment (CYFRA21-1) 33.21ng/ml. [Western medical diagnosis] Right lung cancer. [Chinese medical diagnosis] Lung accumulation. Syndrome: Heat invading the lungs, long-term disease entering the meridians. [Treatment principle] Open the lungs to dissipate fire, stop coughing and bleeding. [Prescription] Ma Xing Shi Gan Tang, Gan Su He Ji, Liang Ge San, Xie Bai San, Zun Da Zao Xie Fei Tang with added ingredients. Ephedra 10g, apricot kernel 10g, raw gypsum 30g, licorice 6g, mulberry bark 10g, wolfberry bark 10g, zi 10g, forsythia 15g, mint 6g, gardenia 10g, magnesia nitrate 10g (to be taken orally), perilla leaf 10g, pinellia 10g, gelatin 10g (to be processed), Wu

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Mei 10g, poppy shell 10g. Decoct in water and take orally, one dose per day. After taking 15 doses, hemoptysis decreased, and other symptoms improved markedly. The original formula was then modified to Liangge San, with added Wu Yu He Ji with additional ingredients. Prescription: Houttuynia cordata 20g, Haipiao 20g (decoct first), Panax notoginseng 3g (dissolve in two portions), raw cinnabar 20g (decoct first), Anemarrhena asphodeloides 10g, Fritillaria thunbergii 10g, Ophiopogon japonicus 10g, Codonopsis pilosula 10g, Schisandra chinensis 3g, Agrimonia pilosa 30g. The dosage was increased tenfold, ground into powder, sieved, and taken orally three times a day, 6g each time, dissolved in warm boiled water. Two months later, the family reported that the cervical lymph node had slightly reduced in size, while other conditions had returned to normal, and the patient was basically able to take care of themselves.

Commentary: Professor Pei Zhengxue believes that for lung cancer with fever, Ma Xing Shi Gan Tang is repeatedly effective. For patients with dry cough or scanty sputum, using Gan Su He Ji (licorice, Perilla frond, Pinellia ternata, donkey-hide gelatin, black plum, and poppy shell) can stop the cough, transform the phlegm, and prevent or treat hemoptysis.