Diarrhea and Colon Cancer
A Chinese Medical Case Study
||If you're new to Chinese Herbal Medicine, this case study
will show you the detail and complexity involved in Chinese
Medical diagnosis and prescription.
Male, 63 years old. Single. Library assistant. Initial consultation
26th September 2002.
Excessive bowel movements with bleeding for 2 years.
History and Symptoms
During the last two years the patient had also suffered with
distension, gas and tenesmus. He sometimes felt tired, with pain
and had a temperature. His condition had improved recently and
now he has just a bloating feeling with a little bleeding and
had lost weight in the last two years. His sleep is disturbed
as he has to pass urine every two hours. During these frequent
visits to the toilet he had to wait until he passed urine. He
has no night sweating and generally felt cold whilst his appetite
Physical observations noted that his lips were slightly dry and
red/pink. Further probing of his history found that he had a triple
bypass heart operation in 1989. After being told of his cancerous
condition he stopped smoking. Dietary information noted that he
was a vegan and of Indian origin. His current medication included:
carcinosin IM, acid nitric IM and iscador self medicated with
no chemotherapy. Family history noted that his mother had cancer
of the uterus.
Tongue Inspection and Pulses
The tongue was dark pink with lateral ecchymoses patches and
a thin white coating. The pulse was thin and deep.
Carcinoma of the colon for two years.
TCM Diagnosis and syndrome differentiation
Kidney Yang and Spleen Qi deficiency with Blood stasis and damp
Principle of Treatment
Tonify Kidney Yang and Spleen Qi, clear the damp toxic accumulation
and the blood stasis.
Xue Fu Zhu Yu Wan
Jin Gui Shen Qi Wan
Bu Zhong Yi Qi Wan
Eight pills from each formula to be taken three times a day after
meals with water.
Qi Gong to help energy levels.
Course of Treatment
2nd consultation: 3rd October 2002. The lateral ecchymoses
patches on the tongue have decreased, indicating that there is
less Blood stasis. He woke up at 6.30am this morning and had 5
bowel movements before the appointment. The Qi Gong exercises
have developed the increase feeling of Qi felt in his Dan Tian.
The prescription administered is Xue Fu Zhu Yu Wan, Bu Zhong Yi
Qi Wan, whilst Jian Pi Wan replaces Jin Gui Shen Qi Wan.
3rd consultation: 10th October 2002. The bleeding stopped
for one day although the bowel movement is still sluggish. His
energy levels are better and there is no longer any abdominal
distension. The three lateral ecchymoses patches in the tongue
are still present. The pulse is still thin and deep. The diarrhoea
has reduced to four times a day. The prescription administered
is the same as the previous week; Xue Fu Zhu Yu Wan, Bu Zhong
Yi Qi Wan and Jian Pi Wan.
- In Traditional Chinese Medicine (TCM), excessive bowel movements
is categorised as Xie Xie. However, this is a chronic syndrome
of Xie Xie accompanied with Blood stasis that has resulted in
the formation of damp toxic accumulation.
- The Bian Zheng Lun Zhi is further categorised into excess
- The excess aspect of this syndrome is shown in the branch
symptoms of damp heat accumulation and Blood stasis.
- The damp heat accumulation caused by the deficiency of Qi
may well be causing the majority of the bleeding and is indicated
by the patient's tenesmus and discharge of purulent and bloody
- The Blood stasis is caused by a deficiency of Qi and may have
lead to the accumulation of damp heat which further aggravated
the damp toxic accumulation.
- The deficient aspect is the deficiency of Kidney Yang noted
with the diarrhoea before dawn seen on 3rd October, abdominal
pain and the feeling of coldness.
- The other deficient organ is the Spleen as seen with the lose
of weight, tiredness and bleeding (Bo 2000).
- The treatment strategy employed is to treat the same disease
with different methods (Bo 2000).
- Firstly, warm and tonify the Kidney Yang to strengthen the
source Yang, warm the body and the middle Jiao.
- Also invigorate the Spleen, the source of Qi and Blood to
stop diarrhoea, the feeling of tiredness and strengthen the
Zheng Qi in its ability to fight the evil Qi.
- Lastly, spread the Liver Qi to remove the toxic accumulation
and dispel Blood stasis.
The development of cancer in TCM is due to an obstruction of
turbid dampness, a stagnation of toxic heat or a stagnation of
Qi and Blood all of which can be seen in this case and are all
determined by the strength of Zheng Qi (Lan 1998). Most of these
syndromes can be caused by a deficiency of Spleen Qi and its symptoms
are commonly seen in cancer patients (Lan 1998).
The basic pathogenesis of carcinoma of the colon however, is
rooted by a deficiency syndrome characterised by an insufficient
amount of vital essence (Jing) held in the Kidney (Zhufan and
Jiazhen 1993). The relationship between the Kidney and Spleen
lies in pre-heaven and post-heaven Qi. Kidney essence (pre-heaven
Qi) will be greatly depleted if there is a deficient Spleen as
the demands of the Zangfu cannot be meet by the Spleen's production
of Qi and Blood (post-heaven Qi) The fact that the patient is
63 years ago also indicates a deficiency of Kidney Yang which
is commonly seen in the elderly.
Jin Gui Shen Qi Wan is used to warm and tonify the Kidney
Qi or source Yang. A deficiency of Kidney Qi will cause the failure
of the regulation of water in the lower Jiao, thereby affecting
the Bladder's ability to restrain the water which will manifest
as incontinence as seen in this patient.
Bu Zhong Yi Qi Wan is used to tonify the middle Jiao,
the Spleen, and raise the sunken Yang Qi (Bensky and Barolet 1990).
By tonifying the Spleen, it can then regulate water metabolism
and reduce the quantity of loose stool movements whilst also commanding
the Blood to stop the bleeding. The bleeding however can be a
combination of damp toxin accumulation causing the Blood to boil
out of the vessels along with the failure of Spleen Qi to command
Blood (Pi Tong Xue). As the strength of the Spleen improves, the
production of Qi and Blood will increase and the Zheng Qi will
have the power to fight the evil Qi. This struggle between the
Zheng Qi and the evil Qi upsets the dynamic equilibrium of Yin
and Yang, damages the normal physiological functions of the Zangfu
and other tissues, affects the normal ascending and descending
Qi and causes a derangement of Qi and Blood and may explain the
mechanisms of the five bowels movements seen in the morning of
Huang Qi is an important herb used in the fight against
cancer. It raises the Yang and strengthens the Qi. Huang Qi in
combination with Sheng Ma and Chai Hu, all of which are used to
make up the formula Bu Zhong Yi Qi Wan, will give good results.
Huang Qi tonifies Qi and contains the leakage of Blood; it strengthens
the Wei Qi and so consolidates the exterior. Modern research shows
that the use of Huang Qi regulates the readings of cAMP and cGMP
of the liver and blood plasma, and so strengthens the phagocytosis
of the reticuloendothelial system. It can also inhibit the growth
of tumours and sometimes reduce cancer cells (Lan 1998).
Xue Fu Zhu Yu Wan is used to invigorate the Blood, spread
the Liver Qi to dispel Blood stasis, remove damp toxic accumulation
and unblock the channels as the bleeding may be caused by the
blockage of dead Blood in the meridians. The damp toxic accumulation
can also block the Qi movement thereby causing the Blood stasis
as the evil stagnates in the intestines and may well be aggravated
by the patient's spicy Indian diet. This may also explain the
excessive five bowel movements seen on the morning of the 3rd
October as the herbs to remove the Blood stasis are Qi regulating
and therefore an increase in the movement of Qi will lead to an
increase in bowel movements.
Jian Pi Wan is used to strengthen the Spleen whilst reducing
food stagnation and stop diarrhoea. This replaced Jin Gui Shen
Qi Wan in the second consultation as the patient's five bowel
movements of 3rd October needed to be resolved quickly to stop
the lose of fluid and blood, both of which are Yin and their depletion
will aggravate the damp toxic accumulation.
However, Bo (2000) states that a deficiency of Kidney Yang accompanied
with a deficiency of Spleen Yang could be much better treated
using Si Shen Wan, Li Zhong Wan and Tao Hua Tang. I disagree.
In this case the addition of damp toxic accumulation along with
the benefit of the western medical diagnosis of cancer, allows
the physician to modify their treatment strategy accordingly to
one which treats the syndrome differentiation but also attacks
the cancer. Therefore, warming the source Yang, uplifting the
middle Jiao Yang Qi to greatly strengthen Zheng Qi are the best
ways to promote strength to fight the cancer whilst regulating
Qi is the best way of dispelling damp toxic accumulation and Blood
stasis without injuring Yin and Zheng of which are too important
in this critical case.
The long history of this condition accompanied with the lost
of Blood, fluid and weight over the two years along with the age
of the patient in relation to the depletion of Kidney essence
make for a poor prognosis. The emphasis is to reduce the branch
(Biao) symptoms as the root (Ben) cause of a deficiency of Kidney
essence is means a poor prognosis.
Bensky, D. & Barolet, R. (1990). Formulas & Strategies.
Seattle: Eastland Press, Inc.
Bo, P. (2000). Traditional Chinese Internal Medicine. Beijing:
People's Medical Publishing House.
Lan, J. 'The Use of Huang-Qi in the Treatment of Cancer', The
Journal of Chinese Medicine, 28, 9, p1.
Zhufan, X. & Jiazhen, L. (1993). Traditional Chinese Internal
Medicine. Beijing: Foreign Languages Press.