Narrative review of Wang Yutang’s clinical experience in the treatment of breast cancer with liver depression and spleen deficiency and liver kidney yin deficiency
Review Article

Narrative review of Wang Yutang’s clinical experience in the treatment of breast cancer with liver depression and spleen deficiency and liver kidney yin deficiency

Jin Xu1, Wenshuo Zhao1, Zhong Yang1, Shiyi Liu2

1Department of Oncology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China; 2Wangjing Hospital, Chinese Academy of Traditional Chinese Medicine, Beijing, China

Contributions: (I) Conception and design: J Xu, S Liu; (II) Administrative support: Department of oncology, Beijing Hospital of Traditional Chinese Medicine; (III) Provision of study materials or patients: J Xu; (IV) Collection and assembly of data: All authors; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

Correspondence to: Jin Xu. Department of Oncology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China. Email: xujinflm@sina.com; Shiyi Liu. Wangjing Hospital, Chinese Academy of Traditional Chinese Medicine, Beijing 100010, China. Email: liushiyi928@163.com.

Abstract: According to Wang Yutang, the causes of breast cancer include internal causes: the body is injured by seven emotions, the Qi and blood in the body is maladjusted, and the viscera function is disordered; external causes: the deficiency of meridians is attacked by wind and cold, etc. The occurrence of breast cancer is closely related to liver, spleen and kidney. The main syndrome differentiation is liver depression and spleen deficiency and liver kidney yin deficiency. In the treatment principle, it can soothe the liver, strengthen the spleen, tonify the kidney, regulate and tonify the Chong Ren. The treatment of liver depression and spleen deficiency is to soothe the liver and relieve the depression, strengthen the spleen and nourish the blood, and to add and subtract Danzhi Xiaoyao Powder. Deficiency of liver and kidney yin is treated by nourishing the liver and kidney, regulating and tonifying the Chong Ren, and adding and subtracting Liuwei Dihuang pill. Dr. Wang skillfully used drugs to soothe the liver, relieve depression and resolve phlegm, as well as drugs to soothe the liver and regulate Qi, eliminate carbuncle and gangrene, and paid attention to the symptoms.

Keywords: Wang Yutang; breast cancer; breast cancer with liver depression and spleen deficiency; breast cancer with liver and kidney yin deficiency; experience of traditional Chinese medicine


Received: 15 June 2020; Accepted: 30 July 2020; Published: 30 September 2020.

doi: 10.21037/lcm-20-17


Introduction

Breast cancer is recorded in traditional Chinese medicine (TCM) literature as breast rock, stone carbuncle and so on (1). According to Wang Yutang’s clinical experience of TCM, the main incidence group of breast cancer is middle-aged and old women, and the disease location is mainly breast, which is most closely related to liver, followed by spleen and kidney. The syndrome differentiation is mainly liver depression and spleen deficiency syndrome and liver kidney yin deficiency syndrome (2), and the treatment is based on the methods of soothing the liver, strengthening the spleen, nourishing the liver and kidney, and regulating and nourishing the Chong Ren. Now the clinical experience of breast cancer treatment is introduced as follows.

We present the following article in accordance with the Narrative Review reporting checklist (available at http://dx.doi.org/10.21037/lcm-20-17).


Methods

Etiology and pathogenesis

Etiology

(I) Internal cause: it is mainly due to internal injury of seven emotions, failure of wish, depression and anger, etc., which cause Qi and blood disorder in the body and disorder of viscera function. Zhu Danxi’s Gezhi Yu Lun contains “Worry, anger and depression, accumulation all day long, spleen Qi elimination and obstruction, liver Qi rebellious, and then become a hidden nucleus, such as a big chess piece, no pain and no itch, decades later, the sore pit, known as breast rock, with its sore shape inlaid like a cave, cannot be cured.” According to Yu Tuan’s “Yixue Zhengchuan”, this disease is mainly caused by melancholy and angry middle-aged women. (II) External cause: deficiency of meridians is attacked by wind and cold. According to “Zhubing Yuanhoulun”, it is said that “Someone whose breast meridians are deficient, is attacked by wind and cold, and the blood is astringent.”

Pathogenesis

According to Dr. Wang, women take blood as the most important factor, consume blood after menstruation, gather blood during pregnancy to raise the fetus, and bleed during childbirth, so that women’s Qi is surplus and blood is insufficient. Chong meridian is the blood pool. Ren meridian connects with the uterus and pregnancy. The woman’s Tiangui is exhausted after 7 years. Her liver and kidney are yin deficient. Her blood does not nourish her liver. If her liver is out of support, she will be depressed, worried, angry, frustrated and blocked. Thinking excessively will hurt the spleen, spleen deficiency without the right to transport, and lack of Qi and blood, the liver will be deprived of nourishment. Failure of wish will make the liver Qi be more stagnant. The liver Qi defiantly hurts the spleen. The spleen deficiency cannot transport and digest water and grain. The Qi will be stagnant, phlegm will coagulate, block the meridian, and then the person will have breast cancer (3). According to Dr. Wang, the liver stores blood and dredges. The spleen controls blood and transports, which is both the basis of postnatal and the source of Qi and blood. The kidney stores essence, which is the basis of congenital. The occurrence of breast cancer is most closely related to the liver, followed by the spleen and kidney. The syndrome differentiation is mainly liver depression and spleen deficiency syndrome and liver kidney yin deficiency syndrome.

Syndrome differentiation and treatment

Syndrome of liver depression and spleen deficiency

According to Dr. Wang, this syndrome is mainly seen in early and middle stage of breast cancer, postoperative period, radiotherapy and chemotherapy period and young and middle-aged breast cancer patients. Main syndromes: breast pain, hypochondriac pain, fatigue, bitter mouth, impatience and irritability, less intake, reddish and dark tongue, white fur, stringy pulse. Treatment: soothing the liver and relieving the depression, strengthening the spleen and nourishing the blood; prescription: adding and subtracting with Danzhi Xiaoyao Powder: Chaihu, Danggui, Fuling, Baishao, Baizhu, Danpi, Zhizi, Xiangfu, Yujin, Shanyao, Huangqi, etc.

Deficiency of liver and kidney yin

Dr. Wang thinks that this syndrome is more common in the late stage of breast cancer, after endocrine therapy and elderly breast cancer patients. Main syndromes: pain in both flanks, sore back and knees, dizziness and tinnitus, bone steaming and hot flashes, night sweat, dry mouth, bitter mouth, feeling trouble and heat, insomnia, red tongue and little fur, slender and fast pulse. Treatment: nourishing liver and kidney, regulating and tonifying Chong Ren; prescription: adding and subtracting Liuwei Dihuang Pill: Dihuang, Shanyao, Shanyurou, Danpi, Fuling, Zexie, Tusizi, Zhizi, Gouqizi, etc.


Summary

Medication characteristics

(I) Make good use of liver soothing and Qi regulating drugs, such as Xiakucao, Chaihu, Yujin, Xiangfu, Bayuezha, Ezhu, etc. Among them, Xiakucao is good at purging the liver and gall. Chaihu, Yujin, Xiangfu and Bayuezha are good at soothing the liver and relieving the depression. Ezhu is good at removing blood stasis by breaking Qi. (II) Make good use of drugs to eliminate carbuncle and gangrene. For breast cancer patients with ulceration and purulence, Dr. Wang used Tianhuafen, Baiji, Pugongying, Baijiangcao, etc. to clear away heat, detoxify, eliminate carbuncle and discharge pus. Among them, Tianhuafen is good at clearing away heat, promoting fluid production, detumescence and purulent discharge. Pugongying is good at clearing away heat, detoxifying and diuresis. Baiji is good at astringent hemostasis, detumescence and generating muscle. Baijiangcao is good at clearing away heat, detoxifying, detumescence and purulent discharge, removing blood stasis and relieving pain. (III) Make good use of drugs to resolve phlegm and disperse the knot, such as Tubeimu, Gualou, Shancigu and so on. Among them, Tubeimu is good at clearing away heat and phlegm, dispersing and removing toxin. Gualou is good at clearing lung and phlegm, benefiting qi and broadening chest, eliminating phlegm and carbuncle. Shancigu is good at detoxifying, clearing heat and eliminating carbuncle. (IV) Add and reduce with symptoms. Add Huangqi to invigorate the spleen and Qi for those with deficiency of Qi; add Nvzhenzi and Hanliancao to nourish the liver and kidney for those with symptoms such as hot flashes, perspiration, joint pain and upset after endocrine treatment; add Yinyanghuo and Roucongrong to warm the kidney yang and strengthen the muscles and bones; remove heat, cool blood and annoyance for those with Danpi and Zhizi; Fuxiaomai to remove heat from deficiency and stop perspiration; Suanzaoren to nourish the liver and calm the mind for those with insomnia; Longgu and Muli can not only calm the mind, but also soften firm things, disperse the knot and astringent (4).

Examples of medical records

The patient, female, 57 years old, was treated mainly for “more than 3 years after operation of right breast cancer”. In November 2013, the patient underwent right breast tumor puncture pathology: invasive cancer. After two cycles of TCH neoadjuvant chemotherapy, the right breast cancer modified radical operation was performed on January 3, 2014. Postoperative pathology: invasive cancer, stage: pT1N0M0. Immunohistochemistry: Er (90% strong positive), PR (<1% strong positive), HER-2 (+ +), Ki-67 (40%). Fish: amplification of HER2 gene. NPH adjuvant chemotherapy for 6 cycles and sequential radiotherapy were performed. Then oral administration of anastrozole was as endocrine therapy. On April 2017, endometrial thickening and hysteromyoma were found in the reexamination, and total hysterectomy was performed. After that, no recurrence or metastasis was found in the reexamination.

The patient’s symptoms on September 13, 2017 were as follows: feeling of abdominal falling after urination in the morning, fatigue, perspiration, loss of appetite, pain in the left hip, difficulty in falling asleep, easy to wake up at night. The tongue was reddish, the fur was thin and white, and the pulse was stringy. TCM diagnosis: breast cancer. Syndrome differentiation of TCM: liver depression and spleen deficiency, the remaining poison is not clear. Treatment: soothing the liver and strengthening the spleen, clearing away the remaining poison. Prescription: Xiakucao 15 g, Shancigu 10 g, Tubeimu 10 g, Baizhu 15 g, Danpi 10 g, Ezhu 10 g, Pugongying 15 g, Baijiangcao 15 g, Yujin 10 g, Fangfeng 10 g, Huangqi 30 g, Nvzhenzi 15 g, Chaihu 10 g, Fuling 10 g, Taizishen 15 g, Hanliancao 15 g, Longgu 30 g, Muli 30 g, Suanzaoren 30 g, Jiaosanxian 30 g; 14 doses, decoction, one dose a day, morning and evening.

On October 12, 2017, the symptoms were as follows: in the morning, the feeling of abdominal falling was obviously reduced, sleep was improved, sweat was reduced, slight fatigue was found, the left hip was in pain sometimes, the stool was slightly dry, appetite was improved and ate normally. The tongue was reddish and dark, the fur was thin and white, and the pulse was stringy. On the basis of the previous prescription, subtract Fangfeng, add Roucongrong 10 g, and then take 14 doses. The patient persisted in taking medicine for 3 months, all the symptoms were relieved, the general situation was well, and no recurrence or metastasis of the cancer was found in the regular reexamination, which is still in the follow-up.


Acknowledgments

Funding: This work was supported by the Double Hundred Project of Traditional Chinese Medicine Inheritance in Beijing.


Footnote

Provenance and Peer Review: This article was commissioned by the Guest Editors (Bo Li and Lyubima Despotova-Toleva) for the series “Narrative & Evidence-based Medicine for Traditional Medicine: from basic research to clinical practice and trail” published in Longhua Chinese Medicine. The article has undergone external peer review.

Reporting Checklist: The authors have completed the Narrative Review reporting checklist. Available at http://dx.doi.org/10.21037/lcm-20-17

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/lcm-20-17). The series “Narrative & Evidence-based Medicine for Traditional Medicine: from basic research to clinical practice and trail” was commissioned by the editorial office without any funding or sponsorship. The authors have no other conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.


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doi: 10.21037/lcm-20-17
Cite this article as: Xu J, Zhao W, Yang Z, Liu S. Narrative review of Wang Yutang’s clinical experience in the treatment of breast cancer with liver depression and spleen deficiency and liver kidney yin deficiency. Longhua Chin Med 2020;3:9.