Retrospective Study for a Triple Negative Breast Cancer Case

Ruan Jin Zhao

Abstract

Publishing a cancer case study presents considerable challenges. The extended duration of treatment makes it difficult to consolidate all relevant records within a single paper. However, it is essential to highlight that each treatment session may significantly influence energy regulation and contribute to balancing organ function.   Enhancing quality is achieved through the incremental improvements made with each treatment. This approach ultimately contributes to improved patient survival rates and quality of life.

Retrospective analysis of case studies helps validate medical theories and refine clinical methods, especially when patients achieve positive outcomes after long-term care with comprehensive records containing valuable health information such as lifestyle and diet. Assessment includes the patient’s emotional status, medication regimen, use of herbal remedies, and relevant acupuncture points and manipulation techniques. The patient has been diagnosed with life-threatening breast cancer. At first, she declined integrated therapy which combines modern oncology and traditional Chinese medicine. After several discussions, the patient’s trust in the doctor’s care and expertise grew, leading her to follow the recommended treatment and ultimately overcome breast cancer. Remarkably, she has remained cancer-free for twenty-five years while continuing acupuncture and herbal medicine.  

Keywords: Triple negative breast cancer, acupuncture, traditional Chinese herbal medicine, Bing De Ling.

General Information:

Mrs. K, born in 1951, was 50 years old at the time. She is a short, well-proportioned woman who presents as pleasant and elegant. She is a mental health counselor. She has no children. She has generally been healthy and has had no complaints about her life. She did not use any medications or supplements. She did not consume alcohol, and had no history of substance abuse. Being very serious-minded, she takes everything to heart. She describes herself as stubborn and is strict with her diet. She is highly conscious of her health and prefers to wear a mask.   

Subjective Complaints and Medical History:

The patient’s initial office visit occurred on March 13, 2001. She came to the clinic after discovering a lump in her left breast that had been present for over one year but less than two years. A mammogram performed in December 1998 revealed no micro-calcifications or abnormalities. The patient expressed concern regarding the possibility of malignancy, which prompted her initial evaluation. She initially hesitated to seek medical attention and declined further examination by a physician, hoping that dietary changes and the use of herbal and nutritional supplements would resolve the issue. After more than six months, her anxiety increased significantly as she noticed the lump in her left breast continued to enlarge. Ultimately, she chose to address the situation and began exploring natural healing therapies.

Family Medical History:

The patient’s parents both passed away from cardiovascular diseases at over eighty years old. She has an older sister who is alive and healthy, and there is no family history of cancer.

Physical Examination:

Blood pressure was 140/90 mmHg; the patient exhibits no fever. Blood oxygen saturation is 98%, pulse rate is 78 beats per minute, and respiration rate is 20 breaths per minute. The patient’s complexion was grey and lacked luster. She reports feeling fatigued and notes inadequate sleep last night due to her visit to the physician. No masses or cysts are observed on the scalp. There are no enlarged lymph nodes above or below the clavicle or in the neck region. The thyroid shows no nodules or goiter in either lobe.

The patient’s heart sounds weak but regular, without murmurs. Pulmonary examination reveals clear lungs, with no bronchial or abnormal breath sounds, and no evidence of pleurisy or pleural effusion. The abdomen is soft with no palpable masses or areas of tenderness. No enlarged lymph nodes are noted.

The lump was in her left breast in the upper quadrant around the 1–3 o’clock position. The lump size was about 7.5 x 8 cm. It was very hard and immobile; its edge was not smooth.  Her nipple was sunken, and the aureole had an orange-peel texture. There was an enlarged lymph node of about 2 cm in diameter in her left armpit.

The tip of her tongue was red, while the underside was purple with congested veins. Her tongue coating is white, thin, and sticky. The cun pulse was thin and wiry, her heart pulse was deep and weak, and the Fu Yang (instep) pulse was palpable.

The patient presented her previous year’s annual blood test report. Complete blood count and blood chemistry results were within normal limits, with the exception of mildly elevated total cholesterol and LDL levels.

Assessment and Therapeutic Strategy:

At first, the patient declined to undergo further mammogram examinations, believing that radiation could lead to cancer development. She also refused a biopsy out of concern that it might cause cancer to spread. For similar reasons, she is unlikely to agree to surgery, radiation therapy, or chemotherapy. Currently, a cancer diagnosis relies on pathology results; without pathology confirmation, an official cancer diagnosis cannot be made. The oncologist will not proceed with treatment. Given her current condition, relying solely on traditional Chinese medicine is uncertain and does not align with clinical oncology guidelines. The recommended approach is to combine Western and traditional Chinese medicine. There is no need to worry about cancer spreading from the biopsy. An enlarged lymph node in the left armpit indicates likely metastasis if cancer is confirmed.    

The patient was advised to use both Western and traditional Chinese medicine. A biopsy for pathology is essential before beginning targeted clinical care. She was also informed that, at her young age, there was a strong possibility of a full recovery, and a less possibility of spending her entire life battling this cancer, that she could enjoy life after treatment. Her insistence on only using acupuncture and herbal medicine put me in a difficult position, as others may criticize me. I asked her to take time to consider her options and told her I could provide acupuncture and herbal medicine treatments while she decided. Based on the provided clinical findings, the default diagnosis is breast cancer. The patient has agreed to receive acupuncture and herbal medicine and will consider further steps.

Her pulse was thin and wiry, with her heart pulse being very weak. The tip of her tongue appeared red, while the tongue body was dark with purple spots underneath. The tongue coating was thin and white.

Reviewing the history shows the patient experiences significant mental /emotional tension and has endured a repressive environment for an extended period. Her heart Qi is notably weak, and her liver energy is stagnant; coldness further blocks the flow of energy, causing phlegm to accumulate and, ultimately, tumor development. The main issue originates from heart Qi deficiency, with liver Qi stagnation, with the accumulation of phlegm, and blood stasis as a result. The appropriate treatment should address the underlying cause and resolve its effects. Following the principles of Shen Xiang Therapy is recommended as the most effective approach[1].

1). The acupuncture treatment plan is developed according to the Principle of Shen Xiang therapy. Selected acupoints include Du.20 and Si Shen Cong, aimed at opening the orifices and awakening the Shen (mind), thereby supporting heart energy and promoting mental calmness. Ren.12, Ren.6, and St.36 are utilized to strengthen spleen and stomach function. Four A Shi points surrounding the lump in the left breast, along with addition to Liv.14 and Liv.2 for regulation of liver energy, and Kid.2 to enhance kidney activity.

Needling Technique: This method involves gentle manipulation to position the needle appropriately. Its objective is to stimulate mental awareness, open the sensory orifices, cultivate the heart Qi, and promote mental calmness, while simultaneously facilitating the unblocking of Qi flow across all channels. This method allows the heart to regulate both the Ying and Wei Qi and helps restore immune function. The four needles surrounding the lump are placed with their tips positioned at the dermal layer of the skin where dermal dendritic (immune) cells are found. The needle tips are kept at this tissue depth and gently vibrated at 8 Hz for 12 seconds, ensuring adequate stimulation.  

2). Herbal medicine: The patient reported chemical sensitivity and requested a lower dosage. Bing De Ling[2,3] liquid is prescribed, one ounce twice daily, to balance the Ying and Wei Qi, with focus on activating Wei Qi.

Su Xiao Jiu Xin Wan[4]: Place three pills under your tongue twice a day. This aromatic remedy is used to promote alertness, soothe the mind, strengthen willpower, and help the heart regulate Ying Qi and Wei Qi. Additionally, it may aid in preventing blood clots. The formula is a patent combination of Bing Pian and Chuan Xiong.

Take two San Sheng Wan[5] capsules twice daily to help transform phlegm and relieve stagnation. This process clears segregation and improves molecular communication in the extracellular matrix, markedly altering the tumor micro-environment.

Pearl Probiotics should be taken as one capsule per dose, twice daily, to support the balance of gut bacteria. According to Traditional Chinese Medicine (TCM) principles, this approach is considered effective for maintaining gastrointestinal health and energy.

March 16, 2001: Second visit. The patient was relaxed and calm. She slept well for three hours after the last acupuncture session and reported her best sleep in years. She tolerated the her cuues tos Dher best sleep .Dues. technique were used. The patient felt encouraged.

At her third appointment on March 20, 2001, the patient exhibited a cheerful demeanor, displayed no signs of anxiety, and noted decreased tenderness in her left breast. The lump present in her left breast had become slightly smaller. She was receptive to my recommendations and demonstrated a cooperative attitude. Her behavior and responses were clearly different compared to previous visits.  

I recommended that she continue with acupuncture and herbal medicine treatments twice weekly. Concurrently, we assisted her in arranging consultations with an oncologist and oncology surgeon for biopsy pathology and expedited surgical intervention. She consented to this plan but explicitly stated her refusal to undergo a mastectomy, affirming that her breast represents her pride and identity. I respected her perspective and assured her that I would discuss her wishes with the surgical team.

Secondly, she declined both radiation therapy and chemotherapy. I clarified to her that radiation and chemotherapy are not required if breast cancer is in situ, at stage zero, and the tumor measures less than 5mm. However, since her tumor is quite large, she should undergo radiation therapy after the lumpectomy. I informed her that I have seen cancer occur along incisions in six breast cancer patients who did not receive radiation after lumpectomy. Radiation is necessary. She is hesitant to undergo post-surgical radiation. Regarding chemotherapy, we will follow the oncologist’s recommendation after the pathological results. I assured her I would help manage chemotherapy side effects and discuss minimizing treatment with her oncologist if chemotherapy is needed.

Today, being a doctor requires strong communication skills and the ability to negotiate with patients. Since many patients do research and gather information online, doctors no longer hold unquestioned authority in front of their patients. Compared to the past, patients are less likely to accept treatment plans without hesitation.     

Diagnosis Established and Integrated Therapy:

On April 10, 2001, the patient underwent a biopsy, which revealed poorly differentiated invasive ductal carcinoma. Testing showed that the tumor was negative for estrogen receptor, progesterone receptor, and Her-2—making it triple negative. A single enlarged lymph node in the left armpit tested positive for metastatic cancer. The cancer is classified as stage III, high grade, and carries a poor prognosis. Due to the large size of the tumor, the surgeon recommended a radical mastectomy along with removal of the affected lymph nodes. The patient declined the proposed intervention. On April 13, 2001, the patient presented to my clinic for acupuncture treatment. I explained to her that surgery remains the most effective approach and would prevent the need to continuously address the tumor throughout her life, allowing her to focus on other important matters. Another option is to begin with a course of neoadjuvant chemotherapy to shrink the tumor, then proceed with a lumpectomy. The number of chemotherapy sessions will be determined by your response to treatment. After two rounds of discussion, she ultimately agreed to receive chemotherapy from an oncologist. Acupuncture and herbal medicine will continue to be administered twice weekly during the chemotherapy period.

The patient made it clear that she did not want to have much chemotherapy. As a result, she refused to have a vein port surgically inserted—a procedure usually done to make chemotherapy easier and to prevent harm to arm veins.  

On April 20, 2001, the patient underwent her initial chemotherapy session. She reported no discomfort and experienced no gastrointestinal symptoms; both bowel movements and urination remained within normal limits. Consequently, a second chemotherapy was administered two weeks later without incident. Notably, the patient’s tolerance to chemotherapy was remarkable. The tumor size was reduced significantly to 2 cm in diameter following two sessions of chemotherapy. After four sessions, the tumor further decreased to less than 1 cm. Approximately eight weeks later, on June 15, 2001, the patient underwent a successful lumpectomy at Sarasota Memorial Hospital. Given the small tumor size, no drain line was required. Three lymph nodes were surgically removed, with cancer cells identified in only one node.

Five days after her lumpectomy, the patient resumed twice-weekly acupuncture at my clinic. One-month post-surgery, she began radiation therapy—five sessions per week with weekends off—for a total of 28 sessions. After two weeks, Mei Bao Shi Run Shao Shang Gao6 was used to protect the left breast skin from radiation damage. The patient experienced no side effects or skin lesions during treatment.

Post Surgical care:

Patients experienced excellent recovery following chemotherapy, lumpectomy, and radiation therapy, with no reported side effects. She did not report peripheral neuropathy or lymphatic edema in her left arm. Acupuncture therapy frequency was reduced to once per week. The selection of acupoints was largely unchanged, adhering to the principles of Shen Xiang Therapy. The aim remained to enhance heart energy, calm the mind, and harmonize Ying Qi and Wei Qi, promoting smooth energy flow through the meridians and extracellular matrix. The herbal medicines were also continued without modification.

The patient prefers taking Bing De Ling liquid and believes it is very beneficial to her. Because she has triple negative breast cancer, hormone therapy and anti-HER-2 drugs are unnecessary. To help prevent cancer recurrence, she receives acupuncture treatments every two weeks without interruption. She has maintained this routine for twenty-five years.

In August 2015, the patient experienced stress following a relative’s death and reported bilateral breast tenderness with a mildly elevated CA 15-3. She requested biweekly acupuncture and increased her Bing De Ling dosage. Mammogram, ultrasound, and MRI showed no cancer, and her CA 15-3 normalized after two months; both the patient and I were relieved.

Over a span of 25 years, the patient experienced urinary tract infections on two occasions. Each time, the herbal medicine Wu Lin Qing was prescribed—6 pills per dose, taken twice daily. Acupoint selections were then adjusted to eliminate damp-heat from the lower Jiao using Sp.6, Kid.3, and U.B.60. The patient recovered without the use of antibiotics.

In June 2002, the patient presented with acute right-sided sciatic pain and significant anxiety, primarily concerned about possible metastasis of her cancer to the pelvic bone. It is common for oncology patients to immediately associate any new discomfort with potential cancer recurrence. A CT scan was performed, which revealed no evidence of malignancy; instead, degenerative arthritis in the lower spine was identified, specifically an L4-5 bulging disc compressing the L4 nerve. The subsequent three acupuncture sessions focused on the lower back. The patient was positioned on her left side, and the following acupoints were utilized: U.B.22, Du.4, G.B.30, G.B.34, and U.B.37. Following treatment, the patient experienced complete resolution of her right sciatic pain.   

It is recommended that her diet includes a wide variety of foods, encompassing sources of fiber, carbohydrates, and protein. Beef should be limited to once a week, with chicken and fish serving as the primary sources of protein. She should avoid sugar and dairy products, although plain Greek yogurt is acceptable. Food supplements such as Vitamin B complex, Vitamin D3, calcium, and magnesium are advised. The total number of food supplements should not exceed five to prevent excessive burden on the liver and kidneys.  

She is currently still working full time. Due to the pandemic, she receives treatment online only and wears a mask whenever she goes out. She has never contracted COVID. At 75 years old, she is always the first patient to arrive at my clinic every other Friday morning. She dresses beautifully, often wearing a red velvet hat and low high-heeled shoes, walking with confidence and strength. She believes that acupuncture and Chinese herbal medicine were instrumental in helping her through cancer treatment and have truly helped prevent a relapse. She considers preventive therapy essential.

Discussion and Summary

In contemporary society, it is common to observe polarized views and a lack of neutrality. For example, some individuals do not place trust in traditional Chinese medicine, while others are skeptical of modern medicine and instead place complete confidence in natural healing techniques, rejecting Western medical approaches altogether. Clinically, we encounter numerous patients in this manner. As physicians, we must communicate with patients patiently and guide them toward the most effective treatment pathway, or at least toward the therapy we consider optimal for their care.    

In clinical oncology, particularly in preventing cancer recurrence, with the guidance of Shen Xiang Therapy, it requires that during each treatment session, the doctor assesses the patient’s energy flow and adjusts acupoints and herbal prescriptions accordingly. This process relies on pulse diagnosis, clinical manifestations, and tongue examination to achieve an accurate and definitive diagnosis. The goal is to maintain the patient’s energy and blood flow in a state of homeostasis or promote spontaneous healing. This role requires a high level of expertise and differs significantly from managing simple disorders such as pain, where immediate responses are often observed. Cancer prevention therapy often takes months or years to show results, so each treatment session must be precisely planned and executed to create conditions that inhibit cancer growth.

Even if we do our utmost for the patient, there is still no guarantee that cancer will not recur. It is essential for both the patient and their family members to understand this. While we will make every possible effort, it may not be sufficient, as the underlying disease mechanisms are far more complex than we currently comprehend.  

Acupuncture and Chinese herbal medicine as supportive therapies play an essential role for cancer patients, both during treatment and in the prevention of recurrence, necessitating full patient engagement. Each intervention should aim to offer patients clear support and demonstrate demonstrable progress throughout their care. Furthermore, it demands that practitioners possess extensive expertise and maintain a professional attitude, ensuring each session offers tangible benefits that accumulate over time. Summarizing and publishing the case study is quite challenging because of the lengthy treatment process and the broad scope involved. However, it is essential to systematically analyze and research similar cases, as this would be highly valuable for both clinical and preventive medicine.   

References

1 Ruan Zhao, Shen Xiang Wen Tong神香溫通湯 Therapy: Advancing Towards a Cure for Cancer. New England Journal of Traditional Chinese Medicine, Pp.39-46 Vol. VII, Issue1, Spring 2025 

2 Qing Xu, et al, Chinese Herbal Formula, Bing De Ling病得靈, Enhances Antitumor Effects and Ameliorates Weight Loss Induced by 5-Fluorouracil in the Mouse CT26 Tumor Model. DNA and Cell Biology, Vol.24, No.7, 2005. Pp.470-475

3 Yingtao Zhang, et al, Bing De Ling病得靈, a Chinese herbal formula, inhibits cancer cells’ growth via p53. Frontiers in Bioscience E2, 221-230, January 1, 2010.

4 Su Xiao Jiu Xin Wan速效救心丸 is a patent Chinese herbal medicine, made by Tian Jin Zhong Xin Pharmaceutical Company.

5 San Sheng Wan 三聖丸is a patent Chinese herbal medicine for transforming phlegm, made in AnFaLa, USA.

6 Mei Bao Shi Run Shao Shang Gao 美寶濕潤燒傷膏 is a herbal healing cream for burning wounds.