Authors: Ruan Jin Zhao

Abstract

This case describes a patient with advanced prostate cancer and multiple bone metastases who has maintained a good quality of life through an integrative treatment approach centered on acupuncture, traditional Chinese herbal medicine, limited hormone therapy, and localized radiation. Diagnosed at age 68 and now 89, he has lived for more than 20 years without experiencing urethral obstruction, dysuria, urinary incontinence, catheterization, or the adverse effects of chemotherapy. Given his age, underlying conditions, lifestyle, and personal preferences, the treatment strategy combined multiple therapies in a way that respected his wishes and aimed to reduce suffering rather than add to it. The acupuncture and herbal prescriptions followed the principles of Shen Xiang Therapy, intended to strengthen the heart, calm the mind, support defensive qi, and stimulate immune function. Using gentle needling and aromatic herbs to relieve obstruction and resolve phlegm, the treatment was intended to guide the body toward a self-healing state. Although the cancer cells may not have been eliminated from his body, the disease has remained unable to significantly disrupt the patient’s normal physiological function, allowing him to enjoy both longevity and quality of life.

Keywords: Prostate Cancer, Bone Metastasis, Acupuncture, Chinese Herbal Medicine, Shen Xiang Therapy

Patient Present Condition and Brief Introduction:

Today, April 29, 2026, Mr. P and his wife came to my clinic for their final acupuncture session before returning from Florida to Virginia for the summer. They will take enough prescribed herbal medicine for the next five months with them. For the past 22 years, they have followed the same routine: spending seven months in Florida during the cold season and five months in the North during the summer. While in Florida, Mr. P receives acupuncture treatment once every two weeks and continues taking traditional Chinese herbal medicine. His main complaints today are right knee pain, low energy, poor balance, and an unsteady gait. Three weeks ago, he tripped and fell while walking; he believes the fall was related to reduced sensation from peripheral neuropathy.

He reports no back pain, dizziness, headache, or urinary discomfort. His tongue is slightly dark with a thin white coating. His pulse is thin and wiry, with a weak heart pulse and deep pulses at both kidney positions. His blood pressure is 120/70 mmHg, heart rate is 68 beats per minute, oxygen saturation is 98%, and PSA is 2.2. His ankle pitting edema resolved completely after taking Zhen Wu Tang pills. He is able to drive and walks without a cane or walker. This is his current condition 21 years after being diagnosed with late-stage prostate cancer. How has he survived for so long, and what treatments has he received? At a recent follow-up visit to the Veterans Hospital, his physician regarded him as an exceptional case, took a photo with him, and asked for the contact information of his Chinese medicine doctor. This remarkable outcome has been attributed to acupuncture and traditional Chinese herbal medicine.

Mr. P was born on 1936, and first came to my clinic on November 23, 2004. He had recently been diagnosed with advanced prostate cancer with multiple bone metastases. He declined chemotherapy, radiation therapy, and hospice care. His wife was also unwilling to give up on treatment. He hoped to spend the remaining years of his life without the suffering caused by repeated chemotherapy or radiation, and to preserve a clear mind so he could continue to enjoy life. For him, traditional Chinese medicine represented both a final source of hope and the natural therapy in which he had long believed.

Prostate cancer is one of the most common cancers in men. Advances in medical science and technology have significantly improved patients’ quality of life and survival rates. However, many patients still die from the disease because of delayed diagnosis or inappropriate treatment.

Clinical Status at Initial Presentation and Treatment Plan:

Mr. P presented with advanced prostate cancer and multiple bone metastases. His Gleason score was 9, and his PSA level was 17.6. MRI and CT/PET imaging identified metastatic lesions in the left scapula, left pelvic bone, T7, T9, L5, and the left sacral region. His pain was severe enough to disturb sleep, and he arrived at the clinic using a cane with his wife’s assistance.

His urologist referred him directly to an oncologist. Given the advanced stage of his disease, surgery was not an option. The oncologist strongly recommended chemotherapy and brachytherapy, but he declined without hesitation. He generally avoids all Western medications, including over-the-counter drugs such as Tylenol. After discussing the situation with his wife, he decided to pursue natural therapies instead. On the recommendation of a friend, he came to my clinic for acupuncture and herbal medicine treatment.

Main Complaint: Severe pain in the left pelvic bone and lower back, affecting both walking and sleep. He also reported left shoulder pain with limited range of motion, reduced grip strength in the left hand, and numbness on waking. He had nocturia about three times per night. There was no urinary retention, and urine volume and stream were adequate.

Observation and Physical Examination: The patient appeared slightly pale. His skin was very dry, without itching or lesions. There were no signs of malnutrition or ankle edema.

His tongue was slightly dark purple with a thick, sticky coating. His pulse was deep and slow at 50 beats per minute.

His blood pressure was 160/95 mmHg. Cardiac examination revealed no murmur, and breath sounds were normal bilaterally. There was no pleural effusion or pleuritis. The abdomen was soft, with no palpable mass. The liver and spleen were not enlarged. Murphy’s sign was negative, and there was no ascites.

Laboratory testing showed a mildly low hemoglobin level of 11.8 g/dL, with a normal platelet count. Liver function, renal function, and lipid profile were all within normal limits. His serum testosterone level was 2500 ng/dL (normal range, 200–1700 ng/dL).

Current medical history: He had generally been in good health and had no harmful habits. He played tennis three times a week. About two months earlier, he developed pain in the left pelvis and lower back, which he initially thought was a sports injury.

Past medical history: He was a veteran and had been exposed to Agent Orange in Vietnam. He had hypertension for several years but did not take antihypertensive medication, instead using vitamin and herbal supplements. His gastrointestinal function was somewhat weak, and raw or cold foods tended to cause diarrhea. Otherwise, he had no other significant medical history.

Family history: Both of his parents died of heart disease in their 70s. One brother died of heart disease at age 72. He had one son and one daughter. Tragically, his son died of a brain tumor at age 42.

Syndrome Differentiation and Treatment:

From a Traditional Chinese Medicine perspective, this case is characterized by Heart and Kidney Yang deficiency with damp-heat toxin initially accumulating in the lower jiao and later spreading to the upper jiao and other regions.

Basic acupoint selection: DU20, Sishencong, HT7, PC6, REN12, ST36, REN4, REN6, and KI2.

Additional acupoints based on symptoms:

Low back pain: DU3, BL23, GB30, and GB34.

Edema: REN9, SP6, and SP10.

Peripheral neuropathy: SP3, KI3, KI6, GB41, and LR2.

Hemiplegia and limb numbness: LI4, LI11, LI16, GB34, and GB31.

The acupuncture technique used in this case consisted of gentle, shallow needling. In the treatment of cancer, the aim of acupuncture was to stimulate immune activity and enhance the body’s ability to recognize tumor antigens. This stimulation was intended to act on antigen-presenting cells in the superficial layers of the skin and mucosa, areas associated in traditional Chinese medicine with defensive qi, which protects the body from external harm. By targeting these superficial tissues with precise mechanical stimulation, including pressure and vibration, the treatment was intended to promote antigen uptake by these cells and support a more effective immune response.

Note: Antigen-presenting cells are distributed throughout the body, with many located in barrier tissues that interface with the external environment, such as the skin, mucous membranes, and the linings of the respiratory and gastrointestinal tracts, where they help defend against pathogens. After maturation, they migrate to lymph nodes and other secondary lymphoid organs, where they present antigens to T cells and initiate an immune response.

TCM Herbal Medicine:

Bing De Ling was prescribed initially as a liquid at 1 ounce twice daily. After one month, it was changed to capsules, 1 capsule twice daily. This established herbal formula is used to harmonize Ying Qi and Wei Qi and may be understood in modern terms as an immune modulator. It was intended to support natural killer cell activity and promote increased production of gamma interferon.

Hama Oil (frog oil) was prescribed as 2 capsules twice daily. It is extracted from the fallopian of the female tree frog and contains multiple growth factors, unsaturated fatty acids, and estrogen-like compounds. In traditional Chinese medicine, it is regarded as a tonic that helps nourish the Kidney essence and support hormonal balance.

Jie Jie Wan (for the prostate) was prescribed as 3 pills twice daily. Traditionally, it is used to clear damp-heat toxin from the lower jiao and promote urination.

Su Xiao Jiu Xin Wan was prescribed as 3 pills twice daily, taken sublingually. If the patient developed chest pain or shortness of breath, the dose could be increased to 5 pills up to four times daily, or more as needed. This aromatic formula is used to open the orifices, revive the mind, tonify Heart Qi, and promote blood circulation. It is one of the principal remedies in Shen Xiang Therapy.

Zhen Wu Tang Wan was prescribed as 6 pills twice daily. It is intended to treat lower leg and ankle edema associated with Heart Yang deficiency by supporting Yang Qi, promoting fluid metabolism, and reducing swelling.

From a traditional Chinese medicine perspective, cancer is considered to arise in part from deficiency of Heart Qi, particularly when associated with profound emotional injury. In this case, the death of his son was believed to have caused deep psychological and emotional trauma that may have contributed to the development of disease. He was also exposed to Agent Orange during military service, and many Vietnam veterans with similar exposure later developed lymphoma and other cancers. However, it remains uncertain whether Mr. P’s prostate cancer was directly related to Agent Orange exposure.

Because the patient’s left lower back pain was severe and his cancer was highly aggressive, I strongly recommended targeted radiation therapy in addition to acupuncture and herbal medicine to help relieve pain. Since he had not previously received radiation, the risk of excessive cumulative exposure was low. After three sessions of radiation therapy combined with acupuncture and herbal treatment, his lower back pain and shoulder blade pain were brought under good control. As his symptoms improved, both the patient and his wife gained greater confidence in the treatment plan.

Because his serum testosterone level was markedly elevated at 2500 ng/dL (normal range, 270–1070), I recommended that he follow his oncologist’s advice and begin hormone therapy. However, after learning about the potential side effects, he declined Lupron injections instantly. He ultimately agreed to Zoladex, administered as a subcutaneous implant for androgen suppression. He regarded this as the greatest concession he was willing to make to modern oncologic treatment.

After five months of treatment, Mr. P showed marked improvement. His clinical symptoms were largely controlled, his lower back pain had resolved, and his PSA level had declined to 1.2. Bone scan and PET imaging indicated healing of the previously identified bone lesions. Acupuncture frequency was reduced to once weekly. On May 20, 2005, Mr. P and his wife returned to the North. Because his wife was concerned about interrupting treatment, they were advised to continue acupuncture with a local practitioner and to keep the herbal regimen unchanged. The recommended acupuncture frequency was once every two weeks, with the same treatment principles and point selection whenever possible. We also remained in contact by phone and email to coordinate care. Although Mr. P and his wife initially lacked confidence in the new acupuncturist, I assured them that I would communicate with my colleague whenever modifications in point selection were needed. Fortunately, the colleague was highly cooperative. Even when they later needed to change acupuncturists because of relocation, communication remained smooth, and the same therapeutic principles were maintained.

In the second year after treatment began, Mr. P and his wife returned to Florida on October 12, 2005. His overall physical condition was very good. He was pleased to continue acupuncture every two weeks and to remain in the same herbal regimen.

In the third year, on August 10, 2006, Mrs. P called the clinic and also sent an email reporting that Mr. P had developed an acute stroke with right-sided weakness and impaired speech. In the emergency department, he was diagnosed with a thrombotic event in the left side of the brain and was treated promptly with anticoagulant therapy. Mrs. P asked about the best next steps for his recovery. During hospitalization, Mr. P improved substantially, with approximately 70% recovery; he was able to stand independently and walk slowly with a cane. I recommended that he return to Florida as soon as possible for acupuncture and physical therapy, as stroke recovery is often most responsive during the first three months. Missing this window can make full recovery more difficult.

Mrs. P brought her husband back to Florida the following week for acupuncture treatment. He received acupuncture three times per week, and after nine sessions over three weeks, he improved rapidly. Because he had been physically active and remained relatively strong, the combination of acupuncture and physical therapy led to near-complete recovery of his right-sided weakness. He was able to walk without a cane, and his speech returned to normal. Once his condition stabilized, acupuncture frequency was reduced to once weekly and then, two months later, to once every two weeks. Throughout treatment for both stroke recovery and prostate cancer, care remained centered on supporting Heart Qi and calming the Shen, with particular emphasis on Shen men (HT7) and DU20.

Each year, Mr. P and his wife spend about eight months in Florida, during which he receives acupuncture every two weeks without interruption. During the other four months in the North, he continues acupuncture with a local colleague approximately once every three weeks. Through close communication, we have tried to keep the treatment principles, acupoint selection, and needling techniques as consistent as possible.

Unique Features of This Case

In addition to the integrated treatment regimen described above, Mr. P preferred to take a drink consisting of 1 teaspoon of maple syrup and 1 teaspoon of baking soda dissolved in 8 ounces of water after dinner each day. He believed that this drink was beneficial.

The patient’s testosterone level remained elevated despite antiandrogen therapy, which may have been related to his long-term use of yohimbine, a supplement with mild monoamine oxidase–inhibiting and stimulant-like properties that is commonly used to enhance sexual function. He was later advised to discontinue it completely.

Mr. P had a strong aversion to Western medications and was often nonadherent with hormone therapy, frequently delaying replacement of his Zoladex implant beyond the recommended interval. Over the past 20 years, he underwent only six Zoladex implantations. Even at the highest dose, the therapeutic effect typically lasted no more than three months. Therefore, antiandrogen therapy likely made only a limited contribution to the overall control of his prostate cancer.

As he aged, Mr. P developed multiple comorbidities, including joint pain from degenerative arthritis, post-stroke sequelae, hypertension, lower-extremity edema associated with congestive heart failure, mild deep vein thrombosis, and an inguinal hernia. In addition to prostate cancer, these conditions were also managed with acupuncture and herbal medicine, with treatment adjusted as needed.

Discussion and Evaluation:

This case of advanced prostate cancer with multiple bone metastases demonstrates that long-term survival with preserved quality of life is possible under carefully coordinated integrative care. More than 20 years after diagnosis, the patient remains alive and functionally well. The case suggests that acupuncture and traditional Chinese herbal medicine may provide meaningful supportive benefits in the management of severe and chronic cancer-related illness. Successful long-term care in such complex cases requires close collaboration between physician and patient. The clinician must be able to build on the effects of each treatment over time, while the patient’s adherence depends in large part on perceivable clinical benefit.

With the wide range of therapies now available for many diseases, a key responsibility of the acupuncture physician is to help patients make informed treatment choices and to coordinate potentially beneficial approaches in a rational and integrated way. To do this effectively, clinicians must remain familiar with emerging therapies, medications, and remedies, while understanding the strengths and limitations of each. This knowledge helps build professional credibility and, more importantly, fosters patient confidence.

Maintaining adequate hydration and electrolyte balance and preventing urinary tract infections are important in older patients with prostate cancer. Because aging may blunt symptom awareness, urinary tract infections can go unrecognized until they become more severe. Fall prevention is also essential, as falls may lead to fractures or thrombosis, complicate treatment, and worsen prognosis. Trauma may also increase the risk of reactivating dormant cancer cells and promoting renewed tumor growth.

References

1.  Schafer EJ, Laversanne M, Sung H, Soerjomataram I, Briganti A, Dahut W, Bray F, Jemal A. Recent Patterns and Trends in Global Prostate Cancer Incidence and Mortality: An Update. Eur Urol. 2025 Mar;87(3):302-313. doi: 10.1016/j.eururo.2024.11.013. Epub 2024 Dec 11. PMID: 39668103; PMCID: PMC11862828.

2.  Ruan Jin Zhao, Shen Xiang Wen Rong Therapy : Advancing Towards a Cure for Cancer. New England Journal of Traditional Chinese Medicine, Vol.VII, Issue 1 Spring 2025

3.  Kashem SW, Haniffa M, Kaplan DH. Antigen-Presenting Cells in the Skin. Annu Rev Immunol. 2017 Apr 26;35:469-499. doi: 10.1146/annurev-immunol-051116-052215. Epub 2017 Feb 6. PMID: 28226228.

4.  Bhanja A, Rey-Suarez I, Song W, Upadhyaya A. Bidirectional feedback between BCR signaling and actin cytoskeletal dynamics. FEBS J. 2022 Aug;289(15):4430-4446. doi: 10.1111/febs.16074. Epub 2021 Jun 30. PMID: 34124846; PMCID: PMC8669062.

5.  Qing Xu, and Et al. Chinese herbal formula, Bing De Ling, 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

6.  解結丸/Jie Jie Wan，中成藥，廣州聯合製藥 /patent herbal medicine made by Guang Zhou United  pharmaceutics. 

7.  速效救心丸/su xiao jiu xin wan, 中成藥， 天津中新藥業/patent herbal medicine, made by Tian Jin Zhong Xin Pharmaceutics.

8.  真武湯丸/Zhen Wu Tang capsule. Originally from <<Shang Han Lun>> . The ingredients: Pao Fu Zi, Fu Ling, Bai Zhu, Bai Shao, Sheng Jiang

9.  Henrique T, Zanon CF, Girol AP, Stefanini ACB, Contessoto NSA, da Silveira NJF, Bezerra DP, Silveira ER, Barbosa-Filho JM, Cornélio ML, Oliani SM, Tajara EH. Biological and physical approaches on the role of piplartine (piperlongumine) in cancer. Sci Rep. 2020 Dec 17;10(1):22283. doi: 10.1038/s41598-020-78220-6. PMID: 33335138; PMCID: PMC7746756.