Professor Wang Zemin’s Experience in Treating Breast Cancer

Yue Lian¹ ZeMin Wang¹ Rui Xiong² Cong Fu² WenLi Zhou²

Abstract: TAccording to the 2018 International Agency for Research on Cancer (IARC) survey data, the incidence rate of breast cancer in the global female cancer is 24.2%, ranking first among female cancers. In recent years, the incidence rate of breast cancer has been gradually increasing, with a rate of 3% ~ 4% per year, and the incidence of breast cancer in first-tier cities located in the eastern seaboard is particularly obvious. In terms of the age of incidence, it tends to be younger and younger, with most of the cases rising gradually from the age of 20 and reaching a high value at the age of 40~50. At present, the treatment of breast cancer is mainly based on surgery, radiotherapy, chemotherapy and targeted therapy, but the toxic side effects of radiotherapy and chemotherapy after surgery are huge and the aesthetic problems bother the patients, and the cost of treatment is high, so to a part of the patients refused to radiotherapy, chemotherapy and other western medical treatment means. Chinese medicine has a long history and rich experience in treating breast cancer, and the price is low and easy to be accepted by common people.

Keywords: breast cancer; pure Chinese medicine treatment; breast rock; Xianfang Livestrong Drink

Chinese medicine refers to breast cancer as “breast stone”. Song-Chen Ziming “Complete Prescriptions for Women” says: “Initially it is like a small binding kernel, or like a soft shell turtle, or a small stone token, and is not red or painful. Accumulating over time it gradually enlarges, and the rock breaks open like a ripe pomegranate, or there may be internal ulceration forming a deep hole. This presentation pertains to depression of the liver and spleen depression, and anger, and detriment and taxation of the qi and blood. It is called breast stone. The principle treatment is to soothe the liver and relieve depression, dissolve phlegm and disperse binding.” In the modern day the principal treatments for breast cancer include surgery, radiotherapy, chemotherapy and targeted therapy, while traditional Chinese medicine (TCM) is an adjuvant treatment^［1］. Due to the high cost of traditional treatment, some patients choose TCM ^［2］. According to Professor Wang Zemin, the treatment of breast cancer should focus on prevention, focusing on correcting negative lifestyle, and dietary habits, insist on physical exercise, and maintaining a good mental disposition. Diseases such as breast hyperplasia should be actively treated if they occur, and TCM herbal treatment should be used throughout treatment if breast cancer is found. As modern people work under great pressure and have a lot of social obligations, they are prone to Qi stagnation, blood stasis and phlegm congelation, which leads to the occurrence of mammary gland diseases. Wu Qian in the Qing Dynasty said in his book “Golden Mirror of Medicine”: “People with depletion and deficiency of spleen and kidney are prone to suffer from symptoms of agglomerations and accumulations”. Kidney is the foundation of the innate nature and spleen is the foundation of the acquired nature, and deficiency of spleen and kidney is deficiency of positive qi, and deficiency of positive qi is prone to suffer from masses. Therefore, for the treatment of breast cancer, it is mainly to adopt the treatment methods of dredging the liver and regulating qi, softening hardness and dispersing the accumulations, strengthening the spleen and benefiting the kidney and other treatments. For some of the breast cancer patients who choose purely traditional Chinese medicine for treatment, significant curative effects have been achieved through the pattern discrimination and treatment with traditional Chinese medicine. For patients treated with pure Chinese medicine, Prof Wang Zemin also requires patients to do appropriate exercise, and in the process of taking Chinese medicine, cooperate with the exercise of traditional movement practices such as the Eight Brocades, Taiji, etc. Treatment based on the concept of “three parts treatment, seven parts nourishment”, implying his emphasis on supportive lifestyle measures in the healing process, has a good prognosis in the clinic. Chinese medicine treatment of breast cancer can avoid the toxic side effects of radiotherapy, improve the quality of life, reduce the treatment cost and prolong the survival period.

Treatment principles

1） Soothe the liver and regulate qi, strengthen the spleen and benefit the kidneys.

“All diseases are caused by qi”, and qi stagnation, blood stasis, and phlegm coagulation are the main patho-mechanisms of breast cancer. The Nei Jing says, “Anger moves upward, sadness moves downward, shock is chaotic, thought is binding of the qi”, and “uncontrolled joy/excitement and anger injure the organs”, which indicates that rebellious qi can affect the ascent and descent of qi in the internal organ system, and can lead to fullness, distention, and pain in the breast. By dredging the liver and regulating qi, activating blood circulation, and removing blood stasis, one can restore the liver’s functional nature, and achieve the efficacy of supporting the right qi to expel evils.

2） Open the chest to remove phlegm, eliminate swelling and dissipate lumps.

“All diseases are caused by phlegm’”: Phlegm is an important pathogenic factor in Chinese medicine, and many diseases are related to phlegm, with breast cancer being no exception. Phlegm is a Yin evil, so it should be warmed from the middle and dispelled, the chest should be opened, and the knots dispersed, so that the phlegm can be discharged out of the body or dispersed in the body to make it disappear such that the disease can be cured. The combination of Er Chen Tang and Ruan Jian Tang (Soften Hardness Formula) can be used to add and subtract, Rian Juan Tang consists of Chai Hu, Bai Shao, Xiang Fu, Zhi Shi, Fu Ling, Ban Xia, Calcined Corrugated Ziziphi, Hai Fu Shi, Jie Geng, Chen Pi, and Zhi Gan Cao. Ruan Jian Tang is a clinical formula created by Professor Sun Yimin which is effective in softening and dispersing masses in nodular diseases. Er Chen Tang is an effective formula for phlegm-fluids diseases. Ruan Jian Tang can eliminate nodules, reaching the disease foci and get the therapeutic effect, together with Er Chen Tang, it can open the chest and remove phlegm.

3） When there are ulcerations and discharges from breast cancer the treatment should be focused on clearing heat and eliminating toxins, subduing swelling and dispersing knots. Traditional Chinese medicine believes that discharge from ulcerations is mostly caused by stasis and fire, and one can use clearing heat and detoxification, eliminating swelling and dissipating knots, together with Gu Bu Tang (顧步湯) to generate flesh in the area and close the mouth of the ulceration. This formula is from the book “Notes on Effective Formulas for Women”, which is “highly efficacious medicine for sores and ulcers, and first among formulas for external medicine applications”. It is suitable for all kinds of sores, ulcers, and expressions of toxic heat, where there is a clear Yang pattern and a robust patient. This formula’s main attributes are clearing heat and eliminating toxins, activating blood circulation and removing blood stasis, and clearing the channels and breaking up masses, with the supporting actions of opening the surface, moving qi, and removing phlegm and dispersing knots, and its combination of Medicinals comprehensively embodies the methods used for internal treatment of sores and ulcers in the yang syndromes in external medicine. Gu Bu Tang is from Volume XIII of the “Record of Discriminatory Evidence.” It has the effect of tonifying qi and blood and draining poison. It is mainly used for treating gangrene of the feet. When there is a great loss of qi and blood, qi and blood fail to travel through the meridians and channels, and the fire poison, and evils cause gangrene of the feet; and swelling and toxicity. Traditionally it is said that Gu Bu Tang treats gangrene of the feet, with one dose the black color is dispersed, the pain stops with two doses, and it is cured with three doses.

Case Study

Overview of The Case

Patient Zhu was a 48-year-old female from Hunan, first seen on January 7th, 2021. In August 2020, a nodule was found in the right breast, and the nodule disappeared after taking Lactobacillus and Dispersing Tablet（RU BI XIAO and SAN JIE PIAN）. Later, she became aware of a pulling sinking sensation within her right breast, and it the breast began to harden and bleed, then in January 2021, it ulcerated and bled and pus appeared.

Later on 4 January 2021, she went to Hunan Xiangya Hospital for consultation and examination. A CT scan of the chest and abdomen showed: 1）Right breast cancer with bilateral axillary, mediastinal, hilar, hepatogastric hiatus and retroperitoneal lymph node metastasis, bilateral lung, and intrahepatic metastasis, and metastasis to the left pubic bone and multiple thoracic and lumbar vertebral bones. 2） Small amount of pleural effusion in the right chest cavity. Ultrasound report: 1) multiple irregular non-homogeneous masses in the right breast, the largest one located in the right breast at 3, 4, and 5 o’clock in the nipple area, with unclear margins, lobulated, roughly 42×29×38mm. 2) Bilaterally in the axillary region several hypoechoic nodules were observed, the largest one on the right side the size of about 17.2×12.6mm, and the left side of the largest one the size of about 15.3×13.4mm.3) Multiple hypoechoic nodules were seen in the right supraclavicular region, with the largest one on the right measuring 22.5×14.3mm and the largest one on the left measuring 6.4×3.8mm.〖JP〗

MRI of the hepatobiliary tract showed: 1) Multiple metastases in the liver and multiple lymph node enlargements in the hilar region and retroperitoneum.2) Multiple masses in both breasts and multiple nodal foci in both lungs and spine as seen on the scan were consistent with breast cancer with extensive metastases.

Pathological examination report: 1) Special findings: E-Cad+P120membrane+CK5/6-EGFR-CK+GA

TA-3+SOX-10-GCDFP-15 region+P53 missense mutation ER-CerbB(3)AR (about 90% strong) Ki-67 about 30% PR (repeated about 50% weak.) 2. (Medium) 2. Pathological diagnosis: (right breast mass puncture material) tendency invasive carcinoma, need immunohistochemistry co-diagnosis; Supplementary immunohistochemistry report: (right breast mass puncture material) invasive ductal carcinoma grade II.

Therefore, the final diagnosis was a huge mass in the right breast consistent with breast cancer with involvement of the skin and muscular layer of the chest wall, accompanied by multiple metastases.

Treatment history

Because the patient did not want to do surgery or chemotherapy (her attending doctor’s persuasion is ineffective and the patient signed off), she sought Professor Wang Zemin of Beijing Sihui Hospital of Traditional Chinese Medicine for conservative treatment with Chinese medicine.

The first visit was on 7 January 2021. His findings were: palpation: a firm mass in the lower right breast, accompanied by piercing pain and bleeding, pulling pain in the right axillary lymph node, distension and pain on the right side of the back, bowel and urine regular, decent appetite, sleep poor, menstruation is regular, the edges and tip of the tongue are red, with a thin white coat, the underside of the tongue shows evidence of blood stasis, the pulse is stringlike and rapid, the face is yellowish. The effect is typically impatient, there is a tendency to get angry, and she is overworked. According to the tongue, coating, pulse, and the patient’s daily life habits, the Chinese medicine diagnosis is phlegm congealing, stagnation of qi, and blood stasis causing breast rock.

Treatment: clear heat and eliminate toxins, eliminate swelling and dispersing knots, stop bleeding, and relieve pain.

Proposed prescription: Xian Fang Huo Ming Yin combined with Gu Bu Tang with alterations.

Prescription: Chen Pi 10g, Jin Yin Hua 90g, (Cu) Ru Xiang 10g, (Cu) Mo Yao 10g, Chuan Bei Mu 30g, Tian Hua Fen 30g, Tai Zi Shen 10g, (Fu Chao) Bai Zhu 10g, Fu Ling 30g, Xia Ku Cao 15g, Chai Hu 12g, (Jiao) Shen Qu 10g, (Jiao) Shan Zha 10g, (Jiao) Mai Ya 10g, Bai Hua She She Cao 30g, Ban Zhi Lian 15g, Ling Zhi 6g, Hong Dou Shan pi 6g, Pu Gong Ying 30g, Gua Lou 30g

Decoction with water makes one dose which should be divided and taken twice in the morning and evening.

March 4, second diagnosis: the above symptoms were clearly reduced, the ulceration was closed, and the pain decreased. Observations: The tongue was light red, with less fluid, the coating was white, the bottom of the tongue reflected blood stasis, the pulse was as before, the color of the face is slightly dark, the sleep is poor, and the bowel movement was regular. The original formula was modified increasing Jin Yin Hua to 90g.

At the April 29 appointment, the patient had been to Hunan Xiangya Hospital on April 13 (after taking more than 30 doses of medication) for a follow-up examination, a whole chest CT scan which was compared with the 2021-1-19 imaging. ①The result was that the multiple soft tissue mass shadows that had been seen in both breasts were significantly reduced compared, shrinking by as much as 21mm; the nipple invagination, right supraclavicular node was shrunken by 11mm; both axillae, the largest on the right side was shrunken by nearly 11mm, and the largest on the left side was The bilateral midclavicular nodes were reduced by about 15mm; the mediastinum and both pulmonary hilums and the multiple enlarged retroperitoneal lymph node shadows shown were reduced to different degrees compared with the previous ones by about 10mm; the right peritoneal thickening was reduced compared with the previous ones, and no obvious enlarged lymph nodes were seen at present. The high-density nodules in both lungs were significantly smaller and reduced compared with the previous ones.②The pleural effusion on the right side was significantly reduced.③The multiple low-density nodular shadows seen in the liver were significantly reduced compared with the previous ones.

Hepatobiliary tract MRI showed 1) Multiple intrahepatic metastases were significantly smaller and reduced compared with before; multiple lymph node metastases in the hepatoportal area and retro-abdominal area were significantly smaller and disappeared compared with before.2) Multiple breast masses in both breasts as detected by the scan were significantly reduced compared with before; multiple lung metastases in both lungs were significantly reduced compared with before; multiple thoracolumbar spinal bone metastases in multiple thoracic and lumbar vertebrae were significantly reduced compared with before; and oedema of the right chest wall was relieved compared with before.

Chest ultrasound: 1) Multiple solid masses in the right breast, significantly smaller than before.2) Multiple slightly larger lymph nodes in the axillary region bilaterally and in the supraclavicular region bilaterally, significantly smaller than before.

August 12, follow-up: the patient reported that she went to the hospital for review on July 28, and the right breast lump was once again reduced by 10mm, with no obvious changes in the lungs and other nodules. The right breast ulcer was completely healed, pain in the lumbar area at night, bowel movements were fine, and sleep was fine, a white tongue with red tip and edges and stasis in the network vessels at the root of the tongue. Continue to follow the prescription, adding 30g of Mu Li in the formula to soften and disperse the nodules.

Conclusion

This case is an example of long-term phlegm congealing, stagnation of Qi and blood stasis, with stasis and fire, stasis blocking ying-blood, and heat corrupting the flesh leading to ulceration. Since the tongue was red with thin white coating on the edge of the tip, and the pulse string-like, the pattern was identified as heat and toxicity within. The treatment is to clear away heat and toxicity, dissipate nodules and swelling, and activate blood circulation to relieve pain. Therefore, we used Xian Fang Huo Ming Yin and Gu Bu Tang to clear heat and toxicity and eliminate swelling and nodules. Jin Yin Hua is sweet and cold and enters the heart, clearing heat and eliminating toxicity, eliminating swelling, and dispersing knots. Huang Qi assists in wound healing. Ru Xiang and Mo Yao reduce swelling and relieve pain. The patient in this case has been treated for only 8 months, and her symptoms have basically disappeared without obvious discomfort, and she is still in the process of consolidation treatment. The use of Chinese medicine in the treatment of breast cancer has broad applicability, and efforts should be made to explore the great treasures of the motherland’s medicine and to use the ancient for the present to benefit more patients.

參考文獻

References

［1］Wang W, You RL, Qin WJ, Hai LN, Fang MJ, Huang GH, Kang RX, Li MH, Qiao YF, Li JW, Li AP. Anti-tumor activities of active ingredients in Compound Kushen Injection. Acta Pharmacol Sin. 2015 Jun;36(6):676-9. doi: 10.1038/aps.2015.24. Epub 2015 May 18. PMID: 25982630; PMCID: PMC4594177.

［2］ÖZENVER, N., ÜNLÜ, S., GÜNDODU, S., DEMREZER, L. Ö. (2024). Green tea extracts and substantial catechin derivatives: Evaluation of their potential against breast cancer. Food and Health, 10(1), 85-95. https://doi.org/10.3153/FH24008

Author information:

Wang Zemin, Chief Physician of Oncology Department, Wangjing Hospital, China Academy of Traditional Chinese Medicine, Professor and Master’s tutor of Beijing University of Traditional Chinese Medicine, and Vice President of Difficult Diseases Branch of Chinese Society of Ethnomedicine.

Lian Yue, Professional Master of Wangjing Hospital, China Academy of Traditional Chinese Medicine, China.

2.Rui Xiong， Cong Fu, WenLi Zhou,Beijing Sihui Hospital of Traditional Chinese Medicine.

王澤民教授治療乳腺癌經驗

連越¹ 王澤民¹ 熊睿² 付聰² 周文麗²

摘要： 據2018年國際癌症研究機構（IARC）調查數據顯示，乳腺癌在全球女性癌症中的發病率為24.2%，位居女性癌症的首位。近些年來，乳腺癌發病率逐步升高，每年以3% ~ 4% 的速度遞增,位於東部沿海的一線城市中發病尤為明顯。從發病年齡來看，也逐步趨於年輕化，大部分從20歲後逐步上升，在40~50歲時達到高值。目前對乳腺癌的治療以手術、放化療及靶向治療為主，但手術後的放療、化療的毒副反應巨大及美觀問題困擾患者，且治療費用高昂故至一部分患者拒絕放療，化療等西醫治療手段。中醫藥治療乳腺癌有著悠久歷史和豐富的經驗，且價格低廉容易為普通百姓接受。

關鍵詞：乳腺癌；純中醫藥治療；乳岩；仙方活命飲

中醫將乳腺癌稱之為乳岩。宋·陳自明《婦人大全良方》就有記載：“若初起，內結小核，或如鱉、棋子，不赤不痛。積之歲月漸大，巉岩崩破如熟石榴，或內潰深洞，此屬肝脾鬱怒，氣血虧損，名曰乳岩。治法以疏肝解鬱，化痰散結為主。

目前，乳腺癌的主要治療方法包括手術、放療、化療和靶向治療，中醫藥則是輔助治療方法^［1］。由於傳統治療費用高昂，一些患者選擇了中醫治療^［2］。

王澤民教授認為：乳腺癌的治療首先應預防為主，改變不健康的生活和飲食習慣，堅持體育鍛煉，保持心情舒暢。

如果出現乳腺增生等疾病應該積極治療，若發現乳腺癌應將中醫中藥治療貫穿始終。由於現代人工作壓力大、應酬多，容易產生氣滯血瘀痰凝，而導致乳腺疾病的發生。

清代·吳謙在其所著《醫宗金鑒》中曰：“脾腎虧虛之人，易患癥積之症”。腎為先天之本，脾為後天之本，脾腎虧虛則正氣虧虛，正氣虧虛就易患腫瘤。

所以對於乳腺癌的治療，主要是採用疏肝理氣、軟堅散結、健脾益腎等治法，辯證施治，對於一部分單純選擇中醫中藥治療的乳腺癌患者，通過中醫的辯證治療取得了顯著的療效。

對於純中醫藥治療的患者，王澤民教授還要求患者進行適當的運動，在服中藥過程中，配合如八段錦、太極、六字訣等傳統功法的鍛煉。

“三分治，七分養”的治療理念在臨床中預後效果良好。

中醫藥治療乳腺癌可以避免放化療的毒副反應，提高生活品質，降低治療費用、延長生存期。

治療原則

1. 疏肝理氣，健脾益腎。“百病皆生於氣”，氣滯血瘀痰凝是乳腺癌致病的主要病機。

《黃帝內經》中雲：“怒氣則上，悲則氣消，驚則氣亂，思則氣結，喜怒不節則傷髒”。可見氣機逆亂影響臟腑氣機升降，故可致乳房脹滿或脹痛。通過疏肝理氣，活血化瘀。可使肝的疏泄功能恢復，達到扶正以祛邪的功效。

2. 寬胸滌痰，消腫散結。“百病多因痰作祟”，痰是中醫中重要的致病因素，疾病多與痰相關，乳腺癌也不例外。

痰為陰邪，故應溫中祛痰，寬胸散結，使痰排出體外，或在機體內消化使其消失才可治癒疾病。

可用二陳湯合軟堅湯臨證加減，軟堅湯由柴胡、白芍、香附、枳實、茯苓、半夏、煆瓦楞子、海浮石、桔梗、陳皮、炙甘草組成。

軟堅湯為孫一民教授臨床多年所創時方，對於結節類疾病有很好軟堅散結效果。二陳湯則為痰飲專方，對於一切痰飲疾病都有療效。軟堅湯可有效消除癥積之症，以達病灶，獲取療效，配合二陳湯寬胸滌痰。

3. 乳岩出現潰破溢液時，治法則應以清熱解毒，消腫散結為主。

中醫認為潰破溢液多為瘀久化火所致瘡癰，可用仙方活命飲清熱解毒，消腫散結，配合顧步湯使破潰處結痂收口。

仙方活命飲出自《校注婦人良方》，本方為“瘡瘍之聖藥，外科之首方”，適用於陽證而體實的各種瘡瘍腫毒。仙方活命飲以清熱解毒，活血化瘀，通經潰堅諸法為主，佐以透表、行氣、化痰散結，其藥物配伍較全面地體現了外科陽證瘡瘍內治消法。

顧步湯出自《辨證錄》卷十三。具有大補氣血，泄毒之功效。主治腳疽，因氣血大虧，不能遍行經絡，火毒惡邪而致腳疽，及無名腫毒。

顧步湯治療腳疽一劑而黑色解，二劑而疼痛止，三劑痊癒。

驗案舉例

病例概述

患者朱某，女，48歲，湖南人，幹部，2021年1月7日問診。

於2020年8月發現右側乳腺結節，服用乳必消和散結片後結節消失。後自覺右乳內有牽引、下墜感，且開始變硬，溢血，至2021年1月發生潰爛，出血，出膿等症狀。

後於2021年1月4日前往湖南省湘雅醫院進行就診檢查，胸部CT平掃及全腹部CT平掃+增強檢查顯示：①考慮右乳癌並雙側腋窩、縱膈、門區、肝胃間隙及腹膜後淋巴結轉移，雙肺、肝內轉移，左側恥骨、多個胸腰椎骨轉移。②右側胸腔少量積液。

超聲檢查報告：

①右乳可見多處不規則非均質性腫塊，較大者位於右乳3、4、5點鐘位居乳頭0.6cm處，邊緣不清，分葉狀，大小約為42.4×29.9×38.1mm。②雙側腋下區可見多個低回聲結節，右側最大一個大小約為17.2×12.6mm，左側最大一個大小約為15.3×13.4mm。③右側鎖骨上區可見多個低回聲結節，右側最大一個大小22.5×14.3mm，左側最大一個大小6.4×3.8mm。

肝膽道MR平掃+增強+功能成像（DWI）：肝內多發轉移瘤，肝門區及腹膜後多發淋巴結腫大。掃描所及雙乳多發腫塊，雙肺及脊柱多發結節灶，符合乳腺癌並廣泛轉移。

病理檢查報告：

1.特檢結果：E-Cad+P120膜+CK5/6-EGFR-CK+GATA-3+SOX-10-GCDFP-15區域+P53錯義突變ER-CerbB(3)AR(約90%強)Ki-67約30%PR（經重複 約50%弱.中）

2.病理診斷：（右乳腫塊穿刺物）傾向浸潤性癌，需免疫組化協診；補充免疫組化報告：（右乳腫塊穿刺物）浸潤性導管癌Ⅱ級。

故最終診斷為右乳巨大腫塊符合乳腺癌並累及皮膚、胸壁肌層，且伴隨多發轉移。

治療經過

因患者個人意願為不採取手術及無意願化療（主治醫生勸說無效且患者簽字），故尋北京四惠中醫醫院王澤民教授進行中醫中藥保守治療。

2021年1月7日就診。

一診，刻下：右下側乳房質硬、刺痛伴溢血，右側腋窩淋巴結節牽扯痛，右背脹痛，二便調，納可，眠差，月經正常，舌邊尖紅苔薄白，舌底絡瘀明顯，脈弦數，面色淡黃，平素急躁易怒，操勞過度。根據舌苔脈象及患者日常生活習慣故中醫辯證為：痰凝氣滯血瘀所致乳岩。治法：清熱解毒，消腫散結，止血止痛。

擬方仙方活命飲合顧步湯加減。

處方：陳皮10g，金銀花90g，醋乳香10g，醋沒藥10g，浙貝母30g，天花粉30g，太子參10g，麩炒白術10g，茯苓30g，夏枯草15g，柴胡12g，焦神曲10g，焦山楂10g，焦麥芽10g，白花蛇舌草30g,半枝蓮15g，靈芝6g，紅豆杉（皮）6g，蒲公英30g，瓜蔞30g。水煎服，每日一劑，分早晚兩次溫服。

3月4日，二診：上述症狀明顯減輕，潰破處收口，疼痛減輕。刻下：舌淡紅少津苔白，舌底絡瘀，脈象如前，面色略暗，納可眠差，二便調。沿用原方加減，金銀花加量至90g。

4月29日，復診：患者於4月13日（服藥30餘劑後）前往湖南湘雅醫院復查。

全胸CT平掃+增強：

①對比2021-1-19片，雙乳內見多發軟組織腫塊影較前明顯縮小，縮小21mm之多；乳頭內陷，右鎖骨上結節縮小11mm；雙側腋窩，右側最大者縮小近11mm，左側最大者縮小8mm;雙側鎖骨中結節均縮小約15mm；縱膈及雙肺門、所示腹膜後多發腫大淋巴結影較前不同程度縮小、減少，減少約10mm；右側腹膜增厚較前縮小，現未見明顯腫大淋巴結。雙肺內高密度結節較前明顯縮小、減少。

②右側胸腔積液明顯減少。

③所示肝內見多發低密度結節影較前明顯縮小。

肝膽道MR平掃+增強+功能成像（DWI）：肝內多發轉移瘤較前明顯縮小、減少；肝門區及腹部後多發淋巴結轉移瘤較前明顯縮小、基本消失。掃描所及雙乳多發腫塊較前明顯縮小；雙肺多發轉移瘤較前明顯縮小；多個胸腰椎多發骨轉移瘤較前明顯縮小；右側胸壁水腫較前緩解。

胸部彩超：右側乳腺多發實性腫塊，較前明顯縮小。雙側腋下區、雙側鎖骨上區多發稍大淋巴結，較前明顯縮小。

8月12日，復診：患者自述於7月28日前往醫院復查，右乳腫塊再次明顯縮小至10mm，肺部及其它結節無明顯變化，刻下：右乳潰破已完全痊癒，夜間腰後疼痛，二便可，納眠可，舌白邊尖紅，舌底絡瘀。繼續沿用前方，方中加牡蠣30g以軟堅散結。

小結

本案為痰凝氣滯血瘀，瘀久化火，瘀阻營血，熱腐肌肉所致潰爛，且舌象邊尖紅苔薄白，脈弦數，故辨證為熱毒內蘊。

治法以清熱解毒，散結消腫，活血止痛為主。故運用仙方活命飲合顧步湯進行清熱解毒，消腫散結；金銀花性甘、寒入心，取清熱解毒，消腫散結之功效；黃芪托瘡生肌；乳香、沒藥，消腫止痛。

本案患者自治療至今僅八個月，目前症狀基本消失，無明顯不適，仍在鞏固治療中。運用中醫藥治療乳腺癌的前景廣闊，應努力挖掘祖國醫學的偉大寶庫，古為今用造福更多患者。

作者簡介：

1.王澤民，中國中醫科學院望京醫院腫瘤科主任醫師、北京中醫藥大學教授、碩士生導師，中國民族醫藥學會疑難病分會副會長。

連越，中國中醫科學院望京醫院專業型碩士。

2.熊睿,付聰, 周文麗,北京四惠中醫醫院。