Prostate Cancer - National TCM Master Li Furen’s “Castration Kidney-Tonifying Decoction” (Qu Shi Bu Shen Tang)
25. Prostate Cancer - National TCM Master Li Furen’s “Castration Kidney-Tonifying Decoction” (Qu Shi Bu Shen Tang)
Li Furen, a National Master of TCM, was a chief physician at Beijing Hospital and a direct disciple of the renowned physician Shi Jinmo.
Pathogenesis
Prostate cancer patients are advanced in years, with deficiency of the lower jiao and gradual depletion of the Tian Gui (reproductive essence). After bilateral orchiectomy, although the tumor is controlled, the Kidney Jing and Qi are abruptly attenuated, the Tian Gui is exhausted, and the Chong and Ren vessels become empty. This leads to disharmony of Qi and Blood, and imbalance of Yin and Yang, manifesting as episodic hot flashes, flushing with sweating, insomnia, and vexation - typical symptoms. This formula takes the Six-Ingredient Rehmannia Pill as its base, with modifications emphasizing Kidney tonification and Essence filling, Yin-Yang balancing, and sweating restraint and Spirit calming.
Formula Composition
Castration Kidney-Tonifying Decoction (Qu Shi Bu Shen Tang)
Composition: Raw Rehmannia 15g, Prepared Rehmannia 15g, Cornus Fruit 12g, Gardenia Fruit 12g, Solomon’s Seal 10g, Dodder Seed 12g, Wolfberry 12g, Rehmannia Root Bark 10g, Poria 15g, Hangzhou White Peony 15g, Winter Wheat 30g, Alisma 10g, Licorice 3g
Efficacy: Tonifies the Kidneys and fills Essence, balances Yin and Yang, restrains sweating and calms the Spirit
Indications: Post-orchiectomy prostate cancer (Kidney deficiency with Yin-Yang disharmony pattern), characterized by hot flashes, flushing with sweating, insomnia, and vexation
Prepared Rehmannia and Raw Rehmannia together serve as the sovereign; the two Rehmannias used in parallel - Prepared Rehmannia nourishes the Kidneys and fills Essence, while Raw Rehmannia clears heat and nourishes Yin; one tonifies and one clears, balancing Yin and Yang within the Kidneys. Cornus Fruit, Gardenia Fruit, Solomon’s Seal, Dodder Seed, and Wolfberry form the minister group, a large cluster of Kidney-tonifying herbs - Cornus Fruit tonifies the Liver and Kidneys and astringes Jing; Gardenia Fruit combined with Wolfberry takes the principle of the Two-Erishing Pill to nourish the Liver and Kidneys; Solomon’s Seal tonifies the Yin of the Spleen, Lung, and Kidneys; Dodder Seed evenly tonifies Yin and Yang with a slightly warming bias, combined with Yin-nourishing herbs in the principle of “seeking Yin within Yang.” The five herbs jointly achieve the effect of filling Essence and consolidating the root. Rehmannia Root Bark, Hangzhou White Peony, and Winter Wheat serve as assistants (first group) - Rehmannia Root Bark clears and removes deficient fire and dispels bone-steaming tidal fever; White Peony nourishes Blood and astringes Yin; Winter Wheat clears the Heart and restrains sweating. These three herbs target the core post-surgical symptom of flushing with sweating and represent Li Furen’s experienced combination for managing the “castration syndrome.” Poria and Alisma serve as assistants (second group), employing the Six-Ingredient Rehmannia Pill’s method of draining turbidity - draining water and filtering dampness so that tonification does not stagnate. In formulas of the Rehmannia Pill type, Poria and Alisma are indispensable; omitting them risks the adverse effect of turbidity rising upward, such as ear itching. Licorice serves as the envoy, moderating all the herbs and assisting White Peony in its sour-sweet Yin-nourishing action.
| Herb Group | Herb Dosage | Function |
|---|---|---|
| Sovereign | Prepared Rehmannia 15g, Raw Rehmannia 15g | The two Rehmannias used in parallel: Prepared Rehmannia nourishes the Kidneys and fills Essence; Raw Rehmannia clears heat and nourishes Yin; one tonifies and one clears, balancing Kidney Yin and Yang |
| Minister | Cornus Fruit 12g, Gardenia Fruit 12g, Solomon’s Seal 10g, Dodder Seed 12g, Wolfberry 12g | A large group of Kidney-tonifying herbs; Cornus Fruit tonifies Liver-Kidney and astringes Jing; Gardenia Fruit + Wolfberry (Two-Erishing Pill principle) nourish Liver-Kidney; Solomon’s Seal tonifies Spleen-Lung-Kidney Yin; Dodder Seed evenly tonifies Yin and Yang with a warming bias, “seeking Yin within Yang” |
| Assistant 1 | Rehmannia Root Bark 10g, Hangzhou White Peony 15g, Winter Wheat 30g | Rehmannia Root Bark clears deficient fire and removes bone-steaming; White Peony nourishes Blood and astringes Yin; Winter Wheat clears the Heart and restrains sweating; three herbs targeting the core post-surgical symptom of flushing with sweating |
| Assistant 2 | Poria 15g, Alisma 10g | Six-Ingredient Rehmannia Pill’s turbidity-draining method; drain water and filter dampness so tonification does not stagnate; omitting them risks turbidity rising upward (ear itching) |
| Envoy | Licorice 3g | Moderate all herbs; assist White Peony in sour-sweet Yin-nourishing |
Pattern-Based Modifications
| Coexisting Pattern | Modified Herbs |
|---|---|
| Liver-Kidney Yin deficiency | Add Anemarrhena 10g, Phellodendron 10g, nourish Liver-Kidney Yin and clear heat |
| Dry mouth and throat | Add Scrophularia, Ophiopogon, nourish Yin and generate fluids |
| Dry hard stools | Add Trichosanthes, Hemp Seed, moisten the intestines and promote bowel movement |
| Severe tidal fever and sweating | Add White Caltha, reduce deficient heat and stop sweating |
| Insomnia | Add Jujube Seed, nourish the Heart and calm the Spirit |
| Dry, gritty eyes | Add Chrysanthemum, Cassia Seed, clear the Liver and brighten the eyes |
| Vexation and irritability | Add Gentian, Acorus, clear Liver fire and open the orifices |
| Dizziness and tinnitus | Add Gastrodia, Mother-of-Pearl, calm the Liver and anchor floating Yang |
| Spleen-Kidney Yang deficiency | Remove Rehmannia Root Bark; add Raw Astragalus 15g, White Atractylodes 15g, strengthen the Spleen and tonify the Kidneys, warm Yang and transform Qi |
| Lower back soreness and leg weakness | Add Achyranthes, Dipsacus, tonify the Kidneys and strengthen the lower back |
| Lower limb edema | Change Poria to Poria Peel; add Polyporus, Raw Coix Seed, drain water and reduce swelling |
| Palpitations and shortness of breath | Add Codonopsis, Schisandra, boost Qi and nourish the Heart |
| Poor appetite and loose stools | Remove Raw Rehmannia; add Fried Coix Seed, Charred Medicated Leaven, strengthen the Spleen and stop diarrhea |
| Abdominal and epigastric distension | Add Tangerine Peel, Cypress Fruit, regulate Qi and reduce distension |
| Difficulty in bowel movements | Add Cistanche, warm the Kidneys and moisten the intestines |
| Concurrent Heart Blood stasis | Chest pain with purple tongue: add Salvia, Chuanxiong, Perilla Stem, invigorate Blood and resolve stasis |
| Concurrent phlegm-turbidity obstruction | Cough with abundant phlegm: add Pinellia, Tangerine Red Peel, Tangerine Peel, transform phlegm and regulate Qi |
| Concurrent Liver stagnation with Qi stagnation | Flank distension and depression: add Vinegar-processed Bupleurum, Buddha’s Hand, Cypress Fruit, Curcuma, disperse the Liver and relieve stagnation |
Summary
The formula is built on the skeleton of the Six-Ingredient Rehmannia Pill, with Moutan Bark removed (its cooling and Blood-invigorating properties are inappropriate post-surgery) and Chinese Yam removed (its even-tonifying function is already covered by Solomon’s Seal and Wolfberry). Five herbs - Raw Rehmannia, Gardenia Fruit, Solomon’s Seal, Dodder Seed, and Wolfberry - are added to strengthen the Kidney-tonifying and Essence-filling power, combined with Rehmannia Root Bark, White Peony, and Winter Wheat to clear deficient fire, astringe Yin, and stop sweating. It is suitable for post-orchiectomy prostate cancer patients with hot flashes, sweating, insomnia, and vexation due to Kidney deficiency with Yin-Yang disharmony; in clinical practice, modifications can be made according to two subtypes: Liver-Kidney Yin deficiency and Spleen-Kidney Yang deficiency. It should not be applied to patients with benign prostatic hyperplasia or those with prostate cancer who have not undergone surgery.
References
[1] Zhang Chunhe, Li Yueqing (editors). Selected Cases of Renowned TCM Andrologists [M]. Beijing: People’s Medical Publishing House, 2015.
[2] Zhao Jiancheng, Xie Jizeng, Yang Jianyu (editors). Grand Dictionary of Tumor Formulas [M]. Beijing: Ancient TCM Book Publishing House, 2009: 34.
[3] Li Furen. TCM Treatment After Orchiectomy for Prostate Cancer [J]. Journal of Traditional Chinese Medicine, 1992.
25. 前列腺癌—國醫大師李輔仁「去勢補腎湯」
李輔仁國醫大師，北京醫院主任醫師，施今墨嫡傳弟子。
病機
前列腺癌患者年事已高，下元虧虛，天癸漸竭。行雙側睪丸摘除術後，癌瘤雖得以控制，但腎之精氣驟然衰減，天癸枯竭，衝任二脈空虛，致氣血失和、陰陽失調，出現陣發性潮熱、烘熱汗出、失眠煩躁等典型症狀。本方以六味地黃丸為底方化裁，著重補腎填精、平衡陰陽、斂汗安神。
方藥組成
去勢補腎湯
生地黃 15g 熟地黃 15g 山萸肉 12g 女貞子 12g
黃精 10g 菟絲子 12g 枸杞子 12g 地骨皮 10g
茯苓 15g 杭白芍 15g 浮小麥 30g 澤瀉 10g 甘草 3g
| 藥組 | 藥物 | 功用 |
|---|---|---|
| 君 | 熟地黃 15g、生地黃 15g | 二地同用，熟地滋腎填精，生地清熱養陰，一補一清，平調腎中陰陽 |
| 臣 | 山萸肉 12g、女貞子 12g、黃精 10g、菟絲子 12g、枸杞子 12g | 大隊補腎藥群，山萸肉補肝腎澀精，女貞子合枸杞子取二至丸滋養肝腎法，黃精補脾肺腎三髒之陰，菟絲子平補陰陽而偏溫，與滋陰藥相伍”陽中求陰”，五味合奏填精固本之效 |
| 佐₁ | 地骨皮 10g、杭白芍 15g、浮小麥 30g | 地骨皮清退虛火、除骨蒸潮熱，白芍養血斂陰，浮小麥清心斂汗。三味針對術後烘熱汗出的核心症狀，是李輔仁應對”去勢綜合徵”的經驗配伍 |
| 佐₂ | 茯苓 15g、澤瀉 10g | 六味地黃丸瀉濁之法，利水滲溼使補而不滯。地黃丸類方中茯苓、澤瀉不可或缺，棄之則易出現耳癢等濁氣上攻之弊 |
| 使 | 甘草 3g | 調和諸藥，兼助白芍酸甘化陰 |
加減法
| 兼證 | 加減藥物 |
|---|---|
| 肝腎陰虛 | 加知母 10g、黃柏 10g，滋補肝腎、養陰清熱 |
| 口乾咽燥 | 加玄參、麥冬，養陰生津 |
| 大便乾結 | 加瓜蔞、麻仁，潤腸通便 |
| 潮熱汗出甚 | 加白薇，退虛熱止汗 |
| 夜眠難安 | 加酸棗仁，養心安神 |
| 雙目乾澀 | 加菊花、決明子，清肝明目 |
| 煩躁易怒 | 加龍膽草、石菖蒲，清肝瀉火開竅 |
| 頭暈耳鳴 | 加天麻、珍珠母，平肝潛陽 |
| 脾腎陽虛 | 去地骨皮，加生黃芪 15g、白朮 15g，健脾補腎、溫陽化氣 |
| 腰痠腿軟 | 加牛膝、川斷，補腎強腰 |
| 下肢浮腫 | 茯苓改茯苓皮，加豬苓、生薏仁，利水消腫 |
| 心悸氣短 | 加黨參、五味子，益氣養心 |
| 納少便溏 | 去生地黃，加炒薏苡仁、焦神曲，健脾止瀉 |
| 脘腹脹滿 | 加陳皮、香附，理氣消脹 |
| 大便不暢 | 加肉蓯蓉，溫腎潤腸 |
| 兼心血瘀阻 | 胸痛舌紫加丹參、川芎、蘇梗，活血化瘀 |
| 兼痰濁困阻 | 咳嗽痰多加半夏、橘紅、陳皮，化痰理氣 |
| 兼肝鬱氣滯 | 脅脹鬱悶加醋柴胡、佛手、香附、鬱金，疏肝解鬱 |
小結
全方以六味地黃丸為骨架，去丹皮之涼血活血（術後不宜），去山藥之平補（已用黃精枸杞替代），加生地、女貞子、黃精、菟絲子、枸杞子五藥強化補腎填精之力，合地骨皮、白芍、浮小麥清退虛火、斂陰止汗。適用於前列腺癌睪丸摘除術後潮熱汗出、失眠煩躁屬腎虛陰陽失調者，臨證可分肝腎陰虛與脾腎陽虛兩型隨證加減。良性前列腺增生及未經手術的前列腺癌患者不宜套用。
參考文獻
[1] 張春和，李曰慶主編. 中醫男科名家驗案精選[M]. 北京：人民衛生出版社，2015.
[2] 趙建成，謝繼增，楊建宇主編. 腫瘤方劑大辭典[M]. 北京：中醫古籍出版社，2009：34.
[3] 李輔仁. 前列腺癌睪丸摘除術後的中醫藥治療[J]. 中醫雜誌，1992.