A 70-year-old woman suffering from severe abdominal bloating, loss of appetite, and debilitating fatigue following radical colon cancer surgery was successfully managed by restoring the digestive ascending and descending pivot before applying deep tonification.

Case ID: CHC-0079

Case Summary

This case describes a 70-year-old woman who underwent radical resection for sigmoid colon cancer, subsequently developing severe upper abdominal bloating, extreme fatigue, and an inability to eat. The original report documented a conventional diagnosis of post-colon cancer surgery syndrome and cholecystitis, with a TCM assessment of Intestinal Tumor (Chang Tan) driven by Damp-Heat Accumulation and Middle Jiao blockage. She was managed by Professor Hu Shiping using a highly strategic phased approach: initially focusing on restoring the “ascending and descending” dynamics of the Spleen and Stomach to clear the damp-heat and unblock the intestines, and only later transitioning to heavy tonification to rebuild her systemic energy, resulting in a rapid recovery of her strength and digestion.

Patient Presentation

• Patient: 70-year-old female (Surname: Li).
• Main Complaint: Upper abdominal distension and pain, poor appetite, and extreme fatigue.
• History: The patient sought consultation on October 10, 2023. Over two months prior, she was hospitalized for bloody stools and diagnosed with colon cancer and cholecystitis (gallbladder inflammation). She underwent a radical resection for sigmoid colon cancer. Following the surgery, she developed severe upper abdominal bloating and pain, a complete loss of appetite, and an inability to eat. This was accompanied by systemic muscle aches, extreme lethargy, and legs so exhausted she could barely walk.
• Associated Symptoms: Her urination was normal, but her bowel movements were difficult to pass.

Examination and Diagnosis

• Conventional Diagnosis: 1. Post-radical surgery for colon cancer; 2. Cholecystitis.
• TCM Tongue and Pulse: The tongue body was dark red (舌暗红) with a thin, yellow coating. The pulse was stringy and slippery (脉弦滑).

TCM Assessment

The original practitioner interpreted the presentation as Intestinal Tumor (Chang Tan) driven by Damp-Heat Accumulation (肠覃 – 湿热蕴结).

According to the holistic principles of Chinese Medicine, the major surgery at age 70 severely traumatized her Middle Qi (the Spleen and Stomach). The Spleen and Stomach act as the body’s central pivot: the Spleen must ascend clear energy upward to nourish the muscles, and the Stomach must descend turbid waste downward for excretion.

Because her central pivot was damaged, Damp-Heat accumulated and blocked the Middle Jiao. The Stomach failed to descend the turbidity (causing the severe bloating, pain, and constipation), and the Spleen failed to ascend the clear Yang (depriving her limbs of energy, causing the extreme leg fatigue and generalized muscle aches). Her dark red tongue, yellow coating, and stringy-slippery pulse provided objective confirmation of this active Damp-Heat accumulation and trapped Qi.

Treatment Approach

The primary treatment principle was to harmonize the Liver and Spleen, clear and resolve damp-heat (调和肝脾，清利湿热). The strategy avoided immediate heavy tonification—which would have further bloated her obstructed digestive system—and instead prioritized “acrid-opening and bitter-descending” (辛开苦降) to mechanically restart her digestive motility and clear the inflammatory damp-heat.

Interventions and Herbal Formulas

• Initial Herbal Formula (October 10, 2023): A 15-herb decoction designed to forcefully restart the digestive pivot and clear damp-heat.
  • Acrid-Opening and Bitter-Descending: Qing Ban Xia (Pinellia, 15g) is acrid and warm, while Huang Qin (Scutellaria, 10g) is bitter and cold. Together, they form a classic pairing to break up central congestion and restore the Spleen/Stomach ascending and descending functions.
  • Clearing Damp-Heat and Phlegm: Huang Lian (Coptis, 12g) and Zhu Ru (Bamboo Shavings, 10g) strongly clear heat and dry dampness. Zhi Shi (Immature Bitter Orange, 15g) and Hou Po (Magnolia Bark, 10g) move Qi downward to relieve the severe bloating.
  • Strengthening Spleen and Aiding Digestion: Chen Pi (15g), Mu Xiang (15g, added later), Sha Ren (15g, added later), Fu Ling (15g), and Gan Cao (5g) gently awaken the Spleen to resolve dampness. Mai Ya (Barley Sprout, 30g) and Ji Nei Jin (Chicken Gizzard Lining, 10g) specifically digest stagnant food.
  • Soothing Liver and Stopping Pain: Chai Hu (15g), Bai Shao (20g), Zhi Shi (15g), and Gan Cao (5g) functionally recreate the classic formula Si Ni San (Frigid Extremities Powder). This combination soothes stagnant Liver Qi, releases trapped Yang energy to the limbs, and effectively stops the abdominal pain. Bai Shao also protects the body’s Yin from being damaged by the other drying herbs.
  • Administration: 7 doses, water decocted, taken warm after breakfast and dinner.
• Second Visit (October 18, 2023): After 7 days, the abdominal bloating and pain completely disappeared. Her appetite returned, her spirit dramatically improved, and her body aches resolved. She could now walk over 4,000 steps without feeling tired. However, she was experiencing spontaneous sweating upon exertion. The practitioner removed the digestive herb Mai Ya and added Fu Xiao Mai (Floating Wheat, 30g) and Huang Qi (Astragalus, 30g) to boost Qi and secure the exterior to stop the sweating. (7 doses).
• Third Visit (October 25, 2023): The sweating suddenly stopped, her energy was abundant, and she walked normally. Her only remaining symptom was occasional mild lower back pain. With the damp-heat cleared and the digestive pivot restored, the practitioner shifted entirely to tonifying the root, prescribing a modified Xiangsha Liujunzi Tang combined with Liver/Kidney-tonifying herbs to consolidate both her postnatal (Spleen) and prenatal (Kidney) foundations.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is Professor Hu Shiping’s strict adherence to addressing the “Middle Jiao Blockage” before applying tonics in a severely depleted post-operative cancer patient.

When faced with a 70-year-old post-surgical patient suffering from extreme fatigue and weakness, the conventional reflex is to immediately administer heavy Qi and Blood tonics like Ginseng or Astragalus. However, Professor Hu recognized that the patient’s digestive system was completely “jammed” by post-surgical damp-heat (evidenced by the yellow tongue coating and severe bloating). If heavy tonics had been used initially, they would have trapped the damp-heat further, worsening the bloating and pain. By first using “acrid-opening and bitter-descending” herbs to clear the blockage and restart the digestive engine, the patient’s body was able to absorb nutrients and recover her strength naturally. Once the “pipes were cleared,” he successfully integrated deep tonification, proving that sometimes the best way to nourish a patient is to first remove what is obstructing them.

Source Original source: Shenzhen Hospital of Beijing University of Chinese Medicine (Longgang) / Traditional Chinese Medicine Bureau of Guangdong Province Original title: 【以案说医】胡世平：肠癌术后升降乱，寓通于补再扶正 Practitioner: Professor Hu Shiping (胡世平) Publication date: August 14, 2024 Original language: Chinese