🌿 Folk Prescriptions

Radiation pneumonitis is a radiation-induced change in lung tissue, a common complication following radiotherapy for thoracic malignancies such as lung cancer, mediastinal lymphoma, and esophageal cancer. It typically results from high-dose, large-area irradiation. Pathologically, early changes are dominated by exudation, while late changes are characterized by fibrosis. Current treatment primarily uses corticosteroids combined with antibiotics, which show some efficacy but carry risks such as tumor recurrence and certain complications after steroid use. Thus, seeking effective, low-side-effect treatments is urgent.
Dr. Gao Ping, Director of the Hematology and Oncology Department at the First Affiliated Hospital of Henan University of Traditional Chinese Medicine, has long used TCM syndrome differentiation to treat radiation pneumonitis, achieving results comparable to steroid therapy without side effects.
Dr. Gao analyzes the etiology and pathogenesis of radiation pneumonitis, noting that the lungs are highly sensitive to radiation. Even normal lung tissue suffers damage during thoracic radiotherapy. Radiation directly injures alveolar epithelial cells and capillary endothelial cells, causing capillary congestion and edema, leading to pulmonary edema. Subsequently, small vessels and bronchi necrose, gradually developing into pulmonary fibrosis and sclerosis. TCM views radiation as a toxic, heat-inducing factor—hot poison. Heat transforms into fire, scorching the lungs and depleting body fluids. Cancer patients have deficient vital energy and internal phlegm-blood stasis. Radiotherapy exacerbates heat injury to yin, overwhelming the body’s defenses. Heat toxins and phlegm-blood stasis combine, depleting lung yin and damaging lung collaterals, impairing lung’s function of dispersion and descent, causing cough, wheezing, shortness of breath, and even cyanosis. This condition is fundamentally deficient with excess symptoms, with yin injury, qi deficiency, blood stasis, and heat toxins as core pathogenic mechanisms. Treatment varies by stage, employing methods such as nourishing yin, tonifying qi, resolving stasis, and detoxifying.
Dr. Gao applies syndrome differentiation clinically, generally dividing cases into three types:
1. Yin Injury and Lung Dryness: Common in the first to third months post-radiotherapy. Main symptoms include irritative dry cough, little or no phlegm, sore throat, dry mouth preferring cold drinks, chest tightness and restlessness, possibly accompanied by low-grade fever, poor appetite, red tongue with little coating and dryness, fine rapid pulse. Treatment: Nourish yin, clear heat, moisten the lungs, and generate fluids. Use Sha Shen Mai Dong Tang (Sandy Solomon’s and Ophiopogon Decoction) or Qing Zao Jiu Fei Tang (Clearing Dryness and Rescuing Lung Decoction) with modifications. Common herbs include Ophiopogon, ginseng, pinellia, donkey-hide gelatin, black sesame, gypsum, loquat leaf, bamboo茹, bamboo leaves, trichosanthes root, anemarrhena, fritillary bulb, saffron, lily, white peony, silver honeysuckle, and solomon's seal.
2. Lung-Spleen Qi Deficiency with Blood Stasis: Patients with pre-existing spleen deficiency, exacerbated by radiotherapy, with prolonged illness and recurrent cough. Phlegm is sticky or thick, white or grayish, more abundant in the morning. Often accompanied by epigastric fullness, poor appetite, nausea, fatigue, lethargy, loose stools, frequent urination, purple-dark tongue, white greasy or yellow greasy coating, slippery or fine slippery pulse. Treatment: Tonify the lungs and spleen, remove dampness, and resolve stasis. Use Sheng Jiang Gan Cao Tang (Fresh Ginger and Licorice Decoction) combined with Er Chen Tang (Two-Ingredient Decoction) with additions. Common herbs include ginseng, astragalus, poria, tangerine peel, processed pinellia, atractylodes, white atractylodes, magnolia bark, August fig, safflower, sappanwood, pill bug, and wasp nest.
3. Exuberant Heat-Toxin with Phlegm-Heat in the Lungs: Post-radiotherapy, increased vascular permeability causes interstitial pulmonary edema, predisposing to lung infection, intensifying heat-toxin and phlegm-fire accumulation. Symptoms include chills, fever, cough with copious phlegm, thick or yellow phlegm, difficult expectoration, severe cough with chest pain or hemoptysis, dry mouth wanting to drink, red tongue, thin yellow or yellow greasy coating, slippery rapid pulse. Treatment: Clear heat and detoxify, clear the lungs and resolve phlegm. Use Qing Jin Hua Tan Tang (Clearing Metal and Transforming Phlegm Decoction) or Qian Jin Wei Jing Tang (Thousand Gold Reed Stem Decoction) with modifications. Common herbs include mulberry bark, scutellaria, gardenia, anemarrhena, houttuynia, honeysuckle, forsythia, flos lonicerae, coix seed, winter melon seed, fritillary bulb, trichosanthes, platycodon, reed rhizome, and dendrobium.
A 60-year-old female patient, after right breast ductal adenocarcinoma radical surgery, underwent radiotherapy for three months, subsequently developing irritative cough, worse at night, no phlegm, dry mouth and sore throat, chest tightness and pain, five-palm heat, irritability, afternoon low-grade fever (37.5°C), poor appetite, red tongue with little coating, fine rapid pulse. After three days of penicillin plus dexamethasone treatment, elevated blood glucose led to switching to TCM. Syndrome differentiation revealed yin injury and lung dryness. Prescribed Sha Shen Mai Dong Tang with modifications: South and North Solomon’s 30g, Ophiopogon 15g, Rehmannia 20g, Scrophularia 15g, Polygonatum 15g, Lily 30g, Mulberry Bark 15g, Job’s tears 20g, Silver Honeysuckle 10g, Softshell Turtle Shell 10g, Artemisia 30g, Licorice 6g. One dose daily, divided into two servings, warm. After five days, cough eased, irritability improved. Removed Artemisia and Silver Honeysuckle, added pill bug, safflower, and wasp nest (each 15g) to improve pulmonary fibrosis post-radiotherapy. One dose daily, decocted. Symptoms gradually improved after half a month. Continued TCM syndrome differentiation treatment alongside routine postoperative chemotherapy. Condition now stable.