🌿 Folk Prescriptions

Radiation pneumonitis is a radiation-induced injury to 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. Early pathological changes are primarily exudative, while late changes are predominantly fibrotic. Conventional treatment uses corticosteroids combined with antibiotics, offering some efficacy but risking tumor recurrence and other complications due to steroid therapy. Thus, seeking effective, low-side-effect treatments is urgently needed.
Dr. Gao Ping, Director of 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 among the most radiosensitive organs. Normal lung tissue also suffers damage during thoracic radiotherapy. Radiation directly injures alveolar epithelial 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 destructive factor—hot poison. Heat transforms into fire, scorching the lungs and depleting yin fluids. Cancer patients have deficient vital energy and internal phlegm-blood stasis. Radiotherapy further injures yin, overwhelming the body's defenses, allowing heat toxins and phlegm-blood stasis to interlock, depleting lung yin and damaging lung networks, impairing lung's function of promoting and descending, resulting in coughing, wheezing, shortness of breath, and even cyanosis. This condition is fundamentally deficient with superficial excess—deficiency of yin, qi deficiency, blood stasis, and heat toxins are the core pathogenesis. Treatment varies by stage, employing methods to nourish yin, strengthen qi, resolve stasis, and detoxify.
Dr. Gao clinically applies syndrome differentiation, commonly categorizing cases into the following three types:
1. Yin Injury and Lung Dryness: Common in the first 1–3 months post-radiotherapy. Key symptoms include irritative dry cough with little or no phlegm, sore throat, dry mouth preferring cold drinks, chest tightness, restlessness, possible low-grade fever, poor appetite, red tongue with little or no coating, fine rapid pulse. Treatment: Nourish yin, clear heat, moisten the lungs, and generate fluids. Use Sha Shen Mai Dong Tang or Qing Zao Jiu Fei Tang with modifications. Common herbs include: Ophiopogon (Mai Dong), Ginseng (Ren Shen), Pinellia (Ban Xia), Donkey-hide Gelatin (E Jiao), Hemp Seed (Hu Ma Ren), Gypsum (Shi Gao), Loquat Leaf (Pi Pa Ye), Bamboo茹 (Zhu Ru), Bamboo Leaves (Zhu Ye), Trichosanthes (Tian Hua Fen), Anemarrhena (Zhi Mu), Fritillary Bulb (Chuan Bei Mu), Codonopsis (Sha Shen), Solomon's Seal (Yu Zhu), Silverleaf Sophora (Yin Chai Hu), Lily (Bai He), and White Violet (Bai Wei).
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 and clumpy, 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: Strengthen the lungs and spleen, resolve dampness, and remove stasis. Use Sheng Jiang Gan Cao Tang combined with Er Chen Tang with modifications. Common herbs include: Ginseng (Ren Shen), Astragalus (Huang Qi), Poria (Fu Ling), Tangerine Peel (Chen Pi), Pinellia (Fa Ban Xia), Atractylodes (Bai Zhu), Atractylodes (Cang Zhu), Magnolia Bark (Chuan Pu), August Fig (Ba Yue Zha), Safflower (Hong Hua), Sappanwood (Su Mu), Pill Bug (Shu Fu), and Honeycomb (Lou Feng Fang).
3. Exuberant Heat-Toxin with Phlegm-Heat in the Lungs: Post-radiotherapy, increased vascular permeability leads to alveolar interstitial edema, increasing susceptibility to lung infection, resulting in internal accumulation of heat-toxin and phlegm-fire. Common symptoms include chills and fever, cough with copious phlegm, thick or yellow phlegm, difficult expectoration, severe cough with chest pain or hemoptysis, dry mouth with desire 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 or Qian Jin Wei Jing Tang with modifications. Common herbs include: Mulberry Bark (Sang Bai Pi), Scutellaria (Huang Qin), Gardenia (Shan Zhi Zi), Anemarrhena (Zhi Mu), Houttuynia (Yu Xing Cao), Honeysuckle (Er Hua), Forsythia (Lian Qiao), Red Vine (Hong Teng), Coix Seed (Yi Yi Ren), Winter Melon Seed (Dong Gua Zi), Fritillary Bulb (Bei Mu), Trichosanthes (Kua Lou), Platycodon (Jie Geng), Reed Rhizome (Lu Gen), and Dendrobium (Shi Hu).
An example: A female patient over 60 years old, after right breast ductal adenocarcinoma radical surgery, underwent radiotherapy. Three months later, she developed irritative cough, worse at night, no phlegm, dry mouth and sore throat, chest tightness and pain, five palms feeling hot, irritability, afternoon low-grade fever (37.5°C), poor appetite, red tongue with little coating, fine rapid pulse. She had received penicillin plus dexamethasone for three days, but due to elevated blood sugar, switched to TCM treatment. Syndrome differentiation revealed yin injury and lung dryness, lacking moistening. Used Sha Shen Mai Dong Tang with modifications: South and North Codonopsis each 30g, Ophiopogon 15g, Rehmannia 20g, Scrophularia 15g, Solomon's Seal 15g, Lily 30g, Mulberry Bark 15g, Function Leaf 20g, Silverleaf Sophora and Softshell Turtle Shell each 10g, Artemisia 30g, Licorice 6g. One dose daily, divided into two servings, warm. After five days, cough eased, restlessness improved. Removed Artemisia and Silverleaf Sophora, added insect-based herbs—Pill Bug, Safflower, and Honeycomb, each 15g—to improve pulmonary fibrosis post-radiotherapy. One dose daily, decocted. After half a month, symptoms gradually improved. Continued TCM syndrome differentiation treatment alongside routine postoperative chemotherapy. Current condition stable.