Presentation summary

Introduction :
Mr. Tsai, a 49-year-old male, was diagnosed in March 2024 with squamous cell carcinoma of the buccalmucosa. He underwent wide excision, partial maxillectomy, marginal mandibulectomy, left MRND, and left ALT free flap on April 3, followed by adjuvant CCRT from May 3 to June 25. Two weeks after radiotherapy, hedeveloped progressive xerostomia, persisting after treatment completion. He reported absence of saliva,severe oral dryness unrelieved by water, and difficulty swallowing solids, tolerating only liquid supplements, fish soup, or beef broth. Even congee was intolerable, leading to poor appetite, nocturia, and disturbed sleep. At presentation on August 27, he was using chlorhexidine mouthwash and pilocarpine without benefit. Hisxerostomia was scored VAS 8, CTCAE grade 2.

Methods :
According to TCM four diagnostic methods, the patient was classified as Heart Qi and Yin-Yang deficiency with blood stasis and heat. He received acupuncture at salivation-promoting points plus herbal medicine formulated to tonify Heart Qi, replenish Yin-Yang, resolve stasis, and clear heat.

Results :
After two weeks, salivary secretion increased, and xerostomia symptoms eased. By week three, improvement reached 60–70%, enabling tolerance of semi-solid foods such as minced meat porridge and tofu soup, withbetter appetite. After two months, he could consume some dry foods with water. Xerostomia discomfort declined to VAS 3, and CTCAE grading improved to grade 1.

Conclusion :
For this case of severe post-radiation xerostomia, integrative TCM therapy combining acupuncture and herbal medicine produced progressive symptomatic relief, reducing discomfort from VAS 8 to VAS 3 and improving CTCAE grading from 2 to 1. These findings suggest that TCM interventions may represent an effective optionfor alleviating radiation-induced xerostomia.