Hi Cathy,
I've not had much personal success with high grade oral melanoma, although low grade can often be managed well as you've done here. For those, modified XFZYT and XCHT or sometimes SMS instead if Damp Heat Patient, have offered me the most success.
Have you noted a change in the tongue and pulse, or other TCM signs? You you have a sense of what dynamic if manifesting in the patient right now....Damp, Blood deficiency? You are seeing Heat (or some Damp), motivating your addition of Tian Hua Fen and stopping Gui Zhi???
I don't have that much to contribute by way of specific recommendations based on what you've presented here. But I can offer what I've unearthed through a recent pub med search on TCM herb activity in melanoma and maybe between your assessment and Steve's thoughts it may be helpful.The following have shown activity in melanoma. Many of these you've already incorporated. The one's you haven't (Huang Qi and Wu Wei Zi) are a little warming, so maybe not best if you are seeing a lot of heat?
Some things to consider:
I've had some success with patients relapsing after a good long term responses by just increasing the dose and frequency if they still fit the TCM picture. Dosage and time of exposure are both important factors in controlling tumor growth in the laboratory studies that are out there.
Also, FWIW, the Natural Path granulars have been more effective for aggressive cases in my hands than tablets or even some of the other granulars, likely because they are more potent with no filler. So you might consider that depending on what you are currently using for this patient. I have clients compound into capsules if they can't give the granular as a power form.
Schizandra (Wu Wei Zi)- sour and warm
Scutellaria (Huang Qin) - already in XCHT
Salvia (Dan Shen) - sweet and neutral; you should be able to add this to either formula you have now
Angelica (Dang Gui) - already in XFZYT but could add more if you have blood deficiency signs
Astragalus (Huang Qi) - sweet and warm
Bupleurum (Chai Hu) - already in both XFZYT and XCHT
Cinnamon (Gui Zhi) - pungent, sweet, warm
Erin