The integrated treatment of cancer in Chinese Hospitals (published in Journal of the Register of Chinese Medicine)
Introduction
In September 2006 I spent two weeks in Chinese herbal medicine oncology wards in China. The first week was in Nanjing Hospital of Traditional Chinese Medicine, Oncology Outpatient Department, and the second week was in the Oncology Inpatient Ward of Dong Feng Hospital, Beijing. Overall I observed the treatment of around seventy patients with cancer.
As in the West, patients have the opportunity to receive “conventional” or “western” treatment of their cancer. This includes the full range of scans and blood tests, as well as surgery, radiotherapy and chemotherapy. However, patients also have the opportunity to be referred for Chinese herbal medicine in addition to their western treatment, which many take up.
The first thing I noticed about the Herbal Medicine Oncology Clinic in Nanjing is that the small room is constantly full of people. As well as the Doctor and patient, several other patients waiting their turn would be standing around openly listening to the consultation. Patients listened unselfconsciously to each others stories, sometimes even joining in to the consultations. This arrangement is a marked contrast to the hushed, strictly private oncology consultations seen in the West. Whereas the western approach can leave patients feeling very isolated, the Chinese way seems to offer mutual support to patients, without the need for a formal “support group”. Of course, such an arrangement would not meet current ethical guidelines regarding confidentiality.
The vast majority of the patients I saw had received surgery for their cancer. A slightly lesser number had at least started to receive chemotherapy or radiotherapy. However, a large number of these had been unable or unwilling to complete the course of treatment because of its side effects. Compared to their western counterparts, it seemed that Chinese cancer patients were more likely to listen to their bodies, and less likely to obey the doctor’s advice. Many made the judgement that the medication was making them feel so ill it could not be doing them any good. For many patients, therefore, the herbal medicine was perceived as analternative to a treatment they were unable to take. For many others, the herbal medicine was perceived assupporting the conventional treatment, in some cases allowing them to complete it.
The dosages used are large by European standards, usually between 200 and 300g per day, and most formulae contain between twenty and thirty herbs.
As might be expected, formulae were partially constructed using traditional syndrome differentiation, including tongue and pulse analysis. In addition, certain strategies were employed which were quite specific to the management of cancer. The following analysis is inevitably schematic, but nevertheless provides a framework to analyse the construction of the types of formulae used:
1 Support and tonification
2 Clearing heat toxins and moving blood
3 Treatment of specific cancers using syndrome differentiation
4 Treating the side effects of western medicine
5 Using herbs to attack cancer cells directly
Support and tonification
All doctors stressed this as perhaps the most important aspect of treatment. Because a tumour is in itself an “excess” condition, usually involving phlegm, blood stagnation and toxins, more emphasis on clearing might be expected. However, the doctors placed great emphasis on the need to treat the underlying chronic deficiencies which are nearly always at the root of cancer. The tumour itself is but the branch, while the deficiency is the root.
Several doctors also said that it is Qi deficiency which allows the cancer to metastasize, so we can see how vital Qi tonification is in preventing the spread of cancer. I was reminded that it is a Qi deficiency that allows the accumulation of pathogens.
Another reason tonification is greatly stressed is that often the cancer itself is attacked aggressively by western medicine, tending to damage the Qi and yin in particular. In a sense the western medicine is treating the branch, leaving Chinese medicine to treat the root. Herbal medicine is used to counter the effects of western treatment,
Even where there were no marked signs of spleen Qi deficiency, the main focus was usually on supporting the spleen Qi. Supporting the patient’s Qi is vital to helping them fight the cancer. Rather than tonifying the spleen directly though, the main thrust was to use herbs for food stagnation and secondly, to support the spleen by draining damp. Comparatively small amounts of herbs which tonify the spleen directly were used (see Appendix).
I also found that a great emphasis was on nourishing the yin, which is damaged by the heating effects of radio therapy, and somewhat less emphasis on nourishing the blood (see Appendix). There was very little use of yang tonics, partly because the medication and radiotherapy were often very heating themselves.
An analysis of the formulas showed that herbs to support the spleen comprised over half the herbs used. If one adds yin and blood tonics to this, this accounts for around 60 – 70% of the herbs used.
2 Clearing heat toxins and moving blood
The use of too many harsh, clearing and moving herbs tends to counteract tonification and so relatively few herbs were used from these categories.. However, the use of Bai Hua She She Cao (fruit and leaves ofHedyotis diffusa) was fairly universal, as was E Zhu (rhimoze of Curcuma phaecoaulis). The latter was commonly fed intravenously to in – patients. These two herbs are particularly renowned in China for their anti cancer properties (see below). The dosage of Huang Lian (rhizome of Coptis chinensis) was surprisingly small by Chinese standards, sometimes only 3g, reflecting the emphasis on avoiding large doses of harsh herbs in the treatment of cancer. In the oncology departments I visited, herbs from this category formed only around 10 – 15% of herbs used.
Treatment of specific cancers using syndrome differentiation
In addition to the general approach to the management of cancer, there are quite specific differentiations of each type of cancer, and it is obviously vital to treat the correct pattern. For example, in the treatment of stomach cancer, common patterns identified include liver attacking stomach, stomach and spleen deficiency cold, stomach heat damaging yin, phlegm cold, and Qi and blood deficiency
Breast cancer: Common patterns include liver Qi stagnation, spleen Qi deficiency leading to damp/ phlegm, kidney and liver deficiency, blood stasis and toxins, and Qi and blood deficiency.
Case history 1
A woman, aged 64, had been diagnosed with breast cancer three years ago. She had undergone surgery, a large amount of radiotherapy, and a small dose of chemotherapy. This had cleared the cancer. However, following the treatment, she had suffered from disturbed sleep, waking every night feeling very hot. It was surmised that the radiotherapy had caused Yin deficiency, particularly of the kidneys and heart. The emotional stress of having the cancer had no doubt contributed to this process. The fear which very often accompanies the diagnosis of cancer often contributes to kidney deficiency.
Her tongue was red, with no coat, and generally very cracked all over. Her pulse was weak, especially in the kidney positions.
It was suggested that the main cause of this cancer was derived from spleen Qi deficiency leading to phlegm forming in the breast.
Treatment principle: nourish Yin, especially of the kidneys and heart, and clear empty heat, clear phlegm and support the spleen.
In treating this patient the herbs selected were to nourish yin and clear empty heat, and, to support the spleen and clear phlegm. Herbs to support treatment were also included (see Appendix).
Outcome: There had been no recurrence of the cancer, and the patient had found the herbs helped her to feel more relaxed and to sleep better.
Colon Cancer: Usefully, two patterns can be frequently distinguished; predominance of spleen Qi deficiency with the build up of damp heat as a secondary factor.
Case history 2
Colon cancer: A 55 year old man was diagnosed with colon cancer three years ago, and had an operation which removed the tumour. He had decided not to take western medicine, and had been taking herbs for the last three years. He had a history of constipation, and tended to feel over hot.
His tongue had a dirty yellow coat in the middle and rear, and the tongue was generally cracked. The pulse was slightly rapid, of moderate strength, and otherwise unremarkable.
The main diagnosis was heat toxins in the lower jiao, including the colon. It was suggested that a primary cause of this had been the inability of the spleen to transform food properly, leading to food stagnation and toxic build up. There was also yin deficiency, which may have been caused by the heat toxins.
Treatment principles: clear heat toxins, support the spleen Qi and remove food stagnation, and nourish yin. As one can see from the following formula, the primary emphasis was on supporting the spleen and nourishing yin (see Appendix).
Outcome: The patient reported that the herbs had greatly reduced the symptoms of heat. He was generally feeling very well, and certainly looked well. His constipation was under control.
Lung cancer: Patterns commonly identified include Qi deficiency of the lungs and spleen, heat toxins and lung yin deficiency, phlegm/ damp in the lungs, Qi stagnation and blood stagnation in the upper jiao, and Lung and kidney deficiency.
Case history 3:
A 51 year old man contracted lung cancer eight years ago. He had undergone an operation, and received four doses of chemotherapy. He often complained of feeling very tired and overheated, and had taken herbs on and off since the operation, when his symptoms were bad.
His tongue was red and dry, with lung cracks. It was yellow and greasy at the rear. The pulse was thin and wiry.
The diagnosis was lung Qi and yin deficiency, damp and phlegm, and Qi and blood stasis.
Treatment principles: tonify the lung Qi and Yin, clear damp and phlegm, and move Qi and blood.
Outcome: The patient continued to feel well, and reported much improved energy levels.
Treating the side effects of western medicine
Herbal medicine plays a crucial role in this respect.
Where a patient suffers from nausea and vomiting, patterns commonly identified are spleen Qi deficiency, phlegm, Qi stagnation. Particular consideration to Food stagnation herbs was (see Appendix). Where a patient also presented with fatigue, other herbs such as Huang Qi and Tai Zi Shen were also considered. The latter is often used in the management of cancer because of its gentle nature.
Renal function impairment may often lead to oedema from kidney Yang deficiency, blood in the urine (due to heat in the blood) and renal atrophy and failure (the collapse of Yang). One study divided a group of 86 patients undergoing chemotherapy into two equal groups, only one of which received Chinese herbs. Only the group receiving the herbs demonstrated a maintained renal function (measured as no significant change in levels of blood urea nitrogen and creatinine, see Li Peiwen, p123). Useful herbs were identified as Huo Xiang (stem & leaf of Agastache rugosa), Ze Xie (rhizome of Alismataceaa), Zhu ling (Polyporus umbellatus), Yi Yi Ren (seeds of Coix lacryma-jobi), Yi Mu Cao (Leonurus heterophyllus) and Kun Bu (Ecklonia kurome).
Often chemotherapy can affect the liver function, causing raised liver enzymes. Patterns such as liver Qi stagnation, damp heat in the liver and liver blood deficiency are often present. Xiao Chai Hu Tang (Modified minor bupleurum decoction) is generally used as the base formula.
A further common side effect is lowered blood cell count. Where this side effect is present, pattern differentiation frequently identifies deficiency of spleen and heart blood, spleen and kidney Yang deficiency, and liver blood and kidney Yin deficiency. Usually Gui Pi Tang modified by the inclusion of Yuan Zhi (root ofPolygala tenuifolia) and E Jiao (gelatine from the hide of Equus astinus) is administered to strengthen spleen and heart blood, whilst in the treatment of liver blood and kidney yin deficiency Liu Wei Di Huang Wan is modified, to include herbs such as Dang Gui, Bai Shao Yao, Tu Si Zi, Nu Zhen Zi and Ji Xue Teng (root and vine of Spatholobus suberectus). Spleen and kidney yang deficiency was often treated with modified You Gui Wan which included Gou Qi Zi, Du Zhong (bark of Eucommia ulmoides), Bu Gu Zi (fruit of Psoralea corylifolia), Dang Gui and Huang Qi.
5 Using herbs to attack cancer cells directly
In addition to using herbs which manage the side effects of conventional treatment, herbs are often selected on their apparent capacity to attack the cancer directly. Ever more research is being conducted on the anti cancer effects of Chinese herbs, and we have space to mention only a few herbs in this regard:
Yi Yi Ren: compounds in the plant have been found to inhibit the growth of tumour cells, and to increase the expression of genes FAS and Apo 1, which help inhibit the growth of tumour cells. The herb has been synthesised into a drug called Kanglaite, which has received FDA approval for a stage II trial in the USA.
Huang Qi: A combined analysis of 34 studies suggests that Huang Qi may increase the life expectancy and effectiveness of platinum-based chemotherapy regimens for advanced non-small cell lung cancer (NSCLC)
Bai Hua She She Cao (fruit and leaves of Hedyotis diffusa): this herb has undergone extensive clinical and laboratory tests. Ursolic acid isolated from the plant has shown an inhibitory effect against lung cancer, by triggering apoptosis (the “suicide” of cancer cells) through inhibition of their DNA synthesis. Other studies show that the plant enhances the activity of the body’s T -lymphocyte cells, which attack cancer cells
E Zhu: this herb is sometimes given intravenously to cancer in-patients. Several clinical studies and laboratory tests have suggested it has an inhibitory effect on cancer cell growth. Please note that several laboratory studies suggest that this herb may decrease the effectiveness of some kinds of chemotherapy, and it is therefore recommended that the herb is not used while the patient is undergoing chemotherapy.
Conclusion
In Chinese hospitals herbs play an integral part of the management of cancer. As well as treating the side effects and improving the quality of life, herbs are used to maintain the patient’s overall sense of well being and energy. Herbs are also used to try and attack the cancer directly, and thereby to strive to increase the life span of the patient.
References and Notes
Chen and Chen: Chinese Medical Herbology and Pharmacology, Art of Medicine Press, 2001
Li Peiwen: The Management of Cancer with Chinese Medicine, Donica, 2003
* indicates herbs unavailable in the UK
About the author
Henry McGrath has been practising Chinese medicine for over ten years. He runs his own clinic in Bristol, and also works at Penny Brohn Cancer Care (formerly the Bristol Cancer Help Centre). He is the acupuncture course leader at the College of Naturopathic Medicine, and has also taught Chinese medicine at other colleges and universities. He is the author of “The TCM Workbook”, an introduction to Chinese medicine theory.
henry_mcgrath@blueyonder.co.uk
December 2006
Appendix
Food stagnation herbs included Gu Ya (sprout of Setaria [Oryzae]), Mai Ya (sprout of Hordeum vulgare), Shen Qu (fermented product of different herbs) and Shan Zha (fruit of Crataegus pinnatifida).
Draining damp herbs included Yi Yi Ren (seeds of Coix lacryma-jobi), Fu Ling (sclerotium of Poria cocos) and Ze Xie (rhizome of Alismataceaa).
Herbs selected which supported the spleen included Huang Qi (root of Astragalus membranaceus), Bai Zhu (rhizome of Atractylodis macrocephala), Gan Cao (root of Glycyrrhiza uralensis) and Tai Zi Shen (root of Pseudostellaria heterophylla). The latter is a particular favourite because of its mild nature, and its property of tonifying yin as well as Qi.
Nourishing Yin herbs included Nan Sha Shen (root of Adenophora tetraphylla), Bei Sha Shen (root of Glehnia littoralis), Tian Men Dong (tuber of Asparagus cohinchinesis), Mai Men Dong (tuber of Ophiopogon japonicus) and Nu Zhen Zi (fruit of Ligustrum lucidum), depending on which organs had been most effected. Where blood was also nourished, Gou Qi Zi (fruit of Lycium barbarum) and Bai Shao Yao (root of Paeonia lactiflora) were particularly favoured (both of which nourish yin as well as blood).
Stomach cancer: Herbs which were used in the treatment of stomach cancer include Tao Ren (kernel of Prunus persica), Hong Hua(flower of Carthamus tinctorius), Dang Gui (root of Angelica sinensis), Bai Shao Yao (root ofPaeonia lactiflora), Sheng Di Huang (root of Rehmannia glutinosa), Yu Jin (tuber of Curcuma wenyujin), Wu ling zhi (feces of Trogopteroris xanthippes)*.
The treatment of Breast cancer
Herbs which have been found particularly useful in the treatment of breast cancer include Feng fang (wasp nest of Polistes olivaceus)*, Huang Qi (root of Astragalus membranaceus), Yan hu suo (rhizome of Corydalis) and Fu Ling (sclerotium of Poria cocos).
Case History 1
Herbs to nourish yin and clear empty heat:
Zhi Mu (rhizome Anemarrhena aspheloides) 10
Huang Bai (bark of Phellodendron chinense) 10
Sheng Di Huang (root of Rehmannia glutinosa) 10
Shu Di Huang (prepared root of Rehmannia glutinosa) 10
Nu Zhen Zi (fruit of Ligustrum lucidum) 10
Mo Han Lian (Eclipta prostrata) 15
Sang Ji Sheng (stems of Taxillus chinensis) 10
Suan Zao Ren (seeds of Ziziphus spinosa) 20
Herbs to support the spleen and clear phlegm:
Fu Ling (sclerotium of Poria cocos) 15
Ze Xie (rhizome of Alismataceaa) 15
Yi Yi Ren (seeds of Coix lacryma-jobi) 20
Zhi Ke (fruit of Citrus aurantium) 10
Chen Pi (aged peel of Citrus reticulate) 6
Zhi Ban Xia (rhizome of Pinelliae ternate) 10
Shan Zha (fruit of Crataegus pinnatifida) 10
Zhi Gan Cao (honey-seared root of Glycyrrhiza uralensis) 5
Supporting herbs: 3g of Huang Lian (rhizome of Coptis chinensis) to clear heat toxins from the upper jiao, 6g of Chai Hu (root of Bupleurum chinense) to move qi in the upper jiao, 10g of Tu Si Zi (seeds of Cuscata chinensis) to support the kidneys, 10g of Chuan Niu Xi (root of Sichuan Cyathula officinalis) to move the blood, clear heat and damp, and 10g of Huai Niu Xi (root of Huai Cyathula officinalis) to tonify the kidneys and liver.
The total daily dose was 225g.
The Treatment of colon cancer
Case History 2
To support the spleen Qi and remove food stagnation:
Shen Qu (fermented product of different herbs) 10
Lai fu zi (seed of Raphanus sativus) 10
Mai Ya (sprout of Hordeum vulgare) 10
Gu ya (sprout of Setaria [Oryzae]) 10
Ji nei jin (gizzard lining of Gallus gallus domesticus)* 10
Hou Po (bark of Magnolia officinalis) 10
Yu li ren (pit of Prunus japonica) 15
Tai Zi Shen (root of Pseudostellaria heterophylla) 10
Gan Cao (root of Glycyrrhiza uralensis) 3
To nourish yin and clear heat:
Sheng Di Huang (root of Rehmannia glutinosa) 20
Bai Shao Yao (root of Paeonia lactiflora) 30
Di gu pi (bark of the root of Lycium chinense) 15
To clear heat toxins:
Xuan shen (root of Scrophularia ningpoensis) 10
Bai Hua She She Cao (fruit and leaves of Hedyotis diffusa) 10
Feng fang (wasp nest of Polistes olivaceus) 10 *
Shi gao (gypsum: Crystalline gypsum) 30
Total daily dose: 213g
A typical formula used comprises Cang Zhu (rhizome of Atractylodes lancea), Hou Po (bark of Magnolia officinalis), Chen Pi (aged peel of Citrus reticulate), Gan Cao (root of Glycyrrhiza uralensis), Da Zao (fruit ofZizphus jujuba), Gui Zhi (twig of Cinnamomum cassia), Bai Zhu (rhizome of Atractylodes macrocephala), Ze Xie (rhizome of Alismataceaa), Fu Ling (sclerotium of Poria cocos) and Zhu ling (Polyporus umbellatus).
In addition, for a predomination of heat toxins, typical base formulae are used were:
| Huang Lian Jie Du Tang | Si miao san |
| Zhi Zi (fruit of Gardenia jasminoides) Huang bai (bark of Phellodendron chinense) Huang Qin (root of Scutellaria baicalensis) Huang Lian (rhizome of Coptis chinensis) |
Huang bai (bark of Phellodendron chinense) Cang Zhu (rhizome of Atractylodes lancea) Niu Xi (root of Achyranthes bidentata) Yi Yi Ren (seeds of Coix lacryma-jobi) |
With these kinds of formulae, many tonics would be used to balance their clearing effects.
The treatment of lung cancer
The herbs used to treat lung cancer included Bai Hua She She Cao (fruit and leaves of Hedyotis diffusa), Tian Men Dong (tuber of Asparagus cohinchinesis), Mai Men Dong (tuber of Ophiopogon japonicus), Wu wei zi (fruit of Schisandra chinensis), Zhi bei mu (bulb of Fritillaria thunbergii), Yu xing cao (Houttuynia cordata), and Sang Bai Pi (bark of the root of Morus alba)
Case history 3:
To tonify lung yin and clear heat:
Yu zhu (rhizome of Atractylodes macrocephala) 10
(geographical variant of Bai zhu (rhizome of Atractylodes macrocephala) from Lin an)
Di gu pi (bark of the root of Lycium chinense) 10
Bei Sha Shen (root of Glehnia littoralis) 20
Mai Men Dong (tuber of Ophiopogon japonicus) 12
Sheng Di Huang (root of Rehmannia glutinosa) 12
To tonify Qi, especially lungs:
Pei Lan (Eupatorium fortunei) 10
Tai Zi Shen (root of Pseudostellaria heterophylla) 15
Huang Qi (root of Astragalus membranaceus) 30
Shan Yao (rhizome of Dioscoreacea opposita) 10
Total grams 129
To clear damp and phlegm:
Jie Geng (root of Platycodon grandiflorum) 10
Gua Lou Pi (peel of Trichosanthes kirilowii) 20
Zhi bei mu (bulb of Fritillaria thunbergii) 10
Fu Ling (sclerotium of Poria cocos) 10
Zhu ling (Polyporus umbellatus) 10
Huang bai (bark of Phellodendron chinense) 10
Total grams 70
To move blood and Qi:
Tao Ren (kernel of Prunus persica) 10
Xing ren (kernel of Prunus armeniaca) 10
Chi Shao Yao (root of Paeonia lactiflora) 10
To clear toxins:
Bai Hua She She Cao (fruit and leaves of Hedyotis diffusa) 15
Total daily dose: 244g
As can be seen, great emphasis is placed on supporting Qi and Yin, while much less emphasis on moving blood and clearing toxins: