Chinese Medicine Times Article<\/p>\n
Henry McGrath<\/p>\n
Contents<\/p>\n
Introduction<\/strong><\/p>\n 1 Managing the Side Effects of Conventional Treatment<\/strong><\/p>\n A chemotherapy<\/a><\/span><\/p>\n i the energetic effects of chemotherapy B radiotherapy<\/a><\/span><\/p>\n i the energetic effects of radiotherapy C surgery<\/a><\/span><\/p>\n i general points to move the blood 2 Addressing the underlying patterns of Cancer<\/strong><\/p>\n A shi (excess) factors<\/a><\/span><\/p>\n i toxic heat B xu (deficiency) factors<\/a><\/span><\/p>\n i qi xu C treating the channel<\/a><\/span><\/p>\n D some common patterns seen in breast cancer<\/a><\/span><\/p>\n i kidney yang deficiency Case History<\/strong><\/p>\n Conclusion<\/strong><\/p>\n About the author<\/strong><\/p>\n *<\/p>\n In TCM hospitals in China, herbs are considered the treatment of choice with cancer patients (see my other articles ). However, in the West not all cancer patients are able or willing to take Chinese herbs, for reasons such as these:<\/p>\n For all these reasons it is important that acupuncture is offered to those with cancer, because a huge amount can be done with acupuncture to support those with cancer. This article will discuss what acupuncture can realistically achieve.<\/p>\n We will look at two distinct areas:<\/p>\n 1 managing the side effects of conventional treatment (chemotherapy, radiotherapy and surgery) Acupuncture treatment usually involves working with both aspects. During conventional treatment, one often has to focus on dealing with its side effects. When this treatment is finished, one can begin to focus more on treating the underlying patterns which led to the cancer developing, in order to help the patient back to full health, and to lessen the chance of recurrence.Contra-indications and cautions<\/strong><\/p>\n I have heard it said by several people that people with cancer should not receive acupuncture, as it can “spread the cancer”. There is, as far as I can tell from a fairly extensive literature search, conversations with others, and many years of experience, absolutely no grounds for such an assertion. In my experience, cancer is far more likely to metastasise (spread) when the patient’s overall health deteriorates. If we can give regular, sustained, long term acupuncture, the effects are invariably positive.<\/p>\n Sometimes breast cancer spreads to the underarm lymph tissue, and lymph nodes are removed in this area (indeed they are often removed for cautionary reasons, & to examine the tissue for signs that cancer may have spread). In these cases most consultants will instruct the patient not to receive any needles in the arm on the affected side, in case of infection. Opinion varies as to how long this prohibition stands, so one needs to receive approval from the consultant before needling in this arm.<\/p>\n Opinion also varies about needling around areas of scars following surgery. If in any doubt, one must seek the approval of the consultant.<\/p>\n <\/a><\/p>\n Introduction<\/strong><\/p>\n There are many different kinds of chemotherapy. It can be administered in various ways: a typical protocol is one intravenous dose every three weeks, for six doses. Sometimes chemotherapy is used to try and shrink a tumour, to make it easier to remove by surgery later. Sometimes, surgery is used to take out the tumour first, then chemotherapy is used afterwards, just in case cancer cells have spread around the body. Sometimes chemotherapy is used in “terminal” cases, in order to try and slow down the growth of the tumour and prolong life as much as possible.<\/p>\n Often chemotherapy requires the use of other supporting drugs to attempt to neutralise its side effects: many patients are on a huge cocktail of medications. This makes many herbalists nervous about prescribing herbs in case of interactions: the beauty of acupuncture is that it does not interact with drugs as herbs do.<\/p>\n The chemotherapy drugs which are used to kill cancer cells are highly toxic to normal cells too. They affect particularly those cells which have a rapid turnover, such as hair cells, red blood cells, immune cells, and epithelial cells. The latter line the digestive tract, which explains why chemotherapy can induce severe nausea. If we think of soft mucosa as yin tissue, it is easy to see why chemotherapy can cause yin xu. This is reflected in the fact that many patients receiving chemotherapy develop a peeled tongue very quickly. Sometimes the peeling will heal itself, and sometimes it will not.<\/p>\n In terms of TCM, chemotherapy causes toxic heat. This heat destroys the yin, and can also dry the blood. By affecting the spleen, it can also cause qi xu.<\/p>\n Some patients are unable to complete their course of chemotherapy due to its high level of toxicity. Chemotherapy can even prove fatal in some cases. Acupuncture can sometimes help patients complete their course of chemotherapy, which they may otherwise have not been able to do. It can certainly help them to cope with the often severe effects of chemotherapy.<\/p>\n The destruction of digestive epithelial cells we can think of as causing spleen qi xu. In fact, the old category of “spleen yin xu”, which is rarely used now, is very relevant here. It is vital to treat the spleen, because if the spleen is weak the patient cannot generate enough qi to recover. Most cancers involve some degree of spleen qi xu to begin with, making this a crucial area to support.<\/p>\n The weakening of the spleen causes food stagnation. This can result in nausea, constipation, or diarrhoea. Acupuncture is generally quite effective at treating nausea: the Cochrane Collaboration has undertaken a systematic review of acupuncture for nausea, and found electro-acupuncture to be the most effective treatment. If treatment is started early, before the spleen becomes too weak, it can be very effective. If the spleen is already weakened by chemo, acupuncture is less effective at treating nausea, constipation and loose stools. If there is little improvement after five treatments, herb should be considered, although it may be necessary to wait until chemo therapy is over.<\/p>\n 1 Nausea:<\/strong> PC6 – PC7 (electro) ST36 – ST37 (electro) SP6 Ren12 Ren6 UB20 UB21 ST44 (nourish SP & ST yin)<\/p>\n In addition, choose points depending on the TCM pattern:<\/p>\n Liver invading spleen\/ stomach<\/strong><\/p>\n P: wiry Nausea worse with stress LV3 LV13 UB18<\/p>\n Spleen qi xu<\/strong><\/p>\n P: weak Nausea tends to be more constant, but not so severe 2 Constipation:<\/strong> GB34 SJ6 ST25 Ren6 LI4<\/p>\n 3 Diarrhoea:<\/strong> KD16 Ren6 ST36 SP6<\/p>\n If toxic heat is predominant (smelly, explosive stools, P: wiry\/ T: red): add LI11 to clear heat.<\/p>\n If the predominant pattern is spleen not holding (P: weak\/ T: pale & swollen): use moxa<\/p>\n Chemotherapy kills the white blood cells which provide immunity. Often this effect is so pronounced that the chemotherapy has to be stopped, otherwise the patient’s life can be endangered. Studies undertaken in the US, Japan and elsewhere show that acupuncture can help to maintain and restore the white blood cell count. Blood samples have been taken before and after acupuncture, and it has been shown that higher levels of certain immune cells exist in the blood after acupuncture.<\/p>\n In terms of TCM, we can say that chemotherapy harms the lung “wei qi” (defensive qi). In such cases it is important to strengthen the lungs. It is also important to boost the spleen and kidneys, as these contribute to the strength of the wei qi. If white blood cells counts are very low, treatment should be given twice or even three times per week until they return to normal. It is important to remember that a severely weakened immune system is a potentially life threatening situation.<\/p>\n Basic treatment protocol:<\/strong><\/p>\n ST36 (moxa) LG9 LI4 UB13<\/p>\n If spleen weak, add: Ren 6 SP3 SP6 UB20 UB21<\/p>\n If kidneys weak, add: Ren 4 KD3 KD7 UB23<\/p>\n Common contributory factors in the development of many cancers are liver qi stagnation and toxic heat in the liver. These imbalances are exacerbated by chemotherapy, which can have a very damaging effect on liver function. During chemo it is common to see red spots appearing on the side of the tongue, indicating that liver heat is developing. If the heat is severe the tongue coat can start to become yellow or even brown. This heat can transform into liver blood stasis, and the tongue starts to appear purple. In such cases it is vital to support the liver during chemotherapy. A diagnosis of cancer, as well as the whole process of orthodox treatment, can cause huge stress, so for this reason too it is vital to soothe the liver. I have found acupuncture to be effective in supporting liver function when it starts early in the process of chemotherapy, preferably several weeks before the chemo is administered. Once the patient has received several doses of chemo, it is much harder to recover function and herbs are usually required.<\/p>\n Toxic heat in the liver<\/strong><\/p>\n T: red sides\/ maybe dirty yellow or brown coat LV5 LV3 UB18 LI11<\/p>\n Cupping is recommended, to draw out the toxins<\/p>\n Liver blood stagnation<\/strong><\/p>\n T: reddish-purple LV8 LV3 UB17 UB18<\/p>\n Chemo commonly kills nerve cells, resulting in numbness\/ tingling\/ pain in the hands and feet. In TCM terms, this can correspond to blood deficiency. Even where there are no other signs of blood deficiency one should still select points to nourish the blood. Acupuncture can be surprisingly effective at treating the symptoms of neuralgia. However, treatment is often ongoing for many months. Ear acupuncture points can enhance the effectiveness considerably. Again, the earlier in the process the treatment starts, the more effective it will be.<\/p>\n Points for blood xu: LV8 LV3 UB17 UB18 UB20 UB21 ST36<\/p>\n For the hands use: ba xie; finger tips; PC7; PC8; relevant auricular acupuncture hand points (see Oleson p275 for example )<\/p>\n For the feet use: ba feng; relevant auricular acupuncture feet points (see Oleson p275 for example)<\/p>\n <\/a><\/p>\n Radiotherapy can be thought of as toxic heat. It can cause severe reddening of the skin and even burns. It has a very heating, drying effect. In TCM terms, it damages yin, body fluids and blood. It can cause heat in the blood. This can interrupt the smooth flow of the blood, causing blood stagnation.<\/p>\n It can cause genetic mutation of normal cells, and in fact can cause cancer itself. In TCM terms, the kidneys are responsible for growth and reproduction, and this can includes the cellular level. Radiotherapy can therefore be said to deplete the kidneys, especially their yin aspect.<\/p>\n Rather than presenting a detailed discussion of the various diseases which can be caused by radiotherapy, which are far too numerous to mention, it is more helpful to present the energetic patterns which one commonly sees, and general treatment principles. Following that, we shall briefly discuss only two common problems, erythema (skin reddening) and lack of salivation (xerostomia).<\/p>\n Obviously, one must make a proper TCM diagnosis, to see which particular patterns need addressing. Usually radiotherapy will have a profound effect on the tongue and pulse, and diagnosis is therefore relatively easy.<\/p>\n Clear toxic heat and cool the blood<\/strong><\/p>\n LI11 SP10 UB17 UB18 LV3; slide cupping along the back shu points<\/p>\n Clear heat from the heart & calm the shen<\/strong><\/p>\n Often the heat from radiotherapy will overheat the heart. This may affect the shen, causing insomnia, agitation and anxiety. This will worsen the already traumatic emotions resulting from a cancer diagnosis.<\/p>\n PC6 PC7 HT7 UB15<\/p>\n Invigorate the blood<\/strong><\/p>\n It is crucial to keep the blood moving, in order to prevent any further development or relapse of the cancer.<\/p>\n UB17 UB18 LV8 LV3 LI4 SP10 HT5<\/p>\n Nourish yin (liver, kidney and heart)<\/strong><\/p>\n The yin is often severely depleted by radiotherapy, and one often sees a peeled tongue in such cases. The yin has a nourishing function, so it is vital to support it during radiotherapy and beyond. One must identify which organs have been most affected, and treat accordingly.<\/p>\n LV3 KD6 HT7 SP6 UB15 UB18 UB23 Ren 6<\/p>\n This is a manifestation of the patient overheating due to the radiotherapy. It can cause considerable distress and discomfort, as well as severe itching and pain. One can distinguish between the shi pattern of heat in the blood, and the xu pattern of liver\/ kidney yin deficiency.<\/p>\n Heat in the blood<\/strong><\/p>\n SP6 SP10 UB17 UB18 LI11<\/p>\n Liver\/ kidney yin deficiency<\/strong><\/p>\n KD6 SP6 LV3 UB17 UB18 UB23 LI11 Ren6<\/p>\n Radiotherapy is commonly used where the tumour is near the surface of the body, and therefore accessible. It is therefore often used in head and neck cancers.<\/p>\n One unfortunate effect is that it kills all or part of the salivary glands. This can be very debilitating, with patients often unable to eat properly. Many have to carry around a bottle of water at all times otherwise their mouth becomes unbearably dry. I have treated people who have to sip water every half hour, which means they are awake for much of the night. This can lead to total exhaustion.<\/p>\n A protocol has been developed which is effective at treating this condition. Studies show that around 70% of people respond positively to the treatment , and this has been my experience too. Several hospitals in the South West of England (Torbay, Plymouth & Exeter) are now using this protocol with cancer patients with this condition, and also reporting good results.<\/p>\n Xerostomia protocol:<\/i><\/p>\n Ear points: shen men; point 0; salivary point (located at the inter-tragic notch)<\/p>\n Extra point on large intestine channel, on the radial aspect of the distal inter-phalangeal joint of the index finger<\/p>\n <\/a><\/p>\n Introduction<\/strong><\/p>\n This can lead to blood stagnation in the area where the surgery was performed. Often the cancer developed because of blood stagnation, so it is vital to treat this aspect. It is particularly important to address if major meridians have been cut by the surgery.<\/p>\n I have found that patients who receive a course of acupuncture before surgery tend to have few complications, and recover quickly. After the surgery, one should continue to ensure that no blood stasis develops.<\/p>\n In most cases this should be done as a preventative measure before surgery:<\/p>\n UB17 UB18 SP10 LV8<\/p>\n Following surgery it is important to keep qi flowing in the area. Scar tissue is a block to smooth qi flow, so acupuncture should be used to address this. Needles are placed in a circle around the scar, facing inwards. They should be about 3cm away from the scar, and 3cm away from each other.<\/p>\n If a meridian has been cut, a needle should be placed on the meridian, either side of the scar, about 3cm away from the scar.<\/p>\n One should check with the consultant that they are happy for scar needling to take place, as some are concerned about possible infection. It is obviously especially important to follow correct sterile needling procedures in any case.<\/p>\n Needling can generally be done within a few days of surgery, generally the earlier the better.<\/p>\n A day or two before surgery, a plaster is soaked in capsicum (chilli pepper) tincture and placed on ST36. One South Korean blind controlled trial found that patients who had such plasters needed less morphine and anti nausea drugs following surgery.<\/p>\n As with any disorder, various TCM patterns can be identified for each type of cancer, so an accurate diagnosis is essential. However, it is particularly important to address the factors listed below. In addition, one must try to identify which meridian the cancer is on, and clear the channel. We will look in more detail at breast cancer, but the principles are similar for any cancer.<\/p>\n Emotional factors are often important. One should pay particular attention to treating this aspect, using the seven emotions, and the five elements correspondences.<\/p>\n <\/a><\/p>\n In modern terms this can correspond to a high level of chemicals, environmental pollutants, oestrogen in the water supply and in meat, and food toxins such as refined food and saturated fats. The presence of such toxins may cause genetic mutations, thus contributing to cancer. It is vital to clear these toxins to allow the body to recover, and prevent recurrence of cancer.<\/p>\n One of the best ways to clear toxins is by slide cupping along the bladder channel on the back, covering all the back shu points. In addition one can needle LI11 LI4 & LV5.<\/p>\n This is a major contributory factor with many cancers. It can correspond to platelet aggregation, and impairment of the micro-circulation. This prevents cells releasing toxins, and also prevents them taking in adequate nutrients and oxygen, thus contributing towards the development of cancer. One should use standard points to move blood:<\/p>\n SP10 PC7 UB17 UB18 LV3 LV8<\/p>\n The accumulation of phlegm contributes to many cancers. If this is caused by a weak digestion (spleen), then tonification is also necessary. One can use:<\/p>\n PC5 (indicated for phlegm in the upper body) ST36 SP6 SP9 ST40 UB20 UB21<\/p>\n <\/a><\/p>\n Cancer is often considered to be a disease of excess, and indeed the tumour itself is an excess by definition. However, there is always underlying deficiency too. It is therefore vital to apply appropriate tonification.<\/p>\n Many, perhaps most, cancers develop against a background of exhaustion, implying qi xu. I have seen numerous cases of people who developed cancer after prolonged periods of overwork and lack of proper rest. It is vital to educate people that overwork may have contributed to the development of their cancer, and that they must learn to slow down and take proper rest. Some kind of spiritual practice is very helpful to allow the person to “switch off” from everyday concerns, and find some kind of peace.<\/p>\n Spleen qi deficiency can lead to the accumulation of phlegm based cancers. This corresponds to the digestive system not extracting nutrients properly, and waste products being stored in the cells. Over time, phlegm can block the flow of qi, causing stagnation and toxic heat to accumulate.<\/p>\n The kidneys are responsible for growth and reproduction, and this can be thought of on a cellular level. If there is deficiency of the kidneys, the cells cannot reproduce accurately, and mutation occurs.<\/p>\n It is important to identify the most qi deficient organ, which is usually either the spleen or the kidneys.<\/p>\n This pattern is often involved in cancers of the upper body, such as lung, head and neck. Yin has a nourishing, moistening function, and when it is weak the tissues become irritated, dry, and inflamed.<\/p>\n Key points to nourish the yin include:<\/p>\n SP6 LG6 KD6 Ren6<\/p>\n It is important to identify the cause of the blood xu: is it inadequate nutrients in the diet, or spleen qi deficiency? Unless proper nutrients are taken in, one cannot properly tonify the blood. In the absence of herbs, diet is therefore crucial. My book provides lists of key foods to strengthen the blood.<\/p>\n Blood deficiency can lead to blood stagnation, a common pattern in many cancers.<\/p>\n Key points to nourish the blood include:<\/p>\n UB17 UB18 UB20 UB21 SP10 LV8<\/p>\n <\/a><\/p>\n As well as identifying which organs are involved, one must identify the channel affected. It is a question of looking at the site of the cancer and seeing which channel it is on. Obviously this is much easier for cancers near the surface, such a breast cancer. In some cases it is obvious by the type of cancer, for example lung and liver cancers involve the lung and liver respectively.<\/p>\n Channels commonly affected in breast cancer include the stomach, liver, and spleen.<\/p>\n Channels commonly affected in cancers of the head and neck include the kidney and stomach.<\/p>\n Points should be selected which clear the appropriate channel.<\/p>\n Electro – acupuncture can be used at a frequency of 2Hz, at which cancer cells do not thrive.<\/p>\n
\nii digestive problems
\niii lowered immunity
\niv liver damage
\nv neuropathy<\/p>\n
\nii general treatment principles
\niii erythema (redness\/ burning)
\niv xerostomia (dry mouth)<\/p>\n
\nii scar needling
\niii medicinal plasters<\/p>\n
\nii blood stagnation
\niii phlegm<\/p>\n
\nii yin xu
\niii blood xu<\/p>\n
\nii kidney yin deficiency
\niii liver yin deficiency
\niv liver qi stagnation
\nv spleen\/ stomach qi deficiency
\nvi toxic heat<\/p>\nIntroduction<\/h2>\n
\n
\n2 addressing the underlying patterns of Cancer<\/p>\n1 Managing the Side Effects of Conventional Treatment<\/h2>\n
A Chemotherapy<\/h2>\n
i The energetic effects of chemotherapy<\/h2>\n
ii Digestive problems<\/h2>\n
\nT: maybe purple sides<\/p>\n
\nNausea tends to come & go, & be more severe when present<\/p>\n
\nT: swollen & pale<\/p>\n
\nLack of appetite
\nUse moxa<\/p>\niii Lowered immunity<\/h2>\n
iv Liver damage<\/h2>\n
\nP: wiry<\/p>\n
\nP: wiry\/ choppy<\/p>\nv Neuropathy<\/h2>\n
B Radiotherapy<\/h2>\n
i The energetic effects of radiotherapy<\/h2>\n
ii General Treatment principles<\/h2>\n
iii Erythema<\/h2>\n
iv Xerostomia (dry mouth)<\/h2>\n
C Surgery<\/h2>\n
i General points to move blood<\/h2>\n
ii Scar needling<\/h2>\n
iii Medicinal plasters<\/h2>\n
2 Addressing the Underlying Patterns of Cancer<\/h2>\n
A Shi (excess) factors<\/h2>\n
i Toxic heat<\/h2>\n
ii Blood stagnation<\/h2>\n
iii Phlegm<\/h2>\n
B Xu (deficiency) factors<\/h2>\n
i Qi xu<\/h2>\n
ii Yin xu<\/h2>\n
iii Blood xu<\/h2>\n
C Treating the channel<\/h2>\n