Oncology in Chengdu

[Guest guest]

A fascinating report from a former student of mine now studying in

chengdu. for those who want to get clinical for a change.

 

 

   I have annotated a few days in clinic in the onclogy department.  I

thought I might send the notes off to you, in case you are interested

in how it is being treated here.  What you will discover is two totally

different approaches to oncology, yet there is one similarity.  Both

practitioners draw on the same formula and use it over and over and

over again.  Of course there are variations on that formula based on

presenting symptoms, but that basic formula remains the same.  The

difference in formulas is due to the fact that the two doctors have

different theories that they are working with.  Read on, and you will

understand.  Hopefully, you will be intrigued, too.

 

4/19/04

Today in oncology, the doctor we observed argues that

the old ways of treating cancer are basically

ineffective, according to his clinical experience.

The ¡®old way¡¯ is to see cancer as either of the

following patterns:  deficiency, blood stasis, toxin,

or phlem stasis.  He argues that while these are

complications that result in cancer, they are not the

root of cancer pathology.  And when the disease is

treated as such, the results are ineffective.

 

Modern research, according to him, is showing that

cancer cells are almost identical to normal cells.

The difference is that a normal cell will go through a

full life-cycle: new cell, adult cell, old cell, dead

cell.  The cancer cell, on the other hand is just a

new cell that never achieves a full life-span.  And in

stem-cell research, if you take the normal cell of a

frog and a cancer cell of a frog, both will develop

into a full frog.  In other words, there is very

little difference between the two cells, just the

possibility of development.  Using this theory, this

doctor is clinically demonstrating that it is possible

to transform the immature cancer cell into a mature

cell, through supplementing both the spleen and

kidneys.  It is not unlike treating a child who cannot

develop physically.  You support the spleen and

kidney. 

 

And he¡¯s not saying that chemo, radiology, or surgery

are useless.  On the contrary, he thinks that they are

necessary.  His argument is that the two, herbal

medicine and moderns medical approaches to cancer can

and should be used together.  When used together, the

possibility of success increases by 1/3, not to

mention that the side-effects of cancer treatment are

overcome, according to him, by 1/3: patients don¡¯t

experience alopecia nor does their white blood cell

count.

 

The reason the doctor thinks that the chemo,

radiology, or surgery are necessary is that the time

it takes to transform cancer cells into adult cells

takes awhile.  Also the cancer cells tend to

congregate into tight bundles, which eventually

prohibit blood supply to areas, thus leading to

necrosis.  More necrosis is more stasis to contend

with, may that be blood, toxin, or phlegm.  So this

doctor believe in the marriage of both modern and

ancient.

 

He tends to prescribe the same herbal formula to most

patients, Zan Yu Dan, which is an herbal formula for

treating impotence from kidney yang deficiency with

deficiency of both qi and blood.  The formula¡¯s

ingredients include rou cong rong, fu zi, ba ji tian,

rou gui, she chuang zi, xian mao, dang gui, bai zhu,

gou qi zi, yin yang huo, shan zhu yu, shu di huang,

jiu zi, and du zhong.  He also commonly prescribe a

separate decoction of hong shen alone at about 30-50

grams because it has been demonstrated to kill cancer

cells and boost the immune system.    Here are a few

case that we saw today: 

 

1) A 70 year old female with sinusitis.  Previously she

had been both diagnosed and treated for a nasal mass

from lymphoma with chemotherapy.  The mass in the

sinuses appeared gone from the MRI, but her white

blood cell count was low, she had alopecia, and she

still had sinusitis with a thick yellow discharge.

She also was complaining of poor sleep.  Her tongue

fur was greasy and white and her pulse was tight,

wiry, and thin.  Without much of a diagnosis, the

doctor prescribed:  shu di 30, ba ji tian 30, jiu zi

30, suan zao ren 30, dang gui 20, fu zi 20, du zhong

30, huang qi 60, shan zhu yu 20, rou gui 1-, yin yang

huo 30, gan cao 5, bai zhu 20, she chuang zi 15, gou

qi zi 30, bu gu zhi 20, xian mao 30, rou cong rong 10,

tu si zi 30.

 

 

 

2) A 54 year old male with non-Hodgkins lymphoma.  The

patient has undergone two treatments of chemotherapy,

which so-far has been unsuccessful.  The doctor we

were observing asked the patient to get a blood test

to see the states of his white blood cells.  When the

patient returned, he reported that his white clood

cell count was low.  The doctor prescribed the

following formula.  Hong shen 50g to be taken as a

separate decoction.  Shu di 30, ba ji tian 30, rou

cong rong 30, shan zhu yu 20, dang gui 10, fu zi 30,

jiu zi 15, huang qi 100, bai zhu 15, rou gui 10, du

zhong 30, wu wei zi, 15, tu si zi, 30, yin yang huo

30, she chuang zi 15, xian mai 30, sha ren 10, zhi shi

10.

 

       It looks to me like this guy is doing

very little TCM diagnosing.  He admitted to the rest

of the group observing with me that he could not

really feel pulse qualities.  He also was trained in

his undergraduate years at TCM school but spent six

years of his graduate studies studying biomedicine,

specifically focusing on oncology.  He doesn¡¯t seem

too enamoured with TCM¡¯s theories and pattern

differentiation.  It doesn¡¯t however, mean that the

information he is imparting should be thrown out or

rendered useless.  It is something to contemplate and

possibly experiment with on patients. 

 

4/20/04

 

    Today I sat observing another doc in the oncology department who

had a totally different take on the treatment of cancer than

yesterday's guy.  His approach was more TCM based.  He was looking for

patterns in patients.  But he also tended to prescribe the identical

formula to everyone.  He argued that radiology and chemo are basically

treatments by fire, and because they are hot in nature, they tend to

damage yin and qi and create heat symptoms such as bitter taste, dry

throat, yellow urine, irritability, rapid pulse, etc.  If during

treatment, the heat is severe, the treatment principle should be to

purge the fire.  If, on the the other hand, it is mild but still

present, the treatment principle should be to supplement qi and nourish

yin.

 

Here are some cases:

 

1)  62 year old female with colon cancer.  It's possible that the

patient had no chief complaint or presenting symptoms other than the

colon cancer.  It is also possible that the translator did not

translate for us.  The patient had surgery twice, once in 2002 and also

last year.  The tongue was enlarged and presented with a thick and

greasy tongue coating.  The prescription was:  huang qi 30, dang shen

30, fu ling 30, bai zhu 30, fa ban xia 20, chen pi 15, sheng jiang

20, hou xiang 15, dang gui 15, gou qi zi 30, wu wei zi 30, san leng 15,

e zhu 15, dan shen 30

 

I can't say that I really understood the case above, but what is

interesting to note is the formula because it tends to be used over and

over, except, of course, with some minor variations.  Also, the patient

was sent home, as were many today with the following patent: Fu Fang

Ban Mao Jiao Nang.  I can't say I have ever seen it, but the main

ingredients must be ban mao, a heat and toxin clearing insect.  I

believe it is beetle.

 

2)  57 year old male with stomach cancer with mets to the liver.  The

liver has multiple masses.  Unfortunately the cancer was discovered in

its late stage, so no surgery or chemo could be prescribed.  Basically

the treatment, both on the biomedical and the TCM ends is palliative. 

The presenting symptoms are:  epigastric distention, severe pain in the

epigastrum, edema, poor appetite, distention with even the smallest

amount of water. The edema appears to be climbing up the legs.  The

patient cannot sit up because it is too painful.  The treatment

principle is to promote appetite and relieve edema.  The doctor

believes that the edema is a result of malnutrition and protein

deficiency, either due to a lack of protein in the diet and/or the

inability to process food.  The formula is: huang qi 30, fu ling 30,

bai zhu 30, fa ban xia 20, chen pi 15, shan zha 30, zhu ling 30, ze xie

30, dang gui 15, gou qi zi 30, san leng 15, e zhu 15, yan hu suo 30.

 

It looks here like we have variations of liu jun zi tang and wu ling

san with the addition of some blood moving.  The patient was also sent

home with a pain killer, as well as an oral compound of amino acids.  I

am not quite sure why the latter was prescribed, maybe due to the fact

that the doctor thinks that the lack of protein is the biomedical cause

of the edema.

 

3)  45 year old male with naso-pharyngeal carcinoma, whose chief

complaint is right ear obstruction.  The patient has undergone 36

chemotherapy treatments and is currently undergoing radiotherapy.  His

blood platelets are low, so the radio therapist has curtailed treatment

until platelet count goes up.  Accompanying signs and symptoms include

a pale face, thirst, and lassitude. The tongue is enlarged, pale and

toothmarked with a thick and greasy, yellow tongue fur.  The pulse is

slippery and rapid.  According to the doctor the treatment principle is

to supplement qi, nourish yin, clear heat toxicity, promote blood

circulation and remove blood stasis: huang qi 30, dang shen 30, fa ban

xia 20, dang gui 15, gou qi zi 30, wu wei zi 30, san leng 15, e zhu 15,

dan shen 30, xia ku cao 30, huang qin, bei sha shen 30, sheng di 30,

xuan shen 30, mai men dong 30.

 

The patient was sent home with Fu Fang Ban Mao Jiao Nang and Huang Qi

Fu Xheng Jiao Nang, two patents I am unfamiliar with.  It looks to me

like the base formulas are Liu Jun Zi Tang with Sha Shen Mai Men Dong

Tang, here.  You can see that unlike the previous formulas, he puts an

emphasis on nourishing lung yin with the sha shen, sheng di, xuan shen,

and mai dong.  Maybe this is due to the fact that the patient has

naso-pharyngeal cancer.  But you can see that the chief complaint, ear

obstruction, isn't directly addressed.  Of course that obstruction can

be dealt with by treating the root, but there doesn't seem to be much

of a branch treatment.

 

4)  75 yrar old male with lung cancer.  The patient's right lung

initially had cancer, but that cancer had metastasized to the left lung

upper lobe.  The patient has undergone 27 radiotherapy treatments as

well as surgery. The presenting symptoms include:  weak knee koints

with light pain, tastelessness, poor appetite. dry throat,

palpatations, shortness of breath, bitter taste, dry mouth, cough with

sticky, stringy phlegm, poor sleep.  The tongue coat is thick and

greasy.  The treatment principle, according to the doctor, is to

supplement qi, nourish yin, clear heat, and remove toxin.  The formula

is: huang qi 30, bai zhu 30, gan cao 30, shan zha 30, dang gui 15,

gou qi zi 30, wu wei zi 30, san leng 15, e zhu 15, dan shen 30, sha

shen 30, mai dong 30, xuan shen 30, suan zao ren 30, huang qin 20, xing

ren 15, zhe bei mu 20, xia ku cao 30, jie geng 20.

 

Once again, we are seeing a formula being continuously used but

slightly altered, either to emphasize or deemphasize a treatment

principle or to promote another principle.  But the base formula is

there:  huang qi, bai zhu, dang shen, ban xia, cheng pi, dang gui, gou

qi zi, san leng, e zhu, dan shen.  The basic treatment principle that

this formula emphasizes is to supplement qi, yin and blood, as well as

invigorating blood and breaking up blood stasis.  It also appears that

when there is lung cancer with radiotherapy of chemo, the doctor wants

to emphasize nourishing yin with sha shen, mai dong, and xuan shen. 

And in the case above because there was a cough with a lot of phlegm,

the doctor also treated it with the huang qin zhe bei mu, xing ren, and

jie geng.

 

5)  38 year old male with testicular cancer.  The patient had

previously had one of his testes extracted surgically.  The current

chief complaint is shortness of breath.  Other presenting symptoms

include:  stomach distention from gastritis, lassitude,  and a rash on

his back that appears, to the doctor, to be herpes.  The doctor

comments that evils tend to invade after chemo, radiation and surgery,

since all of these procedures damage qi and yin, making the body more

prone to invasion.  The patient's face is pale with dark circles below

the eyes. The formula is huang qi 30, dang shen 30, fu ling 30, bai zhu

30, fa ban xia 20, chen pi 15, gan cao 6, da zao 30, dang gui 15,

gou qi zi 30, wu wei zi 30, san leng 15, e zhu 15, dan shen 30 suan zao

ren 15.

 

Once again, the basic same formula.  Not much attention paid to pattern

discrimination, if you ask me.  The only thing somewhat unusual with

the formula is the suan zao ren, and the patient didn't even complain

about insomnia.  He complained of lassitude.  Either the translation is

not making it through to us, or the doc is a little lax.  The doctor

did, however comment that generally after surgery or chemo, a patient

has an 80-90% chance of recurrence or metastasis.  This is the most

important period of time for preventative treatment.  If there are no

signs of cancer after five years, the patient has a very good chance to

survive.  If there is no cancer for eight to ten years, the treatment

is considered a cure.  If, however, cacer appears within a five year

period, the survival rate decreases 25%.  If there are 3 place of

metastasis, there is almost no survival.  If, however, you use herbs,

these odds, according to the doctor, change dramatically.

 

6)  75 year old male with esophogeal carcinoma.  Originally the

patient's chief complaint was difficulty swallowing.  After herbal

therapy the patient now has an easier time swallowing.  He also had a

geographic coat.  The patient is coming in for a follow up formula for

treatment.  He presents with spoder nevi on his face.  His tongue is

purple with spot and is wet and quivering.  He no longer has a coating,

which the doctor deems to be a good sign that his treatment is working,

since previously the patient had a geographic coating.  The doctor

believes that the coat has sloughed off and will slowly grow back

again, not geographic, this time.  According to the doctor, the

diagnosis is blood stagnation.  The prescription is: huang qi 30, dang

shen 30, fu ling 30, fa ban xia 20, sheng jiang 20, sha ren 30, gu ya

20 shan zha 30, dang gui 15, gou qi zi 30, gou qi zi 30, mai dong 30,

sheng di 30, yu jin 30, zhi ke 20, ban zhi lian 20, gan cao 6.

 

O.K.  the basic root formula is there, except the main blood stasis

herbs, san leng, e zhu, and dan shen.  The doctor did say that the

diagnosis is blood stasis, but he seems to only be treating the stasis

with dang gui and yu jin.  In this rendition of the base formula, he

appears to be emphasizing qi transformation of the spleen and stomach.

 

7)  52 year old female with a mass in the head.  The patient has

undergone surgery, but not all of the mass was removed.  For the last

four months, she has been undergoing chinese herbal medicine

treatment.  After four months treatment with herbs alone, the mass is

decreasing in size, according to CT scan.  The patient's original

complaint of dizziness also is improving.  Today she is presenting with

a yellow and tired complexion.  Her hemoglobin count is low, too.  The

tongue is red, dusky with spots on the sides.  According to the doc,

60% of cancer patients will have spots on the tongue.  The formula is:

huang qi 30, dang shen 30, bai zhu 30, fa ban xia 20, sheng jiang

20, xia ku cao 30, dang gui 15, gou qi zi 30, niu zhen zi 30, wu wei zi

30, san leng 15, e zhu 15, dan shen 30, ji xue teng 30.

 

The only thing unusual about this formula is the addition of the niu

zhen zi and the ji xue teng.  I wonder if they are added to improve the

hemoglobin count.

 

 

 

Well, it looks like we have a totally different method of treatment

than the one we saw yesterday.  Nevertheless, we can see that the same

formula is used with every patient, except, of course with some

variations here and there.  Yesterday's doctor based his treatment on

modern research, while today's doc based his on the notion that the

biomedical therapies tend to damage qi and yin; so his goal is to

supplement both, as well as transforming phlegm, invigorating blood,

and dispelling blood stasis.  Interesting to see that two totally

different approaches to treating cancer can both be effective.  The

question that comes to mind, of course, is how effective are they?  And

what sort of research has been done to justify either method? 

Hopefully, I can find these out in the coming days.

 

 

 

 

 

Chinese Herbs

 

 

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