I often wondered during my acupuncture training how difficult it might be to treat a terminally ill patient: to be unable to cure the patient, watch them slowly deteriorate, succumb to the disease and then lose them. Would my personal emotions overpower my compassion so that I would lose professional detachment and be unable to treat the patient? A few years passed before I had the opportunity to test myself.

Michael was 64, a tall, striking man with a great sense of humour, looking tired and emaciated in the last stages of pancreatic cancer. He was sitting in his armchair holding a small thermos containing, as I soon found out, liquid morphine. As is quite common in cases of pancreatic cancer (1) there were hardly any symptoms initially. Michael smoked 20-30 cigarettes a day for nearly thirty years before giving up, aged 55, he was a director of a big plant for many years and worked under tremendous pressure. Digestive problems plagued him for years: no meal ever lacked meat - beef, lamb and duck being his favourite (“Salad? That’s rabbit food”) – or a sweet desert, and he ignored the gradually increasing symptoms of indigestion and occasional attacks of abdominal pain. Eventually he was diagnosed with gallstones. During the operation the surgeon noted an abnormal looking pancreas and a biopsy proved it to be malignant cancer. As a small part of the pancreas was left in working order Michael did not have to take insulin and after surgery he was prescribed chemotherapy.

The next two and a half years passed between regressions and remissions; there were moments when he thought he had beaten the disease, only to suffer another disappointment. The worst blow for Michael was the development of diabetes, depriving him of his beloved sweets. The cancer spread and the remaining part of his pancreas was removed. A bout of flu in autumn weakened his immunity and he developed ascites and lost a lot of weight. The pain by now was unbearable; only liquid morphine helped. All I could offer was palliative care. Michael died six weeks later.

I did wonder if I could have helped him more had I encountered him earlier in his illness: probably not. With pancreatic cancer, mortality rates and speed of the disease’s progression are very high, only around 2% of patients survive for five years (2). Although adjuvant chemotherapy plus radiotherapy increase life expectancy, most pancreatic patients eventually experience extreme pain and die - symptomatic, palliative treatment is therefore very important, if not the best and only course of action. Having treated Michael, I stopped worrying about how I could handle terminally ill patients; emotions did not take over and my personal experiences with cancer only made me more compassionate and understanding of his and his family’s needs and fears. I felt angry however and disappointed about how little could have been done for Michael. My question now was how I could provide potential future cancer patients with a more comprehensive treatment, thus dealing with various aspects of
the disease.

Treating cancer the TCM way

Surgery, radiation and chemotherapy will be used together with herbal treatment, acupuncture, suitable diet therapy, qi gong exercises and tui na (3). Chinese herbs can minimize and counteract the effects of drugs and enhance their effectiveness. Following the belief that cancer is, like other diseases, a manifestation of a serious underlying imbalance, the exact individual pattern is identified and treated accordingly, involving suitable Western and Eastern modalities used in combination for the patient’s benefit.

Some would say similar attitudes should be taken in Western clinics. There is some evidence of the increasing use of acupuncture and Chinese herbs to treat cancer (4) and there has even been some research conducted (5, 6, 7, 8) in China, Japan, Australia and the US. Oriental medicine being used in combination with Western medicine is still unusual and there are some concerns that the standards of trials in the East may not meet current Western regulatory requirements (5). At the moment Chinese medicine takes a primarily supportive role to Western treatment: to help pain control (6) and to alleviate side effects of chemo- or radiotherapy (7) (nausea, diarrhea, reduced energy levels)

Traditional Chinese medicine combine therapies for cancer according to the requirements of individual cases and according to individual diagnosis. Cancer in general seems to be treated on three levels:

1.The cancer is removed/reduced with herbs (which are usually toxic) aided with acupuncture
2.Wei Qi is weakened by both the disease and the treatment therefore the immune system has to be supported and strengthened. The body will then fight cancer itself
3.The root cause of the disease must be eliminated to prevent the recurrence of cancer

Acupuncture is used mainly for pain control and to aid side effects of medication, similarly to a Western approach. Its application is, however, much wider. It can help to expel the Heat and Fire-Toxins. It stimulates and invigorates the flow of Qi thus aiding the removal of existing stagnation. It can also help to resolve Phlegm. It must be said here that in cancer treatment, acupuncture works best in conjunction with Chinese herbs, because it is very difficult, (almost impossible, in fact) to expel such a strong and persistent pathogen using acupuncture alone.

There are a variety of herbs which can be used in for pain relief, resolving Phlegm, clearing Heat and Fire, expelling Toxins, tonifying various organs and Qi and rebuilding body immunity damaged by disease or by radio- or chemotherapy.

Chai Hu (Radix Bupleri) combined with Bai Shao (Radix Peoniae Alba) e.g. as in Chai Hu Shu Gan Tang can relieve pain (10).

Certain herbs from the Clear Heat/Relieve Toxicity category have anti-neoplastic properties (11):
Bai He She She Cao (Herba Hedyotidis Diffusae/Oldenlandia Diffusae)
Shi Shang Bai (Herba Selaginellae Doederleinii)
Shan Dou Gen (Radix Sophorae Tonkinensis)
Da Huang (Radix et Rhizoma Rhei)

TCM is used with Western medicine to treat cancer in China. (Image: LCTA)

Extreme caution must be exercised when choosing some of these herbs, taking into consideration both the nature of the malignancy and the condition of the patient. They are very powerful herbs and can deplete the energy of the patient, which has already been depleted by the disease and possibly by the Western treatment.

Groups of Chinese medicinal mushrooms have, for a few years now, been researched for their immune-enhancing and anti-tumour properties (12). Ling Zhi (Ganoderma Lucidum), Yun Zhi (Coriolus Versicolor) and Japanese Maitake mushrooms can all strongly stimulate the immune system. This is particularly important as treatment for cancer can frequently be quite an assault on the immune system; radiotherapy and chemotherapy are toxic to living cells. Scientific research has shown that medicinal mushrooms are particularly effective against breast, liver and lung cancers (4, 12).

The list of the herbs mentioned above for use in cancer treatment is by no means complete.

In addition to any treatment, the patient’s diet should be reviewed very carefully. Certain foods should be omitted completely, or at least seriously restricted: raw and cold foods which deplete the Spleen Qi, dairy products and oily foods which form Phlegm, coffee, alcohol and hot and spicy foods which introduce Heat to the body - which is already full of Fire, Heat and Fire-Toxins. Strengthening, cooling, cleansing foods such as carrots, beetroots, asparagus, cauliflower and tomatoes should be introduced (13)

Qi Gong, T’ai Chi, meditation, visualisation and counselling are all powerful tools for changing a patient’s state of mind (14). They can help them to relax and maintain a positive attitude which is absolutely vital in fighting cancer. These activities will also actively involve the patient in their own treatment thus empowering them, and helping to lift the aura of hopelessness and helplessness which often haunts cancer sufferers. Qi Gong enables the person to regulate and direct the flow of Qi within their own body. There are many claims that regular Qi Gong practice helps cancer sufferers maintain remission, prolong life and ease pain considerably (3).

Anna

Understanding Michael’s case prompted my own research and I felt better prepared when I encountered Anna, a 50 year old businesswoman. She had been given just three weeks to live by her doctor. She had a huge malignant growth on her left cheek, swollen, red and full of puss. Her left eye was pushed out and permanently half open by the growth, which impaired her vision and gave her constant fever. All she wanted was to live a week or two longer than predicted by the doctor. She was full of will to live and joy of life, even in her situation.

At the beginning of December 2003 Anna started to feel discomfort and observed swelling below her eye. She was diagnosed with a malignant cancerous growth within a couple of weeks. Her cancer was spreading rapidly at that stage. The growth had affected the vision in her left eye, caused swelling of the face and cervical lymph nodes and had spread to the area surrounding the eye and optic nerve. The lymph nodes were removed in January 2004. Anna received chemotherapy, followed by three courses of radiotherapy and another of chemotherapy. However, the cancer continued to spread and doctors were considering removing her eye.

Anna considered alternative therapy but her consultant was worried about possible negative interaction. Eventually Anna contacted me mid-May 2004, with her doctor’s consent.

Given the seriousness of her condition (TCM diagnosis: Toxic Heat, Liver Qi Stagnation and Phlegm-Fire Stagnation in the channels of the face) as well as the time restriction (Anna was leaving the country in two weeks) I decided on quite an aggressive and intense course of treatment - my main aim being to expel Fire and help resolve Phlegm, to invigorate Qi and Blood and to support Anna’s Qi.

Initially, Anna received acupuncture every other day. I chose LI4, Liv3, LI11, Sp6, St40, St44 and St36. I needled all points with a reducing technique, except St36 which I strongly tonified. After an initial good response during the sixth treatment, I needled Bl13, Bl20 and Bl23 for ten minutes before doing the front treatment as before, with the exception of St36. Anna received ten treatments in total. I also prescribed Anna some Chinese herbs.

Her appetite was very poor but nevertheless she managed to introduce some dietary changes such as drinking carrot juice, eating beetroot or clear chicken soup and some vegetable stew. She started practising sitting Qi Gong and visualisation on a daily basis. Anna took very active and positive attitude to treatment and responded very well. Her fever fell by 2ْC, the swelling and redness reduced considerably, she felt generally healthier, more energetic and positive, and she even said that her vision was returning to normal. Unfortunately after Anna left the country the treatment was not continued and on last day of June I was informed that she had died.

Did the treatment help to her gain those extra couple of weeks? Were herbs, acupuncture, Qi Gong, visualisation and diet changes strong enough weapons against such a malignant cancer? If so, how big an impact would there have been had she continued with the treatment. Or was it her own tenacity and will to live? I do not know and will never find out. But I do know that I helped her – with pain management, reducing symptoms, and making her feel stronger and more positive. I think that both of us hoped for a miracle that could not have happened. Her cancer was too virulent and too far gone to make a more significant change. However, my views on the efficacy of the comprehensive treatment of cancer, involving a combination of various TCM therapies were confirmed. If Anna has responded so positively in such a short time, it follows that many other cancer patients could also be helped given time and the right approach.

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London College of Traditional Acupuncture & Oriental Medicine is one of the largest and most respected colleges of Oriental medicine in the UK. Based in Finchley, North London, LCTA run courses in Acupuncture, Oriental Herbal Medicine, Tui Na Massage, Nutrition and Qi Gong as well as a thriving Teaching Clinic.

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References:

1. www.cancerresearchuk.org/aboutcancer/specificcancer/pancreaticcancer

2. Beers M H and Berkow R. The Merck Manual of Diagnosis and Therapy (17th Ed). Merck Research Laboratories, 1999

3. Walters R. Options: The Alternative Cancer Therapy Book. Avery Publishing Group, 1993

4. Chinese Herbal Medicine - Lung Cancer Cure? www.rmit.edu.au, 2003

5. Smith J, Rowan N and Sullivan R. Medicinal Mushrooms: Their Therapeutic Properties and Current Medical Usage with Special Emphasis on Cancer Treatments. http://sci.cancerresearchuk.org/labs/med_mush/med_mush.html, 2002

6. Filshie J and Redman D. Acupuncture for Malignant Pain Problems. www.acupuncture.com, 1986

7. Moldovan C. et al. Electroacupuncture Treatment Method for Arm Oedema, Following Surgery for Breast Cancer. www.acupuncture.com, 1986

8. Dundee J W, Yang J and McMillan C. Non-Invasive Stimulation of the P6 (Neiguan)
Antiemetic Acupuncture Point in Cancer Chemotherapy. www.acupuncture.com, 1991

9. Guan-Ting Wang, Jia-Yu Xu, Ai-Mei Zhang and Xian-Yi Wu. Treatment of Postoperative Advanced Gastric Cancer with Chemotherapy and Anticancer Herbs. International Journal of Oriental Medicine, 1992; 4

10. Chen J K Chen T. Chinese Medical Herbology and Pharmacology. Art of Medicine Pres, Inc City of Industry, CA USA, 2001

11. Miller L. The Value of Herbs in the Treatment of Cancer. www.acupuncture.com, 2004

12. www.mycologyresearch.com

13. Pitchford P. Healing with Whole Foods. Oriental Traditions and Modern Nutrition North Atlantic Books, Berkeley, 1993

14. Gascoigne S. The Manual of Conventional Medicine for Alternative Practitioners. Abergavenny: Jigme Press, 1994