ORIENTAL PERSPECTIVES ON CANCER
AND ITS TREATMENT

by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon

CAUSE OF CANCER

Modern medicine attributes most cases of cancer to changes in DNA that reduce or eliminate the normal controls over cellular growth, maturation, and programmed cell death. These changes are more likely to occur in people with certain genetic backgrounds (as illustrated by the finding of genes associated with some cases of cancer and familial prevalence of certain cancers) and in persons infected by chronic viruses (e.g., viral hepatitis may lead to liver cancer; HIV may lead to lymphoma). The ultimate cause, regardless of genetic propensity or viruses that may influence the risk of the cancer, is often exposure to carcinogenic chemicals (including those found in nature) and/or to radiation (including natural cosmic and earthly radiation), coupled with a failure of the immune system to eliminate the cancer cells at an early stage in their multiplication. The immunological weakness might arise years after the exposure to chemicals or radiation.

In the field of traditional Chinese medicine, which evolved its ideas over many centuries, the genetic propensities and the impact of viruses and radiation could not be known: these are 20th century discoveries. However, the Chinese have understood that something from the environment, some kind of toxin, was a likely contributor to development of the disease. Perhaps more importantly for our current concerns, the experience of Chinese doctors points to emotional contributions to the development of cancer. In particular, depression (as in repressed anger), anxiety (worry, fearfulness, and excess circular thinking), and grief (usually because of death of a loved one) are thought to result in stagnation of circulation. If this circulatory disturbance continues, there may be a local accumulation-eventually to become the tumor mass-at the weak point in the body. An underlying weakness in an organ or other body tissue is what allows the problem of stagnancy in circulation to eventually overcome normal patterns of cellular growth. Thus, a tumor, or some other type of excessive cellular activity, occurs.

Stagnation and accumulation, as described in this Chinese model, do not always result in malignancy (one may experience a benign lump), but if the center of stagnancy becomes "toxic," it will produce either an abscess (growth of bacterial cells) or a tumor (growth of one type of body cells). Abscesses and tumors occur by different processes, but there is a frequent overlap in the successful Chinese medical approaches to treating bacterial infections that cause abscesses and in treating tumors.

Chinese doctors interviewing patients who have unusual swellings find a high frequency of reports of depression, anxiety, grief, and similar emotional states. Although it might be argued that these conditions arose because of the cancer, Chinese doctors are convinced that they existed prior to development of cancer. This conception follows the underlying principles of Chinese physiology, developed over 2,000 years ago. Modern researchers in America have noted a similar relationship between depression and cardiovascular disease, another type of circulatory disorder.

Diseases caused by emotional conditions are said to be of internal origin and are distinguished from those diseases of external origin, such as epidemic infections. Depression, anxiety, suppressed anger, and other emotional conditions are traditionally treated in China not with anything like the modern Western technique of psychotherapy, but rather, through reliance on the family and society, and guidance towards restoring for the individual the long-held views on how to live (in ways that help unfold the persons true destiny, overcoming the obstruction that causes emotional stagnation and physical disease). In addition, there are herbal remedies that help relieve the physiological correlates (altered patterns of circulation) to the emotional conditions and some that are believed to address the psychological processes directly.

The "toxic" aspect of tumor growth is the aspect that is introduced from the outside. In modern terms, chemicals in the environment (from natural or man-made sources), components of cigarette smoke, and viruses all count as examples of the toxins depicted by traditional Chinese doctors. In the Oriental context, a toxin is anything that transforms a simple, functional or organic abnormality into a difficult-to-control disease. Long before the formal science of epidemiology, Chinese physicians noted that cancers were more prevalent in some geographical areas than others and attributed this to substances in the environment (e.g., in the drinking water) or to unique characteristics of the local diet. We now know that in addition to ingestion of carcinogens, deficiencies of certain nutrients (such as selenium and flavonoids) that affect a cell's carcinogen susceptibility and that are important to the immune system, may have also been behind regional high incidence of cancers.

TREATMENT

Cancer has long been treated by Chinese doctors, with herb therapies being the main protocol. The treatments varied according to the preferences of the doctor for certain theories of cancer etiology and resolution, and for certain herbs, as well as according to the cancer site and stage of development. The effectiveness of the treatments was not well-established prior to the introduction of clinical trials. Today, the herbal therapies are most frequently coordinated with Western medical approaches that may include surgery, chemotherapy, and radiation, as deemed suitable for the type of cancer.

The herb prescriptions that were given to cancer patients as the sole therapy primarily contain herbs that are said to remove or counteract toxins, remove or shrink accumulations, restore normal circulation, and promote the functions of the internal organs. When Western medical therapies are applied, the toxin-removing and accumulation shrinking therapies become less important, because the Western methods often accomplish the same goal (though it may be the case that using both together will get a better result). As an adjunct to Western medical interventions, Chinese herbs are directed at restoring normal circulation (something that the Western therapies are not designed to do) and protecting the body from damaging effects of those therapies (or treating specific side effects, if they have occurred). To prevent a recurrence of the disease after the therapies have been apparently successful, it is considered important for the person to reduce one's negative emotional influences as well as to strengthen any weak areas of the body so that they are no longer as susceptible to abnormality.

TOXIN-REMOVING THERAPY

An example of an herb used to counteract toxins is sophora root. There are two species used. One is from Sophora flavescens, called kushen by the Chinese, meaning the bitter root of miraculous effect (in comparison to the relatively sweet root of miraculous effect, renshen: ginseng). It contains alkaloids of the matrine series, which, in laboratory mice, have been shown to inhibit the growth of sarcoma-180 (a cancer strain commonly used in experiments). The therapeutic index of the sophora root is 7.8 times higher than a common chemotherapuetic agent called mitomycin C (meaning that it takes 7.8 times as much of the latter to have the same effect). Sophora is used clinically to treat a wide range of ailments, but in terms of its purported "antitoxin" action, it is used to treat dysentery, parasites (trichomoniasis), skin diseases, acute hepatitis, and chronic bronchitis. It is also applied topically with good effect for vaginal trichomonas and for Mycobacterium leprae, the organism that causes leprosy. The other species is Sophora subprostrata, called shandougen by the Chinese, meaning the root of the mountain bean. Sophora is in the legume family and produces bean pods; this species grows in the mountains and also contains matrine series alkaloids. It has similar medical applications.

These two species are of particular interest because they inhibit tumors without inhibiting the immune system, a problematic aspect of nearly all chemotherapy agents. To the contrary, experiments show that they can enhance immune functions, including increasing leukocyte (white blood cell) numbers and promotion of the peripheral immune system responses. The toxicity is quite low, and there are only slight adverse responses when the dosage is especially high.

Presently, there is no clear evidence that these herbs, when used alone, can cure any human cancers. However, they appear to contribute significantly to the curative effectiveness of complex herb formulas and combination treatments of herbs and Western therapies. There are at least two dozen other herbs that have similar activity (inhibiting cancer, promoting immune functions), with various types of active components; and several such herbs are combined together in the production of a complex formula used in clinical practice.

An example of another toxin-removing herb that is often used for cancer is oldenlandia. The Chinese call it baihuasheshecao, describing its white flowers (baihua) and calling it a snake (she) weed (cao), possibly because of early use as a remedy for snake bites. When cancer cells are grown in culture, the addition of oldenlandia extract significantly reduces the cells rapid growth rate. For general use in removing toxins, this herb can be applied successfully in cases of appendicitis, peritonitis (inflammation of the abdominal lining), pelvic inflammatory disease, urinary tract infection, mumps, hepatitis, chronic bronchitis, and many other infectious disorders. The herb is added at high dosage (one to two ounces per day) to herb formulas for treating cancer. It has been used, for example, to treat cervical, breast, and rectal tumors.

RESOLVING ACCUMULATIONS

In an effort to remove accumulations (cell masses, such as a tumor), an herb that is often utilized is curcuma, a member of the ginger family. There are two species commonly used in cancer therapy that, like ginger, have a spicy taste. Curcuma aromatica is called yujin by the Chinese, after its affect on stagnation (yu means stagnation; jin refers to the golden color and to its ability to treat the lungs, the organ system associated with the metal element, for which gold is a symbol). It contains aromatic volatile oils that help to remove excessive lipids from the blood, reduce aggregation of platelets (sticking of the blood cells to form masses), and reduce inflammation. In addition, the herb's oily components enhance fibrinolysis (the process that breaks down fibrous proteins, such as those that protect tumors from the immune system), and promote secretion of bile, which helps to clear congestion of the liver, promote digestion of fats, and aid intestinal peristalsis (intestinal movements that help evacuation). Thus, these essential oils help to get rid of many types of accumulation.

The other species is Curcuma zedoaria, known by the Chinese name ezhu (the origin of this name is obscure). It likewise contains volatile oils. When the extract is injected into mice that have tumors, it is found that the tumors shrink. It is believed that the enhanced fibrinolysis and other processes stimulated by the volatile oils allow immune system cells to enter the interior of the tumor and consume and destroy the tumor cells. One of the main clinical uses of zedoaria is to treat cervical cancer, with the oil injected into the tumor mass (which is accessible through the vaginal opening).

These herbs also have low toxicity. Studies of liver enzymes and of kidney function in patients given large doses of the herb did not show abnormalities. In a few individuals, increased bowel movements may occur.

According to Chinese dogma and experience, salty materials help to soften up and dissolve masses that form in the body. One of the popular materials to use for such purposes is oyster shell. These shells contain calcium salts and complex proteins. Calcium has been shown to enhance immune functions; the complex proteins may interact with cell surface receptors and alter the signals that tell cancer cells to continually reproduce. Seaweeds are used similarly: their effects may rely primarily on sulfated polysaccharides rather than calcium for promoting immune system functions. Kelp (called laminaria) and sea tangle (called sargassum), are examples of seaweeds frequently used for softening masses.

CIRCULATION NORMALIZING

We know now that a tumor develops its own blood supply system (as a branch from the normal supply), but it is a poorly developed circulation, with the cancer cells surviving with low oxygen: such cells are less susceptible to the effects of radiation than those cells that have adequate levels of oxygen. One method of cancer therapy now being investigated is inhibition of angiogenesis (blood vessel formation), which might be accomplished by various cartilage sources, including that from shark and calf, and from compounds of similar structure found in the sea cucumber. Additionally, the blood vessels of surrounding normal tissues are eliminated or displaced by the tumor, thus weakening the surrounding tissues, and making them more susceptible to replacement by tumor mass.

There are many other changes in the blood circulation in those with cancer. According to studies in China, about 90% of cancer patients have abnormal microcirculation patterns (this is circulation through capillary beds) and most cancer patients have high fibrinogen levels in the blood and higher than normal coagulability of blood. Tumors are often surrounded by a fibrin coating that prevents immune cells of the blood stream from entering and destroying the tumor. Since the combination of viscous blood and fibrin coating hinder the penetration of tumors by antineoplastic drugs and by active immune cells, blood-activating herbs (herbs that restore normal blood conditions and circulation patterns) are usually prescribed to cancer patients in order to promote the positive effects of cancer therapies while limiting their negative impacts.

One of the most serious developments for a cancer patient is metastasis from the original site to other body sites, as this process reduces the potential to remove the cancer by surgery or local radiation. For metastatic cancer cells to attach to tissues, so as to develop a new tumor mass, they require the assistance of "sticky" materials from the blood.

A group of herbs classified as blood-activating herbs are used to counter all of these problems. Some blood-activating herbs also have direct cancer-inhibiting actions (just as the herbs for removing toxins do) and others promote immune system attack against cancer cells. In addition, blood-activating herbs reduce the tendency to form adhesions and excessive scar tissue following surgery and reduce some of the side effects of chemotherapy, such as hepatitis and pulmonary fibrosis.

Curcuma and zedoaria, mentioned above because of their mass-reducing quality, are also categorized as herbs for activating blood circulation. Chinese doctors also often rely on two other herbs: salvia and sparganium. Salvia is known to the Chinese as danshen, meaning the cinnabar-colored herb of miraculous effect. This herb is used more than almost any of the other blood-vitalizing herbs for reducing the stickiness of the blood, and increasing circulation to areas where circulation has become restricted. Chinese doctors prescribe salvia in the treatment and prevention of heart attack, stroke, and peripheral vascular occlusion. Sparganium is known to the Chinese as sanleng, referring to its appearance as a plant made up of straws (leng), of which there are most often three (san). This herb is frequently combined with zedoaria to treat firm lumps (as opposed to the soft lumps such as found in lipomas). In the case of a person undergoing radiation therapy, an herb for promoting blood circulation that is relied on to make the cancer more susceptible to destruction is tien-chi ginseng, known by the Chinese name of sanqi, meaning three and seven (referring to the leaf pattern).

PROTECTION FROM SIDE EFFECTS OF CHEMOTHERAPY

For many people, one of the frightening consequences of a diagnosis of cancer is the ordeal of chemotherapy or radiation therapy. Ideally, modern research will lead to less offensive remedies in the future. The dominant chemotherapeutic agents are those that inhibit the reproduction of cells. Since malignant cancer cells reproduce more rapidly than most other cells in the body, the chemotherapuetic agent interferes to a greater extent with the cancer cells than your own, slower growing cells. Any group of cells in the body that need to reproduce rapidly are also inhibited by standard chemotherapy: these include the bone marrow "stem" cells that produce blood cells (especially affecting the white blood cells, thus causing the immune deficiency condition known as leukopenia), the stomach lining cells (causing nausea), and the hair follicles (causing hair loss). It is appropriate to say that the chemotherapeutic agents are poisons that are somewhat selective in which cells they poison. They are usually given for a short time, until a patient's system begins to be inhibited too severely, and then there is a rest period to allow recovery of the immune cells before another dose is administered (in some chemotherapeutic regimens, a low dose of the drug is given regularly).

The Chinese interpretation of chemotherapeutic impact is that it defeats the normal defensive and metabolic systems within the body. It is believed that this action can be countered by using certain herbs that enhance the usual body functions. They can protect the body's cells from the effects of chemotherapy, without protecting the cancer cells, because the cancer is not participating harmoniously in the integrated body metabolism that the herbs support. In fact, as described above, one can make the cancer cells even more susceptible to the medical therapies by using the blood-vitalizing herbs as part of the treatment. The immune-enhancing effect of the tonic herbs used to protect against chemotherapy damage is important in helping to defeat the tumor that is weakened by the drugs.

A laboratory measure of body damage due to chemotherapy or radiation is decline in the white blood cell count (the individual may experience other effects that are deemed uncomfortable, but not necessarily dangerous). If the white cell (leukocyte) count goes too low as a result of the therapies, the cancer therapy must temporarily halt, because the patient is then at high risk of experiencing a dangerous infection. This halt in therapy is a significant problem because it gives the cancer cells a chance to rejuvenate, especially in an environment in which the body's immune system (which might otherwise help to eliminate cancer cells) is weakened.

The main herb used for restoring the immune functions that are inhibited by cancer therapies is astragalus. The Chinese name for this herb, huangqi, refers to the yellow color (huang) of the inner portion of the root, a measure of its quality. The yellow color is conferred by flavonoid components. The main active component for immune system effects are polysaccharides (long chains of sugar molecules). Their influence on the immune system, and on its attack against cancer cells, is shown in illustration #1. This mechanism of action was worked out for a polysaccharide from a medicinal mushroom (the shiitake mushroom that is often used in Oriental cuisine)-but the effects are the same as astragalus.

The influence of the astragalus polysaccharide was confirmed in tests at the well-known M.D. Anderson Hospital in Houston, Texas during the 1980's. Unfortunately, an immune-enhancing drug was not developed from this work because of the inability to patent a polysaccharide component from plants. But many effective health food products have been generated from the herbal polysaccharides. In Japan, the most widely used natural cancer therapy agents are polysaccharide extracts from medicinal mushrooms. Ganoderma (Japanese: reishi), lentinus (Japanese: shiitake), and coriolus (yielding the commercial product PSK, for polysaccharide krestin) are the main mushrooms used as sources of immune-restoring, cancer-inhibiting polysaccharides.

Astragalus is used in China for almost all immune deficiency disorders, and also for most autoimmune disorders, because of its broad-spectrum normalizing effect for the immune system. It helps regulate T-cells, produce interferon (a cellular component that helps fight viruses and cancers), and promote phagocytosis (swallowing up foreign cells or particles by immune system cells).

An herb that is used for the purpose of countering blood cell deficiency from cancer therapies is millettia. The Chinese name, jixueteng, means the chicken's blood vine, referring to the blood (xue) red color of the stem. The herb is used extensively for restoring both red and white blood cell counts that are depressed by a variety of causes. Millettia is classified with the herbs for promoting blood circulation, having a property similar to that of salvia-these herbs are frequently combined in the formulas cancer patients receive.

Deer antlers are sometimes used in herb medicine formulas for treating bone marrow suppression, because the antler is the fastest regenerating part of any mammal, and it is an extension of bone. The non-ossified inner portion is gelatinous and has been shown to promote blood cell generation.

For the nausea associated with chemotherapy, anti-nauseant herbs that have been found useful for other purposes, such as for morning sickness or nausea caused by consumption of contaminated foods, are used. Among the best herbs for this purpose are ginger root (the same as obtained in the grocery store), a medicinal mushroom called hoelen, which grows on pine trees and contains a pectin-like substance (pectin is usually obtained from apple and other fruit peels), and the bulb-like underground stem (rhizome) of pinellia. The latter is a poisonous herb when collected, but it is processed by Chinese herbalists to remove the toxicity.

These herbs reduce nausea, vomiting, and diarrhea. Ginger and hoelen contain substances that bind up components in the stomach (and intestines) that instigate a nausea reaction. Pinellia calms the nerves that affect the stomach and intestines and reduces any inflammation of the lining of these tissues. A combination of pinellia, hoelen, and ginger is used in Japan for nausea and vomiting associated with pregnancy. The herbs are included in numerous remedies for acute digestive disorders caused by eating contaminated foods or because of disturbed digestive functions that arise because of emotional stress, viruses, and liver diseases. In China, such herbs are usually combined with a fermented mixture of wheat and herbs called shen-chu (Chinese shenqu; spirit of fermented grain); it contains digestive enzymes.

Numerous technical books have been written about the treatment of cancer and the side effects of cancer therapies. They reveal an extensive knowledge of the subject by Chinese physicians. These books are rarely accessible by the public, as they are meant for specialists in the field. However, individuals who have a diagnosis of cancer can work with practitioners trained in herbal medicine to coordinate a treatment with their oncologist.

QI: A BASIC CONCEPT IN RELATION TO CANCER

Qi (pronounced "chee" with emphasis on the "ch"), is a term used by Chinese doctors to describe the source of nutritive substances and metabolic activities in the body. Qi is derived primarily from foods, but some is also present in the body as essential essence at birth and some is acquired through breathing.

According to the Chinese concept, the patterns of interaction between the various parts of the body can be charted as a circulation of qi. Acupuncturists, in their study of the medical technique, memorize the main interaction channels-meridians-of the body. By stimulating a point or region of this interaction channel, one can have an influence elsewhere, that is, somewhere along the pathway of qi circulation that might be less accessible to the practitioner (such as deep within the body). This concept helps explain how, for example, an acupuncturist can insert a needle in the hand and have an effect on the intestines. From the Western point of view, the needle causes a release of substances that affect the nervous system and the hormones; the different points cause different effects because they generate more of one or another of the transmitting substances, or because of proximity to a certain part of the nervous system or to certain blood vessels.

Depression, anxiety, and grief are examples of emotions associated with impairment of action. A person who is depressed, for example, may be very dissatisfied with the life he or she is leading, but be unable to take any action to change it. The person who suffers from anxiety may have a particular goal in mind, but, upon taking a step towards it, is turned away at the slightest provocation or indication of trouble. The person suffering from grief may feel that there is no point in pursuing any of the usually pleasurable activities as it seems inappropriate to their state of mind. People with anxiety, depression, and grief may complain of lack of energy or vitality. From the Oriental perspective, this is the binding up of qi, disrupting its normal pattern of circulation.

A common modern medical treatment for these mind/body conditions is to apply sedatives. At first, it would seem strange to use a sedating agent to treat someone whose actions are impaired and who feels lethargic as a result, but, it often works-at least temporarily. This is because the qi is binding up, and by relaxing (sedating) it, it can unwind and flow more freely. The bound qi is like someone who exercises too vigorously without stretching first and the muscles cramp up so that there is no further motion. The basic energy to move exists, but it has become uncoordinated, bound up, and solid: a sedative (in this case, a muscle relaxant) will reduce the energy to those bound muscles, so that motion can take place again: relaxation leads to motion, not stillness.

The qi that becomes bound up by emotion can form a mass that could occur in many areas, depending on which part of the body is susceptible, due either to some previous experience or to an inborn pattern (including genetics). However, qi stagnation is not enough to produce cancer. Breast swelling, one of the signs of qi stagnation, is far from breast tumors, and constipation (another sign of qi stagnation) is far from intestinal cancer.

From the qi stagnation, there can occur a build-up of fluids, sometimes an excess growth of cells. Thus, breasts may develop the benign lumps and intestines may develop polyps or local pockets of inflammation. The swelling, which is sometimes palpable, is said by Chinese doctors to correspond to entanglement of qi and an accumulation of phlegm (this is the general term for most substances in the body that have a sticky or mucus-like nature and are not very hard to the touch but are less fluid than water). Still, this is not a tumor.

Again, if this condition persists, the blood circulation to the area of accumulation will eventually become disrupted. The capillary beds will have to bend and turn and develop abnormally to work around the swelling. This can cause the soft mass to become more firm. It is said that the blood circulation in the area has stagnated. Instead of coursing through normal tissues, it must slow, and be diverted around areas of accumulation-and thus the stagnant blood accumulates there too. Nonetheless, this is not a tumor, though at this point a lump or mass might be detected by modern medical techniques (if not by simpler methods) and a doctor may be concerned about the nature of the problem.

Now, enter the complicating factor of a "toxin." As described previously, the toxin can be a chemical, a virus, or some other influence that transforms ordinary irregularities in the body to more active and dangerous ones. We know now that viruses and chemicals can enter the body at one time and not yield a cancer until much later. Thus, the toxin need not enter after a lump has formed. Rather, it might be present before the lump is formed and only display its effects once the accumulation is there. At the point when the various conditions (qi stagnation, accumulation of fluids, toxin) come together, a tumor does form.

Thus, cancer prevention, from the Oriental view, would involve early treatment of depression, anxiety, grief, or other strong emotional factors that bind up qi circulation, avoidance of excessive phlegm substance in the body so that accumulation will not proceed, promotion of blood circulation so that stagnation will be minimized, and elimination of toxins.

Once a cancer is diagnosed, the rule of thumb in Western medicine, as well as Oriental medicine, is to allow it no more time to grow. Thus, modern therapies are initiated very soon after the diagnosis. In most cases, there is no time to try an alternative therapy first to see if it works, and, if not, go on to the more orthodox modern methods. Therefore, most of the time Chinese medical therapy is applied to assist the modern therapies. When the modern therapy is finished, it is a good idea-essential, even-to look again at prevention, because cancer recurrence is quite common.

HERBS COMMONLY USED IN ANTICANCER FORMULAS

Examples of Antitoxin Herbs Used in Cancer Therapy

Isatis

Paris

Solanum

Wasp's nest

Lonicera

Prunella

Sophora

Wikstroemia

Oldenlandia

Scutellaria

Viola

 

Examples of Mass-Reducing Herbs Used in Cancer Therapy

Chih-ko

Laminaria

Curcuma

Sargassum

Fritillaria

Oyster shell

Examples of Blood-Vitalizing Herbs Used in Cancer Therapy

Pangolin scales

Frankincense

Sparganium

Carthamus

Myrrh

Zedoaria

Curcuma

Persica

Salvia

Examples of Tonic Herbs Used in Cancer Therapy

Adenophora

Cordyceps

Glehnia

Licorice

Astragalus

Coriolus

Gynostemma

Rehmannia

Codonopsis

Ganoderma

Jujube

Ophiopogon

May 1997