THE TREATMENT OF GASTRO-INTESTINAL CANCERS
WITH CHINESE MEDICINE

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

BACKGROUND

Cancers affecting the digestive tract, including oral, esophageal, stomach, and intestinal tumors, are among the most common of all the cancers associated with aging. These cancers occur mainly after age 50, and their incidence rates increase with age. About one of every fourteen men and women in America will be diagnosed with a gastro-intestinal cancer at some time in their lives, with over 180,000 receiving that diagnosis each year.

Genetic propensity to experience certain cancers has been noted: familial history of the disease has been deemed a risk factor and at least one gene has been identified as being associated with the development of colon cancer. Direct causative factors have also been identified: mainly the substances that are ingested. High fat and low fiber diets have been implicated in intestinal cancers: byproducts from metabolism of fats that reach the intestines may be the culprit. The slow transit rate of low-fiber fecal material encourages prolonged exposure of the intestinal cells to the fermenting components. Oral and esophageal cancers have been associated with use of tobacco products as well as certain herbal materials taken as teas. Stomach cancer has been associated with ingestion of food that was improperly stored, thus being contaminated with bacteria and fungi and byproducts of their metabolism. Aging involves a longer duration of exposure to cancer inducers and the loss of cancer-inhibiting capabilities, including reduction in immune system responsiveness. Chronic inflammatory diseases, such as ulcerative colitis, increase the risk of cancer, probably by increasing the rate of DNA activation of the affected cells.

Preventive methods, such as dietary changes, stopping use of tobacco products, treating inflammatory diseases effectively, and taking nutritional supplements that aid immune functions, are certainly applicable to these cancers. Still, many people do not pursue these methods and cancer remains a serious health problem. Therefore, treatment of the disease remains an important subject. Modern Western medicine treats gastro-intestinal cancers primarily with the combination of surgery and chemotherapy. If the borders are clearly defined, tumor masses can be excised, and chemotherapy would then be used to treat any remaining cells; if surgery can't be performed, chemotherapy may be the sole remedy. Radiation therapy is utilized when it is believed that the tumor cells are limited to a narrow region without much intervening tissue between the radiation source and the target cells, most often when the tumor is in the head or throat.

Because of the high death rate associated with gastro-intestinal cancers (even with treatment 5-year survival rate with stomach cancer is 17% and with colorectal cancer is 78%) and because of the serious side effects of chemotherapy and radiation therapy, many cancer patients seek out alternative and/or complementary methods of treatment. Several of these methods are widely promoted though poorly evaluated. Reviews of some of the methods have been publicized, as in Michael Lerner's book Choices in Healing. Chinese medicine is favorably mentioned there, as well as in other sources, mainly because of its reputation as a complementary rather than alternative approach. It is often used to reduce the side effects of standard Western methods while enhancing the overall outcomes.

CHINESE METHODS OF TREATMENT

In modern China, there are two basic methods of treatment that have been explored. One is to rely on herbal combinations as the main therapeutic method, as this has been the only available treatment until recently. The other is to rely on modern Western medicine and to integrate it with herbal medicine in an attempt to increase the survival rates and improve quality of life. The latter has become the dominant method utilized during the past decade in China; however, herb-only treatments are still used in cases where Western medical interventions are deemed unlikely to have any significant clinical benefits.

Within the Chinese herbal methodology there are four approaches that will be explored here:

1. Using "anticancer" herbs. These are materials that have a reputation (usually derived from folk medicine practices) for inhibiting tumors; their effects have been confirmed by laboratory animal experiments and, in a few instances, by clinical trials. Because Chinese medical treatment of cancer usually involves a combination of several approaches, rather than use of a single therapeutic agent, clinical trials of individual herbs or isolated herbal constituents as the primary therapeutic method are limited to a few highly effective materials, usually developed as drug products and not available in the West. The anticancer crude herbs have a role similar to that of modern chemotherapy, and, in a few cases, Chinese anticancer folk remedies have been used as a source of new chemotherapy drugs (examples are indirubin, harringtonine, and camptothecine used for leukemia).
2. Using immune-boosting therapies. The herbs are used to counteract side effects of Western medical therapies and also help the immune system attack the cancer. The herbs listed as qi tonics are the primary ones involved in this method, though there are other tonic herbs that have similar benefits. This method of therapy is called "Fu Zheng" therapy, meaning "to support normality."
3. Using blood-vitalizing herbs. These herbal materials are reputed to enhance the effectiveness of Western cancer therapies and also assist the body in responding to the cancer via its normal immunological mechanisms. From the traditional viewpoint, cancers, especially those in the abdomen and any that are physically hard (as opposed to, for example, soft lipomas), involve blood stasis, a condition treated by these herbs.
4. Using phlegm-resolving herbs. This is a strategy based on ancient Chinese ideas about abnormal masses. There is laboratory and clinical evidence that this approach is effective. The traditional concept involves the idea that the tumor mass starts out as an accumulation of "tan," which is translated as phlegm.

This division into four categories is based on the theoretical framework that has evolved in China over many centuries (with concerns about side effects of drugs entering during the past few decades). In the book An Illustrated Guide to Antineoplastic Chinese Herbal Medicine (1), the herbs are divided into these four categories plus three others: herbs for eliminating dampness, miscellaneous herbs, and herbs for topical applications. However, the herbs for eliminating dampness appear to be coincidental: that is, these are herbs that have some antineoplastic properties and happen to fall into the very large class of herbs for regulating moisture. The herbs listed for external use are actually used internally, but are considered so toxic that they are classified as being limited to topical applications.

In the book Cancer Treatment with Fu Zheng Pei Ben Principle (2), a chapter on "common principles for treatment with traditional Chinese medicine" has these four subdivisions: supporting vital energy and strengthening body resistance (these are mainly the qi tonics); activating blood and relief of blood stasis; antipyresis and antitoxin (these are the traditional functions assigned to most of the "anticancer" herbs"); and softening hard lumps and dispelling nodes (this is mainly the "phlegm-resolving" method).

Many times there is overlap of herbal actions among the herbs that have been separated into the various categories; for example, herbs that directly inhibit cancer cells may also act via the immune system and might also have blood-vitalizing properties. One of the best English language reviews on the individual anticancer herbs is the 1992 publication Anticancer Medicinal Herbs (3). This book does not separate the more than 200 herbs by category of action, but rather combines all into a lengthy presentation. This book was relied upon as the primary resource for the information about cancer-inhibiting actions of herbs in the tables of the current article.

TESTING FOR ANTICANCER ACTIVITY

Human clinical trials are so complex (especially when using combination treatments and herbal prescriptions that may fluctuate according to the patient's needs) that confirmation of effectiveness of the herbs is usually carried out in the testing of animals or in cell culture tests. Certain cancer cell lines have been developed for purposes of the laboratory testing. Among the most commonly investigated in China are sarcoma-180 and sarcoma-37, JTC-26, leukemia-16, Ehrlich's ascites, and cervical cancer-14. Typical animal testing methods are to transplant the cultured cancer cells into the animals (usually mice, rats, or guinea pigs), and to administer the test compound to some of the animals, but not in others (control group). In the control group, the tumor cells will usually continuously grow, and will eventually cause death. In the treated group, the successful compounds will limit the size of the tumors. After a certain period of time, the tumor size (or other measure of cancer activity) will be compared and an inhibition rate will be determined; survival time or percent of animals surviving a prolonged period may also be used as a measurement. Successful compounds usually inhibit the tumor growth by at least 20%; some herbs or herbal constituents are reported to reach over 95% inhibition, and, in such cases, the animal long-term survival rates are often over 90%. The effectiveness (inhibition rate) of an herb will often vary from one cancer line to the next. One can also apply extracts of the herbs to cells in culture and determine rates of inhibition. When this in vitro approach is used, one eliminates the role of the immune system, circulatory system, and other complex biological systems and instead determines the direct inhibitory effect of the herbs on the cancerous cells. For controls, one can not only compare to cancer cells untreated by the herbs, but one can also set up a comparison of non-cancer cells to see if the herbs also inhibit those. A potentially useful anticancer agent will strongly inhibit the cancer cells but not the non-cancer cells; otherwise, the side effects of the substance would likely be severe.

ANTICANCER HERBS

Anticancer herbs are those that usually have use in treating unexplained swellings, infections, and other syndromes that are thought to reflect a localized pathological process. In the early development of traditional Chinese medicine, these swellings were said to be due to the presence of "du," or toxin. The swelling induced by snakebite (or poisonous insect bite), an abscess induced by bacteria, or a tumor could all produce similar symptoms, which we can now differentiate by detailed examination through modern technologies. Many of the herbs used to treat these conditions are classified as having the property of clearing heat and cleansing toxin. This property most closely matches the description of treating an infection or inflammation (especially if it causes localized heat or a fever) rather than a tumor. It has been noted, in laboratory experiments, that many herbs with potent antibacterial and anti-inflammatory properties also inhibit cancer cells.

There are several dozen herbs in this category. Table 1 presents some examples of the herbs that are commonly used for intestinal cancers. These are also used for other types of cancer.

TABLE 1: Anticancer Herbs, with Focus on Those Used in Treatment of Intestinal Cancers.

USING QI TONICS

Modern studies reveal that qi tonic herbs enhance immune functions (as well as having other benefits). This immunological activation can inhibit tumor growth and restore those immune functions impaired by chemotherapy, radiation, or stress reactions (including stress from surgery). Virtually all the qi tonics have the ability to enhance production of white blood cells and enhance immune attack against cancer cells. Further, most have a direct inhibitory effect on certain cancers.

The use of qi tonics in cancer therapy arises both from traditional approach and from modern experimentation. From the traditional view, both the systemic and local abnormalities that develop with cancer are thought to be due to weakness and pathology of the qi. Thus, treatment is based on tonifying the qi and clearing the pathological qi (known as xie qi; the "anticancer herbs" help to get rid of xie qi, and the strong normal qi also rids the body of it). During the 1960's, as modern Western cancer therapies were introduced to China, it became clear that side effects of the drugs (and radiation) were impeding the ability of doctors to optimally treat patients. Therefore, a group of physicians and researchers was organized to find ways to counter the side effects. This group developed the method of "Fu Zheng" therapy, which has been relied upon ever since (4). The complete name for the therapy is usually Fu Zheng Qu Xie (support the normal, dispel the evil) or Fu Zheng Pei Ben (or Fu Zheng Gu Ben; support the normal and strengthen the root).

Two of the herbs initially found to be very helpful for this type of therapy were astragalus and ligustrum; this information was made available to the Western world in 1983 at an international symposium in Beijing, sponsored by American and Chinese organizations. Astragalus is one of the main qi tonics relied upon by traditional and modern Chinese doctors. Ligustrum is also a tonic herb, but is in the category of yin tonics. It has been found that many of the drug side effects correspond to damage to the "yin essence." However, qi tonics appear to be the most important in the tonic group for the treatment of cancer. According to traditional doctors, tonifying the qi can benefit the yin essence, especially if one pursues a nutritious diet. A book devoted to this method of therapy was recently published in English: Treatment of Cancer with Fu Zheng Pei Ben Principle by Pan Mingji (2).

TABLE 2. Qi Tonic Herbs Commonly Used in the Treatment of Cancer.

BLOOD-VITALIZING HERBS

Cancer may be induced by many factors, but stagnation of circulation is considered by many Chinese physicians to be a dominant immediate cause. As described by Pan Mingji (2), "Disharmony of qi and blood occurs when either one of them is defective. Stagnation of qi can lead to stasis of blood. Prolonged stagnation of qi and blood will inevitably lead to occurrence of a tumor." Along similar lines, cancer specialist Jia Kun says (5):

The extremity of the seven modes of emotion may disturb the normal circulation of blood and qi and the function of the viscera...Stagnation damages [the] spleen and in turn makes the muscles weak. When weak muscles meet and combat the exogenous pathogenic factors [e.g., toxins: du, or pathological qi: xie qi], a tumor is formed...Persistent stasis of qi finally leads to blood stasis, which accumulates and forms a lump or lumps.

Researchers in China have noted that individuals with cancer have abnormal blood conditions which manifest as higher blood viscosity and poorer circulation of blood through small vessels. There are about 140 Chinese herbs that are considered to have the property of activating blood circulation and removing stasis. About three dozen of these herbs are used extensively. One of the most intensively investigated herbs for activating blood circulation is salvia. It is said to be both a blood tonic and mild activator that has essentially the same properties as the famous traditional prescription Tang-kuei Four Combination (Si Wu Tang).

There have been many developments in this field during the past few decades. Dr. Pan Mingji (2) mentions the following findings:

1. About 90% of cancer patients have abnormal microcirculation patterns.
2. Most cancer patients have high fibrinogen levels in the blood and higher than normal coagulability of blood.
3. Tumors are often surrounded by a fibrin coating that prevents immune cells from entering.
4. Tumors often have poorly developed circulation and thus the cells survive with low oxygen; such cells are less susceptible to the effects of radiation than those cells which have adequate levels of oxygen.
5. 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.
6. Some blood-activating herbs have direct cancer inhibiting actions and others promote immune system attack against cancer cells.
7. Blood-activating herbs reduce the tendency to form adhesions and excessive scar tissue following surgery.
8. Blood-activating herbs reduce some of the side effects of chemotherapy, such as hepatitis and pulmonary fibrosis.

It has also been pointed out by Han Dewu and Xu Ruiling (6), that the combination of viscous blood and fibrin coating hinder the penetration of tumors by antineoplastic drugs and by active immune cells. Therefore, blood-activating herbs are usually prescribed to cancer patients in order to promote the positive effects of cancer therapies while limiting their negative impacts, to inhibit the cancer directly, as well as indirectly through immune system attack, and to prevent metastasis.

TABLE 3. Herbs for Activating Blood Circulation and Removing Stasis, Used in Treating Tumors.

PHLEGM-RESOLVING HERBS

The term "phlegm" is a translation of the Chinese tan, which refers to sticky fluids (other than blood or semen) derived from moisture and fat. From the modern perspective, we might include mucus, synovial fluid, and lymph among the normal manifestations of tan, and fatty tumors, cysts, plaques comprised of fatty substances, and goiters as descriptions of things traditional doctors would lump under the heading of pathological tan. The reason so many different items can be put into one simple category is that Chinese physiological principles are primarily arrived at by projection: a few basic essential components are suggested to make-up the whole body. In contrast, through the methods of modern investigation, each component of the body can be visualized and described in great detail, without a need felt to link the different observations (rather, it is thought that each component can be dealt with individually from the point of view of diagnosis and treatment).

Masses of cells are generally thought to represent phlegm masses. These masses are not inherently painful (though they can become so when they press on nerves or organs); when they are large they are somewhat movable during palpation, and the palpable large masses seem to be somewhat soft. These are all characteristics associated with accumulated phlegm. Fluid filled masses, such as cysts and abscesses, are also described as phlegm masses. If the mass or swelling produces sharp pains, it is thought that blood stasis is also present.

To treat soft accumulations and poorly defined masses, one applies herbs that are said to resolve phlegm. Most of the herbs will also treat cough or sinus congestion, thus making the link to what we, in modern times, think of as phlegm disorders. These herbs are not as often used in treating intestinal cancers, but they are sometimes applied for that purpose. Following is a table of a dozen phlegm-resolving agents commonly mentioned for cancer therapy.

TABLE 4. Phlegm-Resolving Herbs Commonly Used in Treating Cancer.

FORMULAS

There are so many cancer treatment prescriptions listed in the Chinese literature for each type of cancer, that an extensive listing of the formulas may not be very instructive, except to show that many of them include herbs from the four tables listed here. Generally, an anti-tumor prescription should be formulated to meet the needs of the patient involved, taking into account not only the type of cancer but also the utilization of Western therapies.

Some formulas for colon cancer are given in the book An Illustrated Guide to Antineoplastic Chinese Herbal Medicine (1). These formulations are from Chinese medical journals published from 1981 to 1986. Ingredients of a formula indicated for carcinoma of large intestine include the following that were mentioned in the tables above: the anticancer herbs akebia fruit, sophora, pteris, oldenlandia, smilax, solanum, sargentodoxa, dryopteris, coix, and scutellaria; the blood-vitalizing herbs salvia and eupolyphaga; and the phlegm-resolving herb trichosanthes seed. A formula indicated for multiple adenoma of the large intestine included the anticancer herbs sophora, sargentodoxa, and scutellaria, the phlegm-resolving herb gleditsia spine, and the blood-vitalizers salvia and pangolin scale. A prescription for carcinoma of the large intestine, ileocecal region (lymphosarcoma), and anal carcinoma included the anticancer herbs sophora, paris, scutellaria, sargentodoxa, coix, and oldenlandia. These three sample formulas indicate primary reliance on anticancer herbs with a few blood-vitalizers. In some cases, herb decoctions are also given by enema (either the same formula as the oral prescription or a slightly different one).

In the book Experience in Treating Carcinomas with Traditional Chinese Medicine (7), fourteen prescriptions for intestinal cancers are mentioned. Three examples are cited here. One formula for rectal carcinoma includes the anticancer herbs sargentodoxa, oldenlandia, prunella, and dryopteris; the phlegm-resolving herbs sargassum and trichosanthes seed; and the qi tonic ginseng. Another formula for rectal cancer is virtually the same, except for the addition of the anticancer herb solanum, and trichosanthes root replaces trichosanthes seed. A formula for indurated intestinal carcinoma includes the phlegm-resolving herbs blue citrus, citrus, and chih-shih; the blood-vitalizing herbs sparganium, zedoaria, salvia and curcuma; and the qi tonic astragalus. The last formula is aimed at treating stagnation of qi and blood, rather than relying on anticancer herbs.

In the book Treatment of Cancer with Fu Zheng Pei Ben Principle (2), eight prescriptions for internal use are mentioned in the treatment of intestinal cancer. One is labeled "the approved prescription often used by the author," and includes the anticancer herbs patrinia, agrimony, oldenlandia, solanum, lonicera, and coix, and the qi tonic herbs codonopsis, atractylodes, licorice, and gynostemma. This is indicated for recto-colonic carcinoma. A formula for "stagnancy and damp-heat type" carcinoma, corresponding with rectal carcinoma, includes the anticancer herbs patrinia, solanum, agrimony, and coix, and the qi tonic atractylodes. For the "stagnancy and toxin type," corresponding to middle or advanced stage colon carcinoma with chronic intestinal obstruction, the recommended formula includes the anticancer herbs patrinia, scutellaria, oldenlandia, lonicera and solanum; the blood-vitalizing herbs curcuma, red peony, and rhubarb; and the qi tonic gynostemma. These formulas have a relatively large component of the anticancer herbs, with some tonics and blood-vitalizers.

In the book Treating Cancer with Chinese Herbs (8), there are five prescriptions mentioned as being used by physicians in China for treatment of cancer of the large intestine. One includes the anticancer herbs oldenlandia, lonicera stem, scutellaria, solanum (both S. lyratum and S. nigrum), patrinia, and sargentodoxa; in cases of intestinal obstruction, the phlegm-resolving herbs trichosanthes root and gleditsia spine, and the laxative blood-vitalizer rhubarb, are added. A second formula, indicated specifically for cancer of the rectum, includes the anticancer herbs oldenlandia, sargentodoxa, solanum, and akebia fruit; the phlegm-resolving herbs trichosanthes root, oyster shell, and chih-shih; the blood-vitalizers salvia and pangolin scale; and the tonic codonopsis. A third formula includes the anticancer herbs scutellaria, coix, and lonicera stem, and the phlegm-resolving herbs chih-shih and laminaria.

Among the dozen sample formulas listed here, the herbs that are mentioned repeatedly include the anticancer herbs sophora, oldenlandia, scutellaria, solanum, agrimony, coix, sargentodoxa, and patrinia; the blood-vitalizers salvia and pangolin scales; the phlegm-resolving herbs trichosanthes, gleditsia, and chih-shih; and the tonics atractylodes and gynostemma.

GENERALIZED CANCER FORMULAS

Several cancer doctors have sought general formulations for treatment of tumors. One of the best known herbal combinations that has been given for gastro-intestinal cancers is called Ping Xiao Dan, developed by Dr. Jia Kun in 1958. It was originally made as a powder of eight ingredients and was later manufactured as a convenient pill and tablet. The ingredients are chih-ko, curcuma, agrimony, niter, lacca, alum, strychnos, and pteropus. Three of the ingredients, chih-ko, curcuma, and agrimony, are commonly used in the practice of Chinese medicine in the West. The other ingredients, which include minerals (niter and alum) and potentially toxic herbs (lacca and strychnos) are usually not deemed acceptable here. In 1989, ITM developed an alternative preparation (called Chih-ko/Curcuma Tablets), that included chih-ko, curcuma, and agrimony, with other herbs that substitute for those deemed unacceptable. The formula has the anticancer herbs lonicera, prunella, sophora subprostrata, and wasp nest; the blood-vitalizers myrrh, frankincense, and arca shell; and the phlegm-resolving agents gleditsia spine, fritillaria, oyster shell, sargassum, and inula.

According to studies in laboratory animals, Ping Xiao Dan enhances immune functions, despite the fact that its design is based on traditional methods of resolving masses by dispersing stagnation of phlegm and rectifying blood circulation. Trials in eight Chinese clinical institutes from 1958 through 1986 showed that its use increased survival rates and promoted tumor regression in cancer patients suffering from several different types of cancer. It has mainly been used in treating cancers of the esophagus, large intestine, lung, liver, breast, and kidney. Clinical evaluations are still being conducted to elucidate its range of action and degree of effectiveness.

A book about the use of Ping Xiao Dan was produced by Jia Kun in 1983, and published in English in 1985 (5). In it, he recommends that 4.5-9.0 grams of the formula be taken each day. Further, he recommends that a prophylactic course of Ping Xiao Dan be taken every six months; 4.5-6.0 grams per day for one week. This is especially important for those who previously suffered from cancer, but it is also suggested to be a useful cancer preventive for otherwise healthy individuals.

Jia Kun and his colleagues at the Shanxi Academy of Traditional Chinese Medicine published a report in 1984 (9) summarizing the results of treating patients with malignant tumors for three months or more using Ping Xiao Dan. Response to treatment was rated markedly effective if the main symptoms were eliminated or greatly reduced and if the tumor mass was shrunk by at least half (and did not progress again during the next three to six months); it was rated as effective if there were some symptom improvements and there was a little shrinkage of the tumor or at least no further growth of the tumor mass. For five tumor types-lung, liver, esophagus, stomach, and bone-the results were essentially the same. The treatment was markedly effective in 11.3%-16.7% of the patients treated and effective for 44.4%-58.3% of the cases. In other words, Ping Xiao Dan was able to halt tumor growth in about 2/3 of the cases and was able to substantially shrink the tumor in about 1/7 of the cases.

In general clinical practice, Ping Xiao Dan is rarely given as a sole remedy for cancer. In China, it may be used along with high dosage herb decoctions; in America, dried decoctions-in the form of convenient extract granules-or tableted herb combinations are often used instead.

Duration of treatment is highly individualistic. In his book, Jia Kun presents several case studies. In one representative example, he tracks a patient's progress through 61 visits to the clinic, over a period of about 8 months (he went to the clinic twice per week). At each visit, slight modifications were made to the formula that he was taking in the form of a tea along with the consistent use of Ping Xiao Dan. At the end of eight months, his cancer tests came out negative and he was basically healthy. He was then told to continue taking an herb tea (similar to the one he had been using at his last visit). On follow-up, he was found to still be healthy and strong more than 12 years later.

DOSAGE OF HERBS

It is important to make sure that the herbal ingredients are provided in adequate dosage. Some formulations are suitable for use in small amounts, such as the few grams of Ping Xiao Dan mentioned above. However, many ingredients require substantial dosages to have the desired effect. As an example, Chang Minyi (3) relays information about "a universal anticancer prescription of the Quli Herbal Store in Shanghai." The basic prescription relies primarily on three herbs, Solanum nigrum, Solanum lyratum, and Duchesnea indica (a somewhat poisonous anticancer herb). Each of these herbs is used in a dosage of 45-60 grams in decoction as a one day dose. To treat each specific cancer type, two to four herbs are added to the base prescription, most of them in doses of 15-30 grams each. As an example, for stomach cancer, one adds 30 grams of Scutellaria barbata and 30 grams of Salvia chinensis (this is salvia leaves, which contain different active constituents than found in the roots). Thus, the formulas typically contain about 200 grams of herbs in decoction. Dr. Pan Mingji (2) lists four prescriptions for intestinal cancers that are "by Chinese scholars and folk prescriptions." Two of them are indicated for oral ingestion only: one contains 172 grams and the other 245 grams of herbs to make a decoction. The latter includes 60 grams of smilax, 30 grams each of oldenlandia and agrimony, and 20 grams of solanum. Dr. Hong-yen Hsu (8) relates a formula for treatment of oral cancer (for the gums), which uses 30 grams each of prunella, solanum, taraxacum, and oldenlandia, plus 15 grams of viola, for making a decoction.

DIET AND NUTRITION

Jia Kun (5) emphasizes the importance of proper nutrition. Among the recommended foods that he mentions are peanut residue (after extracting the oil), barley, wheat bran, and soy bean. He also recommends a tea made from the mineral stalactite and regular drinking of green tea. These substances provide protein, vitamins, minerals, fatty acids, and other components. They might be replaced, in part, by use of nutritional supplements. For example, stalactite mainly contains calcium; wheat bran is high in vitamin E and some B vitamins. Other constituents, such as saponins and isoflavones in soybeans and flavones (polyphenols) in green tea, are accessible either through these foods or from some nutritional products. Flavones and other flavonoids found in fruits and vegetables (and available in nutritional supplements) are poorly absorbed when ingested, and a substantial portion remains in the gastro-intestinal tract where they can inhibit development of cancer. One of the dietary flavonoids, quercetin, inhibits cancer cell lines that exhibit estrogen binding sites by 50-80%; the isoflavonoid genistein, found in sophora, pueraria, and soy beans, appears to inhibit estrogen and testosterone dependent cancers (10).

Pan Mingji (2) recommends taking foods that provide a high level of nutrients, recognizing that many cancer patients have a poor appetite and do not eat enough food to assist the body's fight against cancer. He provides a long list of potentially useful foods, many of them not readily available in the West. Among the more common Western foods suggested are eggs, milk, peanuts, beans and bean products, lean meat, sea food (shellfish and fish), mushrooms, walnuts, fruits, water chestnut, rice, wheat products, cabbage, cauliflower, lettuce, celery, bean sprouts, eggplant, green pepper, asparagus, and other fresh vegetables.

REFERENCES

1. Ou Ming, et al., An Illustrated Guide to Antineoplastic Chinese Herbal Medicine, 1990 The Commercial Press, Hong Kong.
2. Pan Mingji, Cancer Treatment with Fu Zheng Pei Ben Principle, 1992 Fujian Science and Technology Publishing House, Fuzhou.
3. Chang Minyi, Anticancer Medicinal Herbs, 1992 Hunan Science and Technology Publishing House, Changsha.
4. Dharmananda S, Chinese Herbal Therapies for Immune Disorders, 1992 Institute for Traditional Medicine, Portland, OR.
5. Jia Kun, Prevention and Treatment of Carcinoma in Traditional Chinese Medicine, 1985 The Commercial Press, Hong Kong.
6. Han Dewu and Xu Ruiling, Progress in the research on blood activation and hemostasis removal, Abstracts of Chinese Medicine 1988; 2(4): 466-483.
7. Shi Lanling and Shi Peiquan, Experience in Treating Carcinomas with Traditional Chinese Medicine, 1992 Shandong Science and Technology Press, Shandong.
8. Hsu Hong-yen, Treating Cancer with Chinese Herbs, 1990 Oriental Healing Arts Institute, Long Beach, CA.
9. Jia Kun, Wang Huichuan, and Liu Bianlin, Observation of curative effects of Ping Xiao Dan in treating 180 cases of malignant tumor, Shaanxi Journal of Traditional Chinese Medicine 1984; 5(6): 10-11.
10. Boik J, Cancer and Natural Medicine, 1995 Oregon Medical Press, Princeton, MN.

APPENDIX 1: Books About Treating Cancer with Chinese Herbs

The treatment of cancer is a complicated and serious matter. One must study the field diligently. This review is intended to help practitioners select books for study. ITM has in its library ten English language books about anticancer herbs and on treating cancer with Chinese herbs. They are listed in order of copyright date:

Treating Cancer with Chinese Herbs by Hong-yen Hsu (Oriental Healing Arts Institute, Long Beach, CA, 1982)

Prevention and Treatment of Carcinoma with Traditional Chinese Medicine by Jia Kun (Commercial Press, Hong Kong, 1985)

Structure Activity Relationship Analysis of Chinese Anti-Cancer Drugs and Related Plants by Eric Lien and Wen Li (Oriental Healing Arts Institute, 1985)

Icones of Medicinal Fungi from China by Ying Jianzhe, et al. (Science Press, Beijing, 1987)

The Treatment of Cancer by Integrated Chinese-Western Medicine by Zhang Daizhao (Blue Poppy Press, Boulder, CO, 1989)

An Illustrated Guide to Antineoplastic Chinese Herbal Medicine by Ou Ming, et al. (Commercial Press, 1990)

Cancer Treatment and Prevention by Binyan Sun (Offete Enterprises, San Mateo, CA, 1991)

Anticancer Medicinal Herbs by Chang Minyi (Hunan Science and Technology Publishing House, 1992)

Experience in Treating Carcinomas with Traditional Chinese Medicine by Shi Lanling and Shi Peiquan (Shandong Science and Technology Press, 1992)

Cancer Treatment with Fu Zheng Pei Ben Principle by Pan Mingji (Fujian Science and Technology Publishing House, 1992)

The first thing to note about these books published over a ten year period is that none of them are suitable for reading by the cancer patient. All are too technical for that purpose, either with Western science or Oriental medical terminology, and none are addressed to the patient with explanations of the "how and why" of cancer and its treatment, though such explanations are offered in short form for the practitioner in the introductory chapters to some of the books. Also, there is very little in these books that could be shown to an open, but skeptical, oncologist that might convince such a medical professional to become actively involved in Chinese medical therapy for cancer. Only the Structure Activity Relationship Analysis... is presented in the form of modern scientific investigations, but it only purports to show that chemotherapeutic agents similar to the ones now used by medical doctors have been isolated from Chinese plants. That is a long way from the concept of using complex Chinese herb formulas for management of cancer cases.

Cancer Treatment with Fu Zheng Pei Ben Principle is by far the most medically-oriented clinical text, including Western and Chinese treatments, but it contains too many general statements along with the scientific details to impress the Western oncologist; further, the Western medical recommendations are now more than ten years old. Anticancer Medicinal Herbs offers brief pharmacological reviews, but these are compromised somewhat by the apparent assumption that herbs with anti-bacterial properties are also cancer inhibitors (sometimes true, but the connection is not necessarily obvious to the Western observer), by presenting complex formulas that include the herb under discussion as only one of many ingredients, and by not giving references to the claimed results (sometimes book names are mentioned in English but the source is unclear).

For the professional audience of Chinese herb prescribers, the next thing to note is the extreme diversity in recommended treatments for cancer of any particular site. This diversity, which has many origins and explanations, demonstrates the fact that no one therapy stands out dramatically as an effective treatment, despite such names as the "anticancer single blade sword" (referring to a formula that kills cancer and relieves pain but does not harm the patient). Although part of the diversity may be explained in terms of adjustments of the formulation to individual cases, the fact is that the majority of variability is a reflection of different methods being tried for the general problem of cancer. The one partial exception to this trend is found in the book Prevention and Treatment of Carcinoma... where a single remedy-Ping Xiao Dan-is recommended for virtually all patients; still, these patients almost always take another prescription, which takes up the more typical variability. In China, physicians often devise their own version of Ping Xiao Dan with several substitute ingredients. This situation is quite different than in America, where Western herbalists might tell their patients to take the "Hoxey Formula" or "Essiac Tea" and offer little or nothing in the way of modification for individual needs; rarely does an herbalist produce an altered version of these formulas based on understanding the principles of cancer treatment.

Cancer Treatment with Fu Zheng Pei Ben Principle offers several adjunctive formulas to go along with surgery, chemotherapy, or radiation therapy; these come with recommendations for numerous alterations depending on specific symptoms. The formula ingredients differ considerably from those offered in other books aimed at treating cancer with herbs alone.

The primary value of the book Treating Cancer with Chinese Herbs is that it shows the reader how closely connected modern cancer treatments are to earlier treatments that were probably aimed at diseases other than cancer but which had similar presentations. Put another way, this book reveals that cancer therapies are, largely, not to be separated from all the other therapies used in traditional Chinese medical practice. Most of the formulas predate the introduction of Western therapies (other than surgery).

The book Cancer Treatment and Prevention introduces a somewhat unique diagnostic system and places emphasis on the use of warming therapies for treatment of cancer (something not included as a special consideration in any of the other books). The author states that about 80% or more of cancer cases in China are due to cold syndrome, to be treated with aconite, cinnamon bark, dry ginger and other warming herbs, and that an easy measure of the cold condition is the absence or small size of nail lunala (growth marks) and the presence of tooth marks on the tongue and possibly on the inner cheeks.

The book The Treatment of Cancer by Integrated Chinese and Western Medicine demonstrates the common practice in China of using standard Western drug therapies along with Chinese herbs. Its lack of explanations, however, makes it difficult to use.

Both An Illustrated Guide to Antineoplastic Chinese Herbal Medicine and Anticancer Medicinal Herbs present valuable reviews of individual ingredients used in cancer therapy, with brief presentations of sample formulas. The latter book is more usable, having interesting historical descriptions of the various applications of the herbs, and fairly detailed descriptions of experimental formulas (though the results of using the formulas are rarely presented, and when they are, the details are minimal). The pictures (photos of herbs) in the Illustrated Guide... are interesting but not especially relevant to the practitioner in the West. The pictures (water colors) in Icones of Medicinal Fungi from China are beautiful and make the book valuable as a work of art, but the basis of this book was a series of screening experiments to find the most effective polysaccharide-containing mushrooms, and after a brief mention of identification marks, habitat, and distribution for the species under consideration, a single sentence relates the detected anticancer potential, with reference number (to a long list of Chinese language publications).

Experience in Treating Carcinomas presents suggestions of formulas-some traditional, some new-for each type of cancer and devotes most of the pages to case studies: up to two dozen patients with that type of cancer. The studies are accompanied by notes about the patient, type of cancer, and treatment responses, making it especially valuable to practitioners who see a substantial number of cancer patients and who, therefore, might like to know what other practitioners do in a variety of specific cases. There may be too many details for the beginner, however.

Of all the books, the one which is perhaps most useful to the Western practitioner is Cancer Treatment with Fu Zheng Pei Ben Principle, so I usually recommend that all practitioners get this book as a primary text.

APPENDIX 2: Where to Get Herbs for Treatment of Cancer

Obtaining the desired materials is sometimes problematic. Practitioners who do not maintain a crude herb pharmacy may have difficulty obtaining the herbs for making a decoction. In such cases, it is probably best to obtain dried concentrated extracts of the individual herbs to be combined into formulas; these are imported to the U.S. by about ten suppliers in Taiwan, mainland China, and Japan, and there is at least one manufacturer in the U.S. To obtain the equivalent of a 100-200 gram decoction, as is often used in China, one should recommend a dosage of 18-27 grams per day of the extract granules or powders. This large amount can be consumed in two to three batches of 9 grams each (one teaspoon is about three grams). A one month treatment is thus obtained from about 500-800 grams of extracts.

Some traditional prescriptions that are used for treating cancer, such as Lithospermum and Oyster Shell Combination, Tang-kuei Sixteen Herb Formula, and Forsythia and Laminaria Combination are available in extract form, already combined. A formula developed in Japan about forty years ago for treatment of gastro-intestinal cancers, called WTTC (for wisteria, trapa, terminalia, coix), is similarly obtained in this form.

The pills and tablets described in the Chinese books on treating cancer are usually not available outside China. Instead, they are prepared for use at the hospital complex where they are utilized, or, in a few cases, prepared for use within China but not for export.

For those who wish to do everything possible, dosages can be gradually increased, or additional formulas consumed, but a gradual change in treatment is important to avoid confusion over possible side effects. To overcome lack of expertise in certain areas of the country where Chinese herb therapy is not very common, a patient seeking Chinese medical therapy for cancer may need to travel to a place where many experts are working in this field. To my knowledge, this means coming to a major city along the West Coast of the U.S. (Los Angeles, San Francisco, Portland, Seattle), where herbal medicine has been a standard method of therapy for more than a decade, though there are exceptions (for example, several very competent practitioners can be found in New York City and several other large U.S. cities).

Practitioners are cautioned about the too-common practice of simply looking up a formula for a particular type of cancer and using it without a theoretical framework. Cancer patients, like others with serious, chronic diseases, usually experience substantial changes in their condition, especially under the influence of Western medical anticancer treatments. Therefore, one must be prepared to interpret and respond to those changes within the general framework of Chinese medical experience and also in keeping with the understanding of cancer pathophysiology, the effects of the Western therapies, and the therapeutic principles embodied in the herbal formulations.

May 1997