Cancer Theories

This was an article I wrote just after graduating from Chinese medical school. I have just read it for the first time in many years and thought I'd share it. It's by no means a finished product, just thinkings on a very difficult subject.

CANCER & CHINESE MEDICINE
By Ross Rosen, J.D., M.S.T.O.M., L.Ac., C.A., Dipl. O.M. (NCCAOM)

I. INTRODUCTION
Cancer is a cellular malignancy resulting from uncontrolled cellular growth. This loss of control may be the result of changes to the DNA caused by a number of factors, including genetics, immunological deficiencies, viruses and exposure to toxins and carcinogens. Eastern medicine has many views regarding the causes of cancer, including, the 7 emotions (an excess of depression, anger, anxiety, worry, fear, grief and overthinking can cause imbalances in the circulation of qi), qi and blood stagnation, phlegm-damp accumulation, and internal and external toxins. What is consistent among the eastern etiologies, however, is that internal causes are a major culprit. And as always, we need to factor into the likelihood of the formation of cancer the terrain/environment that the cancer can grow in. Each person has his/her unique constitution/body condition/strengths and weaknesses which leave him/her vulnerable or with a strong defense to the formation of cancer.
Traditional Chinese Medicine typically classifies tumors as qi and blood stagnation, or phlegm-damp accumulation. These are the two main etiologies for the formation of a mass. This is not to say that treating qi and blood stagnation or phlegm-damp accumulation is sufficient to treat cancer -- if it were, cancer would not be the threat that it is today. What qi and blood stagnation or phlegm-damp accumulation tell us is the main pathological influence contributing to the formation of the tumor. This becomes significant for determining the root cause of the cancer itself.

II. THE ELEMENTS IMPLICATED IN UNCONTROLLED GROWTH
While eastern and western explanations differ regarding the genesis of cancer, they are not as disparate as they may seem at first glance. The main link between these two theories is the idea that cancer is caused by a lack of internal control. While the east and west attribute different paradigmatic processes to this lack of control, they are in effect, similar. If we accept the premise that cancer is caused by uncontrolled growth, to understand this process according to Chinese medicine we must first look to the elements and organs which are most responsible for this function. In Chinese medicine, it is the water element/kidneys, and the wood element/liver which govern growth. Under the theories of Chinese medicine, the kidneys, and hence the water element, control the processes of growth, development, maturation and death. It is the kidney energy that fills the 8 extra meridians, and the kidney yin and yang which form the yuan qi. It is our kidney energy that regulates the 7 and 8 year cycles of men and women. It is our reserves, our essence, our potential. This energy may be likened to the concepts of DNA and genetic influences that are attributed to western medicine. The other element, wood, is considered to be the element of birth. It has an upward and outward energy. This element is constantly creating and growing. It is the manifestation and activation of the potential of the water element. Together, the water and wood elements represent the movement from the winter to the spring and the ascension of energy.

III. CAUSES OF UNCONTROLLED GROWTH
The reason that cells proliferate out of control is that the water energy or wood energy depending on etiology (which will be discussed later) goes unchecked. Like any system, the human body has to have counterbalancing forces. The counterbalancing or controlling force behind the water element is the earth element, associated with the spleen and stomach. The control for the wood element is the metal element, associated with the lungs and large intestine. The reason that energy gets stuck in either the water or wood phase is either the weakness or deficiency of the controlling phase, or an apparent excess in the element itself. In either event, the control element is unable to perform its function. Thus, a deficient earth element will allow the water element to become excessive and stagnate, and a deficient metal element will permit wood energy to stagnate. To be clear, it is an excess of water energy, not of the kidneys, and it is an excess of wood energy, not of the liver. A deficient spleen or lungs will not result in a strong kidneys and liver; on the contrary, it creates an overabundance of energy within those phases. This results in the associated organs working overtime to attempt to deal with the excess. But due to the deficiency in the control elements, this excess continues to build, and the organs are unable to transform and utilize this abundant energy. As a result, the entirety of energy that typically passes from one phase to the next is undermined. Excess still remains in the overabundant phase and it is this excess which creates stagnation.

IV. CAUSES OF LACK OF CONTROL
It is this failure of the control cycle, which enables the stagnation of either the water or wood elements. This stagnation, then, disrupts the sheng cycle, not allowing for the energy to transfer from the excess element to the next. This further exacerbates the vacuity of the controlling element, which makes it more unable to assert its dominance over the water or wood elements. The cause of this lack of control, then, is identical to the cause of a weak earth element or metal element. Practitioners of Chinese medicine are well aware of these causes; poor diet (including excessive intake, cold and raw foods, excess sweets, dairy, fried or greasy foods, etc.), alcohol, anxiety and worry, overthinking, grief, inability to let go, environmental pollutants and toxins, and lack of exercise are some of the main culprits.

V. CANCER THEORY
To summarize, a weak earth or metal element will allow for stagnation in the water or wood element respectively. This stagnation will cause an uncontrolled growth of otherwise healthy cells. This uncontrolled growth will eventually lead to stagnation, the primary pathogenic factor being either qi and blood stagnation or phlegm-damp accumulation. In either event, the accumulation will build, and when severe enough, heat will develop and eventually lead to a toxin. This toxin will catalyze the tumor into a malignancy as it will cause the proliferated cells to grow at a faster rate. The heat toxin will determine the severity of the cancer; if too hot, it will cause poor differentiation of cells due to the rapidity of the growth. Factors in determining the severity of the stagnation and heat toxin, and hence the severity of the malignancy include genetics influences, lifestyle factors, general constitution, and the quantity and quality of our emotions.
While all this is occurring, the earth and metal elements are weakening even further. Because the lungs and the spleen are the bodies main organs involved in immune response, the defense of the outer aspects being monitored by the lungs and skin, and the interior being maintained by the spleen (which is responsible for controlling the lymphatic system), our immunity begins to diminish even further. Thus, the body becomes unable to deal with the constant introduction of external pathogenic influences (toxins and carcinogens) which are ubiquitous in the air we breathe and the food and drink we consume. These external toxins which are now unable to be dealt with begin to invade and mix with the internal toxins caused by the uncontrolled proliferation of cells. If the patient's spleen and lungs are still strong enough to provide an adequate defense against these external pathogens, the growth of the tumor may be delayed, since the external toxins and carcinogens would not have enough time to mix with the tumor cells and internal toxins. What is interesting to note is the similarity now between the western and eastern ideas surrounding cancer; i.e., that cancer can be contributed to by air pollutants/toxins/chemicals, and by toxins in our food and drink. These are how carcinogens can enter our body - once our earth and metal elements are too weak to provide an adequate defense.
Another consideration is the site of the cancerous activity. While there is no consistent basis for determining the site of a tumor in a high-risk patient, there are a number of factors which may determine where tumors arise, including, (1) the patient's constitution (tumors may often be situated in the organ of, or in a location under the influence of, a patient's constitutional element, i.e., throat cancer in a metal constitution, or cervical cancer in a water constitution; the tumor site may be also at the locus of the element in the control cycle to the patient's constitutional element, or an area under its influence, i.e., colon cancer in a wood constitution); (2) the area of greatest abuse, i.e., lung cancer in a smoker, liver cancer in an alcoholic; (3) genetics, i.e., breast cancer in mother and daughter.

VI. DIAGNOSIS
Treatment of the cancer cells depends on the proper differentiation of which elements are most out of balance. There are two ways to determine which element is the root cause of the cancer. They are accomplished through the 4 examinations which are the hallmark of Chinese medicine. During the intake, one should be looking for predominant signs of either qi and blood stagnation or phlegm-damp accumulation. Signs of qi and blood stagnation (tumor hard and fixed, fixed pain, purple tongue, dark and distended sublingual veins, wiry, choppy pulse, etc.) would point the practitioner to wood as the primary element involved, while phlegm-damp signs (tumor soft or moveable, nausea, thick greasy tongue coat, slippery or soft pulse, etc.) may point to the water element. In essence, determine whether the patient's disharmony is one of a breakdown in qi dynamic or water metabolism. The second is that there should also be corresponding deficient signs in the control element. Thus, if it is unclear whether the water or wood element is implicated and there are clear signs of spleen qi deficiency, one would suspect water involvement. Lung qi deficiency would implicate wood. This becomes difficult at later stages of the cancer since by this time the spleen and lungs will both be very deficient (and a deficiency in earth will cause a deficiency in metal and vice versa) and there will be clear signs of both phlegm-damp and qi and blood stagnation since dampness will impede the smooth flow of qi, and qi stagnation will prevent the proper transformation of fluids.

VII. TREATMENT
In general, the treatment strategy involves draining the excess stagnation from either the water or wood elements and tonifying the deficiency in the earth or metal elements. For a water excess and earth deficiency, one should transfer energy away from the wood element to encourage or stimulate the transfer of energy from water to wood. In addition, the kidneys should be mildly strengthened to facilitate water metabolism while simultaneously supplementing the spleen and stomach to exert proper control over water and aid in the transformation and transportation of fluid metabolism. For a wood excess and metal deficiency, one should transfer energy away from wood and fire and simultaneously supplement metal. Where there is evidence of a breakdown in both control cycles, a skilled practitioner will need to incorporate both treatment strategies, each to the degree of the disharmony as he determines it.
A. Acupuncture The foregoing principles can be accomplished in a number of ways and according to individual styles and training, i.e., TCM, 5 Element, meridian style, etc. Typical point prescriptions may include points from the following:

WATER/EARTH WOOD/METAL

Sedate: LV 1, LV 2, LV 3 Sedate: HT 8, LV 2, LV 3
KI 1, SP 6

Tonify: ST 36, SP 3, SP 4, Tonify: LV 4, LU 1, LU 8,
KI 3 LU 9, SP 3, LI 4


These representative point prescriptions should be incorporated into and combined with other points to address the more specific presentation of the patient, his symptoms, constitution, etc.
B. Herbs Herbal therapy should follow the same principles enumerated above. Thus, herbs which promote the circulation of liver qi, supplement the kidneys and tonify the spleen and stomach should be used where tumors are of the the phlegm-damp type, and where qi and blood stagnation is found, one should use herbs which drain the liver by invigorating qi and removing blood stasis, while supplementing the lungs. Special attention should be given to herbs which are known to have anti-cancer properties. Some are included in the following:

WATER/EARTH WOOD/METAL

Herbs which drain the LV Herbs which invigorate qi/blood and
and improve water metabolism remove stasis
Xia Ku Cao, Ji Xue Teng, Xia Ku Cao,
Zhu Ling, Xiang Fu, E Zhu, San Leng, Dan Shen, Hong Hua
Yi Yi Ren, Fo Shou Tao Ren, Ru Xiang, Mo Yao, Dang Gui,
Yi Mu Cao Shui Zhi, Tu Bie Chong, Xiang Fu, Chai Hu,
Yu Jin, Bai Shao, Mu Dan Pi

Herbs which supplement Earth Herbs which tonify Metal
Ren Shen, Huang Qi, Ren Shen, Huang Qi,
Bai Zhu, Fu Ling, Zhi Shi, Bai He, Tian Men Dong, Dang Shen,
Hou Po, Mu Xiang, Dang Shen Xing Ren, Sha Shen, Mai Men Dong

Special focus and attention should be given to herbs which clear heat and remove toxins since it is this toxic influence which contributes to the malignancy and the severity of the disease. Thus, a few herbs from this category should be incorporated into the herbal formula. Some notable herbs in this category which have anti-cancer effects are: Pu Gong Ying, Bai Hua She She Cao, Shan Dou Gen, and Da Qing Ye.

VIII. PREVENTION
From the following discussion it is evident that prevention would include avoiding excessive anxiety and worry, eating a proper diet, engaging in regular exercise, being exposed to clean air, etc. In other words, maintaining a healthy spleen, stomach, lungs and large intestine. Additionally, one must take specific precautions against the accumulation of phlegm-damp and qi and blood stagnation by assuring the smooth flow of qi and blood.

IX. CASE STUDIES
A. Female, 31 years old -- breast cancer.
1. Background: Two lumps were detected in patient's right breast, and lumpectomies were performed. The first tumor was 2.5cm, cells were poorly differentiated, and were estrogen positive. Second tumor was <1cm, cells were better differentiated, and were estrogen negative. Patient's cancer was staged at level II. Strong familial history of breast cancer was reported; mother diagnosed at age 41 and died at age 47; multiple cousins on maternal side also diagnosed at early age. The patient came for treatments one week after lumpectomies in order to heal from treatment and boost immunity prior to chemotherapy and radiation, and manage side effects.
2. Signs and Symptoms:
3. Diagnosis:
4. Treatment:
a. Acupuncture:
b. Herbs: After the initial treatment, the patient was given the following formula:
Huang Qi
Dang Shen
Tai Zi Shen
Tian Men Dong
Dang Gui
Bai Shao
Mu Dan Pi
Ji Xue Teng
Xia Ku Cao
Pu Gong Ying
Fu Ling
Zhu Ling
Bai Zhu
c. Analysis: This patient represents a case in which a breakdown in both control cycles is evident. It was determined that the initial disharmony began with a metal deficiency, i.e., deficient lung qi. Thus, tonifying the lungs and invigorating liver qi were adopted as the primary strategy (huang qi, dang shen, tai zi shen, tian men dong for the lungs; dang gui, bai shao, mu dan pi, ji xue teng for invigorating the liver qi and blood; xia ku cao and pu gong ying for addressing the toxins and draining the liver in general). The secondary strategy was to tonify the spleen and stomach and improve water metabolism (fu ling, zhu ling, bai zhu).

B. Female, 51 years old -- cervical cancer.
1. Background: patient's symptom signifying cancer was sporadic vaginal bleeding 2-3 days per week. After diagnosis, hysterectomy was performed, followed by chemotherapy and radiation. The patient came for treatments one year following western treatment and intervention in order to recouperate and address side effects of treatment.
2. Signs and Symptoms: In addition to patient's main symptom of vaginal bleeding, she also has a history of bleeding and bruising easily. She has irritable bowel syndrome and colitis manifesting in frequent (5-6 times each morning) loose and watery stools. In addition, patient has hemorrhoids. Patient has significant edema and weight gain. Since her chemotherapy and radiation, patient has experienced high blood pressure, with frequent malar flushing (2-3 times per day, accompanied by sweat on her forehead), and tinnitus. She also has cramping in the lateral aspect of her legs (ST channel) and drooping of the corner of her mouth at ST 4. She wakes one time per night to urinate. She also has a family history of migraines. Dry skin and skin sensitivity have resulted from her cancer treatments. Her pulse was deep and slippery, with a very weak chi position. Her tongue was pale, short, puffy and scalloped with some cracking in the center and anterior one-third. Since her cancer treatments, patient has been getting colds every 2-3 weeks.
3. Diagnosis: Spleen and Kidney deficiency with dampness.
4. Treatment:
a. Acupuncture: LV 1, KI 3, ST 36, ST 25, SP 9, SJ 4
b. Herbs: patient was unwilling to take herbs


edema lessening
more urination
less BM- turning more solid
no migraines