Dr. Henry Liang presented the recent Health World TCM Seminar entitled “The Role of Chinese Medicine in Supporting Patients Undergoing Cancer Treatment – Fundamental Knowledge & Clinical Strategies for Optimal Results”.  Dr Liang graduated from Guangzhou University of Chinese Medicine in China with eight years of full time training, and was awarded Bachelors and Masters degrees of medicine (Chinese medicine). He held the position of Senior Doctor at the hospital affiliated with the Guangzhou University of Chinese Medicine. During his PhD study from 1996 to 2003 at RMIT University (Melbourne, Australia), Dr Liang conducted research on the efficacy of Chinese herbal medicine in support of cancer patients. He has had extensive clinical experience both in the hospital environment and in clinical practice. Dr Liang specialises in using Chinese medicine in supporting patients during cancer treatment.

Cancer – A Modern Epidemic

Cancer is overtaking heart disease as the leading cause of mortality worldwide.¹  Conventional treatments for cancer include surgery, chemotherapy and radiotherapy. Despite the rapid improvement in cancer diagnosis and treatment, therapeutic outcomes from these conventional interventions remain unsatisfactory.^2,3,4 In addition, many of the conventional interventions may cause traumatic side effects. These limitations, at least partially, explain the growing popularity of complementary and alternative medicine (CAM) including Chinese medicine in supporting cancer patients. In 2005, surveys in Japan and 14 European countries revealed that 44.6% and 35.9% of cancer patients respectively used CAM therapies.^5,6 These results are consistent with similar surveys conducted in other regions of the world.⁷

Chinese Medicine for Supporting Cancer Patients – A Historical Perspective

The use of Chinese medicine for supporting cancer patients can be traced back to Shang Dynasty 3,500 years ago.⁸ Over the centuries, Chinese medicine has been developed into a distinctive system of diagnosis and treatment. Various types of Chinese therapeutic interventions including Chinese herbal medicine, acupuncture and Qi gong have been employed in supporting cancer patients. On the basis of its concept of holism, Chinese medicine realises that the causes and progress of cancer are associated not only with external factors (such as external pathogens, improper diet and environment), but also with internal factors (such as healthy Qi deficiency, weak constitution of the body and emotional irritations). Accordingly, Chinese medicine emphasises both eliminating pathogenic factors and enhancing healthy Qi of the body  in supporting cancer patients.⁸

Supporting Evidence for Chinese Medicine in Supporting Cancer Patients

Scientific evidence supporting the use of Chinese medicine as an alternative or complementary approach in supporting cancer patients can be found in the literature from the past three decades. Numerous scientific studies have demonstrated beneficial effects of Chinese herbal medicine and acupuncture on the survival rate, quality of life and immune functions of cancer patients when used alone, or in conjunction with conventional therapies. Some of these interventions also increased the tumour responsiveness to conventional therapies, and alleviated adverse reactions induced by chemotherapy or radiotherapy. Evidence also exists to support the use of Chinese medicine as an alternative approach in relieving cancer related symptoms such as pain and cachexia in standard palliative care for cancer patients.⁹

Patterns of Disease

The majority of clinical studies and specialist Chinese medicine oncologists suggest that the major cancer pathogenesis are related to Heat and Toxins, Phlegm stagnation, Blood stasis and Healthy Qi deficiency. Therefore, clinical strategies of eliminating pathogenic factors include:

Clearing Heat and Toxins, such as:

• Huang qin (Scutellaria baicalensis),
• Ban zhi lian (Scutellaria barbata),
• Bai hua she she cao (Oldenlandia diffusa), and
• Wu wei xiao du yin (Lonicera & Wild Chrysanthemum Formula)

Eliminating phlegm and dampness, such as:

• Zhe bei mu (Fritillaria thunbergia),
• Ban xia (Pinellia ternata),
• Gua lou (Trichosanthes kirilowii), and
• Wen dan Tang (Hoelen & Bamboo Combination)

Removing Blood stasis, such as:

• E zhu (Curcuma phaeocaulis),
• San qi (Panax notoginseng),
• Dan shen (Salvia miltiorrhiza), and
• Xue fu zhu yu tang (Persica & Achyranthes Combination)

On the other hand, clinical strategies of enhancing Healthy Qi of the body include herbs for tonifying Qi, and nourishing Yin, such as:

• Dang shen (Codonopsis pilosula),
• Huang qi (Astragalus membranaceus),
• Nu zhen zi (Ligustrum lucidum),
• Bu zhong Yi qi tang (Ginseng & Astragalus Combination), and
• Shi quan da bu tang (Ginseng & Dang Gui Ten Combination)

Numerous experimental and clinical studies have shown that many Chinese herbs and herbal formulas possess potential for enhancement and/or modulation of immune functions of the body and reduction of blood viscosity.8 It is emphasised that Chinese medicine used for cancer management under guidance of the Chinese medicine theories, as well as integration with modern oncology, may improve the therapeutic outcomes.

Managing Side Effects of Chemotherapy

In addition to anti-cancer effects, all chemotherapeutic drugs have certain adverse effects. For example, reduced blood cell production (in particular white blood cells) by cytotoxic chemotherapy is a potentially life-threatening condition in cancer patients. Accumulated evidence exists to support the potential benefits of Chinese herbal medicine and acupuncture in the management of this complication.¹⁰ Another example, nausea and vomiting are the most common digestive symptoms caused by chemotherapy and can significantly impact on patients’ quality of life and treatment compliance. Plenty of clinical trials provide evidence that acupuncture and Chinese herbal medicine significantly relieve chemotherapy-induced nausea and vomiting, as well as promote digestion of the cancer patients.¹¹ Additionally, Chinese medicine is beneficial for control of hot flashes in breast cancer patients receiving anti-oestrogen treatment, and for relieving radiation-induced mucositis and xerostomia in patients with head and neck cancer.

Immunological deficiency is commonly associated with cancer development. Some conventional anti-cancer interventions such as chemotherapy and radiotherapy can further weaken the already vulnerable immunity in cancer patients.¹² Chinese herbal medicine has been suggested to possess immune-protective and immune-modulatory properties, and can be useful for enhancing immune functions of cancer patients.

The majority of these herbs are in the category of the tonic herbs, including:

• Ren shen (Panax ginseng),
• Huang qi (Astragalus membranaceus),
• Jiao gu lan (Gynostemma pentaphyllum),
• Gou qi zi (Lycium barbarum), and
• Nu zhen zi (Ligustrum lucidum).

Interestingly, many Chinese herbs used in supporting cancer patients also possess the property of enhancing immune functions, such as:

• Huang qin (Scutellaria baicalensis),
• Bai hua she she cao (Oldenlandia diffusa),
• Yi yi ren (Coix lacryma-jobi),
• San qi (Panax notoginseng), and
• E zhu (Curcuma phaeocaulis).

Many clinical studies have shown that immune-boosting Chinese herbal medicine significantly increases the cancer patients’ survival and quality of life. It is therefore suggested that Chinese herbal medicine might be beneficial for preventing cancer recurrence and metastasis.^13,14 This hypothesis needs to be further validated in future clinical studies.

A Gentle Helping Hand

In comparison to chemotherapeutic drugs, Chinese herbal medicine is usually regarded as “gentle medicines” or “agents with fewer side effects”. Nevertheless, it is important to note that some Chinese herbal prescriptions, in particular used for cancer patients, may contain potentially toxic herbs, such as Chong lou (Paris polyphylla), Shan dou gen (Sophora tonkinensis), Shan ci gu (Cremastra appendiculate), Quan xie (Buthus martensi), and Chan chu (Bufo bufo gargarizans). Inappropriate use of these herbs may result in the production of adverse reactions and aggravate the conditions. Therefore, Practitioners supporting cancer patients must take care to be well informed on the potential toxicity and safety of Chinese herbal medicines prescribed.

A Developing Field

In summary, Chinese medicine has a long history being used for supporting cancer patients and has been developing on the basis of scientific research. Further studies on clinical efficacy and anti-cancer mechanism of Chinese herbal medicine are warranted.

References

1. Jemal A, Siegel R, Ward E, et al. Cancer statistics. CA Cancer J Clin. 2009.
2. Chalkiadakis GE, & Ziogas D. Progress and limitations of surgery in improving outcomes of esophagogastric junction cancer. Ann Surg Oncol 2009;16(7):2074-5.
3. De Schutter H, & Nuyts S. Radiosensitizing potential of epigenetic anticancer drugs. Anticancer Agents Med Chem 2009;9(1):99-108.
4. Marin JJ, Romero MR, Blazquez AG, et al. Importance and limitations of chemotherapy among the available treatments for gastrointestinal tumours. Anticancer Agents Med Chem 2009;9(2):162-84.
5. Hyodo I, Amano N, Eguchi K, et al. Nationwide survey on complementary and alternative medicine in cancer patients in Japan. J Clin Oncol 2005;23(12):2645-54.
6. Molassiotis A, Fernadez-Ortega P, Pud D, et al. Use of complementary and alternative medicine in cancer patients: a European survey. Ann Oncol 2005;16(4):655-63.
7. Cassileth BR, & Vickers AJ. High prevalence of complementary and alternative medicine use among cancer patients: implications for research and clinical care. J Clin Oncol 2005:23(12):2590-2.
8. Zhou DH. Clinical oncology of Chinese medicine. Beijing: People’s Health Publishing House; 2003.
9. Molassiotis A, Potrata B, & Cheng KK. A systematic review of the effectiveness of Chinese herbal medication in symptom management and improvement of quality of life in adult cancer patients. Complement Ther Med 2009;17(2):92-120.
10. Wu TX, Munro AJ, & Guanjian L. Chinese medical herbs for chemotherapy side effects in colorectal cancer patients. Cochrane Database of Systematic Reviews(1) 2005.
11. Ezzo J, Streitberger K, & Schneider A. Cochrane systematic reviews examine P6 acupuncture-point stimulation for nausea and vomiting. J Altern Complement Med 2006;12(5):489-95.
12. Bao YX, Wong CK, Leung SF, et al. Clinical studies of immunomodulatory activities of Yunzhi-Danshen in patients with nasopharyngeal carcinoma. J Altern Complement Med 2006;12(8):771-6.
13. Jiang CM, Pang MR, & Gong LY. Clinical observation on effect of chemotherapy combined with Chinese medicine in treating advanced tumour patients and on immunologic parameters. Zhongguo Zhong Xi Yi Jie He Za Zhi 2001;21(12):885-7.
14. Fan G, Zong W, & Zuo J. Dynamic observation and clinical significance of integrated traditional Chinese and Western medicine on interleukin-2 system, T cell and erythrocyte immune system in patients of lung cancer. Zhongguo Zhong Xi Yi Jie He Za Zhi 2000;20(8):586-8.

*Reproduced with kind permission from Health World Limited - Australia and New Zealand