Filed under Cancer
The Role of Chinese Medicine in Dealing with the side-effects of Cancer Treatment such as chemotherapy and radiotherapy
By Dr Greta Young Jie De
Chinese medicine can be used as a supplementary therapy to minimize the adverse side-effects of chemotherapy and radiotherapy and has proved to be efficacious. Professor Li Pei Wen at the Sino-Japanese Friendship Hospital in Beijing has shown that Chinese herbs given prior to surgery which supplement qi , nourish blood, tonify the spleen and enrich yin, will increase the body’s ability to withstand surgery and reduce post-operative complications. Even more importantly, by optimising the body’s immune system, Chinese herbs are able to combat cancer by reducing the incidence of metastasis and other complications.
Chinese Materia Medica
Frequently used Chinese herbs which strengthen the immune system are: Ren Shen, Dong Chong Xia Cao, Wu Wei Zi, Shan Yao, Gan Cao, Ling Zhi and Liu Wei Di Huang Wan. The effectiveness of using these herbs is dependent on the following:
- A relatively strong auto-immune system
- The size of the tumour cells (must be between 106 and 108 )
- Animal studies of the slow-growing type of tumour
- Animal studies of the fast-growing type of tumour
- Presence of the thymus gland (Animal studies where the thymus had been surgically removed thymus showed that Chinese herbs were not effective)
Chinese herbs are multi-targeted and therefore the same herb may be used to treat various symptoms. As an example, an analysis of the various pharmaceutical constituents of Gou Qi Zi shows the following:
- Polysaccharides regulate the auto immune system, lower cholesterol, protect the liver and have an anti-neoplasitc effect
- Betaine stimulates growth, maintains reproduction and is indicated for male infertility
- Biguanide lowers serum lipids for treatment of obesity
- Antioxidants (β-carotene, vitamin E, selenium, flavonoids) and amino aids protect against ageing and other cellular changes and support healthy physiology
Chinese Herbal Treatment to Combat the Adverse Side-effects of Chemotherapy:
- VCR (Vincristine); 5-Fu (Fluorouracil); VDS (Vindesine): Constipation and intestinal paralysis: Augment qi and moisten the intestines with such herbs as Dang Shen, Rou Cong Rong, Hu Tao Rou
- ADM(Doxorubicin or Adriamycin); DRN(Daunorubicin); CTX (Cyclophosphamide): Myocarditis: Sheng Mai Yin + Lian Zi, Suan Zao Ren, Long Yan Rou
- PCB (Procarbazine); TsPA (Thiotepa); HN2 (Chlormethine): Amenorrhoea: Tonify blood and regulate menstruation with such herbs as Dang Gui, Shu Di, Yi Mu Cao
- VLB (Vinblastine); VCR (Vincristine); VP16 (Etoposide, Vepesid) : S/S associated with nervous system: Unblock the network vessels and dispel wind. Herbs are: Gou Teng, Chen Tui, Wu Gong
- BLM (Bleomycin); PYM (Bleomycin A5); BUS (Busulfan): Fibrosis of the lung: Nourish yin and moisten the lung. Herbs are: Sha Shen, Shi Hu, Bai He
- PDD(DDP Cisplatin, Platinol, Neoplatin); HN2 (Chlormethine); Ara-c (Cytarabine): Nausea, vomiting, reduced appetite: Tonify the spleen and downbear counterflow Herbs are: Su Zi, Ban Xia, Zhu Ru
- 5-Fu (Fluorouracil); MTX (Methotrexate); CA (CF Calcium Folinate): Abdominal fullness and diarrhoea: Augment qi and tonify the spleen. Herbs are: Shan Yao, Yi Mi, Chen Pi
- PDD(DDP Cisplatin, Platinol, Neoplatin); MTX(Methotrexate); CPT-11 (Irinotecan, Camptosar): Impaired kidney function: Tonify the kidneys and disinhibit water. Herbs are: Yi Mi, Zhu Ling, Che Qian Zi.
- ADM(Doxorubicin or Adriamycin); CTX(Cyclophosphamide); DACT(Dactinomycin): Hair loss: Invigorate blood and tonify the kidneys Herbs are: He Shou Wu, Dang Gui, Gou Qi Zi.
- HN2 (Chlormethine); MMC(Mitomycin); ADM(Doxorubicin or Adriamycin): Localised stimulation: Invigorate blood and relieve toxicity Herbs are: Da Huang, Huang Lian, Hong Hua.
- Shao Yao Gan Cao Tang (Sun Ten formula-Peony & Licorice Combination): Indicated for abdominal pain, dysmenorrhoea. Relieves spasm of the smooth muscle, skeletal muscle cramps.
- Peoniflorin (Shao Yao Dai) eases pain; Glycyrrhetinic acid relieves spasm.
- Zuo Jin Wan: (Huang Lian, Wu Zhu Yu) is indicated for liver heat harassing the stomach characterised by stomach pain, ulceration, nausea.
- Berberine 小檗硷protects the stomach mucosa; Wu Zhu Yu reduces 5-HT preventing ulceration.
Augmenting Qi to treat Leucopenia:
- Frequently used herbs are: Ren shen, Dang Shen, Bai Zhu, Shan Yao, Huang Qi, Gou Qi zi, Nu Zhen Zi etc.
- Formula: Bu Zhong Yi Qi Tang: Sheng Huang Qi 15g; Gan Cao 5g; Dang Shen 10g; Dang Gui 10g; Bai Zhu 10g; Ju Pi 10g; Sheng Ma 10g; Chai Hu 10g. Decoct with water. To be taken twice daily. Sun Ten formula: Ginseng & Astragalus Combination
TCM Perspective of Radiotherapy:
- Radiotherapy can generate toxic heat and dryness
- Uses toxin to attack toxin
- Eliminates pathogen but damages zheng qi.
- Heat can be attributed to non bacterial inflammation
- Deficiency can be attributed to bone marrow suppression, disruption to internal visceral regulatory function.
- Damage to yin and qi, impaired spleen and stomach function, qi and blood deficiency.
Chinese Medicine as Supplementary Treatment:
- Support zheng qi, reduce the adverse side-effects of chemotherapy
- Complement and enhance western treatment
- Maintain quality of life
- Prolong life
To Tonify Qi and Nourish Blood:
- Indications: Insufficiency of qi and blood as a result of radiotherapy, characterised by fatigue, shortness of breath, vertigo, dizzy vision, wilting and lack lustre complexion, spontaneous sweating, abnormal blood assay with reduced immune function.
- Bu Zhong Yi Qi Tang (Pi Wei Lun): Huang Qi 15-20g; Gan Cao 5g; Ren Shen 10g; Bai Zhu 10g; Dang Gui 10g; Chen Pi 6g; Sheng Ma 3g; Chai Hu 3g. Sun Ten formula: Ginseng & Astragalus Combination
- Key points to bear in mind:
- Tonify with cool or neutral herbs.
- Avoid using warm and parching herbs such as Hong Ren Shen, Lu Rong
- Use Sheng Huang Qi
- Prevent frenetic flow of blood due to blood heat.
To Generate Fluid and Moisten Dryness:
- Indications: Fluid damage and exhaustion due to radiotherapy with liver and kidney yin deficiency characterised by parched throat, vexation thirst, emaciation, low grade fever in the afternoon, lumbar and back ache, insomnia, scant and dark urination, dry bowel movement, five heart heat and irritability.
- Yi Guan Jian: Sha Shen 10g; Mai Dong 10g; Dang Gui 10g; Sheng Di Huang 10g; Gou Qi Zi 12g; Chuan Lian Zi 5g.
- Sun Ten formula: Mai Dong Tang + Chuan Lian Zi, Gou Qi Zi, Dang Gui.
- Herbs to generate fluid and moisten dryness: Shi Hu, Yu Zhu, Huang Jing, Sang Shen Zi 10g each (contraindicated or used with caution where there is diarrhoea). Chuan Lian Zi is bitter and cold and can damage yin – the dosage should be kept small.
To Clear heat and Relieve Toxins:
- Indications: Non-bacterial inflammation of the oesophagus, oral mucosa, urinary bladder, rectum, urethra and skin as a result of radiotherapy characterised by pain, fever, ulcerations, yellow and frequent urination etc.
- Pu Ji Xiao Du Yin: Huang Qin 10g; Huang Lian 10g; Xuan Shen 6g; Chen Pi 6g; Chai Hu 6g; Jie Geng 6g; Lian Qiao 6g; Niu Bang Zi 3g; Ban Lan Gen 3g; Jiang Can 3g; Sheng Ma 3g; Gan Cao 6g.
- Sun Ten formula: Qing Zao Jiu Fei Tang (Eriobotrya & Ophiopogon Combination) + Jing Jie Lian Qiao Tang (Schizonepeta & Forsythia Combination) + Shi Wei Bai Du Tang (Bupleurum & Schizonepeta Combination)
- Action: Disperses wind and dissipates pathogens, clears heat and relieve toxicity.
- Herbs to disperse knotted bind with simultaneous heat clearing function: Pu Gong Ying, Di Ding, Zao Xiu, Shan Dou Gen 10g each.
To Tonify and Nourish the Spleen and Stomach:
- Indications: Spleen and stomach qi deficiency during radiotherapy characterised by poor appetite, sensation of fullness with poor intake of food, nausea and vomiting, epigastric and abdominal fullness, wilting complexion.
- Xiang Sha Liu Jun Zi Tang: Ren Ren 10g; Bai Zhu 9g; Fu Ling 9g; Gan Cao 6g; Chen Pi 9g; Zhi Ban Xia 12g; Mu Xiang 6g; Sha Ren 6g. Sun Ten formula: Qing Zao Jiu Fei Tang (Eriobotrya & Ophiopogon Combination) + Jing Jie Lian Qiao Tang (Schizonepeta & Forsythia Combination) + Shi Wei Bai Du Tang (Bupleurum & Schizonepeta Combination)
- Sun Ten formula: Saussurea & Cardamon Combination
- Action: Harmonises the stomach and downbears counterflow.
- Herbs containing digestive enzymes which regulate qi to negate epigastric and abdominal fullness: Fo Shou, Xiang Yuan, Shen Qu, Ji Nei Jin 10g each; Gu Ya 30g; Mai Ya 30g.
- Caution: Identify damp turbidity and yin deficiency.
Prevention of Pneumonia and Lung Fibrosis caused by Radiotherapy:
- Pathomechanism: Radiotherapy, some of the drugs used in chemotherapy such as cyclophosphamide or constitutional factors.
- Western drugs: Dexamethosone, Prednesol , antibioticsetc.
- Chinese medicine: Invigorate blood, transform stasis, nourish yin and moisten the lung: Dang Gui 10g; Sha Shen 10g; Sheng Huang Qi 15g; Dan Shen 10g; Bai He 20g; Zi Wan 10g; Shi Hu 20g; Chuan Bei Mu 10g; Pi Pa Ye 10g; Xing Ren 10g; Mu Hu Die 10g.
Nephritis due to Radiotherapy:
- S/S: Distension, soreness or percussion pain over renal region, proteinuria, haematuria, elevated BUN (blood urea nitrogen) and CR (creatinine), nausea, elevated blood pressure.
- Chinese medicine: Clear heat and disinhibit water
- Zhu Ling Tang: Zhu Ling, Fu Ling, Ze Xie, E Jiao, Hua Shi 10g each + kidney tonifying herbs such as Gou Qi zi 15g, Nu Zhen Zi 10g and Sang Shen Zi 30g.
- Sun Ten formula: Zhu Ling Tang (Polyporus Combination) + Gou Qi Zi, Nu Zhen Zi and Sang Shen Zi.
Cystitis due to Radiotherapy:
- S/S: Frequent, urgent and painful urination, haematuria, difficult and turbid urination and pain after urination, dark and turbid urine
- Treatment: Drain heat and disinhibit urination.
- Ba Zhen San: Che Qian Zi, Qu Mai, Bian Xu, Shan Zhi, Hua Shi, Gan Cao, Da Huang, Chuan Mu Tong 9g each.
- Haematuria: Da Xiao Ji 20g each; Xian He Cao 10g.
- Pain: Bai Shao 10g; Wu Yao 10g
- Frequent urination: Sang Piao Xiao 20g.
Vaginitis due to Radiotherapy
- Radiotherapy for cervical or uterine cancer causes inflammation characterised by heaviness of the lesser abdomen, scant dark urination, leucorrhoea, vaginal haemorrhage, oedema and ulceration of the uterine mucosa
- Treatment: Clear heat and parch dampness.
- Si Miao Wan: Huang Bai, Yi Ren 15g each, Cang Zhu, Niu Xi 10g each.
- Sun Ten formula: Wei Ling Tang (Magnolia & Hoelen Formula) + Wu Ling San (Hoelen Five Formula) + Ling Gui Zhu Gan Tang (Atractylodes & Hoelen Combination
- Irritability, add Mei Gui Hua 5g, Suo Luo Zi 10g.
- Abdominal pain: Add Sang Ji Sheng, Shen Jin Cao 10g each.
Induced Menopausal due to Radiation of ovary
- S/S: Reduced oestrogen level, elevated pituitary function causing disturbance of autonomic nervous system characterised by sweating, tidal fever, flushed face, vexation, insomnia.
- Treatment: Da Bu Yin Wan: Huang Bai, Zhi Mu 12g each, Shu Di, Gui Ban 18g each to nourish yin and drain fire.
- Sun Ten Formula: Zhi Bai Di Huang Wan (Anemarrhena, Phellodendron & Rehmannia Formula)
- Sweating: Add Wu Wei Zi 10g, Fo Xiao Mai 30g
- Tidal fever: Add Zhi Mu 10g, Dan Pi 10g
- Vexation: Add Yue Ji Hua 10g, Mei Gui Hua 10g.
- Insomnia: Add Bai Zi Ren, Suan Zao Ren 10g each.
Pelvic Inflammation due to Radiation:
- S/S: Extensive radiation of the pelvic cavity causing lower abdominal pain, secondary fibrosis, adhesions and obstruction of ureter and lymphatic ducts characterised by heavy sensation in the lumbar region and oedema in the lower limbs.
- Treatment: Invigorate blood and dispel stasis, unblock network vessel and ease pain.
- Shao Fu Zhu Yu Tang modified: Dang Gui 9g; Pu Huang 9g; Chi Shao 6g; Wu Ling Zhi 6g; Yuan Hu 3g; Chuan Xiong 3g; Rou Gui 3g.
- Sun Ten formula: Shu Jing Huo Xue Tang (Clematis & Stephania Combination)
- For sacral pain, add Di Long 10g; Tou Gu Cao 10g
- For lower limb pain: Mu Gua 10g; Niu Xi 10g.
Skin lesions due to radiation:
- S/S: Skin rash or redness in the skin with possible pain and pigmentation, or parched skin pealing with gradual recovery or possible skin ulceration with increased exudate.
- Oxygen-puff treatment and zinc supplement.
- Yin Hua Jie Du Tang: Jin Yin Hua 10g; Di Ding 10g; Shui Niu Jiao 10g; Fu Ling 10g; Lian Qiao 10g; Dan Pi 10g; Huang Lian 10g; Xia Ku Cao 10g.
- Action: Clears heat, relieves toxicity; nourishes blood and eases pain.
- Promote healing and astringe ulceration: Sheng Huang Qi 20g; Wu Zei Gu 10g
- Reduce exudate: Sheng Da Huang 5g; Bai Ji 10g.
Failure of the skin to heal Post-surgery:
- Sheng Huang Qi 10g; Dang Gui 10g; Zi Cao 10g; Sheng Da Huang 20g; Hong Hua 10g; Lu Gan Shi 炉甘石 20g. Add 400ml of vegetable oil, cook the above ingredients in low fire for 10 minutes, strain. Apply topically.
Low Grade Fever in the afternoon:
- S/S: Five heart heat or steaming bone with tidal fever in the afternoon, malar flush, night sweats, parched throat and thirst, scant dark urination, dry stool. (Fever due to infection must be eliminated)
- Treatment: Qing Gu San 清骨散:Yin Chai Hu 5g; Hu Huang Lian 3g; Qin Jiao 3g; Bie Jia 3g; Di Gu Pi 3g; Qing Hao 3g; Zhi Mu 3g; Gan Cao 3g.
- Sun Ten formula: Zhi Bai Di Huang Wan (Anemarrhena, Phellodendron & Rehmannia Formula)
- Individual herbs: Sheng Di 20g; Dan Pi 10g; Nu Zhen Zi 10g.
- Oncolysis due to radiation causing hyperuricaemia, hyperkalaemia, hyperphosphoraemia and hypocalcaemia.
- Hyperuricaemia: Nausea, anorexia, diarrhoea, lumbar pain, scant urination, haematuria, azotemia.
- Treatment: Wu Ling San: Ze Xie 15g; Zhu Ling 9g; Fu Ling 9g; Bai Zhu 9g; Gui Zhi 6g.
- Sun Ten formula: Hoelen Five Formula
- Chinese herbs: Yi Ren 30g; Che Qian Zi 10g; Tong Cao 5g.