Treatment of Breast Cancer with Chinese Medicine

Almost 80% of cancer patients in these western developing countries have employed some method of Complementary and Alternative Medicine, in the effort to support the therapies of conventional Cancer care (Cho, 2010).  Neoplastic diseases range from three different types, benign, histoid, and malignancy.  The spread of a malignant tumor and the associated complications is the usual cause of death in individuals.  With over 100 different types of cancer, there is no wonder why deaths are rampant and treatments differ widely (Lahans, 2007).             

Histological inspection is one of the common ways to diagnose cancer,  for example if given a diagnosis of small cell Lung cancer, physicians look for abnormalities of genes in the 3p site (Lahans, 2007).  In one study a histological study of tumors was done by randomly taking ten sections of a tumor and staining them with hematoxylin and eosin (or H&E for short) (Wang, 2015).  These chromosomal markers are used to target specific types of cancer with modern cancer treatments.  Chromosomal markers although used for treatment and diagnosis can be used to help a Traditional Chinese Medicine practitioner advance their treatment of a patient.  “We performed immunohistochemical detection of CD31 in tumor sections to determine the antiangiogenesis effects. Tumor microvessel density (MVD) was quantified for high dose group, CTX group and Control group. MVD was determined by counting the number of microvessels per a high-power field in the sections as previously described (Wang, 2015).”   With this knowledge, the physician was able to take a specific herb with properties of steroidal alkaloids and use this to reduce the size of tumors in the body (Wang, 2015).

Pharmacokinetics

Newer Chinese medicine studies have shown the efficacy of supporting cancer treatments in patients received conventional cancer treatments.  In one pilot study, using Acupuncture for the treatment of arthralgia that was secondary to aromatase inhibitor therapy in women with early breast cancer, patients received acupuncture for a 12 week period with results showing positive trends of in stiffness and function.  A pain scale from WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) was used to measure pain, functionality, and stiffness (Oh, 2013).  Another study, with 302 participants, a woman with breast cancer were treated once a week for six weeks, for symptoms that include fatigue, lymphedema, joint pain, and even hot flashes associated with chemotherapy (Komada, 2014).  Results showed that woman using acupuncture had reduced side effects from associated cancer treatments, resulting in better mobility and function of the body and energy (Komada, 2014).

Biomedical

 Treatments in integrative medicine are becoming more popular within the healthcare industry. (Slocum-Gori, Howard, Balneaves, & Kazanjian, 2013)  Many patients are seeking out supportive forms of treatment; primarily they are used for help with energy and side effects of treatment from conventional therapies.  Pain is one of the primary concerns associated with Cancer and the treatments that can produce pain.  Pain when dealing with Oncology patients may have significant diagnostic and therapeutic insinuations. (McMahon, Koltzenburg, Tracey, & Turk, 2013)  The ability to combine both conventional medicine and alternative therapeutics for the treatment of pain or cancer, in general, may have the added benefit of a more compliant patient and healthy patient at the end of therapy.

 

 

Demographics

Breast Cancer is among one of the leading causes of cancer in women and is the leading cause of cancer death in women between the ages of 40 and 55 (Lahans, 2007).  Of these women, 66 percent have no risk factors leading to breast cancer.  Moreover, of a total 85 % of women have no family history of breast cancer.  “In the UK in 2010, there were 11,556 deaths from breast cancer, and a woman has a one in eight chance of a breast cancer diagnosis in her lifetime (Price, 2013)” This places individuals that wherein a low-risk category years ago into a higher risk category.  Moreover, a history of previous breast cancers increases a patient's risk to five times more likely that they will have a reoccurrence again.   Women with a “very high” risk of breast cancer have shown to have abnormalities in the genes BRCA1 and BRCA 2 (Lahans, 2007). 

Women that are diagnosed with this life threatening disease tend to undergo very quickly surgery or multiple surgeries,  which then leads to other conjunctive therapies like chemotherapy.  Other such medications used to fight cancer such as radiation, Herceptin, and tamoxifen can then be added to treatments over the next couple of months and even years.  This, therefore, can reflect on the significance of early detection and treatment for the survival of this population (price, 2013).  Fear of recurrence is another problem that survivors of this disease commonly have and deal with, one study in particular States “Studies have identified FOR as a consistent correlate of lower mental and physical quality of life in survivorship even after demographic factors have been controlled.  Because of this robust and consistent relationship indicating the detrimental effects FOR has on survivors’ quality of life, it is a key mechanism to be targeted by an intervention to improve long-term functioning in survivors (Sommers, 2014).”  Other literature also supports the fact that this is an after effect of breast cancer and should be dealt with.  Acupuncture and traditional Chinese medicine has shown great promise in this area and should be explored more thoroughly to prove it is effectiveness for patients with this disease.

Breast Cancer Treatment and care can cost patients upwards of $100,000 in their lifetime. (Campbell & Ramsey, 2009)  Along with high costs, patients that live for 10 or more years after treatment can be seen having a higher rate of cardiovascular disease, specifically from there irradiation treatments. (Harris, 2008)  Heart disease is not the only morbidity and mortality situation that can be seen in previous patients; many have post-surgical complications which may relate to mortality.  (El-Tamer et al., 2007)  The ability to integrate other forms of healthcare to patients with breast cancer may be the key to allowing patients a long and healthy life after treatment.  (Dobos et al., 2012)

When looking at the treatment of breast cancer, it is important to understand both the biomedical and alternative therapies that are applied to the patient not to cause any conflict within all treatment modalities.  During this ability to show synchronicity we must link both types of medicine so as an understanding of both may be applied.  In Chinese medicine one may see that the kidney Jing and Yuan Qi factors cannot be changed, but merely certain compensations may be made throughout a patient's life.  This most closely relates to the genetic factors that are expressed and cannot be modified in modern medicine.   Other factors such as age that increases the risk of breast cancer by more than 80% in women over 50 years old, therefore, may be related to the kidneys in Chinese medicine.   Kidney yang or kidney yin deficiency can specifically affect the Chong and Ren channels, which in turn leads to inversion of fire and then fire toxicity.  This is caused by the loss of the downward draining function of the menses that can clear heat and eliminate toxins (contaminates) from the body.  Without the capacity to circulate the blood and expel these contaminates, the ability for heat to rise to the upper Jiao becomes quite easy. (Lahans, 2007)

Reproduction can also play a major role in Breast cancer, the risks associated with women that menstruate more than 40 years compared to women that menstruate for 30 years or less is much higher.  Also, women who become pregnant influence their estrogen levels and are at less of a risk for Breast Cancer than those that are never pregnant.   Due to the sociological aspects placed on women around their childbearing years, Chinese medicine places them more at risk for the disease.  This is primarily due to unresolved emotions that constrain the liver.  Therefore, liver qi constraint is relatively common,  although lung qi may also arise.  After long-term stasis of the liver, the heart qi becomes static.  Eventually, the liver and heart combine with the lung qi stagnation and a nodule is formed, this is caused by blood and phlegm stasis, which is a precursor to cancer in Chinese medicine. (Lahans, 2007)

           

Other influences that may be connected with Breast cancer in the United States are oral contraceptives.  The suspected origin of the contraceptive is Mexican wild yam (Dioscorea floribunda), in which diosgenin provides the basis of hormones such as estrogen and progesterone.  (“Wild yam,” n.d.)   In Chinese medicine, the liver and kidney interact with the hormone levels in the body, specifically about the Chong and Ren.  This relationship with the hormone levels becomes disturbed when unnatural hormones are placed in the body, in continuance, blood stasis occurs, and yin deficiency arises giving way to fire toxins.  Therefore, safe and efficient alternatives to oral contraceptives may need closer investigation, which will allow our patients to make a more informed decision. (Lahans, 2007)

Obesity in women can increase a woman's risk of breast cancer, but also increases the mortality rate of woman that are diagnosed with early stage breast cancer. “Obesity and Breast (Cancer | Cancer Network,” 2011)   “For postmenopausal women, significant increases in estrone, estradiol, and free estradiol are associated with increasing BMI.(Cleary & Grossmann, 2009)  Obesity in postmenopausal woman keeps estrogen flowing throughout the body more readily.  Because menopause increases the aromatase activity in the body, which converts testosterone into estrogen, this estrogen is considered “wrong” and is much higher compared to the lower levels of estrogen binding protein found in the blood. (Lahans, 2007)  In Chinese Medicine, the stomach and spleen work in conjunction for digestion and metabolism.  The stomach channel runs directly through the breast. Therefore, an improper diet can lead to dampness accumulation, furthermore, can then result in heat.  Another problem that may arise from spleen deficiency is blood deficiency.  From blood deficiency, the liver may become constrained affecting the upper jiao, in turn causing blood and phlegm stasis in the chest.(Lahans, 2007)

 

Diagnostics

As stated earlier in this paper diagnostic procedures are essential especially in breast cancer as survival rates drop the longer cancer goes undiagnosed.  FNA or fine needle aspiration is commonly used for the diagnosis of malignant and benign tumors.  This is also considered the first step in a series of measures taken for the treatment of breast cancer and is the most important for diagnostic purposes (Lahans, 2007).  In a current study published in 2015, the utilization of a skin impedance detection system was used in the ear to aid in the detection of breast cancer.  This Study was performed in a quiet, controlled condition, with a room temperature that ranged 68 to 78.8 degrees Fahrenheit.  Other factors included a humidity of 50 to 75 percent, and all test subjects were asked to reach the designated location 15 minutes earlier than their appointed time, so as to sit quietly and relax.  This allowed for the skin and muscles of the patient to relax giving a more accurate reading.  Then the skin of the ear was cleaned with 75 percent alcohol for 30 seconds.  The detection probe was then placed on the points with 75g/mm2 pressure and an angle for detection at 90 degrees to allow total connection with the skin of the ear.  The scanner was held for 20 seconds, with an electrical current increased steadily and linearly from a span of 0 in the first 10 seconds to a span of 20 for the next ten seconds then back again.  These measurements were taken at every acupoint in the ear every three seconds and the measurements cycle was repeated three times.  The data was added, and a mean was taken (yine, 2015).       

With this help in detection of breast tumors is new, it may help and be an effective way for practitioners of Traditional Chinese medicine to help patients diagnose this disease early on.  The use of the MT 2 ear acupuncture point is promising for the ability to help as said in the study from the above paragraph “while MT2 is more closely associated with the diagnosis of malignancies (yine, 2015).”  And “CO18 (Neifenmi), AT4 (Pizhixia), TG2p (Shenshangxian), BP-B3 (Ruxian), and MT2 (malignant tumor 2)), which are more related to breast diseases (yine, 2015).”  Although the other points showed no statistically relevant data for diagnosis the point of MT2 showed a definitive reaction in patients with breast tumors.  Distinct forms of diagnosis in TCM include an analysis of the tongue, in which the sides and middle tip are considered the chest and breast.  A simple change in color in these areas from pink to purple can indicate stagnation of blood in the breast, which in turn indicates a poor prognosis.  Another form of diagnosis that is used in the Oriental medical field is abdominal palpation.  One more type of diagnosis is of the nail beds and the flow and response of capillaries; this can be tested by applying pressure to the nails and then watching the refill rate into the nails (Lahans, 2007).            

Palpation of the mass in the breast can help TCM practitioners diagnose what type of breast cancer it may be.  A hard, palpable, non-moving lump that does not change and may not be painful is unique to a blood stasis type tumor.  A different kind may include fast moving, erythema on breast surface over the area involved, possibly orange peel looking skin, probably local and regional node involvement, can be considered a fire poison type of breast cancer.  Along with these classifications, it is important for women to have a staging of their cancer done as soon as possible.  This includes an examination (physical) with a careful inspection and palpation of the affected skin, lymph nodes, and Breasts.  Other pathological examinations are then performed, including imaging and examination of tissue samples.  This system provides a biochemical, genetic map, and anatomical location of the Cancer.  This also informs a patient of potentials for recurrence and information concerning the style of treatment and therapies to be used (Lahans, 2007).  Other clinical manifestations that have been seen are inverted nipples, discharge from the nipples, and even nipple erosion has occurred.  The breast can lose its normal form and become inflamed (Li, 2003).

Recent research

Hormone Replacement Therapy

Hormone replacement therapy (HRT) is frequently used and has shown to increase the incidence of fatal breast cancer.  This is specifically related to oestrogen-progestagen combinations of HRT.  (Lagro-Janssen, Rosser, & van Weel, 2003)  Although after treatments of HRT the risk of breast cancer decreases after two years, this means that the types of breast cancers that are related to HRT will regress as long as the stimulation of Hormones ceases.  Management of Hormones has a great importance in the health of women around the world. (Lahans, 2007)  Furthermore, polymorphisms are linked to breast cancer susceptibility, but also bone mineral density. (Nilsson et al., 2001)  Osteoporosis and heart disease was once thought to be related to a deficiency of Estrogen.  Although it is not thought that anymore, it still doesn’thide the fact the Osteoperosis plays a significant role in women's health around the time of menopause.  Estrogen helps produce and maintain collagen, which is a constituent of bone. (Nilsson et al., 2001) The ability to diagnose patient’s patterns plays a huge role in how to treat in Chinese medicine.  Many factors both physiological and psychoemotional play a part, in which a practitioner should recognize.  Furthermore, once a diagnosis is made the practitioner will have the ability to work and give specific advice to the patient in regards to the issue. 

Ductal carcinoma in situ or DCIS for short is a type of breast cancer that accounts for one-fifth of all breast cancers diagnosed in the United States and is a noninvasive form which is commonly treated with chemotherapy (Dehen, 2013).  Different treatments exist for this type of cancer including endocrine therapy which has results in palliative care and can have significant effects in achieving remission of symptoms. With this being said, another study proved that tamoxifen may be problematic for women, “Overall tamoxifen did reduce the number of future cancers or DCIS in either breast. However, women taking tamoxifen did not live longer than those who did not take it. A total of 15 women would have to take tamoxifen after treatment of DCIS for one woman to experience a benefit (i.e. no future cancers or DCIS in either breast after taking tamoxifen for five years). There are side effects of tamoxifen treatment such as blood clotting problems (stroke, deep vein thrombosis, pulmonary embolism) and endometrial cancer. However, no risk/benefit conclusions are possible because there was limited information about the side effects in this review. The effects of tamoxifen may have been 'diluted' by the consequences of radiotherapy. This review cannot recommend which women might have more benefit from using tamoxifen in terms of age, menopausal status or type of DCIS (oestrogen receptor (ER)-positive versus ER-negative or human epidermal growth factor receptor 2 (HER2)-positive or HER2-negative DCIS).” ( Staley, 2012)  in another study states “Whole-breast radiation therapy following breast-conserving surgery (BCS) was consistently associated with a reduced incidence of local DCIS recurrence and invasive local carcinoma. Women undergoing mastectomy were less likely than women undergoing lumpectomy with or without radiation to experience local DCIS or invasive recurrence. Tamoxifen use reduced risk of recurrent DCIS or invasive carcinoma.” (Kane, 2012)     

Chemo Therapy

Chemotherapy and hormonal therapies are considered systemic adjunctive treatments for breast cancer. The purpose of an adjunctive therapy is to treat micro metastatic diseases before it is clinically detectable in the hope that any smaller tumors will be easy to eliminate. Chemotherapy, is one facet for the treatment of cancer, which employs chemicals to destroy cancer cells.(Cho, 2010) Doxorubicin plus Cytoxan, is a common regimen for women with early stage breast cancer. It is given intravenously in 21 day cycles of administration for 4 to 6 cycles.(Lahans, 2007)  “commonly seen side effects of chemotherapy include gastrointestinal tract problems, hair loss, low blood cell counts, skin rashes, fatigue and infertility.”(Cho, 2010)  there are specific toxicities that can be seen with chemotherapy, cardiac toxicity, pulmonary toxicity, nephrotoxicity, neurotoxicity, and hepatotoxicity have the possibility of being a consequence to chemotherapy.

“Chemotherapy and hormonal therapies are considered adjuvant systemic treatments for breast cancer.” (Lahans, 2007)  The combination of a modified herbal decoction called Xiaoyao and conventional chemotherapy aided and made a significant improvement in the quality of life, furthermore prevented leukopenia and thrombopenia that is associated with chemotherapy. (Wen, Yang, & Huang, n.d.)  Day one today six during a chemotherapy treatment has the most cytotoxic effect, during which both cancerous and noncancerous cells are killed off. Therefore, it is important to help patients protect their gastrointestinal tract; this includes areas from the mouth to the anus. From day seven to day 12, the toxic effects of chemotherapy have mostly passed, although, this is mostly when damage to the bone and organs peak. After day 12 the body’s regeneration and rejuvenation cycle starts, this is where symptoms gradually dissipate, and patients start to feel better. Herbal therapy during these three areas is key to helping patients with side effects of this conventional treatment.(Cho, 2010; Lahans, 2007)  Again, Huang Qi (Astragali Radix) is the prime herb for maintaining white blood cell counts, increasing phagocytosis and promoting apoptosis.  Dan Shen is used to improve blood circulation and increase the overall effect of the chemotherapy regimen in the first few days.  Other herbs such as Fu Ling, Bai Zhu, Ze Xie, Tian Dong, Gou Qi zi, Huang Jing, San qi, Ji Xue Tang, are all used to help the body recover during the time of chemotherapy.  (Lahans, 2007) In the period of 7 to 12 days as the cytotoxic effects of chemotherapy have mostly passed blood cell production, and particular white blood cells must be supported.  (Cho, 2010; Lahans, 2007)  The side effects at this period are slightly more toxic to the renal system. The Herbs used at this period are to help protect the kidneys and bladder function and to prevent any damage. The herbs are the same as before except for the added herbs to protect the kidneys and bladder. Du Zhong, Bu Gu zhi, and Bai Mao gen are used to protect the kidneys and bladder.  Genistein is one of the compounds found in these herbs which is known to have strong anti-tumor properties.  (Lahans, 2007)

Radiation Therapy     

Radiation therapy is used to treat smaller tumors after a partial mastectomy, it is also used with breast preservation is appropriate. Treatment with radiation must be planned, and is run through a treatment simulator and computerized tattooing and planning is therefore essential. Cautions and contraindications are usually along the forms of a pulmonary disease or cardiac disease, also diseases of the autoimmune variety and control of diabetes make for probable patient for therapy. Postoperative and preoperative mammograms are helpful to determine the site and depth of the tumor bed, therefore surgeons embed clips at the tumor bed to better guide radiation oncologists for delivery of radiation therapy. Concha met and radiation therapy and chemotherapy increase local tissue reaction that may worsen both the cosmetic and the therapeutic result. These therapies destroy tissue capillary systems that carry the chemotherapy which in turn can cause the formation of adhesions and scarring, which in turn reduces blood circulation. This is considered efficient or therapeutic effects are no longer able to help someone. Therefore radiation is often delayed until the end of chemotherapy provided that the delays no longer than six months. It is easy to see that the most common therapy is surgery followed by chemotherapy followed by radiation. Radiation therapy (XRT) has affects the last up to 6 to 9 months has ceased. Chinese medicine have herbal formulas designed to help with the oxidation process of XRT. Antioxidants, and by extension Chinese herbs a clear heat, are thought to possibly inhibit radiation from having its full effect.         

Radiation therapy is now the standard of care for women with smaller tumors.  Usually, radiation therapy is performed after a lumpectomy, mastectomy, or an axillary dissection. (Lahans, 2007)  The use of herbal therapy synergistically with radiation therapy, herbal therapy works by boosting immunomodulation or by altering inducible cell death.  (JIA et al., 2013)  Chinese medicine and by extension Chinese herbal therapies improve the efficacy of both chemotherapy and radiation therapy. In fact, many herbs in recent research have shown that an enhancement of effectiveness occurs during radiation therapy patients are on Chinese medical herbs.  The use of herbs that clear heat and move toxins out through the skin via sweating, or through the stool and urine, additionally herbs that improve blood circulation oxygenation cells, radiation, and their works best in an oxygenated atmosphere and tumor cells are very the oxygenated. The use of Pu Gong Yin and Jin Yin hua to clear heat and remove toxins from the body to benefit the breast, furthermore, Dan shen is used to move blood it also improves oxygenation levels to the cancer cells, therefore enhancing the effectiveness of the radiation.  Tai zi shen and Fu Ling work together to potentiate the effects of radiation therapy.  Ling Zhi is a fungus that potentiates the effect of radiation, but also increases macrophage productivity and white blood cell counts. Maybe the most remarkable combination of herbs is Tian Dong, Nu Zhen zi, and bei Sha shen, which helps protect the normal cells from the effects of radiation therapy.  (Lahans, 2007)  Furthermore, side effects of radiotherapy may manifest this painful skin, ulceration, swelling and fibrosis, or even damage to the heart. The use of Sheng Ji Yu Hong Gao and Dan Huang You may be applied twice a day to the affected areas to help soothe the skin.  (Peiwen, Zhiqiang, & Xiuping, 2008)

Surgical

Other strategies of treatment besides herbs discussed above are surgery and which is considered to be the primary conventional defense against all a solid tumor, the purpose of surgery is to remove local and regional diseases which may be a curative route when there is no metastasis before or after surgery.  This type of treatment he had negative side effects, the Hallstead radical mastectomy was designed to exercise the tumor and all surrounding tissue. But women still died even after a negative lymph node status was procured. Furthermore, newer procedures that modify this procedure have become more commonplace. Therefore, the need for more sophisticated diagnosis and staging of breast cancer has arrived. Partial mastectomies have been therefore subcategorized into the category of lumpectomy which includes a wide excision or even a segment on mastectomy (quandrantectomy). Although a local recurrence rate after her lumpectomy is around 39%, postsurgical radiation the rate falls to 10% recurrence of cancer in 80 years. Furthermore, it is standard in cases of tumors and some 4 cm that radiation is received post-surgery of the lumpectomy.

The time after a surgical treatment is crucial for cancer patients as this time is primarily used for healing.  This time for healing is possibly one of the most appropriate times for an anti-cancer herbal formula to be used.  Herbs such as Huang Qi (Astragalus Membranaceus), Dang Gui (Angelica Sinensis), and Ji Xue Teng (Spatholobus), these herbs help improve healing time of wounds and increase blood levels. (Lahans, 2007)   Xiao Ku Cao (Prunellae Spica), Dang Gui (Angelica Sinensis), Zhu Ling (Polyporus), Shan Ci Gu (Cremastrae), Jin Yin Hua (Lonicerae Flos), San Qi (Notogenseng Radix), Huang Qi (Astragali Radix), Tai Zi Shen (Pseudostellariae Radix), Gua Lou Shi (Trichosanthis Fructus), Fu Ling (Poria), Bai Shao (Paeoniae Radix Alba), Tian Dong (Asparagus Radix), Bai Hua She She Cao (Hedyotis Diffusae), are combined together after surgery to both help heal the surgical wound but also to start the treatment for the cancer immediately after the surgery, this formula is used starting about here weeks after surgery. (Lahans, 2007) 

Xia Ku Cao and Jin Yin hua are both heat clearing herbs that clear heat from the qi level and are specific the chest (Breast). Zhu Ling and Fu Ling help drain fluids from the area; they are fungi that increase WBC counts, increase phagocytosis, and are mildly analgesic.  San-qi helps stop bleeding and has anticancer properties.  Dang gui improves the quality of blood and acts mildly as a laxative.  Tai Zi Shen is a neutral temperature qi tonic herb that also generates fluids; it improves lung function and aids in improving general digestive function.  Bai shao and Tian Dong work together to nourish fluids and nourish blood; they also soothe the liver to calm the spirit.  Huang Qi is the master herb of wound healing; it also tonifies the general qi, increases WBC and phagocytosis to clear cellular debris post-surgically; it helps prevent infection along with Jin Yin hua and Xia Ku Cao.  Shan ci gu, Bai hua she she cao, and gua lou shi are all antineoplastics.  They work with the heat clearing herbs to prevent the spread of cancerous cells. (Lahans, 2007)

 

After surgery for different types of breast cancer, there are accompanied internal and external treatments with Chinese medicine. The above formula is used to help with the dealings of healing from the surgery but may also prepare the patient for future radiotherapy and chemotherapy. The use of Sheng Ji San (Powder for generating flesh) may be added to the affected areas that had been surgically operated on and held in place with the gauze dressing. This dressing is to be changed once a day. (Peiwen et al., 2008)

 

Pain Management

 Cancer pain may be the most common and most worrying symptoms among cancer patients. It is estimated that two-thirds of all patients with metastatic cancer have suffered from cancer-related pain. (Cleeland et al., 1994)  Pain is often referred to as one of the five vital signs of an oncological patient. Although pain varies widely between different types of cancers and the various sites that are involved. Also, conventional treatment for cancers such as chemotherapy, radiation, and surgery can induce pain.(Cho, 2010)  Cancer pain has traditionally been treated with opioids, but also with the neurosurgical procedures and intravenous anesthetic. Although pain medication is used in treatments are given many cancer patients continue to suffer in pain. The continued long-term use of opioid pain medication, has a significant change in mental status, constipation, nausea, and also fear of dependence.(Lahans, 2007) in

Biomedical TCM Research

In regards to chemopreventive and use of selective estrogen receptor modulators (SERMs), which have both an estrogenic and antiestrogenic effect on the body.  The most common form used is Tamoxifen, which has an antiestrogenic effect on the breasts and an estrogenic effect on the uterus.  In Chinese Medicine Tamoxifen may be considered a heat toxin that can cause injury to the yin, which in turn causes Yin deficiency heat.  Again this affects the liver and kidneys axis and can significantly impact the Chong and Ren, with such impacts that lead to menopausal symptoms.  The early loss of menses can, therefore, exacerbate any blood stasis, both in the chest and lower jiao.  Blood stasis in the chest can lead to cardiovascular problems and in the lower jiao uterine cancer.  Other medications may also increase the risk of breast cancer, antibiotics such a Flagyl have shown to increase the incidence of breast cancer in mice.  Xanax escalates the blood levels of estrogen, but also the growth of aggressive breast cancer. (Lahans, 2007)

 

Acupuncture is also used to treat DCIS and relieve any related symptoms involved with this disease.  In a patient case report with treatments being given between September 2010 to November 2011 with a total of 24 patients received acupuncture and TCM treatments.  The treatments were provided by eight separate interns with supervision from nine distinct and discrete supervisors.  As a result, “This report describes a case of DCIS in a perimenopausal woman, treated by excisional biopsy followed only by CAM care without the use of chemotherapeutic agents or further surgery. The patient experienced a 75% reduction in volume of her DCIS between diagnosis in 2009 and November 2011, concomitant with the use of alternative therapies. To be sure, the remaining disease is still suspicious for neoplasm, and biopsy would be necessary to confirm this. However, this case represents evidence that DCIS may regress without chemotherapy or radiation, especially in perimenopausal women whose estrogen and progesterone levels are falling.” (Dehen, 2013)  On the last exam of this patient, a rapid multinodular enhancement was present with measurements of 5.7 – 3.8 – 8.1 cm.  at the end of the study the measurements had been markedly reduced in extent, although there was still an abnormal nodular appearing enhancement, still markedly reduced.  The greatest measurement of 5.6 -2 -3.9 cm was estimated due to a now patchy non-mass-like enhancement.  All of this was deduced by Micheal Hanslits, MD, Salem Radiology Consultants, September 8, 2011. (Dehen, 2013)     

Tumor development is augmented by equilibrium and dissemination of cell proliferation and death.  This has been determined and maintained through specific pathways that are regulated by various signal transductions.  Apoptosis, or the programmed cell death or active cell death, is the cause of various physiologic and non-physiologic cell injuries which include cell DNA damage, leading to different types of cancer. (Seong-Gyu, 2004)  Triptolide is an active agent isolated from the Chinese herb Tripterygii Wilfordii, recent clinical studies have shown that this Traditional Chinese Medicine herb possess both anti-inflammatory and immune suppression actionswhich show use for creating apoptosis in cancer cells.  “Unfortunately, high levels of triptolide lead to severely adverse effects, which limit its potential implication on cancer treatment. Interestingly enough, the TFIIH is also involved in the NER process. The NER process repairs the cisplatin DNA damage and eliminates the cytotoxic effect ofisplatin. Therefore, it is possible that triptolide may be used as a chemo-sensitizer to potentiate cancer cells to platinum-based cancer treatment by disrupting the NER activity and increasing the apoptosis event.” (Seong-Gyu, 2004)  “We have shown previously that triptolide (PG490), an oxygenated diterpene derived from a Chinese medicinal plant, induces apoptosis in cultured tumour cells and sensitizes tumor cells to topoisomerase inhibitors by blocking p53-mediated induction of p21. Here we extend our studies to a tumour xenograft model and evaluate the efficacy and safety of PG490-88 (14-succinyl triptolide sodium salt), a water-soluble prodrug of PG490. We also look at the combination of PG490 or PG490-88 with CPT-11, a topoisomerase I inhibitor, in cultured cells and in the tumour xenograft model. We show that PG490-88 is a safe and potent anti-tumour agent when used alone, causing tumour regression of lung and colon tumour xenografts. We also show that PG490-88 acts in synergy with CPT-11 to cause tumour regression.”  Although this study is still trying to find the best therapeutic effect, without causing toxic effects on the body.  Optimizing the amount of Triptolide is a problem due to the fact that too little of this drug shows no effect on the tumors and too much has toxic side effects.  “Our findings that PG490-88 causes tumour regression and that it acts in synergy with DNA-damaging chemotherapeutic agents suggest a role as an antineoplastic agent and chemosensitizer for the treatment of patients with solid tumours.” (Fidler, 2003)  

“Triptolide (TPL), a diterpenoid triepoxide purified from the Chinese herb Tripterygium wilfordii (Lei Gong Teng) was tested for its anti-tumor properties in several model systems. In vitro, TPL inhibited the proliferation and colony formation of tumor cells at extremely low concentrations (2–10 ng/ml) and was more potent than Taxol. Likewise, in vivo, treatment of mice with TPL for 2–3 weeks inhibited the growth of xenografts formed by four different tumor cell lines (B16 melanoma, MDA-435 breast cancer, TSU bladder cancer, and MGC80-3 gastric carcinoma), indicating that TPL has a broad spectrum of activity against tumors that contain both wild-type and mutant forms of p53. In addition, TPL inhibited experimental metastasis of B16F10 cells to the lungs and spleens of mice. The anti-tumor effect of TPL was comparable or superior with that of conventional anti-tumor drugs, such as Adriamycin, mitomycin, and cisplatin. Importantly, tumor cells that were resistant to Taxol attributable to the over-expression of the multi-drug resistant gene 1 were still sensitive to the effects of TPL. Studies on cultured tumor cells revealed that TPL induced apoptosis and reduced the expression of several molecules that regulate the cell cycle. Taken together, these results suggest that TPL has several attractive features as a new anti-tumor agent.” (Shanmin, 2003)   

Bai Hua She She Cao (Hedyotis diffusa) is a commonly used herb for the treatment of cancer in china.  Besides Hedyotis diffusa has activities of anti-inflammatory, antibacterial and central nervous system regulatory actions to benefit the nervous system when the patient is receiving treatment for cancer.  “Previous studies have shown that the triterpenes and polysaccharide from the herb have the ability to inhibit the proliferation of tumor cells, and that the primary extract of the herb could induce apoptosis in human breast cancer cell line SPC-A-1” (Shi, 2008)  Hedyotis diffusa may inhibit c-src kinase activity and has previously been studied for its anti-tumor affects with underlying molecular mechanisms in cancer cells.   “Caspase-3 is a major mediator of apoptosis acting downstream of the mitochondrial signalingpathway.  The dysfunction of mitochondria provoked us to measure the changes of caspase-3 activity inHepG2 cells following the compound treatment.” (Shi, 2008)  this treatment showed that signaling pathways created more apoptosis of malignant cells than in the control, this was measured by caspase-3 activity in the HepG2 cells.  Pharmacological aspects of this herb show promise in having an ability to attack cancer when all other drugs fail or when a break is needed from chemo therapy.    

Liver cancer may be the most common of the Cancers but with techniques to draw out the pharmacological effects and help with fighting breast cancer we must look at all possibilities.  “To determine treatment concentrations, we initially examined effects of four medicinal herbs on cell viability using MTT assay. The growth inhibition of AGS by the Saussurea lappa, Pharbitis nil, Plantago asiatica and Taraxacum mongolicum extracts were determined by quantifying viable cells in the absence or presence of treatment of eachherbal extract at various concentrations for 3 d.”   out of these four herbs only two (Saussurea lappa and Pharbitis nil) showed a growth-inhibiting curve.  For a maximal growth-inhibition (that ended at 80 percent) a concentration of 200 and 60 mg/ml in AGS cells was used.  Pharbitis nil showed the best time range with an average of two days for maximal growth-inhibition and four days for the other.  Although this study was used to determine the efficacy of these herbs on Gastric cancer cells a further study could be performed to see the value of uses on other forms of malignancies.            In this study, an investigation of effects from a 70 percent ethanolic extract prepared medicinal mushroom (I’m-Yunity) and Dan Shen, both alone and in a combination form.  The use of MCF-7 cells as an in-vitro model for Estrogen receptor positive (ER+), Low invasive breast cancer was used. The conclusion was as follows “Treatment by I'm-Yunity did not affect cell cycle progression in MCF-7 cells; however, it promoted active induction of apoptosis. In addition, treatment with Dan shen alone resulted in a pronounced reduction in the expression of Rb, cyclin D1, and p53, and also led to a diminution of p65 and p50 forms of NF-kappaB. The pronounced suppressive effects of Dan shen on expression of the aforementioned genes were largely attenuated in cells treated with I'm-Yunity-Plus suggesting that ingredients in Dan shen must have interacted with those in I'm-Yunity as to culminate in neutralization of the gene suppressive effects of Dan shen. Additional support for such interactions was obtained by targeted cDNA array analysis using human tumor metastasis and BCa/ER signaling gene arrays.” (Hsieh, 2006)  This gives us an understanding that if both are taken together, the results end up being consistent with and interaction that exists between the mushroom and Dan Shen.  This may present a very good efficacy in the treatment of breast Cancer, specifically in patients with ER+ status.

Shen Qi Fu Zheng injection is composed of two Chinese crew drugs. One of these drugs being Dang shen (Radix Codonopsis), and the other being Huang Qi (Radix Astragali), in which both of them can help enhance the immune function of the body. These two herbs are used in conjunction with chemotherapy, this specific type of chemotherapy is called Neoadjuvant chemotherapy which is shown results in decreasing the tumor stage and, therefore enhancing the operability and survival rate of patients. One of the major problems seen in chemotherapy is bone marrow suppression and gastrointestinal reactions. Chemotherapy with the injection of these two herbs given at the same time antsy the with an increased chemo sensitivity although Nate the injection of these two herbs can reduce the damage the liver and kidney chemotherapy protect the poetic system, and enhance the patient’s tolerance to chemotherapy. “ Mongholicus polysacharride extracted from Huang Qi show antitumor effect with no cytotoxicity; it does not directly kill the tumor cells, regulate the systemic immune system by promoting the formation of antibodies creation of cytokine so as to improve cellular immune function and certain non-specific immune function. And it has been proved that condonopsis pilosula polysaccharide extracted from Dang Shen can obviously enhance the moral and can improve the cellular immune function in a low dose administration in the mice model hemolytic anemia, it can increase the peripheral hemoglobin level, and in the Co-Ray irradiated mice, it can promote the spleen endogenous node formation” (Dai, 2008) Breast cancer pain occurs when tumors that secrete (hCG) human chorionic gonadotropin, these include malignant and benign tumors. Other types of pain that are associated with cancer therapy used in treatment are post chemotherapy pain syndromes toxic peripheral neuropathy, Reynaud’s phenomena, and Plexopathy. New studies have shown that glutathione, and calcium and magnesium infusion at the time of treatment reduce signs of toxic peripheral neuropathy. In patients with Reynaud’s syndrome the central sympathetic nervous system hyper-reactivity leads to reduced functional of smooth muscle cells in the terminal arterioles. Other treatments that may cause pain such as Aromatase Inhibitor is often by musculoskeletal pain and stiffness common manifestations include osteoarthritis, tendinitis, trigger finger, and carpal tunnel (all affecting the hand). Pain syndrome from breast surgery can vary in severity. Although a chronic pain is reported after almost a surgical procedure of the breast. Breast surgery pain syndromes are most common after features involving axillary dissection, which is linked directly to severity to the number of lymph nodes removed. 

Lymphedema is also a side effect breast cancer treatment which is swelling resulting from distribution of the lymphatic system, and in turn is crucial for the regulation of body fluid homeostasis. This condition is chronic and debilitating which diminishes quality of life and currently has no cure. Currently lymphedema occurs in 20% of women undergoing breast cancer treatment, and is often associated with abnormal fluid accumulation that is protein rich in the arm due to the impaired transportation of lymphatic fluids. Unfortunately a protein rich environment that is static promotes bacterial which greatly increases the risk of infection today’s treatments are focused on swelling reduction pain reduction, and includes compression garments, exercise, or even massage. All of these therapies require therapists that expertise in manic lymphedema and are usually quite costly. Although lymphedema is common and not persistent symptom for women recovering from breast cancer, one study showed that acupuncture may be suitable for treating symptoms. Their study suggests that acupuncture is the ability to stabilize symptoms and has no major safety concerns, which was reported by women in the study and giving them hope for reducing their lymphedema. (Smith, 2014)

Another study has shown to have a plan for studying Chinese medicinal herbs “We plan to perform laboratory analysis of a number of botanical agents that have been traditionally prescribed by TCM practitioners for metastatic breast cancer (MBC) patients. We have pilot data on a few herbal compounds that show anti-tumour activity, and we will use a similar expanded methodology to screen approximately 50 more botanical agents. We will test the ability of these compounds to cause breast cancer cells to divide using an MTT assay, to commit suicide (apoptosis) using APO-BRDU and to grow using clonogenic assays. The compounds will be tested for their effects using both pulsed and continuous exposure. For herbal extracts with activity, the responsible components will be identified using salt exchange column and high performance liquid chromatography fractions. Promising herbs or combinations could then be entered into Phase I/II clinical trials using tumor response endpoints.”( Dhar)        Another herb that may help combat the carcinogens of regular cancer therapy is Chai Hu, and because of the functions of harmonize in the exterior and interior it has been related to pathological control, but also immunomodulation.  Chai Hu also plays a role in supporting and protecting the cells, but also has the ability to restore cellular and condition. The ability of this herb to have such a preventative and protective effect on the body has everything to do with its pharmacological effects which in turn may be attributed to its autophagy induction.  “The signaling pathway of autophagy is associated with the key regulatory proteins of carcinogenesis, such as tumor suppressor gene p53, phosphatase and tensin homolog (PTEN), death-associated protein kinase, and proto-oncoprotein B-cell CLL/lymphoma 2 (Bcl-2). Autophagy was responsible for massive cancer cell death in vitro and in vivo. Autophagic inducers also promotedautophagic cell death in tumors or augmented the efficacy of chemotherapeutic agents when used in combination during cancer therapy. By eliminating genomic mutations, damaged proteins, and cytotoxic substances, autophagy protected cells against cancers. However, the roles of autophagy in cancers remain controversial, because autophagy might promote tumor growth by providing energy to poorly-vascularized tumor cells.” (Law, 2014)       

HER-2 and NEU (or c-erbB-2) is an oncogene when present reflects an increase of the proliferation activity of a tumor. Overexpression has been proven in 15 to 30% of patients with breast malignancy and is initiated launched to be related with a shorter survival time. The HER2 is a transmembrane growth factor receptor that has tyrosine kinase activity; HER2 is mechanically similar to the epidermal growth receptor, and both are sheaths of the growth factor receptor gene family. This status is a very specific treatment type of chemotherapeutic agents, Herceptin being the primary agent for this chemotherapy. This therapy can be combined with the taxoid agent, like Taxol or Taxotere, which is used in patients as a front-line treatment when they relapse. (Lahan, 2007)       

Ever sense evidence-based medicine has been accepted and applied in the clinical practice of Chinese medical oncology, evaluations of Chinese medical oncology clinical effectiveness is necessary and also important, only to bring Chinese medicine clinical levels into the world of Western medicine but also to create a common language and understanding between Chinese medicine and Western medicine. This will also speak in progress in Chinese medicine oncology which along with randomized controlled studies or even cohorts the medical oncology. It is essential for traditional Chinese medical professionals to exchange information with Western medical professionals in order to integrate and learn between the two, so therefore we are fully understood by Western medical professionals. (Yin, 2013) 

Chinese Medical Treatment.

Prevention

Prevention is a huge topic for women that have gone through breast cancer. The use of Chinese herbs at this time may be considered the most significant. Because women who go into remission are checked every 3 to 6 months for the first two years, the ability for Chinese medicine to detoxify the system from some pharmaceutical agents becomes the most effective. (Lahans, 2007) treatments for the root cause of cancer, therefore, becomes the front runner of all treatments in Chinese medicine. (Cho, 2010; Lahans, 2007; Peiwen et al., 2008)  Potential problems such as osteopenia, hypothyroidism, and anemia of many forms become the next hurdle.  A DEXA scan to determine bone density may be the most appropriate, patients who are anemic need overall general health support, and many have an underlying condition of hypothyroidism. Prevention, therefore, becomes treatment at which time it is important not to forget the toxic exposure that each patient has undergone. In the convincing of patients may be needed so that they understand changes in diet, lifestyle must be used during the two-year period with breast cancer reoccurrence is most likely. (Lahans, 2007) Chinese formulas such as Gua Lou Xiao Yao Tang or Qing Zhi Si Wu Tang are used to detoxify the system and also prevent cancers. Many of the herbs used in these formulas increase cytokines in the body, which boost the immune system to fight an attack cancer cells. (Cho, 2010)

 

 

 

Treatment of Pathologies

Although many other factors in western medicine may increase the risk of breast cancer, it is important to understand that there are only a few basic root causes in Chinese medicine.  The main specific diagnosis and treatments are as follows:

·        Liver depression and qi stagnation

·        Phlegm-damp due to spleen deficiency

·        Disharmony of the Chong and Ren

·        Accumulation of stasis and toxins

·        Qi and Blood deficiency

With these root factors, determining the treatment and any modifications that need to be made will then be based on these diagnoses. (Peiwen et al., 2008) 

Liver Qi Stagnation and Depression

The diagnosis of Liver qi stagnation and depression has multiple signs and symptoms, of which a firm lump in the breast and a distending pain that has no change in color of the skin will occur, there is either an impatience or melancholic mood, oppression and distension of the chest and hypochondriac area, irritability, poor appetite, a bitter taste in the mouth, dry throat, dizziness, with a more severe distention of the breast before menstruation.  When an observation of the tongue is taken a dull color with a thin and yellow coating is observed; the pulse will feel wiry or wiry and thread.  The treatment principle is, therefore, dredge the liver and regulate the Qi, transform phlegm and dissipate lumps.  Normally the formula given for a situation such as this is Xiao Yao San, with appropriate modifications.  Many of the herbs in this formula are being studied and used to see their appropriateness for cancer treatment.  Some that have shown specific advantages against cancer are Huang Qi, Pu Gong Ying, Xia Ku Cao, and Gua Lou.  Huang Qi (Radix Astragali) is used primarily to boost the body’s immune system. Usually, this herb is given as an injection along with chemotherapy to help reduce the size of a tumor and help combat digestive disorders and bone marrow suppression. (Z. Dai et al., 2008)

Etiology and Pathogenesis of Depression

Depression as a psychological state, originates from ministerial fire, from the life gate which spreads to the Zang-Fu organs.  Mental disturbances such as a failure to desire to be satisfied, and injury by depression, anger, or sadness, all cause disharmony of Qi in the Zang-Fu organs.  Dysfunction of the liver qi in it is a regular function of promoting the smooth flow of Qi, and dysfunction of the Gallbladder in pivoting the Qi correctly, eventually cause disease.  Therefore, the Yang Qi stagnates in the interior and is unable to spread; this leads to the minister fire becoming insufficient and unable to perform its function of junior fire producing Qi, also reducing the role in promoting and inspiring the activities of the Zang-Fu.  Excess of Qi turns into fire, and long -term stagnation of this fire creates disharmony causing a loss of position or calmness.  An exuberant fire would overflow the triple burner affecting the Zang-Fu organs causing pathogenic factors.  All of these factors will appear as abnormalities in emotions, cognition, and behavior.

Formula and treatment

Xiao Yao San is commonly given to Patients with liver qi stagnation and depression.  Cu Chao Chai Hu is used to promote the free flow of the liver,  Dang Gui nourishes the blood and emolliates the liver.  Xiang Fu, Yu Jin, and Xia Bai move qi and relieve depression, invigorates the blood and alleviates any pain.  Chen Pi, Qing Pi, Chuan Lian Zi, Ju Ye regulates the Qi and transforms any Stagnation.  Huang Qi supplements the Qi, Pu Gong Ying, Xia Ku Cao, Gua Lou Clears Heat, relieve toxicity, and transforms phlegm to dissipates the lumps in the breast.

Phlegm Damp due to Spleen Deficiency

Phlegm Damp Due to spleen deficiency has symptoms ranging from; firm and uneven lumps in the breast and axillae, a sallow facial complexion, general fatigue of the mind and body, distention of the stomach and chest, a decline in appetite, and loose stools.  The tongue and pulse are pale and scalloped with a white and greasy coating, and a thread slippery pulse, respectively. (Peiwen et al., 2008)  a modified six gentleman decoction is generally used for the treatment of this disease in which the primary herb is Dang Shen (Radix Codonopsis), this herb used in conjunction with Huang Qi (Radix Astragali) as an injectable again has proven in studies to help reduce tumor size.  (Z.-J. Dai et al., 2013; Peiwen et al., 2008)  Other Herbs in this formula that have the action of softening hardness, transforming phlegm, and dissipating lumps, are Gua Lou (Fructus Trichosanthis), Fa Ban Xia (Rhizoma Pinelliae Ternatae Praeparata), Chuan Bei Mu (Bulbus Fritillariae Cirrhosae), and Mu Li (Concha Ostreae). (Peiwen et al., 2008)

Etiology and Pathology of Phlegm Damp Due to spleen deficiency

The Functions of the Spleen in its transportation and transformation of dampness is from the spleens part in water metabolism.  The spleen has the responsibility of transporting the excess fluids through the meridians to the organs for extraction.  This action ensures that the various tissues of the body are moistened properly and free from the retention of dampness.  When the spleen becomes deficient, the transporting function becomes stagnant and therefore the resulting turbid phlegm and dampness. {Liangyue, 2010 #1900}

Formula and treatment

A modified six gentlemen decoction is used to fortify the Spleen and transform phlegm, but also dissipate nodules and lumps.  Dang Shen, Bai zhu, Fu Ling, and Yi Yi Ren fortify the spleen and resolve dampness.  Chen Pi, She Ren, Mu Xiang, and Ji Nei Jin regulates the Qi and disperses accumulation.  Xia Ku Cao, Shan Ci Gu clears heat and relieve toxicity.  Gua Lou, Fa Ban Xia, Chuan Bei Mu, Mu Li soften hardness’, transforms phlegm and resolves Lumps.(Peiwen et al., 2008)

Disharmony of the Chong and Ren

Disharmony of the Chong and Ren, has more symptoms of heat, along with firm lumps in the breasts which are painful on pressure.  Accompanied with irregular menses, aching and limpness of the lower back and legs, a more severe breast distension before menses, a sensation of heat in the chest, palms, and soles.  Furthermore, patients may experience dry eyes and a dry mouth. A tongue and pulse will include a pale color with a thin white coat and a wiry and thready pulse.  Often this diagnosis occurs in women that have not given birth, has had multiple miscarriages, or did not breastfeed.  (Peiwen et al., 2008)  A modification of Liu Wei Di Huang Wan is primarily given. 

Etiology and Pathogenesis

As the downward flow of blood through the menses around the time of menopause there is a propensity for blood to stagnate in the chest, especially when there is other underlying conditions. (Lahans, 2007)  Because a combination of organs feed into these meridians (Chol disharang and Ren),a usual disharmony of these other organs is uncommon.

Formula and Treatment

A Modification of Liu Wei Di Huang Wan is the Common formula given for this particular diagnosis.  Shu Di Huang, Sheng Di Huang, Gou Qi Zi, Nu Zhen Zi, Xian Mao, Yin Yang Huo, Shan Yao all supplement the Kidneys Yin and Yang.  Xing Fu, Yu Jin, Ju Hua, Qing Pi all regulate qi and relieve depression, move blood and alleviate the pain.  Dang Gui and Bai Shao nourishes the blood and relieves the liver.  Chai Hu and Chuan Xiang allows the constrained Liver to flow freely and move the blood.  Gua Lou, Hai Zhao, and Shan Ci Gu transforms phlegm and dissipates the lumps, clears heat. (Peiwen et al., 2008)

Stasis and Toxin

A firm and immovable lump in the breast with a sensation of burning heat and pain, and a discoloration of the skin above the lump, usually a dull purple with an indistinct border, or an ulcerated swelling that may represent an upside down flower, with oozing of foul smelling blood or pus; indicates an accumulation of stasis and toxin.  Accompanying symptoms include; irritability, dry mouth, afternoon fever, shortness of breath, lack of strength, constipation, and a reddish urine. With a tongue that is red in color and a yellow coating, and a pulse that is slippery and rapid. Tao Hong Si Wu Tang Modified; generally, with herbs that relieve toxicity and have anticancer properties such as, Ban Zhi Lian (Herba Scutellariae Barbatae), Shan Ci Gu (Pseudobulbus shancigu), and Bai Ying (Herba Solani Lyrati). (Peiwen et al., 2008)

Etiology and Pathogenesis

This type of toxin is included in infections such as mastitis, lung abscess, appendicitis, and other infectious, cancerous lesions.  In the form of cancer, it is important to note that this toxin is in the shape of purulent tissue decay. (Boik, 1995)  this tissue becomes stagnant and creates a fire toxin or toxic heat.

Formula and treatment

Tao Hong Si Wu Tang He Jin Yin Hua Gan Cao Tang Jia Jian is a modified formula used for the detoxification of these toxins.  Yan Hu Suo, Tao Ren, Chi Shao, Dan Shen, E Zhu, Hong Hua, San Qi Fen are used to invigorate the blood and alleviate the pain.  Jin Yin Hua, Pu Gong Ying, Ye Ju Hua, Ku Shen, Chong Lou is used to clear the heat, dry dampness and relieve toxicity.  Huang Qi supplements the Qi and helps to promote the discharge of puss.  Ban Zhi Lian, Shan Ci Gu, and Bai Ying Relieve Toxicity and have anti-cancer properties.

Qi and Blood deficiency

This is usually seen in late stage Breast cancer, which is characterized by lumps in the breast which erode and ulcerate, in which the erosion gives off a foul smell, the exudate is thin and clear.  Accompanying symptoms consist of dry and lusterless skin, mental fatigue, emaciation, a pale facial complexion, dizziness, feeling flustered, shortness of breath, reduced appetite, difficult digestion, Profuse sweating, sleeplessness, clear urine, and loose stools.  The tongue is pale and has a yellow greasy coating.  The pulse is a deep thread and forceless.

Etiology and pathogenesis

Long term Qi stagnation can eventually lead to the qi not capable of moving the blood, in turn, this causes the blood to congeal (blood stasis).  It is commonly seen with other organ patterns, or with high emotional stress which leads to these trends.  If the blood becomes deficient, it will eventually result in the Qi becoming deficient.  When this happens, the qi is injured and fails to move the blood, and stagnation of blood will occur. (“Differentiation of Syndromes According to Qi, Blood, Fluids,” n.d.)

Formula and Treatment

Dang shen, Bai Zhu, and Fu Ling is used to fortify the spleen and dry dampness.  Huang Qi, and Dang Gui help to supplement the Qi and Blood.  Huang Jing, Xi Yang Shen, and Tai Zi Shen supplement the qi and nourish the yin.  Dan Shen, Chi Shao, Ji Xue Teng, and Xiang Fu Helps to regulate qi, clear heat and invigorate blood.  Bai Zhi Lian, Pu Gong Yin, Bai Hua She She Cao, and Long Kui clears heat, relieve toxicity and also has anticancer properties.(Peiwen et al., 2008)

Acupuncture used for this treatment are consistent with moving qi and blood, but also nourishing blood and tonifying the Qi.  These points consist of ST 36, Ren 6, Ren 4, LV 8, BL 17, LV 3, SP 6, LI 4, PC 6.  Other points may be added to modify for specific symptoms or additional pathologies. 

Additional considerations

Acupuncture has shown that it can be used to treat and manage pain in relation to cancer. (Cho, 2010)  Often after conventional cancer treatment, pain is the dominant symptom, which affects the patient's physical and psychological state. Furthermore, chronic pain becomes the dominant neurological component, even when met with nociceptive pain. (Caraceni & Portenoy, 1999)  “pain is the most debilitating symptom in cancer patients and is difficult for clinicians to treat because analgesic drugs do not always procure complete relief.” (Cho, 2010)  Imaging done on human subjects has shown the acupuncture with stimulation moderates different regions of the brain, some areas of the prefrontal, amygdala, hippocampus and other parts were included in the studies. (Lu, Dean-Clower, Doherty-Gilman, & Rosenthal, 2008)  The analgesic effects of acupuncture have a strong influence on the psychological aspects of pain, this may help the majority of the elderly population, these patients are at a stage in their life when pain may not be directly related to cancer and may respond to acupuncture.  It was also studied that acupuncture used for pain control during surgery showed that the requirements for drugs like morphine. (Lu et al., 2008)  In a study made for the management of symptoms of cancer, the results showed that acupuncture helps to reduce symptoms significantly and improve the quality of life, for patients receiving treatment of cancer.  (Walker et al., 2010)

 Acupuncture has been used for cancer pain for over the past 30 years.  Pain may be the most debilitating symptom during treatment of cancer.  Pain is not the only symptom during cancer treatment; progress has been made for the treatment and prevention of chemotherapy-induced nausea and vomiting. (Cho, 2010)  In a study of Acupuncture for postchemotherapy fatigue, patients who received acupuncture at the points of PC 6 and ST 36 once daily for five days, showed less emesis than those that did not receive acupuncture for the five-day period. (Vickers, Straus, Fearon, & Cassileth, 2004)  In another study produced on the effects of acupuncture and chemo-induced nausea, patients received high-dose chemotherapy and acupuncture at PC6; the results were unfavorable for acupuncture. (“Effect of Acupuncture Compared with Placebo-Acupuncture at P6 as Additional Antiemetic Prophylaxis in High-Dose Chemotherapy and Autologous Peripheral Blood Stem Cell Transplantation,” n.d.)

Chinese herbal therapy is becoming more pronounced with oncology treatment and the therapies that are associated with cancer.  Herb-drug interactions are a serious event that may occur during treatment.  Many of the herbs used for cancer share the same pathway in the liver that the chemotherapy and conventional prescription medications do.  (Cho, 2010)  Eighteen patients had an episode of severe renal failure with the combination of Stephania Tetrandra (fourstamen Stephania root) and Magnolia Officinalis (Magnolia Bark).  This lead to the need for dialysis or a kidney transplant. (Jonge & Vanrenterghem, 2008)  Although this is may have been caused by a contraindication of both herbs, other problems such as a manufacturing error may occur, this error can cause a switch in herbs that are toxic to those with cancer. (Cho, 2010)

 

 

 

 

 

 

 

 

 

 

Conclusion

Although potential problems arise from errors in manufacturing, individual herbs have recently been on the forefront of research.  Although the use of herbal therapy is relatively new in the United States, Chinese herbal therapy has been used for thousands of years in China for the treatment of Cancer. (Cho, 2010)  More recently Herbal Therapies have been used for aiding in conjunction with conventional treatment. Treatments such as chemotherapy, radiation, and even surgery now have the added benefit of Chinese medicine, and more particularly herbal medicine. (Lahans, 2007)  In recent years, surgical procedures for cancer have made significant progress, and more conventional practitioners are looking to integrate for the health of their patients. (Cho, 2010)

It is important to consider the way formulas are written during this time, which should not only be based on the treatment given but also the staging of cancer. (Lahans, 2007)  With stage I, cancer surgery may be the best option in chemotherapy is performed postoperatively to reduce the risk of dissemination. Therefore, it is vital that the use of Chinese herbs to make sure that cancer is not spread be imperative. At stage II and stage III, chemotherapy is usually given before surgery and after and then endocrine therapy and radiotherapy are performed. The use of traditional Chinese herbs to support the vital Qi and expelling pathogenic infections should be continued. During stage IIIB radiation therapy and chemotherapy are prescribed before simple surgery, postoperatively systemic chemotherapy is given. Herbs are given throughout the treatment during this time that the level of stage IV cancer systemic chemotherapy is given in radiation intravenously is also considered, Chinese Herbs for the above are taken but also by the patterns that each patient is identified with. (Lahans, 2007; Peiwen et al., 2008)

 

 

 

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System Based Practices

System based practice has a significant role in the healthcare system, from combining multiple methods to combining major disciplines, all for the hopes of helping individual patients.  “Systems Based Practice refers to all the processes in the health care system that operate to provide cost effective care to individual patients and to populations. It includes the appointment system and referral process all the way to the governmental organization of health care.” ("Systems Based Practice")  Cost effective care can range from 5,000 dollars to 100,000 dollars, according to the WHO the price of affordable healthcare can triple a person's yearly income for one quality of life year and still be cost effective. (Drexler, "Can cost-effective health care = better health care?") 

            Because the average American makes approximately $40,000 yearly, we can assume that if we used the WHO’s rule of thumb, this persons quality of life year cost could be $120,000. (Drexler, "Can cost-effective health care = better health care?") On average no American could afford to pay for this amount of healthcare.  unfortunately, this occurs for most Americans, and costs become to high for them to afford appropriate healthcare.  for example, it is not cost effective to do a PAP smear every year but more effective to have one done every two to four years, and a new breast cancer drug which is very expensive is still a cost effective drug do to it’s quality of life year is high.  (Drexler, "Can cost-effective health care = better health care?")

            In the US population, healthcare has become about a 2.7 trillion dollar business.  Inopportunely, $.33 of every dollar spent goes to waste.   Antibiotics tend to a big contributer in this waste.  Many doctors prescribe Antibiotics during a common cold knowing it will have no effect, many feel that because of the low cost of antibiotics it will not be problematic, but in truth it costs about $1.1billion a year in wasted antibiotics. (Weisleder, "Can You Ration Health Care in a Just Society?")   How does this relate to the rest of the world?  The worldview of system based practice uses a cost-effectiveness analysis formula to adjust for their populations.  “Most countries of the developed world use cost-effectiveness analysis to form policy around their national health insurance plans. We don’t have a national insurance plan, but we do have Medicare, which is national health insurance for people over 65. Yet Medicare doesn’t look at cost.” (Drexler, "Can cost-effective health care = better health care?")

             In the world many countries use these system based views to better help their populations.  In France, which may be considered one of the best (or the best), healthcare systems in the world.  They base this by having a universal healthcare system.  They do this by using both cost sharing and out-of-pocket spending. Cost-sharing keeps a out-of-pocket spending down which totals about 9.6% of the total healthcare cost. Individuals are also able to pay for private insurance which pays for co-pays and any other costs not covered.

            In France there is 200,000 physicians, 92,000 our primary care physicians and 108,000 are specialists. Most physicians of France are self-employed practitioners itself specialists. “Forty-two percent of GPs, mostly younger doctors, are in group practices. An average practice consists of two or three physicians, and three-quarters of practices consist of physicians only. In the rest, the composition is highly variable and can include a range of allied health professionals, typically paid on a fee-for-service basis.” (Mossialos, 2015)  Possibly the most effective cost control that France has implemented, would be that of the cost control for drugs that started in September 2012. This “scheme” that was implemented a allowed patients who agreed to use generic substitutions to drugs where subject to no copayments.  This substitution for patients jumped from 71 percent to 84 percent in just one year.  In-turn this resulted in a savings of over 200 million euros or the equivalent of 237 million U.S. dollars. (Mossialos, 2015)

            As far as patient France has implemented a plan for each patient as they leave the hospital. Patients that will are in integrated hospitals and are moving to out of hospital care and social care are given a developed patient pathway guide that provides detailed patient to the patient on what each professional healthcare provider has as rules in their healthcare. This educates the patient so that there is no overlap or miscommunication between doctors it also helps coordinate physicians plan the best possible health care for their patient and for targeted populations. Also for patients health and quality of care a major project that started in 2008 with electronic medical records has been underway. This allows communication between hospitals, general practitioners, and specialists. This also allows patients to ask for all of their medical records from the general practitioner no matter which practitioner wrote the records. (Mossialos, 2015)

            Throughout the world access to healthcare remains about the same with an average of about 60% being able to see their general practitioner the next day. Although records show avoidable deaths in the population per 100,000 between the 2006 and 2007 was highest in the United States and lowest in France. (Mossialos, 2015) Although many of the percentages are fairly similar, fundamentally throughout the world (according to developed countries data) all of the system based practices are working in the general population except for in the United States. Across the board the public to use these systems is only needing minor changes except for in the US which the public use is needing major changes or fundamentally changed.

Many Acupuncturists are starting to integrate into the medical field, with medical Doctors, naturopathic physicians, chiropractors, and even psychologists.  In the Oriental Medical Field this is a huge step in the right direction and in many cases gives the patient the choice to decide which form of care they would prefer.  Many schools are now teaching students how to incorporate their practice into the medical field so as to better communicate with physicians.  This is an integral part of the teachings of Oriental medicine to help ready new practitioners into a daunting field. 

                        “biomedicine is at its limits nowadays when confronting degenerative diseases, stress-related diseases, and most chronic diseases, which are more related to the way we think and live than to bacteria and viruses. Most notably, biomedicine lacks reference to the self-healing capacity of the human mind and body and focuses on parts rather than the whole, treatment rather than prevention, the suffering disease rather than the diseased person. (Xu, 2011)  Many other countries around the world have implemented Chinese medicine as a preventative for the disease.  In China, the integration has gone hand in hand, and there is much research being done to show how the integration can be beneficial to a patient.  “the integration of CM and Western medicine has been explored for more than a century.” (Xu, 2011)

            Changes that have been made recently, such as acupuncturists working in oncology wings of hospitals and integrative practices opening nationwide.  Unfortunately, we (acupuncturists) have not been given a terminal degree yet which slightly inhibits this community. Although the acupuncture community must pass four board exams to practice and one of them being biomedicine; we are still considered less qualified by the medical community.  With this being said Acupuncturists are now being allocated to hospitals around the country to work on patients in cancer wings and community outreach centers.  Some changes that may be detrimental to helping combine these many disciplinary skills are more classroom hours of integrating these modalities.

            Some skills that may be beneficial to doctorate TCM practitioners that are needed to promote change in our community is research on specific modalities (such as cardiology), to ensure that a full understanding is available for both parties, and to what is within both party’s abilities.  “TCM-related services should be strengthened within the existing county general hospital system. Policies need to support efforts to identify a range of specific TCM services that are most effective in dealing with certain diseases, especially some non-communicable diseases. Also, a special set of human resource/career development policies for TCM physicians should be developed, considering its unique practices and learning.” (Tang, 2012)

            With more doctoral students and practitioners being trained to have higher skills,  hospitals, and hospital board members who have interests in finding new modalities to help their patients should explore the possibility of hiring on acupuncturists.  This relationship could stem a new system of healthcare in the United States.  Skills that are learned by doctoral students include collaborating with those of other medical communities to help better patients and the community.  Doctorally qualified practitioners can bring about positive changes in the community by getting involved with other specialties.

            With creations of programs such as the acupuncture relief program and acupuncturists without borders, doctorate level practitioners should be on the leading edge of community programs.  With the healthcare in America today, changes must be made.  These changes will be done to help patients and communities, with changes that provide more options for the average American.  TCM train doctoral physicians will have the ability to move this medicine forward in the coming years with research, education to hospitals and communities, and clinical practices. 

 

 

 

 

 

Bibliography

 

Drexler, M. (Ed.). (2009, December 15). Can cost-effective health care = better health care? Retrieved January 17, 2016, From http://www.hsph.harvard.edu/news/magazine/winter10assessment/

 

Weisleder, P. (2015, November 17). Can You Ration Health Care in a Just Society? Retrieved January 17, 2016, from http://pediatricsnationwide.org/2015/11/17/can-you-ration-health-care-in-a-just-society/

 

Systems Based Practice. (n.d.). Retrieved January 17, 2016, from             https://www.med.unc.edu/apselect/educational-activities/systems-based-practice-workbook

 

E. Mossialos, M. Wenzl, R. Osborn, and C. Anderson, International Profiles of Health Care Systems, 2014, The Commonwealth Fund, January 2015.

 

Xu, H., & Chen, K. (2011, February 10). Integrating traditional medicine with biomedicine towards a Patient-Centered healthcare system. Retrieved January 27, 2016, from               http://link.springer.com/article/10.1007/s11655-011-0641-2?LI=true

 

Tang, S. (2012, August 30). The Westernization of Traditional Chinese Medicine Hospitals           in China: What needs to be done? Retrieved January 28, 2016, from Https://globalhealth.duke.edu/media/blogs/china/westernization-traditional-chinese-medicine-hospitals-china-what-needs-be-done