Veterinary Healthcare - Treating cancer with TCVM (Proceedings)
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Treating cancer with TCVM (Proceedings)


CVC IN BALTIMORE PROCEEDINGS

According to the Animal Cancer Center at Colorado State University (CSU), cancer is the No. 1 cause of death in geriatric dogs and cats. Nearly half the deaths of companion dogs and cats are from cancer. Roughly half of all dogs and cats will develop cancer if they live to be 10 or older. A recent CSU oncology study involving 254 clients showed that 76 percent of clients used complementary and alternative medical (CAM) therapies, with nutritional supplements the most commonly used. More than half the clients indicated strong interest in CAM; 40 percent expressed average interest, and 3 percent reported no interest. Keum Hwa Choi, Associate Professor at the University of Minnesota, College of Veterinary Medicine, reported that patients receiving both conventional and Traditional Oriental Medicine therapies had better survival rates, longer duration of remission and quality of life than those patients who did not utilize both systems of medicine.

While the ultimate goal in treating neoplasia is complete and permanent remission, that is sadly unattainable with Western medicine, alternative modalities, or various combinations thereof. According to Huisheng Xie, DVM, MS, PhD, Assistant Clinical Professor, University of Florida, College of Veterinary Medicine, and third generation TCM practitioner, one can expect the following when treating neoplasia with TCM (acupuncture, Chinese herbs, Chinese food therapy, Tui-na [Chinese medical massage]):

  • Goal 1: Stabilization—Achieved in 90% cases
  • Goal 2: Shrinkage of mass—Achieved in 30% cases
  • Goal 3: Disappearance of mass—Achieved in 5-10% of cases

Minimally, improved quality of life is achieved with TCM treatment. It has been this author's and other TCM practitioners' experience that cancer patients show improved quality of life with renewed vitality when treated with TCM as sole or adjunctive treatment for cancer, but they typically "crash and burn" within a very short period of time once the body succumbs to the devastation of cancer.

Chronologically, TCM has a 3-6-1-3 goal when dealing with oncology patients. The first goal is for the patient to live 3 months post-diagnosis. If the patient succeeds, then the expectation is for 6 months, then 1 year and finally 3 years.

In TCM, cancer develops from exogenous factors and/or endogenous factors. External factors include toxins such as heat toxin, food toxin, radiation, chemicals, heavy metals, or the 6 pathogenic factors (Wind, Heat, Summer Heat, Cold, Dryness, Damp). Internal organ (Zang Fu) disharmony(ies), imbalance of Yin/Yang, Qi and Blood deficiency (weak constitution) and any factors that result in emotional stress or strong emotions (e.g., boarding, competition, changes in schedule or household), are considered endogenous factors. Either of these factors cause the stagnation of Qi/Blood, Phlegm, Dampness or Toxicity, which then manifest as masses or cancer. Often a root deficiency of Qi, Qi/Yang, Blood or Yin have enabled the external factors to have such a deleterious effect, or are the actual cause of the Zang Fu disharmony.

Possible TCM etiologies for the development of neoplasia include:

  • Trauma, Cold-Damp → Blood Stasis
  • Inappropriate food → Food Stagnation → Accumulation of Phlegm, Heat Toxin
  • Environmental changes (competition, strife in the household, boarding, new animal in household, schedule changes, travel, etc.) → Qi Stagnation
  • Invasion of the 6 Pathogenic Factors → Stagnation of Blood/Qi, Accumulation of Phlegm, Heat, Heat Toxin, Damp
  • Disharmony of Zang Fu (internal) organs → Zheng Qi (Antipathogenic Qi) deficiency → Stagnation of Blood/Qi, Accumulation of Phlegm, Heat, Heat Toxin, Damp

Treatment Strategies for Treating Neoplasia with TCM

Strengthen the Body's Resistance and Tonify Zheng Qi
a. Tonify Qi and strengthen Spleen

  • Herbal Formulas: Si Jun Zi Wan. Bu Zhong Yi Qi Wan, Liu Jun Zi Wan, Wei Qi Booster

b. Nourish Blood and Yin
  • Herbal Formulas: Si Wu Tang, Shi Quan Da Bu, Ba Zhen Tang, Dang Gui Bu Xue Wan

c. Nourish Yin and Body Fluids:
  • Herbal Formulas: Sha Shen Mai Dong, Sheng Mai Yin

d. Tonify Kidney Yang
  • Herbal Formulas: You Gui Wan, Shen Qi Wan

The physiological effects of tonic herbs include enhanced immune system; inhibition of tumor growth, metastasis and mutation; protection of bone marrow and the hematopoietic system; decreased side effects of chemotherapy and radiation therapy; improved quality of life. Proposed mechanisms of these herbs includes stimulation of NK cell activity, synthesis of cytokines to restrict tumor cell growth, and regulation of neoplastic cell growth cycle.

Move Qi and Blood

Stagnation of Qi and Blood is the basic pathologic change seen in the development of cancer. Physiological effects of herbs that move Qi and Blood include destruction of tumor cells, immune system regulation, enhanced effects of primary therapy (radiation, chemotherapy), neuroendocrine regulation, prevention of post-radiation fibrosis and other side effects, and the alleviation of pain.

Herbal Formulas: Xue Fu Zhu Yu Tang, Stasis Breaker or Max's Formula (Jing Tang), Chihko and Curcuma (ITM). Should use in conjunction with herbals that nourish Qi and Blood since we need to ensure that there is adequate Qi and Blood to move (e.g., Wei Qi Booster).

Clear internal Heat and toxins

Infection and chronic inflammation are predisposing factors in the development of cancer. In TCM, Heat-toxin is a major cause of cancer. Herbs that eliminate toxic heat may have direct anti-tumor effects via regulation of the body's immune system, cAMP levels and DNA/RNA synthesis by tumor cells, and growth inhibition of tumor cells. In addition to being antitoxic and stimulating immune function, some of these herbs have antibiotic and anti-inflammatory properties.

Herbal Formula: Viola Clear Fire (Golden Flower), Zhong Gan Ling (Golden Flower)

Soften hard masses, dissolve aggregations

Herbs in this category soften and shrink masses; they are typically used in combination with tonic herbals to prevent the reformation of Qi/Blood/ Phelgm entanglement. There herbs may also alleviate pain from the tumor mass and help to control metastasis.

Herbal Formulas: Stasis Transforming Formula (Golden Flower), Stasis Breaker (Jing Tang), Max's Formula (for weaker animals; Jing Tang), Chihko and Curcuma (ITM).

In TCM the saying is, "Anything that is strange must be Phlegm". Damp is the origin of Phlegm. When Phelgm accumulates, masses develop. Damp obstructs the smooth flow of Spleen Qi so it's ability to transform food into Food Qi (Gu Qi) and transport Gu Qi to the Upper Jiao (Lungs for distribution to the rest of the body and Heart where the transformation into Blood occurs) is impaired. The Spleen hates Damp, and when there is Damp, the Spleen must work extra hard to eliminate the pathogen.

Herbal Formulas: Max Formula (Jing Tang), Phlegm Transforming Formula (Golden Flower)

Bring the body back to balance

The fundamental basis of TCM is balance and harmony. When the body is out of balance, there is disharmony and disease is manifested. Treatment therefore seeks to help the body to come back into balance, eliminating excesses and supplementing deficiencies.

Manage clinical signs and symptoms
a. Anorexia, nausea, vomiting

  • Herbal Formulas: Eight Gentlemen, Happy Earth (Jing Tang)

b. Diarrhea
  • Herbal Formula: Shen Ling Bai Zhu San

c. Constipation
  • Herbal Formula: Ma Zi Ren Wan

d. Inflammation, oral ulcers
  • Herbal Formula: Wu Wei Xiao Du Yin

e. Anemia, pancytopenia
  • Herbal Formulas: Marrow Plus (Health Concerns), Gui Pi Tang, Si Wu Tang, Chemo Blood Support Formula (Golden Flower)

f. Hemorrhage
  • Herbal Formula: Yunnan Baiyao, topically to bleeding lesions or orally. May be used preventatively or in acute hemorrhage due to hemangiosarcoma.

If no improvement is seen after 1 month of herbal administration, reevaluate and switch herbal formulas.

Some Empirical Acupoints for Cancer Patients

NB: Inserting needles in or close to known tumors masses, and electroacupuncture through known or suspect lesions is not recommended due to risk of stimulating tumor growth or spread.

Immune Enhancement: LI-4/11, GV-14, ST-36, Bai-hui
Strengthen Spleen to tonify Qi: BL-20
Strengthen Lung to tonify Qi: LU-9, BL-13
Strengthen Qi to move Phlegm: ST-36, LI-10
Move Qi to resolve stagnation: LI-4, Liv-3
Transform Phlegm: ST-40
Drain Damp to resolve mass: SP-6/9
Bone Marrow Suppression: ST-36, BL-17/18/20/21/23, SP-6, GB-39
Nausea/Vomiting: PC-6, ST-36, SP-4, CV-12/14, BL-20/21
Diarrhea: GV-1, BL-20/21, GB-34, SP-6/9, LI-4/10, ST-36
Inappetance: Shan-gen (small animals), Tong-guan (equine), ST-45, Jian-wei

Food Therapy for Cancer Patients

The nutritional status of cancer patients is often suboptimal due to the effects of cancer itself and nutrient loss via vomiting, diarrhea, effusion/exudate production, GI obstruction and blood/body fluid loss. Additionally, tumors preferentially utilize glucose for metabolic energy and trap nitrogen from glutamine and other amino acids for protein synthesis. Anorexia and insulin resistance may also result from tumor secretions and the secondary production of cytokines.

There is a synergism of treatments when utilizing TCM. Food therapy is critical to the treatment of cancer as most of our commercially available pet foods promote root causes of cancer in TCM.

As cancer cells seem to utilize simple carbohydrates, complex carbohydrates, protein and fat in descending order, the knee jerk reaction is to feed a no to low carbohydrate diet. Research has not been able to confirm that high glycemic index carbohydrates increase the risk of some cancers. Some believe that increased glycemic load (glycemic index multiplied by grams of carbohydrate per serving size) results in the increased of certain forms of cancer. Although we are all hesitant to recommend any radical diet change to our patients without thoughtful and educated consideration, clinical results in this area can speak volumes. TCM food therapy utilizes observed properties of food to help resolve disharmonies and bring balance back to the body. In general, when feeding a cancer patient, a ratio of 50-60:15-30:25-35 (protein: mostly low glycemic index carbohydrates: lightly cooked vegetables) is followed. Supplementation with fish oil, digestive enzymes, probiotics and vitamin-minerals is also recommended. The patient's nutritional status should be followed closely as ration adjustments or supplementation with more oil/substitution with olive oil, flax seed oil or borage oil may be required due to weight loss or intolerance of fish oil.

Recommendations for Specific Conditions

Qi Tonics: Chicken, beef, herring, mackerel, rabbit, mutton, trout, oats, millet, brown rice, winter squash, sweet potato, yam, figs, dates, cherry, lychees, molasses, shiitake mushroom

Drain Damp: Mackerel, radish, turnip, alfalfa, rye, adzuki beans, kidney beans, barley, celery, corn, garlic, Job's Tears (Yi Yi Ren, Coix), marjoram, mustard

Transform Phlegm: Clam, pear, orange, garlic, seaweed, apple, radish, mustard, marjoram, peppermint

Resolve Stagnation: Mutton, venison, crab, shrimp, garlic, peach, clove, coriander, dill seed, radish, mustard, turmeric, hawthorn berry, chestnut

Blood Tonic: Adzuki bean, apricot, beef, beet, bone marrow, carrot, dark leafy vegetables, dates, eggs, heart, kidney beans, liver, longan, lychee, molasses, parsley, sardines

Yin Tonic (for heat signs): Duck, rabbit, clam, eggs, pork (lean), tofu, black beans, kidney beans, string beans, honey, black sesame seeds, asparagus, alfalfa sprouts, wheat, barley, spinach, peas, apples, mango, pear, pumpkin

Yang Tonic (for cold signs): Cherry, chicken, kidney, lamb, oats, shrimp/prawns, cinnamon bark, clove, nutmeg, dried and fresh ginger, garlic, dill seed, fennel seed, basil, parsnip, raspberry, rosemary, thyme, venison, walnut

References

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Sato T, Yu Y, Guo ST, et al.: Acupuncture stimulation enhances splenic natural killer cell cytotoxicity in rats. Jpn J Physiol 46 (2): 131-6, 1996.

Liu LJ, Guo CJ, Jiao XML [Effect of acupuncture on immunologic function and histopathology of transplanted mammary cancer in mice] Zhongguo Zhong Xi Yi Jie He Za Zhi 15 (10): 615-, 1995.

Wu P, Cao Y, Wu J: Effects of moxa-cone moxibustion at Guanyuan on erythrocytic immunity and its regulative function in tumor-bearing mice. J Tradit Chin Med 21 (1): 68-71, 2001.

Stener-Victorin E, Lundeberg T, Waldenström U, et al.: Effects of electro-acupuncture on nerve growth factor and ovarian morphology in rats with experimentally induced polycysticovaries. Biol Reprod 63 (5): 1497-503, 2000.