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Keep informed on current news in the world of Traditional Chinese Medicine.

Home > Newsletters > January 2008 > Chinese Medicine and Cancer Care - Page 4

Chinese Medicine and Cancer Care - Page 4

By Efrem Korngold, LAc, OMD and Harriet Beinfield, LAc

Treatment Strategies

Clinically, Chinese herbs are usually administered not as single agents, but in multi-ingredient formulas. Formulas are designed to address various aspects of the disease pattern, as well as the constitutional needs of the individual patient. For example, a given formula might use herbs that supplement qi, blood, and essence combined with other ingredients to eliminate stagnation, toxins, and reduce tumor mass. Crude herbs are decocted in teas; ingested as powders: compressed into tablets; extracted in alcohol, water, or both; and in China they may be prepared for injection or intravenous administration.

Five principles organize the formulation of many herbal prescriptions for the treatment of cancer: supplement the qi and blood to strengthen host resistance; activate circulation to dispel blood stasis and ecchymosis; relieve pain; eliminate heat and eliminate toxins; and soften lumps and dissolve masses.51

Herbal formulas may contain anywhere from 6-20 ingredients and emphasize 1 or all of the 5 therapeutic principles. The clinical application of these principles might best be illustrated by describing both the known pharmacological properties and actions as well as the traditional characteristics, indications, and effects of several individual herbs and multi-ingredient formulas that are currently being investigated and used clinically in China, Japan, and the United States.

Individual Herbs

The preponderance of herbs used for cancer has been an integral part of traditional practice for centuries. Although recently identified as adaptogenic, immune enhancing, anticoagulant and fibrinolytic, detoxifying, and tumor-resolving, agents such as Astragalus membranaceus (huang qi), Panax ginseng (ren shen), Atractylodes macrocephala (bai zhu), Glycyrrhiza uralensis (gan cao), Poria cocos (fu ling), Ganoderma lucidum (ling zhi cao), Polyporus umbellatus (zhu ling), Cordyceps sinensis (dong chong xia cao), Coix lachrymi-jobi (yi yi ren), Angelica sinensis (dang gui), Salvia miltiorrhiza (dan shen), Rheum palmatum (da huang), Coptis chinensis (huang lian), Scutellaria baicalensis (huang qin), Isatis tinctoria (ban lan gen), Chrysanthemum morifolium (ju hua), Bupleurum chinense (chai hu), Artemesia capillaries (yin chen hao), Sophora subprostrata (shan dou gen), and Oldenlandia diffusa (bai hua she she cao) have 1,800 years of clinical use.

In addition to these venerable medicines, new herbs have been discovered and old ones have been put to new uses. Eleutherococcus senticosus (ci wu jia) and Gynostemma pentaphyllum (jiao gu lan) were discovered, through modern research, to contain saponin glycosides similar to those found in Panax ginseng (ren shen) and to exert similar adaptogenic and anti-cancer effects with the added advantage of being easier to cultivate and therefore cheaper and easier to supply. Astragalus membranaceus (huang qi), Eleutherococcus senticosus (ci wu jia), and Angelica sinensis (dang gui) were also found to contain immune modulating polysaccharides similar to those occurring in Ganoderma lucidum (ling zhi cao), Polyporus umbellatus (zhu ling), Poria cocos (fu ling), Cordyceps sinensis (dong chong xia cao), and Lentinus edodes (xiang gu). Salvia miltiorrhiza (dan shen), Angelica sinensis (dang gui), and Rheum palamatum (da huang) have demonstrated effects on microcirculation including normalization of fibrin, platelet adhesion, and significant anti-angiogenic properties. Coptis chinensis (huang lian), Scutellaria baicalensis (huang qin), Isatis tinctoria (ban lan gen), Chrysanthemum morifolium (ju hua), Glycyrrhiza uralensis (gan cao), Bupleurum chinense (chai hu), Artemesia capillaris (qing hao), Sophora subprostrata (shan dou gen), and Oldenlandia doffisa (bai hua she she cao), traditionally used to treat poisoning, infection, inflammation, and ulceration, have proven to have a broad range of actions including antitumor, anti-histamine, anti-thrombic, anti-proliferative, antiangiogenic,
cytotoxic, and immune stimulating activity.

Because modern investigators are in the habit of analyzing single agents and identifying active compounds, considerable research has focused on celebrity herbs such as: Astragalus membranaceus (huang qi-astragalin polysaccharides), Panax ginseng (ren shen-saponin ginsenosides), Glycyrrhiza uralensis (gan cao-saponin glycyrrhizin), Eleutherococcus senticosus (ci wu jia- polysaccharides and saponin eleutherosides), Angelica sinensis (polysaccharides), Curcuma zedoaria (e zhu-curcumin), Ganoderma lucidum (ling zhi cao-beta glucan polysaccharides), Lentinus (xiang gu-beta glucan polysaccharides), Coriolus versicolor (PSK and PSP-beta glucan polysaccharides), Sophora subprostrata (shan dou gen-matrine and oxymatrine alkaloids), and Isatis tinctoria (ban lan gen-indirubin alkaloid). A single herb is biologically more complex than an isolated organic compound, and in traditional thinking confers a better result due to the natural synergism of all the constituents. Similarly, a multi-herb formula is exponentially more complex than a single herb, delivering even more therapeutic benefits than one herb alone.

Herbal Formulas

Many of the herbal formulas used in modern cancer therapy and research in China are part of the traditional pharmacopoeia. Shi Quan Da Bu Tang (All Inclusive Great Tonifying Decoction), Jian Pi Tang (Decoction For Tonifying The Spleen and Stomach), Si Jun Zi Tang (Four Gentleman Decoction), Bu Zhong Yi Qi Tang (Decoction For Tonifying The Middle and Augmenting The Qi), Ren Shen Yang Rong Tang (Ginseng Decoction To Nourish The Nutritive Qi), Xiao Chai Hu Tang (Minor Bupleurum Decoction) are classical (pre-19th century) prescriptions that belong to the category of tonifying and harmonizing formulas that generally improve health, strengthen resistance to stress and disease, and facilitate recovery from the debilitating effects of chronic illness. Since the adverse effects of modern cancer treatments mimic the consequences of chronic illness—weakness, fatigue, decreased resistance, reduced appetite, weight loss, diminished libido, cognitive decline, musculo-skeletal stiffness and soreness—tonic prescriptions treat these conditions and maintain healthy function. Such formulas share many of the promising anti-cancer agents mentioned above.

Modern herbal protocols often use classical formulas as a foundation, while adding additional ingredients with anti-cancer effects. For example, the formula Fu Zheng Shengjin Tang for treating the side effects of radiotherapy is based on Si Jun Zi Tang (Four Gentleman Decoction) with the addition of ingredients to supplement yin (blood and moisture) and eliminate heat (yang) and toxins: Codonopsis pilolusa (dang shen) (a substitute for Panax ginseng), Atractylodes macrocephala (bai zhu), Poria cocos (fu ling), Glycyrrhiza uralensis (gan cao) are the base formula for supplementing qi to which are added Ophiopogon japonicus (mai men
dong), Asparagus cochinchinensis (tian men dong), Glehnia littoralis
(sha shen), Rehmannia glutinosa (di huang), Anemarrhena asphodeloides
(zhi mu),
and Polygonatum odoratum (yu zhu) for supplementing yin, Scrophularia ningpoensis (xuan shen), Imperata imperitae (bai mao gen), Lonicera japonica (jin yin hua), Solanum lyratum (shu yuan quan), and Oldenlandia diffusa (bai hua she she cao) for eliminating heat and toxins, and, finally, Salvia miltiorrhiza (dan shen) for activating blood and removing stagnation. The objectives of the formula are not only to relieve the blood deficiency (anemia), moisture deficiency (dehydration), heat (due to radiation), and toxins (waste products and dead tissue due to tumor necrosis), but also to enhance the anti-cancer effects of the radiation via the antitumor activity of Salvia miltiorrhiza (dan shen), Oldenlandia diffusa (bai hua she she cao), Glycyrrhiza uralensis (gan cao), and Solanum lyratum (shu yuan quan).52

The same formula, Si Jun Zi Tang (Four Gentleman Decoction), can be used as the core of a prescription to treat the side effects of chemotherapy. Chemotherapy damages the qi and weakens the spleen and stomach, ultimately depleting the essence and undermining the kidney. Adding Astragalus membranaceus (huang qi), Polygonatum odoratum (yu zhu), Pseudostellaria heterophylla (tai zi shen), Euryale ferox (qian shi), Nelumbo nucifera (lian zi), and Dioscorea opposita (shan yao) augment the qi supplementing and stomach and spleen strengthening properties of the formula. Three more herbs Ligustrum lucidi (nu zhen zi), Rehmannia glutinosa (shu di huang), and Lycium barbarum (gou qi zi) replenish essence and strengthen the kidney. This formula called Bu Shen Jian Pi Tang alleviates fatigue, weakness, chilliness, anorexia, anemia, leukopenia, hair loss, and increases resistance to infection.53

In 1983, Jia Kun created a formula called Ping Xiao Dan, containing Citrus aurantium (zhi ke), Curcuma longa (yu jin), Niter (xiao shi), Lacca sinica exsiccata (gan qi), Alumen (ming fan), Strychnos nux-vomica (ma qian zi), Trogopterus xanthipes (wu ling zhi), and Agrimonia pilosa (xian he cao). Dr Kun recommends Ping Xiao Dan as a general formula for the prevention and treatment of cancer, to be combined with additional formulas that are specific for particular types of cancer. Ping Xiao Dan has multiple effects: Lacca sinica exsiccata (gan qi), Trogopterus xanthipes (wu ling zhi), Curcuma longa (yu jin), Citrus aurantium (zhi ke), Strychnos nux-vomicus (ma qian zi), and Agrimonia pilosa (xian he cao) eliminate stagnation of qi and blood, promote the normal function of the liver and intestines, relieve pain, promote tissue regeneration, and dissolve lumps and masses. Niter (xiao shi) and Alumen (ming fan) neutralize toxins and reduce fever and inflammation. And even though the major thrust of the formula appears to be anti-pathogenic, the Curcuma longa (yu jin), Agrimonia pilosa (xian he cao), and Citrus aurantium (zhi ke) also have a tonic effect on the body as a whole: “The combination of all these ingredients…controls and palliates solid neoplasms and manages the corrosion. It also has the function of a tonic, antidote, analgesic and appetizer, revives vigor, nourishes the nerves, encourages recovery, increases the capacity of organs to resist disease, nourishes qi, and causes cancer cells to degenerate, change shape, reduce in size, and melt.”54


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