Oncology and TCM

Zhou Hong is an Oncologist at the Chengdu University of Traditional Chinese Medicine (TCM) Hospital. I spent several days a week with her during April, seeing both walk-in patients and in-patients. We saw people with esophageal cancer, lung cancer, brain cancer, and a variety of tumors, both benign and malignant. It was difficult seeing so many people with cancer. One begins to suspect it’s an inevitable condition. Despite the dire circumstances, Dr. Zhou was very matter-of-fact and relaxed. She went about her business with a high degree of competence, dispensing herbal formulas with ease, and explaining to us interns her diagnosis and treatment strategies.

Zhou Hong
Dr. Zhou at work.

Some people had discovered their cancer early, had undergone either chemotherapy or surgery, and now were on herbs to deal with the after-effects of the whole experience. Others were in the midst of Western treatments for their condition, and were seeking herbs to complement this. Still others were so far down the road, had had cancer so long, that they were foregoing chemo or radiation therapy altogether, and instead had sought out TCM to help prolong their lives.

Some had tumors so big the doctors didn’t want to operate. It became medically impossible to remove some of the growths. This was especially true in cases were the cancer had metastasized, having spread to the liver, or lungs, or brain. Some of the people in these states had proven the pessimistic prognosis of the Western doctors wrong by turning to Chinese medicine. In one case, a women who had been given six months to live chose herbal medicine, and had now lived another six years. Dr. Zhou explained that in these latter cases, the strategy was to improve both the quality and the duration of life.

Some herbs are thought to be anti-carcinogenic. In particular a combination of Huang Qi (Astragulus), Ren Shen (Ginseng) and Ku Shen is administered intravenously to cancer in-patients. This combination is marketed as a patent formula called Kangai. I’m not sure if any clinical trials have been conducted to test the effectiveness of this combination, but almost every cancer in-patient was getting it.

In various herbal formulas, different herbs are included which are said to be specifically anti-carcinogenic for particular conditions. For instance, if a patient has esophageal cancer, Dr. Zhou will include Sha Ren and Dan Shen, among other herbs. Fu Shen is believed to be a general anti-tumor herb, which kills cancer cells and stops cancer cell division.

In was very exciting to be in a place which combines the best of two medical worlds to confront one of the most deadly conditions facing us. In many cases, Western and Chinese medicine work together very well. A patient may be getting radiation treatment, while at the same time taking an herbal formula which addresses the nausea and fatigue associated with this treatment. This formula may also have anti-carcinogenic herbs, and herbs which address the underlying condition which gave rise to the development of cancer in the first place. Another patient may lack an appetite from her chemo treatment, and will get a formula both to stimulate her appetite and boost her immune system. In the West, we refer to this as complementary medicine.

Many of the patients Dr. Zhou treated were returning patients, so she only had to make minor adjustments to their formulas based upon how they were doing. She would always take the patient’s pulse, look at their tongue, and ask them a series of questions.

Zhou Hong Pulse Taking
Dr. Zhou taking a pulse.

Pulse diagnosis allows the practitioner of Chinese medicine to determine the condition of the internal organs and the overall health of the body. There are three positions on each hand, on the radial, or thumb side of the wrist. For instance, on the right hand one has the Lung pulse, then the Spleen/Stomach pulse in the middle, and finally the Kidney Yang pulse furthest from the hand. There are 28 possible pulse qualities, for example Deep, Wiry, or Slippery. The quality of the pulse is an important part of Chinese medicine diagnosis.

Looking at the tongue coat can tell one about the condition of the digestive track, or middle jiao. The heart is represented on the tip of the tongue. One also looks at the color of the tongue. For instance, a pale tongue body means a general deficiency, whereas a purple tongue represents stagnation.

In addition to taking the pulse and looking at the tongue, Chinese doctors will ask the patient a series of questions, called the Ten Questions, although there are usually more than ten. These concern the quality of the stool and urine, the length and quality of sleep, the presence of phlegm and its quality, how strong the appetite is, the presence of bloating or gas, etc. If the patient is suffering from pain, the doctor will want to know the nature of the pain, for instance whether it is a dull ache or a sharp pain. This set of questions requires the patient to really pay attention to their body. My friend Nir joked that the average Chinese five year old could tell you every detail about the quality of their stool, whereas the average Westerner has no idea.

One thing that I found problematic was one case in which a patient who was in the late stages of abdominal cancer was told that she was lucky and they caught it early. She was told her surgery was successful and she was now cancer free. In fact, the doctors went in and the cancer was so big, and had spread so much, that they couldn’t operate. The Doctor thought that telling the patient this would dampen her spirits. Thinking she was free of cancer gave her a great attitude, which the doctor thought important to her quality of life. This is true, but I found it unethical to lie to a patient like that. They rationalized it by saying that “common people” don’t have the education to understand the complexities of medicine. Each patient we saw that morning after this, we couldn’t help but joke, Is that true what the doctor said about her condition, or is she just telling him that? This was the one incongruous aspect of my experience with Dr. Zhou. I can’t comment on whether this is a general practice of Chinese doctors, or even of Dr. Zhou. It may have been isolated to this one instance. It didn’t invalidate her overall approach in my eyes. In this one case I think she was wrong. Overall though, my experience in the oncology department was a positive one.

In addition to working in oncology with Dr. Zhou, we also spent time the last month working in pediatrics, respiratory, acupuncture in-patients, and acupuncture walk-ins. My favorite was the acupuncture walk-in clinic, as I have the most affinity for acupuncture and feel the most comfortable with this dimension of Chinese medicine. A future blog with photos will be devoted to my experience there.

The Pulse

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6 responses to “Oncology and TCM

  1. Paul-

    I’ve so enjoyed reading your and Lara’s blogs. I hope that we all can be in the same area for once when you guys get back!!

    Your post connected with my current experiences. A friend here in my program was just diagnosed with metastisized cancer. She starts chemo next week. What’s interesting is that my officemate is from China. “Li” was very surprised that our friend knew about her diagnosis. “Li” said that in her experience, a person with cancer in China wouldn’t be told- so that they would be happy. We talked for quite a while about cultural approaches to disease and information – but I’m intrigued to know that some patients in China do get diagnoses, even if the bad cases get nice information instead.

  2. Paul,
    I reqret that my first stretch of the heart and word is born on the wings of concern (though I confess that I would feel much deeper and profound twists of the gut and horrors of the mind were I think you two dearly in trouble) but I wanted to let you know that I am thinking of you both and while I may be patient for words, I would dearly like to hear some missive about your wellbeing in light of the groans of the earth…Best wishes…namu amida butsu

  3. Paul, just wanted to say I hope you and Lara have not been affected by the earthquake and I’m looking forward to seeing you guys this summer.

  4. Paul, I hope you guys are OK… I just realized the earthquake was very close to Chengdu while talking to my coworkers in Beijing. :-(

  5. What a wonderful experience,Paul,to see treatment as it takes place and be in the company of other professionals in a different culture. I wonder if the woman for whom treatment was not possible “knew” she was very sick when she came for treatment. The “common people” have seen much of life and death and read the signs. Even in the West we have come to acknowledge the mystery of dying,the gifts received and the gifts given.

  6. hey paul,

    this post is fascinating. I can’t believe they tried to soften the blow for that woman with cancer. One of the first things you learn in nursing school is never to try and provide false comfort, and a straight out lie is totally unethical.

    If you find any resources on TCM and oncology send ‘em my way. I think i’m going to be working oncology next year. I moved to miami btw and am 1/3 done with nursing school. hope the rest of your trip goes well

    todd

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