CANCER TREATMENT STRATEGIES AT IEP
TREATMENT BACKGROUNDIn most instances, standard medical therapies for cancer are administered as soon as possible, are aggressive, and have adverse effects. These modern medical procedures, which have the quality of emergency care, are taken because of the great difficulty involved in controlling cancer. Their ultimate aim, in some cases, is eliminating the cancer, but when this is unlikely, they may be utilized to provide increased survival duration and reduced symptoms (e.g., relief from the obstruction caused by a tumor mass). Modern medical treatments should be considered as a high priority. Treatment delays may lead to metastasis that could otherwise have been prevented, or may lead to irreversible or difficult-to-reverse health problems that are secondary to the tumor growth or to its subsequent late treatment. While some relatively non-toxic anti-cancer therapies are in development, such as vaccine-based immunological treatment, the majority of research is currently aimed at utilizing existing surgical, radiation, and chemotherapy strategies with new combinations and delivery methods and, when available, with newly developed drugs. Against this background, Chinese medicine and other methods of natural healing or complementary health care are applied in an attempt to minimize the injury caused by the standard methods and, hopefully, to improve the overall effect, including faster shrinkage of tumors, more complete elimination of cancer cells, and longer patient survival. Some clinical trials with natural therapies have been conducted that indicate that these favorable outcomes are possible. Unfortunately, few such trials are deemed to be conducted, reported, and interpreted adequately to lead to incorporation of the method into standard oncology practices. This is why these treatment methods remain a complementary approach usually administered by non-M.D. health professionals or obtained by patients who purchase over-the-counter products found in health food stores. I have reviewed some, but certainly only a small portion, of the literature on these complementary methods and produced a number of articles based on my findings; several of these are posted on the ITM website (other articles, posted on the website, will be mentioned later in the text). The main articles are:
Oriental perspectives on cancer and its treatment The purpose of the current article is to outline some treatment approaches that are either not covered in these articles or are not sufficiently described in relation to clinical practice. Further, the information obtained from China must be modified according to the specific situation that exists at this clinic. ACUPUNCTUREThere is little, if any, evidence that acupuncture therapy can control cancer growth or disease progression in cancer patients. However, there is some evidence that acupuncture can alleviate side effects of cancer treatments (some of this is reviewed in the article Zusanli). Patients at IEP specifically mention benefits of acupuncture in terms or alleviation of pain, digestive distress, mental agitation, and insomnia. Indeed, the perception of direct relief of these and other symptoms as a result of acupuncture therapy is one of the main reasons cited by patients for continuing participation at IEP. In the review articles I have presented on acupuncture therapy (e.g., Acupuncture treatment of asthma, Synopsis of scalp acupuncture, etc.), I have noted that Chinese medical journal reports almost always indicate the use of acupuncture on a daily basis or, at the least every other day. This applies to a wide range of diseases and disorders, including side effects of cancer therapies and cancer pain. I have likened this daily treatment approach to the way in which herbs and drugs are utilized: normally, the patient takes these every day until they are no longer appropriate to use. The common practice in America, of administering acupuncture once per week (or less frequently), does not seem to have much correlation with what is done in China. In discussing this matter with acupuncturists, the general impression I have obtained is that the frequency of acupuncture is reduced to once per week because of the high cost of acupuncture services (in the U.S., the median cost is about $50 per session) and the difficulty most patients would have in coming to the clinic regularly, as well as the part-time nature of most acupuncture practices (practitioners are usually available 2-4 days per week). It is usually reported that more frequent acupuncture, such as twice per week, does yield better results (see the recent article: Restructuring American acupuncture practices for details of the issues raised here). According to my conception of the mechanism and role of acupuncture, there is a means of evaluating an appropriate interval between acupuncture treatments, and that is to determine how long the benefits of an individual treatment last. If the benefits last for one day or less, then daily acupuncture is indicated. If they last for two days or more, then a lower frequency acupuncture is indicated. The duration of effect can change as the situation for the patient changes over time. For example, the immediate cause of symptoms (such as cancer or cancer therapy) may be removed, thus making frequent treatments no longer necessary. One of the measures of the success of acupuncture and other therapies in alleviating symptoms may be an increase in the duration of beneficial effects for each individual treatment. Based on these observations and concepts, I encourage patients who are highly symptomatic to visit the clinic frequently, at least 2-3 times per week. There is some limitation to our ability to provide daily acupuncture to any large number of patients (not enough scheduled treatment opportunities), so daily acupuncture is usually not suggested except in the most critical cases. In order to encourage a relatively high level of participation in acupuncture (more than one treatment per week), I have established the fee structure for these patients based on a single monthly fee regardless of number of treatments. Acupuncture sessions are set at 30 minutes. Because the patient comes to the clinic frequently, there is no need for any lengthy "intake" period (discussion of medical conditions that have changed since the last visit), so that almost the entire office visit time can be used for administering treatment. In the Chinese medical literature, needle retention time of 20 minutes is common, and this duration fits easily into the schedule. However, needling front and back points in one session becomes difficult. According to Chinese medical literature, it is common that one set of points is stimulated one day, with another set of points stimulated the next day, alternating the two basic sets day-by-day. This approach of alternating between two point sets is workable for those who come in frequently (at least twice per week), but probably has little benefit if the patient comes infrequently. Greater effects of treatment are reported in the Chinese medical literature if additional stimulus to the needles is given (compared to only manually stimulating at time of insertion). This includes manually stimulating the needles (for about 1 minute) at intervals of 5-10 minutes and applying moxibustion or cupping. Practitioners are encouraged to actively work with patients during the 20 minute needling period, rather than just inserting the needles and going away until the treatment is over. An assistant is available during some hours to help with these activities. Still, the patients should experience periods of uninterrupted rest, with duration of 4-8 minutes, during which the patient may experience the mind-body effects of the stimulus that has been applied (hopefully in a quiet and peaceful environment). Continually working on the patient with different stimuli throughout the 20 minute needling period may not be advantageous. In the application of acupuncture, a basic treatment plan repeated frequently is likely to be better than a treatment pattern that varies markedly from one visit to another. This concern about consistency may again be likened to the practice of prescribing herbs and drugs. If you were to give patients a different herbal prescription each day, you would not expect to get the same good results that you would if you had the consistent effect of repeated application of the same prescription (the same applies to drug therapies). At IEP, different practitioners will treat the patient on different days: it is therefore important to observe the treatment pattern administered each time and to make an effort to coordinate the treatments, rather than simply provide a personalized prescription that is unrelated to the previous personalized prescription. While altering between two set patterns from one day to the next during administration of frequent acupuncture is described in the Chinese literature, changing patterns entirely over a period of several treatments is never mentioned (other than to change treatments if a strategy is apparently not working). Treatment failure should be carefully evaluated to determine whether or not the acupuncture therapy that has been administered is the best choice and whether it has been used consistently. If it then appears that a different strategy is called for, the change can be made. There is a considerable difference between patients merely liking the treatments they receive and having patients show remarkable improvements such as those indicated in the Chinese medical literature. One reason that acupuncture may lack broader acceptance by the medical community in the West is that both acupuncturists and patients are willing to accept minor improvements as evidence of its effectiveness, while the medical profession finds the minor improvements to be within the bounds of what is considered normal, but not something worth actively pursuing or worthy of direct recommendation and referral. Therefore, efforts should be made to assure significant improvements from the treatments applied, without unreasonable expectations. Some of the techniques that the Chinese claim to be important, such as strong needle sensation and scarring moxibustion, are simply not acceptable here and must be replaced by more gentle needle stimulus and more limited moxibustion. Certainly, this is a critical consideration; a patient who finds the treatment substantially uncomfortable is unlikely to benefit or to even return for further treatment. Many medical procedures are uncomfortable and are tolerated in expectation of positive effects that will result; in the case of acupuncture, there may be too much uncertainty about the potential for positive effects to tolerate discomfort. Therefore, some modifications of the Chinese practice are often necessary. NUTRITIONAL STATUSThere is a vast medical literature on nutrition research. Overall, this research shows that well-nourished people do better than malnourished people in virtually every area with regard to health. In relation to cancer therapy, well-nourished people survive and recover better from surgery than do those who are malnourished. There is some evidence, though it may be less direct, to imply that well-nourished people also do better with radiation, chemotherapy, and other injurious experiences. Nourishment can be described in terms of three categories of substances (see Nutrient supplement basics for practitioners of traditional medicine for additional details):
With regard to major nutrients, protein intake is most often the one that is deficient, and this may be the result of limited appetite or limited ability to prepare meals. However, some natural health care proponents may intentionally or inadvertently recommend a low protein diet as a "cleansing" one, not realizing that the resulting protein deficiency can have adverse consequences for the cancer patient. As a general rule of thumb to use in estimating protein needs, a low-body-weight woman who does little physical exercise has a daily requirement on the order of 50 grams, while a high-body-weight man who does a lot of physical exercise has a daily requirement on the order of 100 grams (with others falling somewhere in between, based on body weight and physical activity). IEP makes available Narula-Soy powder as an easy-to-digest soy protein powder that provides 13 grams of protein per ounce of powder (one serving is one ounce). High protein foods include egg whites and seafood, as well as most meats; the main vegetable sources are legumes (including soy beans, peanuts, and lentils). Fat consumption is usually adequate and sometimes excessive, especially if processed foods and restaurant foods are consumed. Fats rich in omega-3 fatty acids are considered potentially beneficial and are obtained mainly from fish and from seeds (notably, flax seeds). Those who cannot obtain significant levels of omega-3 fatty acids can take supplemental capsules that contain these oils (see the article: Reducing inflammation with diet and supplements). Usual dosing recommendations are 3 grams of encapsulated oil per day. There are frequent literature recommendations to utilize olive oil over other vegetable oils in food preparation. Foods that have been stored for too long may contain rancid fats that are considered potentially harmful and should be avoided. Carbohydrates are usually adequate in the diet and sometimes excessive. Carbohydrates are present in substantial quantities in fruits and vegetables, the foods that are deemed to be of particular benefit because of their trace and non-nutrient components. Starch, as obtained from grains, is rapidly converted to sugar: a high grain diet corresponds to a high carbohydrate diet. In my article The role of dietary and herbal flavonoids on gastro-intestinal health, I present a modified food pyramid that places more emphasis on fruits, vegetables, and proteins, and somewhat less emphasis on grains. This dietary approach may be useful for cancer patients. There may be some benefit to providing vitamins and minerals in quantities that exceed usual dietary intake. For example, some research indicates a potential benefit to consuming selenium, a trace element, in amounts on the order of 100-300 micrograms per day, while dietary intakes are usually less than 50 micrograms per day. Antioxidants, which include vitamins C and E, may have a role in protecting the non-cancer cells from damage. In the natural process of repairing damage from surgery or radiation, the tissues may "use up" a larger amount of vitamins and minerals than would otherwise be needed. IEP provides most patients with a comprehensive vitamin/mineral mixture, Calmagnium, and an antioxidant mixture, Quercenol. These formulas also help new patients replace a "shopping bag" full of individual nutrition supplements with a two bottles, which helps with compliance (total dosage for the two formulas together comes to 3 tablets twice per day). Non-nutrient components include substances that are ingested in the diet but are also manufactured by the body (hence, they are neither vitamins nor minerals) and substances that have a role in health but are not immediately required for survival. As examples, coenzyme Q10 is an essential compound that is found in the diet but is also manufactured by the body (so, if dietary sources were excluded, there would still be enough to live on) and fiber is a component of food that is not manufactured by the body, is important to maintaining good health, but does not provide a substance that is of immediate need for survival. Long-term deficits in these two non-nutrient substances is associated with increased risk of cardiovascular disease and cancer. In relation to cancer, several non-nutrient substances have been implicated in preventing it (that is, they lower the risk of cancer) when ingested with some frequency. The list of protective compounds includes flavonoids (including isoflavones, flavonols, anthocyanidins, and tea polyphenols), fiber (and accompanying phytic acid), coenzyme Q10, and sulfur compounds (found in garlic, broccoli, cabbage, brussel sprouts, etc.). At high doses, these same substances may have direct anti-cancer activity, though their effects are much weaker than those of standard oncology therapies (chemotherapy, radiation, surgery) and should not be relied upon as a primary therapy for cancer. A diet rich in natural foods from several categories, including fruits, vegetables, legumes, meat, fish, dairy products, and grains, can provide much of the non-nutrient substances. Certain foods are especially noteworthy for their contents of potential anti-cancer substances, including apples (quercetin and related compounds), soya beans (genistein and daidzein), tea (especially green tea), broccoli, etc. These foods can be suggested for inclusion in the diet. Some of the compounds in these foods have been isolated and provided as supplements. For example, soy isoflavones are available in Narula-Soy (mentioned above) and Genistemma (White Tiger formula). Tea polyphenols are present in Quercenol (White Tiger) and Genistemma. Coenzyme Q10 is provided in tablet form in special products (including 100 mg, 60 mg, and 18 mg dosage forms, the latter being the amount in a tablet of Cartaequin). These non-nutrient substances, as well as the nutrients, can be considered as helpful in stabilizing the cancer patient, improving general health conditions, and, possibly, improving the effects-while reducing the adverse effects-of standard medical therapies. However, their impact may be subtle (a sudden change in health and improvement in cancer status should not be expected by adding these to the therapeutic regimen). Some care must be taken in having patients alter their dietary practices or having them take large amounts of supplements: there are a number of factors that influence the ability and willingness of patients to comply. If some of this nutrition information is provided to patients, most will learn something about nutrition that they didn't know before and they may opt to adjust their diet accordingly-if they are in a position to do so. The ability to take supplements, whether powder, liquid, capsule, or tablet form, may be limited as a result of the effects of cancer or its treatment, and, therefore, some judgment must be used in determining whether or not to prescribe additional nutrient or non-nutrient materials. Poor appetite, weak digestion, and abdominal distress (all of these can be considered a type of digestive system disturbance) can sometimes be addressed by dietary changes and acupuncture without resorting to herbs or other supplements. Some cases of digestive system disturbance, such as those caused by a tumor pressing against the stomach, ascites, or other physical factors, may not at all be benefited by giving supplements that are intended to increase the production of gastric juices, promote digestive functions, and so on. Indeed, adding more kinds of material to the digestive system could be counterproductive. Therefore, before prescribing herbs and supplements to aid in treatment of digestive system disturbance, one should carefully consider what may be the root cause of the problem. If a supplement is administered, the anticipated beneficial effects ought to be noted with the use of a single bottle in most cases, and sometimes with a slightly longer period of use. Among the remedies for digestive system disturbance that are available at IEP are these:
An advantage of Galletaine, if it is indicated, is that the dosage is 1 tablet per meal. The other formulas require multiple tablets for each dose. Intestinal disorders represent a separate category of concern. Some intestinal disorders are merely secondary to general digestive disorders; thus, diarrhea may be due to stomach/spleen disorders while the intestine itself is in relatively healthy and normal function. There are separate remedies for intestinal disorders which will not be described here, but include glutamine powder (bulk powder to add to water; especially useful for post-surgical intestinal inflammation; see the article: Amino Acid Supplements I: Glutamine), Triphala (Herbs from India), and Picrorrhiza 11 (Seven Forests). Official Description of Nupagen IMMUNE ENHANCEMENTThe complex interaction between cancer and the immune system remains largely a mystery. Cancers develop in persons who appear to have normal immunological condition as well as in those with debilitated immunity. Immune-based cancer therapies, which sometimes work very well in laboratory animal models of cancer treatment, usually have disappointing effects in humans. The immunological impact of chemotherapy and radiation are better known than the impact of the cancer itself. These treatments impair the bone marrow production of blood cells, particularly white blood cells (leukocytes) and they can also impair the functional quality of the immune cells circulating in the plasma. Immune suppression by cancer therapies can lead to flare up of chronic viral infections and can also make a patient susceptible to serious bacterial infections. In order to avoid these problems, chemotherapy and radiation are interrupted if the immune parameters drop too low; additionally or alternatively, stem cell stimulants, such as Nupagen and epogen, can be administered (by injection, usually once per week until recovery). In the Chinese medical literature some evidence is presented that acupuncture, moxibustion, and herbal therapies can counteract some of this immune suppression. The strongest evidence is for herbs, with less information about acupuncture and moxibustion effects. The strongest clinical evidence is for complex herb mixtures made mainly of tonics and for polysaccharides derived from herbs. The effect of herbs is not to eliminate immune suppression entirely, but to reduce its severity. In laboratory animal studies, by contrast, it is sometimes reported that the herb extracts "reverse immunosuppression." Two tableted formulas are offered at IEP to protect the immune system and aid immune recovery from the effects of chemotherapy and radiation. One is Gynostemma Tablets (Seven Forests), which is structured similar to the complex formulas used in Chinese clinical trials and the other is Coricepium (White Tiger), which is based on the polysaccharides. Composition-A may be used in place of Gynostemma Tablets if the latter is not available. These remedies are very expensive for ITM to produce and contribute significantly to the cost of IEP. Gynostemma Tablets is made of concentrated extracts and usually administered in doses of 4-5 tablets each time, three times daily and Coricepium 3 is made of expensive mushroom extracts of high quality (with astragalus and lycium extracts as well); it is administered in doses of 3 tablets each time, three times daily. If both remedies are used together, the daily cost (just for manufacturing the materials and providing them at IEP) is on the order of $100 per month. Therefore, one should be cautious in using these when not indicated. The expense is justified in cases where the remedies are indicated and showing some benefits. At this time, there is no clear evidence that such remedies prevent recurrence of cancer or treat cancer. Therefore, their use is limited to protecting the immune system from cancer therapies and aiding the recovery of the immune system from damage caused by such therapies that have just been discontinued. Generally, these formulas are applied from the start of the cancer therapies and continued until the end of the cancer therapies, plus a few weeks afterwards (up to 6 weeks). In elderly persons with a localized cancer (e.g., lung cancer) who do not wish to use Western medical therapies because of the poor prognosis, Coricepium may be of some benefit, as the immune system in these patients may already be severely compromised. The complex herb formulas administered in China are often given in doses that are higher than can be attained with Gynostemma Tablets. At 15 tablets per day (750 mg each), the tablets provide the dried decoction from about 2 ounces of dried crude herbs (about 60 grams). By contrast, the herbal decoctions often are made from 2-3 times that dosage. The use of a lower dosage can be partially justified by the following:
The use of the polysaccharide tablets (Coricepium) boosts up the dosage considerably. At 9 tablets per day (750 mg each), these tablets provide the equivalent of an extract of more than 70 grams of dried herb material, thus bringing the total between the two formulas to about 130 grams. Generally, there is no need to add additional herbal prescriptions to these two formulas. Gynostemma Tablets includes herbs that benefit digestion, promote circulation, tonifies the qi, blood, yin, and yang, and calms the spirit. Asking cancer patients to take more, especially if they are already taking some supplements related to nutrition, is probably asking too much and threatening to disturb their digestive functions. In addition, the costs become prohibitive. Still, if other Chinese herbal formulas are clearly indicated and the patient is willing and able to take them and tolerates them well, then one or two other formulas can be given. As mentioned in the review article on using polysaccharides, it may be possible to administer the polysaccharide remedies on an every-other day basis. Such application would permit a lower cost as well as a reduction in tablets per day or use of a different formula on the alternate days (something like the acupuncture protocol using two sets of points on alternating days). As a substitute to the Gynostemma Tablets, ITM provides crude herbs to be made into tea in the form of Astragalus/Oldenlandia Tea. This tea is a different formula, though the principles of therapy are similar. The tea can have two purposes: one is to substitute for using tablets for a patient that does not feel comfortable taking a large number of tablets (or simply can't swallow tablets) and the other is to initiate therapy with a tea that can be followed up by tablets. Regarding the latter, once a patient becomes used to the convenience of tablets, it may be difficult to introduce a tea; on the other hand, if a tea is introduced initially, the switch to tablets later is often welcomed. Granule formulas, administered by adding the granules to hot water to make a tea, become an easier option for those who have gotten used to using a tea in the first place. Astragalus/Oldenlandia Tea provides a dosage of herbs somewhat higher than that of Gynostemma Tablets, has a taste that some patients come to appreciate, and has been favorably received (in terms of good reports about its effects). The herb formula comes with instructions to make up a batch of tea from the herbs on one day and then another batch using the herb dregs the next day. To boost the dosage, as may be needed in cases of strongly immuno-suppressive chemotherapy, the second batch should be taken on the same day rather than the next day. There are numerous other immune-enhancing herbal prescriptions available from ITM, which include the following: Astragalus 10+, Ganoderma 18, Millettia 9, Antler 8, Ginseng-Royal Jelly (Pine Mountain), and Pantosterone (White Tiger). One or more of these formulas might be selected in the event of treatment failure with the other approaches. Of the formulas mentioned here, two may be of interest because they do not require a large number of tablets. Antler 8 and Pantosterone both provide a significant amount of deer antler in a small number of tablets. A daily dose of 1 gram or so of deer antler powder is often sufficient (recommended doses of Antler 8 are up to 6 tablets per day and for Pantosterone are just 2-3 tablets per day; Pantosterone is not recommended in cases of prostate cancer). Also, the Ginseng Royal Jelly Tablets are made with highly concentrated extracts, which permits dosing at low levels. The tablets are sugar coated, small, and easy to swallow. These three formulas will add significantly to the total treatment costs if added to the other herbs. ANTI-CANCER HERBSThere are numerous herbal materials from around the world that have been claimed to have cancer-inhibiting effects. In America, it is common for people interested in alternative cancer therapies to take herbal formulas such as Essiac Tea, Hoxey Formula, and other preparations that have been heavily promoted. Thus far, little evidence has been accumulated that would support an anti-cancer action of these herbs. Similarly, in the Chinese system, numerous herbs and formulas have been reported to have anti-cancer effects. Several organizations, including the National Cancer Institute (NCI) in the U.S., have screened thousands of herbs for potential anti-cancer activity. When herbs are found to have such activity, they are entered into various trials (usually starting with animal studies, followed by a series of clinical evaluations leading to rejection of the compound or to development of a new drug). Several Chinese herbs have been developed into anti-cancer drugs in China and some of these are under advanced levels of examination by NCI. Most of these, like other chemotherapy drugs, are quite toxic. One of the plant drugs turned into an anti-cancer drug recently is Taxol from the yew tree. The drug is now synthesized because only tiny amounts of the drug could be isolated from the yew bark, and the collection of the bark involved destroying the trees. This drug is now quite widely used. Herbs of low toxicity that are claimed to treat cancer have not been developed into drugs and their effectiveness remains questionable. In China, the pair of herbs oldenlandia and scutellaria are repeatedly included in herb formulas for cancer patients. These two herbs have low toxicity and are used in high dosages (a third herb, solanum, is also widely used in Chinese anti-cancer formulations and is regarded, in China, as of very low toxicity; Westerner's know the herb as "nightshade," for which the leaves are deemed highly toxic; the Chinese use the roots). A combination of "anti-cancer" herbs is prepared by ITM as Paris 7, and includes oldenlandia and scutellaria. One of its ingredients, subprostrata (Sophora subprostrata) has been further developed in China into an anti-cancer drug, namely oxymatrine. This compound has very low toxicity and is reported to have immunological benefits similar to the herbs described in the previous section. ITM has obtained oxymatrine to make a tablet by the same name (White Tiger). A compound prescription, Ping Xiao Dan, is reported in the Chinese literature to have good effects on shrinking tumors. An herbalist in China, Jia Kun, has used this formula, in pill form, accompanied by decoctions of herbs that are similar to Paris 7 to treat a wide range of cancers. Ping Xiao Dan (which is not a single formula, but is a name applied to several similar formulations) contains some toxic ingredients that are not acceptable for use in the West, but a formulation that is of similar nature and which includes some of the herbs found in the accompanying decoctions used by Jia Kun is Chih-ko/Curcuma (Seven Forests). These three tablets, Chih-ko/Curcuma, Paris 7, and Oxymatrine, are the main "anti-cancer" compounds provided by ITM. There is some question as to their value when standard medical therapies are being used at the same time, since those therapies accomplish the same goal: shrinking tumors and inhibiting cancer cells. Their role at IEP is mainly in treating patients who have failed to respond to standard medical therapies. It is difficult to administer, at the same time, both the "anti-cancer" formulas and the immune enhancing formulas, so one generally has to choose one herbal strategy at a time and follow it. Paris 7 is a concentrated extract of the herbs, but to get into the range of effective dosage (assuming it has any effect) one must prescribe 5-6 tablets three times daily, and higher doses may be acceptable. Chih-ko/Curcuma (herb powders to which some concentrates have been added) is used in doses of 4-5 tablets three times daily. Oxymatrine, because it is an alkaloid fraction derived from an herb, is used in doses of just 1 tablet each time, 3-4 times per day. SYMPTOM RELIEFIt is common for patients to present symptoms that are not only those physically related to the cancer and the cancer therapies, but also associated with other factors, such as mental distress and disorders that exist separate from the cancer, such as injuries, chronic illnesses, etc. While herbs are available to address each of the symptoms that might be presented, it is quite difficult to add anything to the herbal protocol already outlined. One should, to the extent possible, rely on herbs that have dual effects. As an example, Oxymatrine (White Tiger) has a sedative effect and could substitute for use of an additional remedy aimed at treating insomnia and nervous agitation. Symptom relief should be addressed as much as possible by the frequent acupuncture that has been alluded to previously. In addition, IEP offers its patients a form of shiatsu ("Zen Shiatsu"; see the article: Zen Shiatsu: the legacy of Shizuto Masunaga) that can aid in providing symptom relief. Although such massage sessions cannot be offered frequently enough or of long enough duration to have the full effect that they might otherwise have, when used in conjunction with acupuncture therapy (either on the same day or as alternative sessions during the treatment period), the massage sessions can provide substantial symptom relief. Sometimes the use of herbs for individual symptoms can be futile and probably should not be attempted in the first place. As an example, bone pain due to cancer metastasis will not respond to common blood-vitalizing and pain-relieving herbs unless the dosage is increased to the level that causes side effects and toxicity. It is much better to have that pain managed by proper use of morphine (in China, the opium poppy is an herb that is available for treatment of pain; in addition, the toxic herb datura is used for pain) and possibly use the herbs as a supplemental therapy. According to Chinese reports, the constipating side effect of morphine can be overcome by a rhubarb-based laxative therapy (at high dose). Also, severe ascites due to advanced liver cancer or other cancer, will not respond to common herbal diuretic formulas. Although ascites is reported to be alleviated in some Chinese medical reports, this is often accomplished with very high dosage decoctions which our patients seem unable to take if they have this symptom. Prescribing herbs in this type of situation may only serve to complicate the treatment of the patient and add confusion. In the use of acupuncture for controlling symptoms, there are some cases where it performs well and others where it does not. Careful evaluation of response is needed so that acupoint selections are optimized. Continuing to needle a point that is indicated for a symptom but which is not resulting in symptom relief may detract from needling other points that would provide benefits for other conditions of concern. PREVENTING CANCER RECURRENCESome patients at IEP are told that they no longer show signs of having cancer, as a result of successful therapy, and they wish to make a strong effort to avoid recurrence of cancer. There is a vast literature on risk factors for getting cancer. This literature points to certain things one can do to minimize experiencing a first diagnosis of cancer, including:
There is much less known about preventing cancer recurrence. The vast majority of cases of cancer recurrence involve the same cells as with the initial cancer. This means that some cancer cells were not eliminated in the otherwise successful therapy, and they begin to multiply some time later, typically at a different site than the original cancer. The recurrence of cancer most often arises within 5 years, which is why many doctors do not consider their patients to be cured of cancer until they have lived for 5 years without recurrence. It is certainly possible that many of the same factors that lead to the initial cancer (or that reduce risk of getting such a cancer) influence the dormant cancer cells that were left behind after the initial therapy. Therefore, many of the strategies used to lower cancer risk for an initial diagnosis of cancer may lower cancer recurrence. On the other hand, the strategies that lower cancer risk are usually followed for many years, whereas the time available to prevent recurrence is relatively short, so their effect may be more limited. For substances that are ingested to protect against cancer, a higher dosage may be needed to inhibit recurrence. Working with the limited knowledge of how to prevent recurrence, the following strategies may be suggested:
Such instructions, if passed on to patients, may be better than loading them up with numerous supplements to take all the time. These procedures suggest a more active role for the person who wishes to prevent cancer, rather than a passive role of taking prescribed pills and expecting the supplements to prevent the recurrence. Most cancer patients are above age 40, and the majority are above age 50. In these patients, the Chinese diagnostic category of yin deficiency syndrome may be present. Chinese researchers and doctors have proposed the Rehmannia Six Formula, the classic yin nourishing prescription, and similar formulations may help prevent cancer. Formulas of this nature are available at IEP, including:
In Korea, the daily use of ginseng is thought to be cancer preventive. Gynostemma is an herb that has active ingredients that overlap with those found in ginseng. Eleuthero is an herb that is reputed to have effects similar to those of ginseng. Ginseng, and these substitutes, may be obtained in the following materials available at IEP:
In Japan, soya products are thought to be cancer preventive. There are numerous soy foods available and IEP can provide the active constituents, soy isoflavones, in Narula-Soy and Genistemma Tablets. Whenever possible, practitioners should help patients select the smallest number of supplements to take that would be consistent with their constitution and what they may already get from their diet. July 2003
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