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Chinese Medicine, Integrated Cancer Treatment and Biomedical Research

by Tai Lahans, L.Ac,, M.ED, PhD

Introduction

Currently in the United States and most of the developed world the rates of incidence for almost all cancers are rising. There are only two cancers whose rates of incidence are declining: lung cancer due to anti-smoking campaigns aimed especially towards the young; and cervical cancer due to early detection via PAP smear screening. Cervical and lung cancers remain high in those parts of the world where health delivery systems lack either the will or the means to intervene with public health and political interventions. In the developed world the rates of incidence of all other cancers are rising. In the United States in 2005 the National Cancer Institute stated that one in every two men and one in every three women are now being diagnosed with cancer in their lifetime. Cancer is the modern epidemic.

The cure for any cancer has yet to be discovered or devised. Because of this lack of cure, many systems of medicine remain involved in the care for cancer patients. Just as the lack of cure for HIV/AIDS put many alternative forms of medicine on the map moving forward the concept of integrated care in medicine, those same forms have been and remain involved in treatment for cancer patients. However, the history of cancer treatment in the United States, unlike that of integrated care for HIV/AIDS in the early days, has been one of organized exclusion of alternative forms including naturopathy, homeopathy, chiropractic, and now Chinese medicine. And the ownership of the definition of various cancers has fallen to conventional medical science and research, and by extension the pharmaceutical industry.

The validity and usefulness of alternative medicine forms in managing chronic diseases including cancers has been questioned in ways that were previously unseen. Partly as a result of this and also as a result of the economic crisis of health delivery and the actuarial system of medical insurance reimbursement, a new mechanism for driving health care has evolved – evidence-based medicine. Now, only reimbursement for research-validated interventions is covered in any form of medical treatment, severely limiting patients’ access to CAM providers. This evidence-based approach has changed not only conventional medicine but also some natural medicine systems like naturopathy in that naturopathy has been forced to adopt even more than it recently has, a theoretical system of health and illness intervention that is based in western science, as opposed to natural systems. It has become what some now call “green medicine”; that is, the utilization of the western science theory for defining illnesses while substituting pharmaceutical drugs with natural substances, and utilization of the one substance one symptom approach. To a large extent the “nature cure” elements of naturopathy – like diet, fasting, herbal medicine, and hydrotherapy – are rarely used. Practitioners who use these modalities of naturopathy are considered old school.

Chinese medicine has become involved in this discussion and the systematic takeover of medicine in the West by the evidence-based medicine approach. At the same time, Chinese medicine and its modalities stands slightly outside the foray because it does not have a century-long history of contention with chemical medicine, as does naturopathy, and because Chinese medicine has a history in China, South Korea, Japan, Singapore, Hong Kong, Taiwan, and other places in the integration of conventional medicine with Chinese medicine. In fact, TCM is itself a more modern hybrid of integrated classical Chinese herbal theory with the western medicine concept of protocols. It is the formation of TCM based in herbal theory to the exclusion of acupuncture palpatory techniques that has partially led to the final loss of palpation as a major diagnostic tool in Chinese medicine in China. Western disease names are followed by a differential diagnosis in Chinese medicine terms. Modern Chinese medicine in oncology has become mainly the western science evaluation of Chinese medicine interventions leaving off the analysis of the strategies that generated those interventions. These interventions are being used extensively in integrated cancer treatment, women’s health issues, chronic viral infections, and sometimes even in acute infectious illnesses. Their use is via a linear approach based in a western diagnosis as opposed to a pattern approach based in signs (including palpation signs) and symptoms from Chinese medicine. As such, the modern use of Chinese medicine is being defined by what western science can understand of it. But Chinese medicine is a perennial form of medicine with foundations in knowledge accrued through a different process than only observation and deduction, dissection and testing.

Perennial forms of medicine and philosophy remain based in an approach that tries to see health as a connection between heaven and earth. They have retained the science and religion connection of the heart/mind concept of Chinese medicine. Perennial forms of medicine understand the workings of life partially from a metaphysical and partially from an instinctual and observational perspective. Chinese medicine is one perennial form; there are many others that have persisted through time, for example, Unani, Tibetan, Ayurvedic, Ayahuasca, and other medical systems. All of these systems include an introspective and highly evolved intuitive experience as part of their diagnostic tool kit. They require development of the human practitioner for their use. And this introspective and intuitive experience is linked to the physical world, the Earth, the material plane, and the Source. The concept of “Qi” is one example of an attempt to explain how the material plane is motivated to exist and become. Although Qi has been visualized, in a sense, by the Japanese who showed through western parameters that the channels and points of Qi flow do exist, western science has not taken up the gauntlet in extending this knowledge. It is perhaps too foreign and certainly not reductionism. And yet Qi is the foundational concept of Chinese medicine. Qi motivates all life processes and injuries to Qi are what cause harm on the physical plane.

The methodological tools coming from modern western science make it difficult or impossible to grasp and analyze the concepts and language of intuitive and instinctive thinking processes. In order to study and measure Chinese medicine and its strategies, there is a need in academics and in Western science to include natural systems approaches in research about the processes of cognition and thinking that lead to an understanding of how the human body works according to Chinese medicine. It is true that the diagnostic methods of both Chinese medicine and modern western medicine are fruitful. But the methodologies of each are vastly different.

The reductionist view still runs modern western medicine and is in search of whatever is the current bottom line of physics regarding a specific disease. The evolution of whatever is down there at the infinitesimal baseline or basis of mechanics has evolved and will probably continue to evolve. Everything points downward, from societies to people, to organs, to biochemistry, to genetics, to physics. Physicists have given up trying to reason upward from the ultimate physical laws to larger scale events in the universe. Perennial systems do still try and reason “upward”. Chinese medicine is closer to the actual ways of thinking and intuiting of humans. Chinese medicine uses observation and palpation as a means of reasoning downward, upward, inward, and in a spiral; and sometimes these observations and palpations are based in skills acquired through the practice of what we would call spiritual technologies founded in and developed through meditation and listening techniques.

Is Chinese medicine epistemologically a science or a philosophy? Many of the concepts of Chinese medicine describing and inferring the physical situation of a human body do not originate experimentally, for example through dissection and testing. This makes it difficult to analyze Chinese medicine in the framework of modern science and logic even though much of Chinese medicine’s tools are logical and replicable. However, we can still justify Chinese medicine on the practical effectiveness of actual diagnoses and therapies.

In modern scientific methodology, there is a difference between theories and models. It is usually believed that a model is the intermediary or bridge from reality to theory. The understanding of modern science is based on theoretical knowledge and this knowledge then leads to scientific discovery.

In Chinese medicine, the distinction between theories and models is obscure. The theories of Chinese medicine can be seen as piles of inter-related models. Chinese medicine can be regarded as a theories or a models system. It is not necessarily deduced by logic (although often very logical) but more by experiential philosophy – an expression of what is seen in nature and in the universe. What is seen is not always with the naked eye but also with the inner eye. Chinese medicine pays more attention to specific visual objects from both inner and outer vision, rather than to abstract objects like mathematical conclusions. At the same time, the models of Chinese medicine are reshaped through philosophical ideas or experiences while remaining remarkably concrete. Every century sees new and different interpretations of the same foundational theories and models of Chinese medicine. The old knowledge is not thrown out; it is reviewed, reconstructed, and re-applied. And so where most of modern clinical western medicine is about forty years old, most of Chinese medicine is several hundred or thousand years old; it is a part of perennial knowledge and what some call The Great Chain of Being.

The models of Chinese medicine possess a layered or spherical four-dimensional structure of a disease pattern that includes the transformations to that disease generated by time. Even so the inter-relations amongst the models are very clear. In modern research, model-based reasoning enables a better understanding of Chinese medicine. New research and new logical methods of modeling, intuition, emotions, and beliefs, and the grounding of spiritual experience can be promoted by exploring Chinese medicine diagnostics and processes thus reshaping modern science. This reshaping of modern science is greatly needed. It is the linearity coming out of the Age of Reason that is partially to blame for the environmental degradation we live in today; and that is in turn partially responsible for the modern cancer epidemic. It was Sir Francis Bacon who said that this modern science has the capacity “to not only tame Mother Nature but to bring her to her knees.” The reductionist model of modern science is a Yang expression that leads to a linear way of thinking, picking apart all of the components of life along the line destroying the very ecology of the living system, that is – the circle. The reductionist model has lost the Yin or listening approach to knowing. The Receptive experience of perennial systems has been overwhelmed by the initiative of using only the mind in the process of knowing truth, thus separating the mind from the heart. Chinese medicine tries to identify and explain all of the relationships of the parts, as opposed to pulling them apart. It tries to maintain the connection of the mind acting from the truth of the heart because the heart (CM) is the main receptacle for the truth, the spirit, the Shen. Since we are part of nature it is we ourselves who are now praying on our knees for a way out. The inclusion of Earth-based sciences and ways of knowing alongside modern science based in reductionism is part of the solution. The evaluation of Chinese medicine within the western scientific model has all of the trappings but none or little of the substance of due process or objective evaluation because the western model is unable to see and weigh the relationships that exist in life as seen through Chinese medicine. It is constructed to eliminate these relationships whereas Chinese medicine is constructed to illuminate and explain them.

Chinese Medicine and Biomedical Research

In the case of cancer and its modern science explanations, etiologies, biology, genetics, cell regulation pathways, immune system regulation, and so on, anything outside of conventional medicine is allowed to provide only supportive care – hence the new term “complementary medicine”. By law “natural medicine” forms are disallowed the direct treatment of cancers, that is, the direct cytotoxic treatment of cancer cells. The supportive care allowed during cancer treatment must be based upon evidence as supplied by western science studies. Partially this comes out of a long history, especially in the United States and beginning in the early 20th century, of conflict between the “regular” doctors (chemical medicine) and the naturopaths, homeopaths, and chiropractors (natural medicine systems). Chinese medicine entered North America in the early 1850s mainly on the West coast; but the discussions regarding the promotion of chemical medicine occurred mainly on the East coast, and therefore did not include Chinese medicine as a natural medicine system. Partially this conflict also comes out of the complexities of utilizing life-threatening drugs to kill cancer cells that, therefore, also threaten the patient’s life. It is unfortunately true that only conventional medicine has the infrastructure to manage these complex medical situations. Even in China, Japan, Singapore, Taiwan and South Korea, Chinese medicine is used as an adjunct to conventional medicine and primarily (but not entirely) as supportive care. It is the western science definitions of cancers that drive the cytotoxic approach. CAM forms follow behind and try to respond to the environment caused by the cytotoxic approach. A new definition for cancer and cancer treatment is needed – one for which only natural medicine systems currently have language.

The modern research and pharmaceutical industries are a major part of the system of providing cancer treatment based on the modern science definition of various cancers. The treatment of cancers requiring cytotoxic drugs and procedures comes out of the linear approach to understanding cancer that looks at the target tissue and the locale as the scene of a crime. These targeted approaches with one-symptom one-drug interventions necessarily generate side effects mainly because they are linear and one-pointed. It is this very linearity constantly seeking the next smallest explanatory item and not taking into account the overall holism of the human body that results in toxicity. Often those toxicities are carcinogenic in and of themselves. Some believe that the use of pharmaceutical drugs, because they are one-pointed in their approach whether it be as a cytotoxic drug or a support drug or an antibiotic, will always create unwanted symptoms caused by injury to multiple bodily systems outside the target tissue. There is a lack of vision within the system of conventional medicine as to the whole entity being treated, and this lack is consciously constructed as part of the reductionist philosophy of the Age of Reason. This is what modern science and medicine is about: the discovery of one drug that will treat that one issue within the human body – the magic bullet. Modern medicine is linear, logical, non-relational, rational, and the end result of the theoretical knowledge accrued to test it. This is the basis for what is currently being called evidence-based medicine. And evidence-based medicine is part of the reductionist view looking for the next smallest entity to explain the mechanism of life.

There are many concepts, theories and models in Chinese medicine that have no analogs in Western science. These include:

the concept of Qi as a prime motivator of life; life force motivating matter
the concept of meridians as channels that carry Qi
the San Jiao as an interface between water, emotions and constraint, immunity, food, temperature regulation, the mind and heart
the Heart/Kidney axis; a main connection between the Source and the Heart and mind
Mingmen as the Gate of Life

All of these components of Chinese medicine play a role in cancer etiology and, therefore, treatment. It becomes impossible to really evaluate their usefulness and validity using the present model of research based in reductionism that takes these components out of relationship to each other and has no way to think of them in the first place because they are theoretically invisible. At the same time, what has become obvious is that, as more complex and deeper knowledge becomes available within the frame of western science, the truth of these Chinese medicine models and theories is often explained, albeit in a way limited by the language of western science.

In cancer complementary care with Chinese medicine, what we most commonly do is to treat the terrains of injury caused by the cancer and by treatment for that cancer, for example, the San Jiao, Mingmen, the Heart/Kidney axis among other things. In other words we treat the constitution of the patient, the diagnostic pattern for the cancer that occurred within that constitution, and the diagnostic patterns for all of the side effects caused by conventional therapies. If we are the best of doctors, we treat the sprit of the disease – that is, the lifestyle and the end results of that lifestyle in the environment, the cause. We frequently do this within one formula and with teaching the patient the knowledge necessary to understand the inner and outer realities of their condition. The modern science analysis of various single herbs and formulas has sometimes explained to its satisfaction why these items are valuable. We have herbs and points and formulas that treat nausea as a side effect of conventional treatment; we have herbs and points and formulas that treat myelosuppression, and so on. And now we are discovering that many of the anti-cancer herbs used classically actually interface therapeutically with many cell regulation pathways and other biological entities connected to various cancers. We are also discovering how single herbs may be contradicted in certain circumstances with specific markers and/or specific chemotherapeutic agents. However, the western science analysis of Chinese medicine cannot evaluate the complexity of the overall treatment strategy contained within a formula. It can only evaluate the pieces of it as defined by western science.

For example, treating for nausea with a Chinese medicine formula will help to eliminate the symptom of nausea. However, it does far more than that by continually rehabilitating the entire gastrointestinal tract function including regulating stool and allowing for better assimilation. Because the Stomach/Spleen (Chinese medicine) is commonly one part of a nausea pattern, utilization of a formula (based upon the pattern diagnosis for that specific case) to treat nausea often also means an improvement in myelosuppressive markers; and improvement in these markers affects sleep, energy, immune function, and the sense of well being - the spirit. The science of Chinese medicine proves immensely valuable in ways that are currently not being evaluated except according to western science and medicine parameters; this means that they are evaluated for relief of one symptom. But when they are evaluated according to Chinese medicine parameters the full scope of what is happening becomes obvious. This is only one example in a great many that comes up in integrated cancer treatment with Chinese medicine. The sum of actions of Chinese medicine strategies in treating a cancer patient adds up to an apparently cytotoxic treatment that helps to eliminate the cancer environment and also to prevent recurrence. This is direct treatment of the cancerous terrain according to the theory of Chinese medicine. And yet by law in the U.S. this treatment would be illegal if seen from the Chinese medicine viewpoint.

As conventional medicine follows its treatment plan, it continually is adding a list of support medications to treat the symptoms of the cancer, the chemotherapy or radiation side effects, and the symptoms of other support drugs. This ends in a patient utilizing a long list of pharmaceuticals all of which create side effects and many of which are taken orally undermining the Stomach/Spleen axis. This is commonly considered the price one pays to kill the cancer cells. It is usually unknown how these drugs interact with one another; western science looks only at one item per study and does not have a currently viable way of understanding how chemicals work together within one body. But seen from the Chinese medicine viewpoint, when the Stomach/Spleen axis is undermined then dampness and phlegm can accumulate; these are known etiological factors for cancers. The cancer terrain is actually encouraged by the support treatment of conventional medicine making recurrence in some patients more possible. Even though modern science cannot foresee or research the interactions of chemical medicines within the body it turns out that judgment calls are made by the provider based upon experience and not science, a very Chinese medicine way of treating. Many of these judgment calls are based upon intuition, also a very Chinese medicine way of practicing. Intuition is driven by the ability to see what is not visible or measurable.

In complementary care, Chinese medicine becomes another of several interventions added to this scenario based upon the modern science evaluation of single substances whether those singles are used as one herb or are within one formula. In other words, utilizing modern scientific research studies to determine what herbal or acupuncture interventions we use means that clinically speaking we are practicing conventional medicine, continually adding more substances to the terrain of the human body in cancer treatment, one by one based upon the western analysis of that single item. We are lead astray from treating the whole patient utilizing classical holistic pattern-based medicine. If new uses for single herbs are found to have actions according to conventional science that are antineoplastic in some way, then often those herbs are added in high dose to a formula that is devised in the traditional or classical way. In the milieu of conventional drug therapies and supportive care, Chinese medicine often is utilized to continually try and rebalance a system already imbalanced by cancer but made even worse by single conventional therapies. It becomes difficult for the Chinese medicine practitioner to understand when and how they are treating a cancer or the side effects of pharmaceutical drugs. The inability of conventional medicine to treat cytotoxically without harming overall health is part of what can contribute to the body’s inability to prevent a recurrence. And treating with Chinese medicine according to the western analysis of single interventions undermines our ability to know if we are creating new side effects that injure the overall terrain of the human body. Chaos and doubt are the results. Then even we who understand Chinese medicine strategies are hard put to know if what we are doing is helping or hindering. And the actuality of monitoring our own research results and evaluations with clear and valid answers is undermined.

Another way of utilizing Chinese medicine in a complementary intervention is to evaluate all of the impacts of conventional medicine according to their translation into Chinese medicine. These impacts are then interpreted via the CM system and their inter-relationships assigned. These inter-relationships become the bases for prioritizing and writing one script thus limiting the number of drugs and substances an individual patient will take while simultaneously being more detailed, more holistic, and more efficient. This efficiency is partly due to the fact that Chinese medicine in its classical form tends to treat the whole as opposed to the anatomical or physiological target. It is this holism that is what makes it so valuable in integrated cancer care. It is continuously rehabilitative of the original injury of the cancer and the injuries incurred by therapy for the cancer with the effect that overall health is improved and, as a result, the possibility of recurrence is lessened. Modern science that is linear and one-pointed in its approach cannot evaluate rehabilitative processes. Hence it does not treat to rehabilitate. Chinese medicine does.

As new more targeted strategies in the conventional treatment of cancers are being researched and are coming through the pipeline, this changes the way that natural medicine systems will be used. This change in orientation of conventional medicine from systemically toxic therapies to more targeted therapies is a welcome and valuable opportunity for patients and for practitioners. However, even in these newer interventions, the use of holistic systems of medicine like Chinese medicine remain of great value because targeted therapies still do not treat the terrain of a cancer’s imbalanced ecology. And they do not treat the spirit of the disease nor the spirit of the patient. Chinese medicine does. Without treating the terrain of the disease there is more likelihood that recurrence will take place. And it is almost always recurrence of a cancer that kills a patient.

The discussion of how to evaluate and integrate systems of medicine is a complex one. And of the many important issues in this discussion is the issue of prevention. Currently conventional medicine equates prevention with early detection. Most research in direct prevention of cancers is funded by and left to non-profit research organizations. The differences in goals between conventional and Chinese medicine in regards to prevention lead one to believe that the utilization of Chinese medicine during cancer treatment could change outcomes in terms of recurrence – secondary prevention. This is precisely because Chinese medicine treats the terrain of the cancer and not only the site of cancer, as though it is the only scene of the crime and is a completely local event. The holism inherent in Chinese medicine connects heaven and earth by treating the heart/kidney axis, by reconnecting the mind with the heart, and by strengthening the Stomach/Spleen axis. All of these approaches help the patient to fight against the cancer from the inside out. This is very important since lifestyle and external exposures are the main issues in the evolution of a cancer. Engaging a patient in their own recovery is essential. Rarely is this done in conventional treatment. Always this is done in Chinese medicine.

The diagnostic models of Chinese medicine attend to information that may or may not be material and measurable in the sense of western science. Early detection in Chinese medicine could refer to the discovery of immaterial injuries that have yet to become symptomatic or measurable but, if left untreated, may evolve into a pre-cancerous or cancerous condition that is finally diagnosable by conventional methods because it can finally be seen. This is something that we must discover and develop. The most obvious conditions or pre-conditions involve the Middle Jiao and pre-diabetes and heart conditions, all of which are foundational for many cancers. We do have something to offer this modern epidemic using our system of perennial and classical medicine.

One of the difficult issues that has evolved in integrative cancer clinical settings where the deepest level and most research could be generated is that these clinics are directed by MDs – individuals trained first and foremost in the western linear and reductionist model. Some of them have limited training in Chinese medicine; the most I have ever encountered is one year of general training. None are trained in integrative Chinese medicine oncology. Given that classical Chinese medicine speaks of its oldest practitioners with thirty or forty years of practice as the mentors of the profession, one year of training for a western medicine practitioner steeped in the western science model is surely a problem. Currently we are being herded by conventional medical settings into acupuncture as the primary interface with integrated cancer care. The truth is that herbal medicine is and has always been the primary interface in cancer treatment. The use of acupuncture as supportive care often translates into “stress reduction treatment”; even the acupuncture therapies are dumbed down. And the time allotted for Chinese medicine treatment is designated by an acupuncture alone treatment of a half hour. No time for teaching the elements of survivorship is given – just as in conventional medicine. These are issues that could be addressed by having Chinese medicine practitioners, as opposed to MDs, design and run the Chinese medicine interface in a clinical integrative setting. This often means impacting the actuarial system for medical insurance reimbursement allowing us to practice our medicine as it was meant to be practiced.

Simultaneously, we suffer greatly from lateral oppression when we think that a Chinese medicine practitioner is smart who can speak about alpha and beta receptors in breast cancer analysis but cannot name the differential diagnostic patterns for breast cancer according to Chinese medicine. Without being able to identify these patterns in our patients we never treat the terrain of that cancer in that individual - an immensely important aspect of secondary prevention and something that must begin at the very beginning of treatment. Over and over again I have found that Chinese medicine practitioners who think they know a lot about integrated cancer treatment know very little about how to use Chinese medicine in cancer treatment. They treat according to western science analyses of herbal medicine protocols and never have a working Chinese medicine diagnosis for the pattern involved in their patient. Some practitioners have even communicated that they are not interested in the Chinese medicine analysis of their patient’s terrain; they wish to use Chinese medicine interventions based upon western science parameters and not upon Chinese medicine strategies. The Western mind linearity of modern science is easier to learn than Chinese medicine. This is lateral oppression and a deeply concerning problem facing our profession.

Without knowing how Chinese medicine explains the cancer terrain, we cannot hope to engage in primary prevention of patients who are not diagnosed. The fact that classical Chinese medicine has not had a historically and specifically cancer-oriented model for cancers demonstrates that cancers have become historically more and more ubiquitous. This does not mean that we are limited to the conventional science approach to understanding how cancer happens. It is immensely important that we understand this and begin to do our own work in understanding cancers.

Because of these issues, realities and differences regarding the integration of these two systems of medicine, it would seem very important to start any understanding of integrated cancer care for practitioners of Chinese medicine with a deep understanding of the Chinese medicine theory and model of cancer etiology and pathology – a model that has always been in flux and is truly not different from conventional medicine in this respect. Starting from this grounding could enable us to come up with more holistic strategies and even offer something substantial to the global understanding of the cancer epidemic. Utilizing primarily western science evaluations of Chinese medicine interventions, driven by elitism and political concerns, as the foundation for deciding which interventions to use has the potential to eliminate the power of the strategies that formed the bases for those interventions. And we truly need those strategies as counter balance to the linear understanding of cancers and their prevention because rehabilitation of the injured environment – inside and outside, human and natural - is the key to prevention. And prevention is the only true cure for cancer.