ADJUNCT CANCER THERAPY AT THE
IMMUNE ENHANCEMENT PROJECT (IEP) CLINIC
by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine (ITM), Portland, Oregon
The TCM Interpretation
People who receive a diagnosis of cancer cannot help but feel that they have been struck by a powerful force; the test results conveyed by a medical expert produce a sense of being injured and weakened; life pathways are suddenly obstructed, and, in some cases, the recipient of such news may become apprehensive of defeat even before embarking on the long journey through cancer therapy. Being informed of having cancer disturbs the spirit, an impact that fits the traditional Chinese medicine (TCM) classification of emotion as pathogenic factor, with anxiety and fear as an initial response. After that, it is not uncommon for anger to arise over inadequacies of diagnosis and prognosis, as well as from learning the limited treatment options; emotional distress may lead to depression. All this distress has a substantial effect on qi, causing it to weaken, stagnate, and to circulate unevenly. The particular manifestation of changes to the body will vary among individuals, but the disruption of circulatory patterns yields common syndromes.
In the Advanced Textbook of Traditional Chinese Medicine and Pharmacology (1) the harmful impacts of strong emotions on health, as manifest via the internal organ functions, are summarized:
Although emotional factors may impair all five zang organs, they mostly affect the heart, liver, and spleen. Because the heart controls the mind, heart malfunction may cause palpitations, insomnia, dream-disturbed sleep, mental restlessness, laughing and weeping without apparent cause, mania, hysteria, etc. Liver trouble often leads to depression, irascibility, hypochondria pain, sighing, a feeling of obstruction in the throat, menstrual irregularities, and pain due to distention or a lump in the breast; these occur because the liver is responsible for the free flow of qi. The spleen controls the transportation and transformation of nutrients. So, spleen dysfunction gives rise to a poor appetite, distending pain in the stomach, and diarrhea. Emotional activities may both disturb the function of a single organ and that of several organs simultaneously. Pensiveness, for instance, injures both the heart and spleen and leads to the expenditure of heart blood and the impeded transport of nutrients. When anger injures the liver, the spleen is often involved as well, resulting in the disharmony of both.
The emotional influences on the organ functions are compounded by physical damage to the body; in the early stages of cancer, the disease itself has not caused much direct physical harm. Yet, the process of arriving at the diagnosis may have already involved various kinds of invasive tests (e.g., biopsy), and if there is a particular tumor site (as opposed to a disseminated disease), initial treatment will often include surgical removal of a mass. Modern surgical techniques are designed to minimize damage, but there is always some level of circulatory disruption at the surgical site; sometimes portions of the body are removed along with the tumor (e.g., mastectomy, colectomy, oophorectomy). Therefore, accompanying the physical injury, the procedure might leave the patient with the feeling of never again fully possessing what was there before, as it is either damaged or missing; the traumatic emotional consequences may be somewhat lessened by knowledge that these surgeries save function and life or, at the least, that they provide hope for such a result. Still the thoughts associated with loss of wholeness are not easily overcome and may lead to melancholy and sleep disturbance.
Chemotherapy is the component of cancer treatment that most frequently leads people to seek help from Chinese medicine; unlike the local damage caused by surgery, chemotherapy has broad influences on body functions and overall sense of well-being. There has been good reason to pursue this kind of natural health care assistance. During China’s immediate post-revolutionary period, it was realized that the attempt to use TCM alone as a treatment for cancer was not yielding significant long-term results. Therefore, considerable laboratory and clinical research was undertaken with the aim of utilizing the medical tradition for a different objective: to help people better cope with the adverse effects of chemotherapy and to improve overall outcomes (e.g., increasing the degree of tumor response, survival rate, and total longevity). This work, dominated by herbal medicine, generated promising results by the early 1960s, and the information about this methodology was eventually brought to the Western world, which was just beginning to adopt Chinese medicine by the mid-1970s. The primary uses of Chinese medicine in the West were initially directed to other applications, such as treatment of pain (e.g., arthritis, sciatica, injuries), but by the mid-1990s acupuncture and Chinese herbs became known as resources for cancer patients. In an evaluation of dozens of surveys conducted with cancer patients to determine how many were turning to “alternative and complementary medicine” and from which methods they sought help (2), 81 such surveys from several countries were considered to have useful data related to Chinese medicine. All but three of the surveys were published during 2000-2010 (the last year checked); the other 3 were published in the earlier interval 1995-1999. Chinese medicine was a common means of therapy that the patients utilized, for which acupuncture was by far the most commonly-tried technique.
The chemicals utilized for cancer treatment are feared for their toxicity and the resulting damaging effects, which often include fatigue, reduced production of blood cells, irritation of the gastro-intestinal tract, and loss of hair. The plan to begin chemotherapy heightens the already existing anxiety and fear arising from the initial diagnosis and any surgical treatment, and the chemicals impair the organs that have been distressed by emotions. Additionally, the impact of the cancer-inhibiting treatments on bone marrow (blood-cell-producing stem cells), which is considered an extension of the kidney system as described by traditional Chinese anatomy and physiology, begins undermining the foundations of the body, namely, the essence stored in the kidney.
While cancer that is detected early (stages 1 or 2) may require but one course of chemotherapy lasting a few months, that same undertaking is only the first of many such protocols when the condition being treated is diagnosed at an advanced stage (stages 3 or 4). In such cases, there will typically be a series of weekly treatments using one or two powerful drugs followed by a change to another series if the first was too difficult to tolerate or if it failed to have the desired effect (either immediately or after a period of temporary success); this process of shifting drugs, each with its unique side effect profile, might continue for years. As a complicating factor, patients who have treatment-resistant tumors are increasingly enrolled in trials of new drugs or new combination therapies which provide hope for a good outcome that was elusive before but also adds the additional worry of being given a placebo treatment at a critical time. Thus, for those with metastatic cancer or suspected metastasis, there is the distress of entering a very uncertain future, with the roller coaster of newly offered hope and dashed hopes. The flow of qi becomes erratic and there is difficulty finding rest day or night; a struggle ensues in the usually simple task of taking in adequate food and then being able to distribute its nutrients.
In addition to impairing the functions of the internal organs, chemotherapy may cause lasting damage to peripheral nerves (neuropathy) and brain cells (cognitive impairment); when treating older patients, there is also potential permanent inhibition of the bone marrow, where the temporary drug-induced suppression transforms into a progressive collapse.
Radiation is used for some patients to eliminate the last remaining cancer cells at the original cancer site from which the bulk of the tumor was surgically removed; other times radiation serves as an alternative to surgery; and this method is often selected for reducing metastatic growths when they are producing severe symptoms, such as spinal metastases that cause pain. Though the techniques of radiation have improved dramatically in recent years, reducing damage to surrounding tissue with more accurate visualization of the tumor location and with far greater focus of the tumor-killing rays, there are still adverse effects of burning some tissues in the radiation pathway and impairing marrow stem cells and body energy. Both chemotherapy and radiation typically lead to lowered blood status and depletion of qi after any prolonged treatment.
Many patients come to the IEP Clinic very soon after receiving their cancer diagnosis (most often, after surgery, and either just before or just after beginning chemotherapy), though others don’t learn about what is offered at the clinic until a later phase in their process of responding to the diagnosis. Indeed, a number of people arrive when last ditch therapies are being pursued, and the patients might not have become aware that they were reaching the end of their journey with a disease resistant to known treatments. In advanced cases, the qi is weakened and the functions of the five zang organs are compromised.
Patients present to the IEP practitioners physical and emotional conditions affected by the stage of cancer at time of diagnosis and phase of medical intervention they are in, while being confronted with personal circumstances that affect how they will proceed with treatment. In keeping with the basic principles of traditional Chinese medicine, each patient is treated according to their unique needs, which differ not only between patients but also, for any given person, from one visit to another. Yet, there are aspects of the IEP clinical work that are relatively uniform; the common methods are outlined briefly here because they may help inform and guide other practitioners less familiar with treating cancer patients. Based on the description given above, a basic treatment needs to be supportive, strengthening, and stabilizing for body and mind; such treatment may be categorized as tonifying. There is also need to release stagnation related to emotional impact on qi circulation, to help resolve the accumulations associated with cancer growth (qi entanglement, phlegm-dampness, and blood stasis), and to alleviate the obstructing effects of cancer therapies on qi and blood circulation.
Three Therapeutic Modes
At the IEP Clinic, there are three basic modes of treatment; the primary one is acupuncture. Acupuncture is expected to produce quick and obvious results that are often felt at the time of treatment and persist to some extent for hours or days thereafter. This treatment method is most easily adjusted in response to patient reports of symptoms of concern. Acupuncture point selection will be a major focus of the following section.
Acupuncture is complemented by a form of massage therapy referred to as “Zen Shiatsu.” This is a modern variant of the traditional Japanese pressure massage; it was developed by Shizuto Masunaga (1925-1981) and it is of particular interest in relation to an acupuncture program because the treatment strategy is largely based on meridian therapy (3). The meridian pathways used by the shiatsu practitioners are similar to the Chinese ones, the main difference being an extension of each meridian to range from legs to arms, passing through the associated diagnostic region of the abdomen. The theory of acupuncture treatment holds that needling has, as one of its major functions, the alleviation of obstruction of qi circulation and consequent normalization of qi and blood flow for the treated meridian. The impact of acupuncture at points on one or, as more common, a few meridians treated in a single session is not limited to the freeing up of circulation in those particular meridians; it has a beneficial impact on the entire system. Acupuncture points are frequently selected because of their individual indications rather than strictly on the basis of a meridian diagnosis, yet, in the overall analysis, meridians are a central feature of treatment strategies. Zen Shiatsu reinforces this meridian-opening effect; it is not necessary for the meridians treated by this application of pressure to be the same meridians as those treated by the acupuncturist: the mutual benefits of opening and stabilizing circulation in one meridian upon the functional capabilities of others allows these two similar but distinctive systems of diagnosis and therapy—acupuncture and Zen Shiatsu—to reinforce one another.
The third mode is Chinese herbs plus nutritional supplements and diet counseling; these sometimes diverse considerations—involving both Chinese and Western approaches to the analysis and selection of ingredients—are bound together as one modality for purposes of this discussion based on the Chinese concept of the close relationship between administering herbs, especially the mild herbs we are able to use in modern practice, and dietetic treatments. A group of practitioners who have training in both Chinese medicine and naturopathic medicine are available during one portion of the clinic schedule to assist IEP patients in the area of diet and nutrition (as well as related concepts of naturopathic therapies), while Chinese herbs are recommended throughout the program.
These three modes of therapy, covering many aspects of adjunctive care, are not comprehensive. One could add, for example, qigong exercises and other natural health care approaches from the Chinese tradition as well as incorporate health care practices from other cultures (e.g., yoga). The three modes that are provided at IEP fit within the limited availability of physical space, the constraints of practitioner and patient time for participation, and the primary range of expertise at the Institute for Traditional Medicine.
The plan described to patients interested in utilizing IEP services is that they will come to the clinic for acupuncture twice per week during the first several weeks of treatment and at those times when chemotherapy or radiation is in progress; the frequency may decline to once per week after sessions of the medical therapy are completed, that is, during periods when there is less physical and emotional distress. Shiatsu services are made available to an extent that allows for treatment every other week, which is almost always provided immediately before or immediately after acupuncture. Typical of supportive shiatsu therapy is pressing along the stomach and spleen meridians, especially the portions at the legs, and along the triple heater (sanjiao) and heart protector (pericardium) meridians that traverse the arms. Acupuncture and shiatsu sessions are just a half hour each; in other settings, the practitioners might spend 45 minutes for an acupuncture visit and an hour for a shiatsu visit, but the shorter treatment duration fits with the concept of offering more frequent and lower cost treatment.
Herbal and nutritional supplements are often provided in accordance with a basic model of “supporting normality,” that is, following the “fuzheng” concept developed in China for this purpose, which would typically incorporate huangqi (astragalus) and baizhu (atractylodes) as spleen qi tonics and danggui (tang-kuei) and gouqizi (lycium fruit) as liver blood nourishing agents. If the qi and blood are full, the Chinese doctrine says, then pathological influences will not be able to disrupt normal functions. One of the common concerns is the bone marrow inhibiting effect of chemotherapy and radiation, for which various forms of Shengxue Tang (Decoction for Generating Blood) are utilized. The formulations used in China vary considerably, but two common ingredients are jixueteng (millettia; spatholobus) and huangqi (astragalus); most other components of such formulas are additional blood-vitalizing agents and tonics (for qi, blood, and essence). I reviewed several such blood generating formulas in my 1998 article Countering the Side Effects of Modern Medical Therapies (4) and in my 1999 article Millettia (jixueteng) (5). The clinicians at IEP have reported that this treatment approach seems to be one of the most effective of the commonly prescribed herbal therapies. The primary formula used at IEP when patients convey concerns over blood tests showing marked inhibition of marrow is a tablet comprised of jixueteng, danshen, sangshen, yejiaoteng, huangqi, chuanxiong, shudi, xuduan, and muxiang.
Standard nutritional supplements recommended to patients include a broad mixture of minerals and vitamins and a mixture of antioxidants intended to replace the multiplicity of products that are recommended in the literature. These provide a substantial quantity of the substances that are purported to be of low quantity in the blood stream (due to reduced food consumption and/or poor absorption) and in particularly high need in light of the effects of the anti-cancer medical therapies.
A naturopathic consultation is offered close to the beginning of the acupuncture series and may be followed up from time to time, with average duration between consultations of about three to four months. At each visit, the patient’s current symptoms, lab test results, drugs, Chinese herbs, nutritional supplements, and daily activities are reviewed. There may be suggestions made for some additional laboratory testing, for undertaking certain diet and exercise strategies, and for supplements not routinely included in the IEP model. Among common recommendations associated with these consultations are eating multiple small meals to manage the problem of reduced appetite, utilizing various protein sources (whether isolates or high-protein foods), taking supplemental fish oil and vitamin D3, using probiotics, taking melatonin for sleep (also used for symptom relief at higher than usual dosage, such as 20 mg/day), and getting basic exercise (even if limited to 20 to 30 minute walks, though more is encouraged when possible). Such direct suggestions are supplemented by referral to specialists who might assist with other methods of addressing unique symptoms or by providing additional treatment programs.
To encourage the greatest level of participation in the IEP program components, the cost of treatment is set by a monthly fee that is established on a sliding scale basis, often allowing free treatment, and currently not exceeding $150/month. The cost to the patient is not influenced by frequency of acupuncture, shiatsu, or naturopathic consultation, or by the selection or quantity of prescribed supplements within our basic list. There will be an extra cost for any of the naturopathic recommendations that are outside the standard supplement regimens and patients will have to incur the costs or submit to their insurance the expenses associated with any additional laboratory testing that they pursue in response to suggestions at IEP.
During most visits to the clinic by cancer patients, a model point formulation is utilized, which is modified as appropriate. The acupuncturists at IEP refer to the most commonly selected acupuncture point set with terms such as “cancer support,” “chemo support,” or “immune support,” and the variations in designation are not intended to indicate different concepts. The primary strategy begins with an adaptation of an approach that was utilized by Wang Leting, a TCM practitioner whose work spanned the pre-revolutionary and post-revolutionary period in China; he practiced for 50 years from 1929-1979. An English translation from the 1984 Chinese book that describes his work is Golden Needle Wang Leting, which was published in 1997 (6).
Much of Wang’s therapeutic efforts revolved around one particular acupuncture point on the stomach meridian: zusanli (ST-36). He is reported to have said: “For hundreds of diseases, don’t forget zusanli,” and “in treating the root, first treat the stomach” and “if a person is diseased and one does not treat the stomach, on what can they rely for life?” In 1998, I produced an extensive review of zusanli and its uses to encourage better understanding of the factors that lead to its selection as a key part of the treatment (7).
Two of Wang’s point formulations serve as inspiration for the foundational acupuncture at IEP. Of particular interest as an adjunct therapy for cancer patients, there was one which Wang Leting described as having an effect like that of the herbal formula Shiquan Dabu Tang (Ginseng and Tang-kuei Ten Combination). This well-known tonic prescription combines the spleen/stomach formula Sijunzi Tang (Major Four Herbs Combination) with the liver blood formula Siwu Tang (Tang-kuei Four Combination) plus huangqi (astraglus) and rougui (cinnamon bark). It has been the traditional formula most frequently recommended for support of cancer patients in recent decades, especially utilized for this purpose by Japanese and Taiwanese doctors who select from a set of about two hundred traditional formulations that are covered by national health insurance. In composing the acupuncture point formula, Wang contemplated the actions of the herbs and compared those with the functions of acupuncture points; thus, for example, he drew a parallel between needling of hegu (LI-4) and the role of astragalus because, among other similarities, they both address insufficiency of defensive qi.
Wang’s Shiquan Dabu acupuncture formula:
Wang also frequently used a formulation which he called Old Ten Needles, the term “old” referring to a traditional style of acupuncture point selection. He worked with certain key points for years and then finalized this particular group around 1966. Wang’s primary application for Old Ten Needles was gastrointestinal weakness and distress, a common concern for the patients at IEP.
Wang’s Old Ten Needles:
The first three points of this small formula are treated bilaterally, making 6 of the 10 points, and the next four are along the front centerline, so each has one needle, making four more.
By the time this information was relayed in the English language text, many acupuncturists in the U.S. were already familiar with a slightly different set of ten needles that was relayed by Miriam Lee in her 1992 book (8).
Lee’s Ten Great Needles:
quchi (LI -11)
All five of these points are treated bilaterally. Like Wang, Lee considered zusanli as a key point and devoted a chapter of her book to using that point alone. Lee had utilized this set of ten needles for a wide variety of disorders, but especially for disorders causing weakness, fatigue, and depression. Other variants of this approach, in which a small group of needles comprise a foundational treatment, have been reported. One of the IEP practitioners had developed his own variant of Lee’s ten needles by replacing quchi (LI-11) with shousanli (LI-10) and replacing lieque (LU-7) with shenmen (HT-7).
Through adding and subtracting from these insightful formulations, we have the group of points used at the IEP Clinic for adjunctive cancer therapy, which I now refer to as “New Twenty Needles” (NTN). These points are still “old” in the sense of common traditional points and combinations, but they are here used for a new application—in support of patient’s undergoing medical treatments for cancer—which postdates Wang and Lee’s primary work. Not all these points would be used at one treatment session, but a total of ten to twenty body points (this count including the bilateral needling, but not including any added ear needles) would form the basis of one session.
New Twenty Needles (NTN):
The points that differ from those listed by Wang and Lee are baihui (GV-20) and yintang (Ex-HN-3), which are especially used in stabilizing the emotional distress common to our patients, and taixi (KI-3), for tonification therapy to resist the impairing effect of chemotherapy and radiation on the kidney yin and yang. To better display how these are used, the NTN points can be described in terms of being “primary” or “secondary”, not to distinguish their relative values, but to draw attention to the fact that the primary points are being used two to three times as often as the secondary ones.
NTN Primary Points:
sanyinjiao (SP-6) Lower Limbs
NTN Secondary Points:
taixi (KI-3) Lower Limbs
Common additions to the above set were the lower limb points yinlingquan (SP-9; substituted for SP-6 or added to it), zhaohai (KI-6; substituted for KI-3), qiuxu (GB-40); upper limb points shousanli (LI-10, frequent substitute for LI-11); shenmen (HT-7; substitute for PC-6 or added to it), lieque (LU-7), waiguan (TB-5); torso points jianjing (GB-21), danzhong (CV-17; also called shanzhong); and head/neck points shenting (GV-24; added to GV-20), fengchi (GB-20), and extra point anmian (near GB-20). In a few instances, two adjacent points on a meridian were needled at the same time, such as LI-10 and LI-11 or GB-20 and GB-21. The additional points mentioned here, though beyond the NTN, belong to the foundational acupuncture treatment group.
The acupuncture set selected during a patient visit may involve some alterations to address symptoms that have become severe. Thus, for example, a complaint of women undergoing treatment for hormone-dependent cancers is hot flashes, and if they become more frequent or intense fuliu (KI-7) in conjunction with yinxi (HT-6) would be used; these are points routinely combined with several others that belong to NTN for this symptom in non-cancer patients. In efforts to alleviate foot neuropathy, extra point bafeng (four points on an affected foot) might be used, sometimes adding yongquan (KI-1) or rangu (KI-2). Nonetheless, when these same symptoms are relatively stable—not especially disruptive or not worsening—the foundational acupuncture with NTN is usually sufficient to provide relief without the necessity of needling points deemed specific to those symptoms.
Due to the relatively short duration of an acupuncture session, 30 minutes, patients are usually treated on one side of the body, laying face up, without needling of back points (GB-20 is the main exception, but can be treated because of the curvature of the neck). The usual set of foundational points also minimizes the need to remove clothing so long as the patient wears loose clothing that allows exposure below the knee and from the elbow down. For points that are ordinarily needled bilaterally, a patient might instead receive left-sided and right-sided points that differ; this method would most often occur if there were unique symptoms on one side; for example, one arm might have swelling from lymphedema while the other arm remains unaffected.
In my article on zusanli, I relayed an immune enhancing protocol that was being evaluated in patients whose primary complaint was pain, based on the pair of zusanli and hegu (LI-4); other pairings I relayed from the Chinese medical literature were zusanli and neiguan (PC-6), reported to be useful for side effects of chemotherapy and radiation such as poor appetite, nausea, vomiting, diarrhea, dizziness, insomnia, and fatigue), and zusanli with sanyinjiao (SP-6) that had been provided to patients undergoing radiation therapy to prevent impairment of white blood cell counts. I pointed out that this set of four points (zusanli, hegu, neiguan, sanyinjiao) were the main ones employed in a study of treating pain due to stomach cancer and the side effects of stomach cancer treatment by chemotherapy. In a more recent study describing treatment of liver cancer patients having postoperative gastroparesis (9), a set of four primary acupuncture points were: zhongwan (CV-12), zusanli (ST-36), neiguan (PC-6), and sanyinjiao (SP-6), which is the same set, except hegu is replaced by zhongwan. As can be seen, this fundamental pattern of treatment applies to chemotherapy and to surgery as well as to different cancer types.
The general stabilizing effect of the point sets used at IEP is illustrated by similar acupuncture formulas for treating tremor. In the book Case Studies from the Medical Records of Leading Chinese Acupuncture Experts (10), a suggested treatment was: zusanli (ST-36), sanyinjiao (SP-6), hegu (LI-4), taixi (KI-3), taichong (LV-3), shousanli (LI-10), shenmen (HT-7), and fengchi (GB-20), with xuanzhong (GB-39) and yanglingquan (GB-34) included for specific treatment of tremor. Wang Leting had compared the acupuncture point yuanglingquan with rougui (cinnamon bark) in Shiquan Dabu Tang because they both treat upwardly counterflowing qi and both eliminate wind, cold, and damp.
The foundational acupuncture set also follows a description I provided in a booklet on treating disturbed spirit (11), which indicated the tendency of Chinese doctors to utilize “five zones” of acupuncture for spirit disorders, typically treating one to four points in each zone: in the area of the head (e.g., GV-20, GV-24, yintang); at the forearm-hand area bilaterally (e.g., LI-10, PC-6, LI-4, HT-7), and on the lower limbs bilaterally beneath the knee (e.g., ST-36, SP-6, KI-3, LV-3). The five zones are treated together to yield a therapy for anxiety, depression, insomnia, easy crying, and other characteristic symptoms of shen disorders. The points zusanli (ST-36), tianshu (ST-25), sanyinjiao (SP-6), taichong (LV-3), quchi (LI-11), neiguan (PC-6), and baihui (GV-20) of NTN are examples of those commonly used in modern Chinese treatments for persistent anxiety and distress. Renzhong (GV-26; also called shuigou) is often chosen in China for these psychological conditions—in addition to, or rather than, shenting (GV-24) or yintang—though this point is not as acceptable for use in the West. Examples of Chinese medical literature reports on this five zone pattern of treatment include a study of patients with mental depression (12) that relied on needling the main points baihui (GV-20), shenting (GV-24), yintang (Ex-HN-3), renzhong (GV-26), anmian (extra point near GB-20), danzhong (CV-17), neiguan (PC-6), daling (PC-7), shenmen (HT-7), and taichong (LV-3) and treatment of “depressive neurosis” with herbs and acupuncture (13) using taiyang (Ex-HN-5), shenting (GV-24), qucha (BL-4), baihui (GV-20), neiguan (PC-6), shenmen (HT-7), sanyinjiao (SP-6), and taichong (LV-3).
For the purpose of calming the disturbed spirit, some practitioners at IEP also add ear points, most often turning to variants of the “5NP,” referring to Nogier’s Points (NP) that have since been adopted into the Chinese system. These particular points were initially recommended by Dr. Michael Smith for the National Acupuncture Detoxification Association (NADA) protocol, namely 5NP = sympathetic, shenmen, lung, liver and kidney. A simplified version is more commonly applied at IEP, called “3NP” = shenmen, liver, and kidney. Sometimes, ear point selection varies from these standardized protocols, simplifying to shenmen alone or by substituting a point in the basic set (e.g., heart replacing lung) or adding one or two other points to 3NP.
In a recent study of using acupuncture for patients with lung cancer (14), points selected for treatment were: hegu (LI-4), taichong (LV-3), zusanli (ST-36), sanyinjiao (SP-6), lieque (LU-7), and 3NP. This pattern is consistent with that used at IEP. As another example, a protocol for cancer patients monitored for effects on depression and sleep disturbance (15) utilized the points fenglong (ST-40), yinlingquan (SP-9), xuehai (SP-10), sanyinjiao (SP-6), neiguan (PC-6), yintang (Ex-HN-3), baihui (GV-20), sishencong (Ex-HN-1; these are four points surrounding GV-20), and ear point shenmen. Except for the shift of zusanli to fenglong and addition of xuehai, this pattern fits reasonably well with what is being done at IEP. Sishencong can serve an alternative to using shenting (GV-24) in treating distress symptoms, and is also sometimes the choice for this purpose at IEP.
The New Twenty Needles and commonly used added points serve multiple functions but especially help with the emotional distress associated with cancer diagnosis and treatment, supporting immune functions, alleviating pain, and normalizing the gastrointestinal system. Standard herbal formulas prescribed to the patients will further support one or more functions of the acupuncture treatment.
Extraordinary Results: Examples of Treatment Effects
The ideal cases where success can be declared are those where the IEP methods of therapy assist patients recently diagnosed with stage 1 or stage 2 cancer get through the course of medical treatment, such as surgery and chemotherapy, with relative ease. Thanks to the three modes of therapy described above, particularly the dramatic effect often experienced from receiving acupuncture, there is an amelioration of anxiety and other emotional distress, they find that the medical and adjunctive interventions—though taking a lot of time—produce a minimum of disruption to capabilities, and they arrive in just a few months to the end result of being evaluated by their oncologist as cancer free or, at least, there is not a recurrence due to undetectable metastatic cells for some years after the initial course of treatment. Quite a few patients have this situation and for them the stabilizing effect of acupuncture and other adjunctive therapies is greatly appreciated. The course of their participation at IEP might involve about 60 acupuncture treatments and about 15 shiatsu sessions, a commitment that could be afforded by some patients attending clinics charging standard rates.
However, a sense of success is sometimes more evident in those situations where the patient has advanced cancer and is not expected to be cured of the disease; the patient may not be able to work or can only do so to a limited extent: these are difficult situations where a person suffers greatly in a state of little hope in the absence of such a program of adjunct therapy. For these situations, being able to tolerate the ongoing chemotherapy attempts is a great achievement and maintaining reasonable pain control is welcomed; the ability to function, make difficult medical decisions, and be present to family members accomplishes much in transforming a terrible situation into one which can have many bright moments.
Below, ten examples of patients with advanced cancer treated at IEP are described. They came to the program at ages 48-75, which is a typical range for patients at IEP. Most of these patients came to the clinic with stage 3 or stage 4 cancer (one had indeterminate staging with signs of metastatic disease); in all but two of the cases conveyed here the patient died, usually shortly after their last visit to IEP, indicating that they retained activity and mobility until their last few days. Practitioners at the clinic selected these cases as examples of extraordinary results because of the very favorable feedback from the patients and their families (sometimes also their doctors) as well as their impression that individual treatments yielded especially good responses. The patients are not presented here in any particular order; there were seven women and three men in the collection of cases, and this represents the roughly 2:1 ratio of female to male cancer patients treated at the clinic. IEP chart notes present any noteworthy comments made by the patient at each visit as well as the basic details of the treatment administered (e.g., acupuncture points). The records can be used to determine compliance with recommended frequency for acupuncture and shiatsu, the dates when chemotherapy or other medical treatment is initiated or terminated, what symptoms are of primary concern, any reported significant changes in symptoms, the total duration of participation at the clinic, and, in most instances, the cause for completion of the treatment program.
1. Patient TV, a 75-year-old man with terminal cancer. He had gone to the hospital in very serious condition and was diagnosed with stage 4 lung adenocarcinoma (patient was non-smoker) and came to our clinic about seven months later. Chemotherapy caused notable tiredness, weakness, and fatigue. However, his primary complaint was severe chest pain, particularly at the primary tumor site; he also suffered some abdominal pain, and from time to time, felt pain all over his body. He continued to receive chemotherapy during the first several months of his IEP clinic visits.
He responded very well to acupuncture, with notable pain reduction. Pain would return, but acupuncture would help control it each time and his appetite improved as well. He received 38 acupuncture treatments, often with electro-acupuncture incorporated for pain control, and 18 shiatsu treatments over the period of six months before he was no longer able to attend the clinic; he lost ability to walk and sit-up and then went into a coma and died one month after his last visit to IEP.
It was found that electro-acupuncture (EA) was especially effective for his pain. An example of EA was hegu (LI-4) to taichong (LV-3) on the left, lingxu (KI-24) to qimen (LV-14) on the right, but the specific point selection for EA varied. Aside from the usual points selected for cancer support, points for chest pain such as lingxu (KI-24) and wuyi (ST-15) were commonly used.
The success in this case was the marked pain relief that allowed him a quality of life he would not otherwise have had during his final months. Pain in late stage 4 cancer is often intractable; patients do not like taking high doses of morphine or other powerful pain drugs (this patient had been using oxycodone), as they feel they cannot mentally function at an adequate level. In this case, the impairment of breathing that occurs with any high dose of such pain drugs would compromise breathing capabilities that had already been reduced by the lung tumor and would therefore risk bringing on coma and early death. Despite coming to our clinic with a far advanced cancer condition, he remained stable during the months of his visits. He most likely succumbed to a circulatory shut down because of the widespread cancer, lack of physical activity, and reduced nutritional status associated with low appetite.
2. Patient VI, a 57-year-old woman with terminal liver cancer affecting the bile duct (stage 4), came to the clinic just after diagnosis; he had undergone exploratory surgery and not had yet started chemotherapy. She received treatments at our clinic for 15 months, and then planned on moving into hospice, but died promptly before she could make that transition. Except for the first three months at IEP, she did not get frequent acupuncture as usual for our protocol; in total she received 88 acupuncture treatments and 29 shiatsu treatments.
She did well with her chemo treatments, with a relatively low level of side-effects; nonetheless, her hair fell out, she had fatigue and hot flashes and she did miss one scheduled chemo due to low blood counts. Practitioner notes after six months of chemo indicated: “generally tolerating chemo well,” and her tumor responded to the treatment, shrinking by 40%, but radiation was added in an effort to get the tumor under greater control. After nearly a year of chemo, and then with added radiation, the practitioner report indicated that she was “feeling well.” A change in the chemo regimen at that point had obvious deleterious effects, with her reporting notable depletion of energy and developing neuropathy. The most serious development, however, was shoulder pain attributed to a tumor pressing upon a nerve. The pain worsened, extending from shoulder to chest, and she was put on morphine. This last phase of her life included a period between when she was reported as “feeling well” to a couple of months later when she was reported as “doing o.k. and “pretty good;” but, she ceased coming to the clinic at that point and died two months later.
This patient was diagnosed at a time when the cancer was advanced and beyond effective treatment. Nonetheless, combining Chinese medicine, chemotherapy, and radiation, she did well with her treatments for over a year, and then suffered a rapid decline due to the fact that the tumor remained and was causing obstruction (pain due to nerve impingement; death likely due to blockage of the liver). Her acupuncture treatment was mainly categorized as “immune support” utilizing the NTN needle set and 3NP as described above.
3. Patient JM, a 48-year-old woman, arrived at our clinic with stage 4 colon cancer. She had already had three surgeries, and several courses of chemotherapy during the year and a half between diagnosis and coming to our clinic for the first time. Surgery included removal of parts of her colon, ovaries, and parts of her liver (this last, just three weeks prior to attending our clinic), and she was pursuing chemotherapy while participating in the IEP Clinic. She had 64 acupuncture treatments, and 16 shiatsu treatments over a period of 10 months. During most of the time at our clinic the practitioners relayed that she was feeling well, and on days when chemo side effects were more prominent (with heartburn, reduced appetite, and nausea), she felt better after getting acupuncture, which was described as “very helpful” for acid reflux and for nausea. A practitioner noted “acupuncture seems to eliminate post-chemo GERD.” She did experience hair loss and fatigue as part of the chemo side effects over time.
After completing her course of chemotherapy, she continued to come to the clinic for about 10 weeks; her hair began growing back (the hair loss had disturbed her), and she was gaining strength, but with some fatigue. After completing our program, she came in to report that she was “doing really well.” She continued taking herbal and nutritional formulations that had been previously prescribed. Her tolerance of the chemotherapy-induced symptoms and her quick recovery from its effects (especially given the immediately prior history of surgery and chemotherapy) were remarkable. During much of her time at the clinic she received acupuncture with the basic chemo support concepts. She remains alive today.
4. Patient CR, a 65-year-old woman, had a diagnosis of ovarian cancer the year before coming to the IEP Clinic. She had undergone surgery and was treated with chemotherapy for nearly 11 months; her cancer was at stage 4. She attended the clinic over a period of more than 8 years. After a total of nine years of chemotherapy, her cancer was deemed untreatable, and she was taken off the last regimen; she continued to come to the clinic for a few more treatments and then ceased coming because of sudden deteriorated health. We learned that she passed away two months after her last visit to our clinic; for the prior two months she had been coming only twice per month for acupuncture.
During her last years at the clinic, the acupuncture frequency was routinely once per week. She was given general cancer support protocols and was also treated for individual symptoms as they arose; for example, when she tried her last chemotherapy drug she had a reaction of severely reduced appetite and that was the focus of therapies with acupuncture and her medications. Throughout much of her time at the clinic, she did report fatigue or low energy, but on many visits she felt well otherwise, and she was given the general acupuncture treatment described as “maintenance” or “tune up” or “cancer support.”
What was remarkable about her case was not only her longevity, but how well she was managing with ongoing chemotherapy for years. For example, 10 months before she died, it was noted in her chart that “her CA-125 was going up, but she doesn’t have any symptoms.” Five months before her death, she was reported to be “eating well, no pain issues,” and she had no insomnia, normal bowel conditions, but low energy. And in the next month, the practitioner wrote “no complaints today.” One of our practitioners considered that “part of the reason she did well for years was her personality (not easily rattled) and that her daughter and family (2 granddaughters) lived across the street…She often talked about them in treatments.” What eventually caused her death, most likely, were metastatic tumors in the lungs, which impaired her breathing, along with the final chemo attempt, which appeared to contribute to a downturn without providing any cancer inhibition; those impairments caused her to come to the clinic less frequently the last two months and then cease getting acupuncture for about 6 weeks before she died.
5. Patient OA, a 75-year-old man, had breast cancer diagnosed 8 years earlier, followed by liver cancer, which had been successfully treated 5 years earlier, but then recurred a year before coming to IEP. There were two tumor-removing surgeries (breast and liver) and a later abdominal surgery for bowel blockages. He came to the clinic at a time when his cancer was not showing up on scans (the cancer appeared to be in remission according to his oncologist, and the apparent remission was reported again a few months later), but he was utilizing doxorubicin-eluting beads, a new type of long-term liver cancer therapy and he eventually received other chemotherapy treatments because his oncologist was sure that the tumor growth would resume if not more aggressively pursued. He had considerable abdominal pain, being treated with morphine. He received 67 acupuncture treatments and 38 shiatsu treatments over 10 months (this is an unusually high number of shiatsu for this period of time, utilized to help address pain symptoms). Acupuncture point selection for this patient was somewhat more varied than for many patients because of the efforts to alleviate certain specific symptoms that arose, but he did frequently receive general “cancer support” treatment as described above.
He had a number of symptoms, many of them involving pain and/or spasms at several sites, which would easily vary from one week to the next. Still, this patient reported “feeling well” and “feeling much better with shiatsu and acupuncture” during the first three months; there were intermittent reports of him feeling well two months before his death. Fatigue remained a persistent complaint, but treatment was helping with pains of the middle back, stomach, and head. Chemotherapy was then discontinued, but a tumor was eventually visualized affecting the bile duct, and he had to have a drain put in for the bile to bypass the obstruction. Chemotherapy was not resumed, and it appears the oncologist did not believe further chemotherapy would be of help. The patient, who had been doing reasonably well at his last visit to our clinic, died within four weeks of that visit.
Despite his advanced age and years of dealing with cancer, the surgeries, and the chemotherapy, he remained in fairly good health during his time with us; he was known locally as a master musician and he continued performing for six months after his first visit to IEP. He likely succumbed as the result of a blood infection associated with the port that had been used for bile duct drainage.
6. Patient LZ, a 51-year-old woman, was diagnosed with stage 3 ovarian cancer a few weeks before coming to the IEP clinic, having had a debulking surgery for the tumor, and starting chemo just the week before her first acupuncture treatment. She originally received twice per week acupuncture, but later took breaks and would come back for a series of acupuncture sessions over a period of about three years. She then took off about one year and came back toward the end of her life for two treatments; she died two months after the last treatment.
She managed remarkably well through a long course of various chemotherapy attempts. She was able to return to work, at least part time and, for a short while, full time, and resumed her active lifestyle (e.g., going skiing). Her utilization of acupuncture was much less than we advised. During her first year, she received 49 acupuncture treatments, a rate of just under once per week (she had started at twice per week, but soon reduced the frequency to once per week), and the second year she had 30 treatments over a period of 9 months, then was absent for about five months following a skiing accident (broke both legs), and then another 32 treatments over a year. Because of the lower acupuncture frequency and taking time off, she probably got much less effect than was possible. It appears she initially was quite drawn to acupuncture therapy and then was less interested in that approach: the first year, she did not receive any shiatsu massage, but for the following years, she arranged to have shiatsu without acupuncture for every other visit. This patient preferred lying in the prone position, so the standard needling received by most patients was usually not administered in her case, and her protocol included several points of the Bladder Meridian and Hua Tuo points and tianzong (SI-11); she might also receive treatment at points of the foundational protocol easily accessible in that position and compatible with the others chosen.
She often reported fatigue and low energy from chemotherapy, but the focus of treatment would typically be for pains that arose in different parts of her body. Sometimes, this was from her physical activities; for example, she reported one day that everything was sore from physical activity (swimming, hiking, and golfing)
What finally depleted her system, it appears, was non-cancer related surgeries: she had chipped talus bones which were treated by surgery (two separate surgeries, one ankle at a time), and then rectal surgery for hemorrhoids. It was right around the time of these surgeries that she ceased getting acupuncture, retired from her teaching career, and, though we don’t know what happened during this time, she developed leg lymphedema, probably from the series of lower body surgeries, and was not able to continue her passion for physical activity. She lived about half hour drive from the clinic and this lengthy transit, which was time consuming for her, yet something she could do regularly while she was relatively healthy. With her skiing accident (broken legs) and later surgeries she wasn’t able to travel to our clinic. So, her location explained why she didn’t get regular acupuncture when it might have helped for recovery from injury and surgery as well as manage the effects of cancer treatments.
7. Patient LC, a 48-year-old woman, had been diagnosed ovarian cancer just two months before starting treatment at IEP; she already had surgery and had undergone the first two chemotherapy sessions. The surgery revealed extensive cancer in her abdomen (categorized as stage 3c, grade 3), and she had a hysterectomy as well as oophorectomy. She came for acupuncture twice per week initially, but soon transitioned to once per week and occasionally missed a week. She received a total of 68 acupuncture treatments and 48 shiatsu over a period of about 19 months.
Her health during the chemotherapy was remarkably stable; she had persistent complaints of constipation, and did develop some hand neuropathy, but did not experience fatigue and low energy. After completing her first course of chemotherapy, which was just over three months long, she rebounded well and her constipation resolved (it would come back as a symptom later). Despite her basic good health, she developed persistent anxiety and feeling “emotional” overall. Her anxiety was primarily over the cancer diagnosis, and, in fact, about nine months after starting at IEP she received the news that the cancer had returned and that the prognosis was poor. A new chemotherapy was begun, and this produced fatigue and some neuropathy (fingers and toes); she otherwise tolerated it well. After a CAT scan, she was put on another chemo drug, and this was less well tolerated; unfortunately, at this time she came in for acupuncture infrequently, and she died four months after starting that new treatment. Her death did not appear to be due to the new chemotherapy effects, as after the first treatment or two that “hit her hard” she was tolerating it well; for example, she reported no neuropathy at her last visit. Her acupuncture treatments were consistent with others for general support, but because of the substantial abdominal symptoms, she would tend to get needled along Conception Vessel points that were in addition to those used for most other patients.
In my interpretation, the turning point for her was a loss of will to live when the cancer tests showed that the disease was progressing. The anxiety that she reported a year and a half earlier—after her first chemotherapy series which resulted in cancer being undetectable—stuck with her and could turn to depression. For one of her chemotherapy series, she was in a research protocol and was convinced she was receiving the placebo. During a later chemotherapy protocol, a practitioner recorded that her mood was low and that she was “scared”; despite this, the same chart record indicates “good quality of life,” and there were other reports of her “doing well.” A later note indicated that she was sad and emotional after having had a liver ultrasound in the morning before her visit to our clinic. At her last visit to the clinic, about 6 weeks before she died, she reported that a recent MRI showed a lesion on the pancreas.
While acupuncture helped with emotional distress, she was not getting treatment with sufficient frequency after the first three months. During her last year at the IEP Clinic, she had taken a substantial break for nearly four months, and then returned for treatments only once per week during the final six months. Her tolerance of several courses of chemotherapy was remarkable, and though she seemed increasingly emotionally defeated, she maintained a relatively good health status through her time at IEP, with many chart notes indicating that symptoms had improved.
8. Patient CB, a 58-year-old man, was diagnosed with stage 4 bilateral lung adenocarcinoma two months prior and had his first chemotherapy just before coming to the clinic; he was also scheduled for a series of radiation treatments for tumors on the spine. He received 250 acupuncture treatments at our clinic over a period of 32 months and did not receive shiatsu other than three treatments during the last weeks of his time at IEP. His final visit to us was followed by his transfer to hospice, and then he died a week after entering hospice.
He was put on a series of different chemotherapy treatments; one of them, which unfortunately caused apparent allergy reaction with significant itching, did result in shrinkage of the lung tumors (this was about 9 months into the treatments). He also developed persistent shortness of breath and coughing that may have been from the presence of the tumors despite their shrinking, or as a reaction to chemotherapy; this symptom was alleviated to some extent by acupuncture. Unlike most of the other patients described here, because of the focus on the lung symptoms, he less frequently received the foundational acupuncture protocol that was given when lying face up, and tended to receive more points aimed at alleviating breathing problems, with several back points, such as the extra point dingchuan and Bladder Meridian points (e.g., BL-7, BL-12, BL-13, along with frequent use of KI-3). For several session, he would sit up for treatment to make it easier to access all the points at once. He sometimes received needles at the standard points, with frequent addition of chize (LU-5). Overall, he suffered from fatigue, nausea, and shortness of breath, and then with pain. Though he struggled with various side effects of the chemotherapy regimens and radiation treatments, he responded well to acupuncture to keep the symptoms under some control.
After about two years, one of the chemotherapies he tried was an experimental one and he was convinced that he received the placebo; regardless, his study participation was suspended because his tumors were growing. Switching then to another chemotherapy, his symptoms stabilized, and his shortness of breath was better. This stability remained for several months, and his CAT scan showed the cancer to be stable as well; his blood lab results also looked good. Unfortunately the tumor at his spine then began growing, so radiation was resumed for that and a tumor in his fibula was also found, which was likewise treated with radiation. A new drug regimen was also tried, since the former drug seemed to be losing its beneficial effects, as demonstrated by the growth of these bone metastases. It was at the time of this transition in medical treatments, with failure of the newly introduced drug to have substantial tumor-shrinking effects, that he began showing deterioration, with worsening lung condition, pleural effusion, loss of muscle mass, and increased pain due to bone cancer; he died a few weeks later, just ten days after his last visit to IEP.
The situation that overwhelmed him was the failure to control the tumor growth more so than the cumulative impact of multiple drastic cancer drugs and radiation. Most likely, his lungs became unable to provide sufficient oxygen and even though he was put on oxygen at the hospital, this did not suffice because of his deteriorated physical condition associated with low appetite and insufficient nutrition.
9. Patient LS, a 57-year-old woman, was diagnosed with stage 4 ovarian cancer three months before coming to the clinic; she had surgery and started chemotherapy during the month prior to her first acupuncture session, and was suffering from significant side effects; she was also losing weight. The cancer had spread over several areas, so that even though she had hoped to discontinue chemotherapy, it was deemed a necessary treatment; at one point she underwent chemotherapy for a tumor at her left shoulder. She had 125 acupuncture treatments and 41 shiatsu sessions over a period of 13 months.
She was highly symptomatic at every visit: fatigue, nausea, loss of appetite, constipation, poor sleep, heartburn, lung congestion, cough, costal pain, and low back pain. Acupuncture and other therapies helped her manage these symptoms, but could not overcome them; they kept her functioning and there were occasional reports of her “doing good” or “feeling better emotionally” or that her “back is better.” Specific benefits were suggested: “ear points helping nausea” as well as general ones, such as this comment relayed by a shiatsu practitioner nearly four months into the IEP clinical program: “feels like she is doing well, shiatsu and acupuncture helping a lot.” About two months before her last visit, she seemed to recognize that she had lost the battle with cancer and practitioners frequently charted her as being “teary” and “crying” and having experience of panic and anxiety, being overwhelmed; sadness, and depression. Nonetheless, she kept coming to the clinic regularly until just a few weeks before she died.
She came on average twice per week for acupuncture as we had recommended, and though she suffered many symptoms, she had functioned quite well until about three months before her death. In this case, the turning point appeared to be a dramatic loss of control over her situation, where she became highly emotional and somewhat disoriented. The chemotherapy, and, perhaps the cancer itself, may have affected her brain functions, and her situation was not helped by the fact that she developed oral thrush and then needed considerable dental work, including a root canal. This patient had not been healthy prior to her cancer diagnosis, having suffered long-term asthma, sinus allergies, and GERD. She had not given up hope on cancer treatment; even two months before her death, she had been given the option of palliative care (end of life care) or another try at chemotherapy, and she chose the latter.
10. Patient CM had come to our clinic many years ago, following a 1999 diagnosis of breast cancer detected during a routine mammogram at age 62. She had a modified mastectomy at that time. Her cancer was in remission and she came back to the clinic for treatment of other non-cancer related conditions and health maintenance. Then, more than ten years after her first cancer diagnosis, she came to the clinic for adjunctive cancer treatment when she was diagnosed with a recurrence of breast cancer (age 73): she was scheduled at that time for a full mastectomy and then chemotherapy. There were findings of cancer cells in the lymph nodes an partial evidence of metastatic sites. For the next 27 months, she came for acupuncture 95 times, but especially tried to arrange to have shiatsu, which she had 65 times. She completed the program in good health; after that, she left on a trip overseas for five weeks and on her return dropped into IEP for just a couple of follow-up treatments. She is alive today at age 76.
Her chemotherapy resulted in fatigue and neuropathy, but these had largely resolved once those treatments ended (some permanent peripheral neuropathy as evident), with her main complaints being various aches and pains, many of them from physical activities she undertook rather than the consequences of cancer treatment. Typical of her favorable reports was a practitioner note indicating: “Doing well, energy better, and walking 2 miles consistently.” This report was six weeks after a course of side effect laden chemotherapy had been completed. While recovery from its side effects is to be expected even without intervention, her recovery was remarkably fast: she was beginning to feel notably better just two weeks after the last chemo treatment. Notes reporting her doing very well are found intermittently throughout the years of treatment.
The basis for her good outcomes include limited aggressiveness of the cancer she had, with a long period of remission after the first treatment, and the fact that she was able to remain physically active. She followed the treatment schedule suggested at our clinic, and pursued several naturopathic recommendations, and she underwent regular testing by her oncologist, taking the medications and supplements prescribed by her doctors. These factors likely contributed to her remaining in overall good health despite suffering somewhat from the immediate reactions to chemotherapy.