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Acupuncture | Shiatsu | Chinese Herbs | Nutrition
Cancer Treatment Strategies at IEP

Essay by Subhuti Dharmananda, Ph.D.
Director, Institute for Traditional Medicine (ITM), Portland, Oregon

The Immune Enhancement Program (IEP) is a clinical facility of ITM, established in 1992 in Portland, Oregon, but based on projects in the San Francisco area initiated as early as 1985. At the Portland facility, several acupuncturists and massage therapists provide treatments to patients, including about 60 persons with various types of cancer.

The primary purpose of the IEP clinic, in relation to cancer patients, is to offer a means of responding to a diagnosis of cancer that supports the essential standard cancer therapies and is satisfying to the patient. There is an opportunity to address certain symptoms that arise without relying on additional drugs (a desire expressed by many patients), to limit the adverse effects of cancer therapies (particularly nausea, fatigue, and immune suppression), and to establish a pattern of therapeutics and lifestyle changes that are aimed at health promotion, not just disease control. Patients are able to participate more fully in the treatments at IEP, compared to at the standard medical facilities, interacting with the practitioners frequently to manage the ever-changing course of bodily sensations, functional disorders, and mental distress. Many patients pursue this therapy for months, or even years, because of the perceived benefits.

Background
In most instances, patients receive standard medical therapies for cancer as soon as possible after diagnosis. No effort is made at IEP to suggest that there is an alternative method of treatment; in fact, if persons are seeking alternatives to the standard therapies, they are encouraged to return to their oncologists for treatments and rely on the IEP for supportive care. The medical therapies (surgery, radiation, chemotherapy) are aggressive in inhibiting cancer growth, far more so than any of the natural therapies; in most cases, time is of the essence. Treatment delays may lead to metastasis of cancer that could otherwise have been prevented, or may lead to irreversible or difficult-to-reverse health problems that are secondary to the advancing cancer cell reproduction. These medical interventions, which have the quality of emergency care, are undertaken because of the great difficulty involved in controlling cancer by any other means and the rapidity with which cancer can cause debility, pain, and death. Their ultimate aim, in some cases, is eliminating the cancer. When this outcome is unlikely, however, they may be utilized to provide increased survival duration and/or fewer symptoms of the cancer. There are a few patients who attend the clinic that are not receiving standard medical therapies: those with cancers that are beyond medical treatment because of their stage, location, or resistance to available treatments, and patients who have completed the entire course of cancer therapy but cannot know if they are truly cancer free.

Aside from surgery, which is undertaken to remove cancerous tissue (sometimes with nearby lymph nodes to try and prevent spread of migrating cells), a major problem with cancer therapies-radiation and drugs-is that they have adverse effects related to their potent inhibition of cancer cell growth. Thus, for example, radiation destroys tumor cells by breaking up molecules in the cells. It does this also, to a certain extent, to otherwise healthy cells surrounding the cancer, including those of the skin, muscles, and bones in the radiation beam pathway, and to cells in the blood stream traveling through the area being irradiated, including critical immune cells. Chemotherapy often has the effect of halting the reproduction of cells that have a rapid reproduction rate, as do cancer cells. The drugs may inhibit cells of the stomach lining, bone marrow, and hair follicles, yielding the characteristic symptoms of nausea, blood cell deficiency (and accompanying fatigue when red blood cell numbers fall), and loss of hair. A concern that has been raised about applying various techniques to protect healthy cells from the adverse consequences of medical therapies is that they could theoretically also protect the cancer cells; however, there is little evidence to support fear of this result. To the contrary, most evidence upholds the benefit of natural therapies in maintaining the strength of patients while they are proceeding through the course of medical anticancer strategies.

There are some relatively non-toxic anti-cancer drugs in development, such as vaccine-based immunological treatment, that promise to reduce these side effects. However, the majority of research is currently aimed at utilizing existing surgical, radiation, and chemotherapy techniques with new combinations and delivery methods and, when available, with newly developed drugs. The research focus is required to assure the best possible treatment of current patients while more easily tolerated therapeutic methods are in various stages of development: it can take many years of research to bring significantly different approaches into clinical practice.

Against this background, Chinese medicine, and other types of natural healing or complementary health care (e.g., nutritional supplements) are applied in an attempt to minimize the injury caused by the standard methods and, hopefully, to improve the overall effect, including faster shrinkage of tumors, more complete elimination of cancer cells, and longer patient survival. Some clinical trials with natural therapies have been conducted that indicate that these desired outcomes are possible. Few such trials are deemed to be adequately conducted, reported, and interpreted to lead to incorporation of the method into standard oncology practices. This is why these treatment methods remain a complementary approach usually administered by non-M.D. health professionals, or involve over-the-counter products found in health food stores.

I have reviewed some, but certainly only a small portion, of the literature on these complementary methods (mainly involving Chinese medicine) and produced a number of articles based on my findings:

Oriental perspectives on cancer and its treatment
The treatment of gastro-intestinal cancers with Chinese medicine
Treatment of leukemia using integrated Chinese and Western medicine
Chinese medical treatment of brain tumor
Prognosis after diagnosis of liver cancer
Counteracting the side effects of Western medical therapies
The physiological responses to immunologically-active polysaccharides
Estrogen-dependent tumors and herbs
Soybeans for cancer patients
How emotions may contribute to cancer [appendix to Emotions and Health]
Do herbs, vitamins, and antioxidants adversely affect cancer therapies?
Questionable cancer therapies

In addition, there are articles about certain herbs often used by Chinese doctors in treating cancer patients, including these titles:

Sophora
Matrine and oxymatrine: subjects of Chinese research [these are active ingredients of sophora]
Sparganium & zedoaria
Oldenlandia and scutellaria
Astragalus/Oldenlandia Tea
Soybeans for cancer patients
Update on soy products: are they appropriate for women concerned about breast cancer?

Articles cautioning about claimed remedies include those about PC-SPES (a product now off the market after discovery of included drugs), and about IP-6 and cat's claw (both likely to be ineffective).

The purpose of the current article is to outline some treatment approaches that are either not covered in the reviews about cancer treatment or are insufficiently described elsewhere in relation to clinical practice. Also, the items of the ITM formulary, described in the book A Bag of Pearls (2004 edition), will be mentioned.

Acupuncture
While there is little, if any, evidence that acupuncture therapy can control cancer growth or disease progression in cancer patients, there is evidence that acupuncture can alleviate side effects of cancer treatments (some studies demonstrating this are reviewed in the article, Zusanli). Patients at IEP specifically mention benefits of acupuncture in terms or alleviation of pain, digestive distress, mental agitation, insomnia; and experience improvement in their general sense of well being. The perception of direct relief of these and other symptoms as a result of acupuncture therapy is one of the main reasons cited by patients for continuing participation at IEP.

A unique feature of the IEP clinic is making it easier (or even possible) for patients to obtain acupuncture treatments 2 or more times per week. This is accomplished by several measures: having a set, low monthly fee for IEP services, so that additional visits during the month do not entail additional costs; by having an extended clinic schedule that allows patients to find relatively convenient times for treatment; by limiting the duration of each visit to half an hour (thus making it less of an obstacle to the daily schedule of activities); and by having treatment administered by the practitioner available at the time of visit, rather than having a patient rely solely on a single practitioner. The value of this approach is described in my article "Restructuring American acupuncture practices," and the basic considerations are re-iterated below.

I have noted that Chinese medical journal reports almost always indicate the use of acupuncture on a daily basis or, at the least, every other day. This applies to a wide range of diseases and disorders, including side effects of cancer therapies and cancer pain. I have likened this daily treatment approach to the way in which herbs, nutritional supplements, and drugs are utilized: normally, the patient takes these every day until they are no longer appropriate to use (some drugs are given by IV administration or injection only once per week, but those are exceptional). The common practice in America, of administering acupuncture once per week (or less frequently), does not seem to have much correlation with what is done in China. In discussing this matter with acupuncturists, the general impression I have obtained is that the frequency of acupuncture is reduced to once per week because of the high cost of acupuncture services and the difficulty most patients would have in coming to the clinic regularly, as well as the part-time nature of most acupuncture practices (practitioners are usually available 2-4 days per week). It has often been reported that more frequent acupuncture, such as twice per week, does yield better results when it is utilized.

If the benefits of acupuncture last for one day or less, then daily acupuncture is indicated. If they last for two days or more, then somewhat lower frequency of acupuncture treatments is indicated. The duration of effect can change as the situation for the patient changes over time. For example, the immediate cause of symptoms may be removed (for example when the cancer treatment is completed and the cancer is either highly restricted or apparently gone), thus making frequent treatments no longer necessary. One of the measures of the success of acupuncture and other therapies may be an increase in the duration of beneficial effects from each individual treatment, allowing less frequent treatments to maintain the benefits.

Based on these observations and concepts, we encourage patients who are highly symptomatic to visit the clinic frequently, at least 2-3 times per week. There is some limitation to our ability to provide daily acupuncture to any large number of patients (not enough scheduled treatment opportunities), so daily acupuncture is usually not suggested except in the most critical cases.

Acupuncture sessions are set at 30 minutes. Because the patient comes to the clinic frequently, there is no need for any lengthy "intake" period, except for the initial appointment, so that almost the time can be used for administering treatment. In the Chinese medical literature, needle retention for 20 minutes is common, and this duration fits easily into the schedule. However, needling front and back points in one session becomes difficult. According to Chinese medical literature, a useful procedure is to stimulate one set of points one day, with another set of points stimulated the next day, alternating the two basic sets day-by-day. This approach is workable for those who come in frequently (at least twice per week), but probably has little benefit if the patient comes infrequently.

Greater effects of treatment are reported in the Chinese medical literature if additional stimulus to the needles is given (compared to briefly manually stimulating at time of insertion, as is common practice in the West). This includes manually stimulating the needles for about 1 minute at intervals of 5-10 minutes and applying moxibustion or cupping. Practitioners are encouraged to actively work with patients during the 20 minute needling period, rather than just inserting the needles and going away until the treatment is over, though some patients prefer not having the interruptions. An assistant is available to help with these activities, such as checking on patients and applying non-needle stimulus (e.g., moxibustion). The patients should experience some periods of uninterrupted rest, with duration of 4-8 minutes, during which they may experience the mind-body effects of the stimulus; continually working on the patient with different stimuli may not be advantageous. For situations where more stimulus is needed or where continued stimulus is considered beneficial-particularly for pain syndromes-electroacupuncture may be used (see the article: Electro-acupuncture).

In the application of acupuncture, a basic treatment plan that is repeated frequently is likely to yield better results than a series of unrelated treatments that vary markedly from one visit to another. This concern about consistency may again be likened to the practice of prescribing herbs and drugs. If you were to give patients a different herbal prescription each day, you would not expect to get the same good results that you would if you had the consistent effect of repeated application of the same prescription. At IEP, different practitioners will treat the patient on different days. Therefore, it is important to observe the treatment pattern administered each time and to make an effort to coordinate the treatments, rather than simply provide a personalized prescription that is unrelated to the previous personalized prescription. While altering between two set patterns from one day to the next during administration of frequent acupuncture is described in the Chinese literature, changing patterns entirely from day to day just to meet a practitioner's favored style is never mentioned. Any treatment failure should be carefully evaluated to determine whether or not the acupuncture therapy that has been administered is the best choice and has been used consistently. If it appears that a different strategy is called for, the adjustment should be made. It does not make sense to continue providing ineffective therapy without evaluation and redirection. One must distinguish between symptoms and conditions that are expected to be resistant to treatment and require prolonged therapy and those which ought to respond promptly; lack of obvious effect in the former case is not a good indication that the therapy needs to be changed, but it is in the latter case.

Immune Enhancement
The complex interaction between cancer and the immune system remains a mystery. Cancers develop in persons who appear to have normal immunological condition as well as in those with debilitated immunity. Immune-based cancer therapies (whether utilizing herbs or drugs) sometimes work very well in laboratory animal models of cancer treatment, but may have disappointing effects in humans. This is because many of the laboratory studies involve transplanted tumors and the stimulation of a host reaction to the foreign cells. By contrast, human cancers develop from the body cells and are detected only after they have defeated any immune attack that might have taken place to eliminate them. In other cases, the control over laboratory conditions and the means of inducing a cancer in laboratory animals fails to provide a good model for what takes place in humans.

The immunological impact of chemotherapy and radiation are better known than that of the cancer itself. These treatments impair the bone marrow production of blood cells, particularly white blood cells (leukocytes) and, to a lesser extent, red blood cells, and they can also impair the functional quality of the immune cells circulating in the plasma. Immune suppression by cancer therapies can lead to flare up of chronic viral infections and can also make a patient susceptible to serious bacterial infections. In order to avoid these problems, chemotherapy and radiation are interrupted if the immune parameters drop too low. Additionally or alternatively, stem cell stimulants, such as Nupagen (for white blood cells) and Epogen (for red blood cells), can be administered by injection as part of the standard medical therapy, usually once per week until recovery.

In the Chinese medical literature some evidence is presented that acupuncture, moxibustion, and herbal therapies can counteract some of this immune suppression. The largest body of evidence is for herbs, with considerably less information about acupuncture and moxibustion effects (immune effects of moxibustion have been a significant area of research; see the article: Moxibustion). The strongest clinical evidence of immune restoration is for complex herb mixtures comprised primarily of herbs classified as tonics, and for polysaccharides derived from herbs. The effect of herbs is not to eliminate immune suppression entirely, but to reduce its severity.

Two tableted formulas are routinely offered at IEP to protect the immune system and aid immune recovery from the effects of chemotherapy and radiation. One is Gynostemma Tablets (Seven Forests), which is structured similar to the complex formulas used in Chinese clinical trials, and the other is Coricepium (White Tiger), which is a concentrated extract rich in polysaccharides from several mushrooms and two herbs (lycium and astragalus). Composition-A may be used in place of Gynostemma Tablets if the latter is not available. These remedies contribute significantly to the cost of operating IEP. Gynostemma Tablets is made of concentrated extracts and usually administered in doses of 4-6 tablets each time, three times daily; Coricepium includes three mushroom extracts; it is administered in doses of 2-3 tablets each time, three times daily.

The expense for these supplements is justified in cases where the remedies are clearly indicated; their use should be continued only where they appear to be showing positive effects. The principal use is protecting the immune system from cancer therapies and aiding the recovery of the immune system from damage caused by such therapies that have just been discontinued. Generally, these formulas are applied from the start of the cancer therapies and continued until the end of the cancer therapies, plus a few weeks afterwards (typically 2-6 weeks). In elderly persons with a localized cancer (e.g., lung cancer) who are unable to use Western medical therapies (or where the effectiveness is questioned even by the oncologist), Coricepium may be of some benefit, as the immune system in these patients may already be severely compromised and that could be responsible for the tumor growth in these cases.

The complex herb formulas administered in China are often given in doses that are higher than can be attained with Gynostemma Tablets. At 15 tablets per day (750 mg each), the tablets provide the dried decoction from about 60 grams of dried crude herbs. By contrast, the herbal decoctions in China are made from 2-3 times that dosage. The use of the polysaccharide tablets (Coricepium) boosts up the dosage considerably: at 6 tablets per day (1 gram of herb extracts per tablets), they provide the equivalent of an extract of more about 90 grams of dried herb material, thus bringing the total between the two formulas to about 150 grams.

Generally, there is no need to use additional herbal prescriptions along with these two formulas. Gynostemma Tablets includes herbs that benefit digestion, promote circulation, tonify the qi, blood, yin, and yang, and calm the spirit. Asking cancer patients to take more, especially if they are already taking supplements related to nutrition, is probably asking too much and threatening to disturb their digestive functions. In addition, the costs become prohibitive. Still, if other Chinese herbal formulas are clearly indicated and the patient is willing and able to take them and tolerates them well, then an additional formula might be used. Certainly, the dosage of herbs attained by adding another formula is within the quantities used in Chinese clinical practice.

As mentioned in the review article on medicinally active polysaccharides, it may be possible to administer the polysaccharide remedies (such as Coricepium) on an every-other day basis. Such application would permit a lower cost as well as a reduction in tablets ingested, or allow for use of a different formula on the alternate days (something like the acupuncture protocol using two sets of points on alternating days).

As a substitute for the Gynostemma Tablets, ITM provides a packet of crude herbs: Astragalus/Oldenlandia Tea. This tea is a different formula, though the principles of therapy are similar. The tea can have two purposes: one is in place of using tablets for a patient who does not feel comfortable taking a large number of tablets (or simply can't swallow tablets), and the other is to initiate therapy with a tea that can be followed up by tablets later. Granule formulas, administered by adding the granules to hot water to make a tea, might be useful in the course of therapy and they become a more acceptable option for those who have gotten used to consuming a tea in the first place.

Astragalus/Oldenlandia Tea provides a dosage of herbs somewhat higher than that of Gynostemma Tablets, has a taste that some patients come to appreciate, and has been favorably received (i.e., good reports about its effects). The packet of herbs comes with instructions to make up a batch of tea on one day and then another batch using the herb dregs the next day. To boost the dosage, as may be needed in cases of strongly immuno-suppressive chemotherapy, the second batch should be taken on the same day rather than the next day.

An ingredient of some Chinese herb therapies for immune enhancement and bone marrow protection is deer antler, which is usually not provided in the form of tea or extracts, but as a powder (loose or in pills). Antler 8 (Seven Forests) and Pantosterone (White Tiger) both provide a significant amount of deer antler in a small number of tablets. A daily dose of 1.0-1.5 grams of deer antler powder is often sufficient (recommended doses of Antler 8 are up to 6 tablets per day and for Pantosterone are just 2-4 tablets per day). These remedies are especially given to aid in boosting red blood cell production. In addition to strict tonification therapy, bone marrow function is sometimes addressed using blood vitalizing herbs that have a tonic nature. The formula Millettia 9 (Seven Forests) is based on prescriptions used in China for this purpose. However, it needs to be used at a higher dosage than the antler formulas: about 4-5 tablets three times daily. These herbs might be used if Epogen is not giving adequate results or is not prescribed despite low red blood cell levels.

Anti-Cancer Herbs
There are numerous herbal materials from around the world that have been claimed to have cancer-inhibiting effects. In America, it is common for people interested in alternative cancer therapies to take herbal formulas such as Essiac Tea, Hoxey Formula, and other preparations that have been heavily promoted. Thus far, little evidence has been accumulated that would support an anti-cancer action of these herbs.

Several organizations, including the National Cancer Institute (NCI) in the U.S., have screened thousands of herbs for potential anti-cancer activity. When herbs are found to have such activity, they are entered into various trials (usually starting with cell cultures, then animal studies, followed by a series of clinical evaluations leading either to rejection of the compound or to development of a new drug). Some Chinese herbs already have been developed into anti-cancer drugs in China and some of these are under advanced levels of examination by NCI. Most of the ones that make it through the process of drug development, like the other chemotherapy drugs already in use, are quite toxic. A recently developed anti-cancer drug derived from a plant is Taxol, from the yew tree. Due to the small amounts of this compound in the trees, it had to be synthesized to prevent complete destruction of the yew populations. Taxol is now quite widely used, but is not thought of as an herbal drug and is known to have significant side effects, not unlike those experienced with other chemotherapy agents.

Herbs of low toxicity that are claimed to inhibit cancer have not been developed into drugs and their effectiveness remains undetermined. In China, the herbs oldenlandia and scutellaria are repeatedly included in herb formulas for cancer patients. These two herbs have low toxicity and are used in high dosages. A third herb, solanum, is also widely used in Chinese anti-cancer formulations and is regarded in China as having very low toxicity (Westerner's know the herb as "nightshade," for which the leaves are deemed highly toxic; the Chinese use the roots). A granule formulation with these three herbs plus others is made available to clients and is described in the article on oldenlandia and scutellaria (other versions of the formula can be made for specific needs). A combination of "anti-cancer" herbs is prepared by ITM as Paris 7, and includes oldenlandia and scutellaria. One of its ingredients, subprostrata (Sophora subprostrata) has been further developed in China into an anti-viral and anti-cancer drug, namely oxymatrine. This compound has low toxicity and is reported additionally to have immunological benefits similar to the herbs described in the previous section. ITM has obtained oxymatrine to make a tablet by the same name (White Tiger).

A compound prescription, Ping Xiao Dan, is reported in the Chinese literature to have good effects on shrinking tumors. An herbalist in China, Jia Kun, has used this formula in pill form, accompanied by decoctions of herbs, to treat a wide range of cancers. Ping Xiao Dan (which is not a single formula, but is a name applied to several similar formulations) contains some toxic ingredients that are not acceptable for use in the West. A formulation that is of similar nature that includes some of the herbs found in the decoctions used by Jia Kun is Chih-ko/Curcuma (Seven Forests).

The three tablet formulas, Chih-ko/Curcuma, Paris 7, and Oxymatrine, and the granule preparation with oldenlandia, scutellaria, and solanum, are the main "anti-cancer" compounds provided by ITM. There is some question as to their value when standard medical therapies are being used at the same time, since those therapies accomplish the same goal: shrinking tumors and inhibiting cancer cells. Their role at IEP is mainly in treating patients who have failed to respond to standard medical therapies. However, Oxymatrine can be used for its roles as immune protector and sedative.

It is usually difficult to administer both the "anti-cancer" formulas and the immune enhancing formulas at the same time, so one generally has to choose one herbal strategy at a time and follow it. Paris 7 is made from a highly concentrated extract of the herbs, but to get into the range of a potentially effective dosage one must prescribe 5-6 tablets, three times daily, and higher doses may be acceptable. Chih-ko/Curcuma (herb powders to which some concentrates have been added) is used in doses of 4-5 tablets three times daily. Oxymatrine, being an alkaloid fraction derived from an herb, is used in doses of just 1 tablet each time, 3-4 times per day.

Nutritional Status
There is a vast medical literature on nutrition research. Overall, this research shows that well-nourished people do better than malnourished people in virtually every area with regard to health. In relation to cancer therapy, well-nourished people survive and recover better from surgery than do those who are malnourished. There is also some evidence to imply that well-nourished people do better with radiation, chemotherapy, and other injurious experiences.

Analyzing foods in terms of nutrients is not always the first priority (see: The ideal meal), but it can prove helpful in understanding certain aspects of diet and the use of supplements. Nourishment can be described in terms of three categories of substances:

  1. major nutrients: protein, fat, carbohydrate;
  2. trace nutrients: vitamins, minerals; and
  3. "non-essential" nutrients and food components: coenzymes, flavonoids, fiber, etc.

With regard to major nutrients, protein intake is most often the one that is deficient, and this may be the result of limited appetite, limited ability to prepare meals, or lack of knowledge regarding dietary protein. However, some natural health care proponents may intentionally or inadvertently recommend a low protein diet as a "cleansing" one, not realizing that the resulting protein deficiency can have adverse consequences for the cancer patient.

As a general rule of thumb to use in estimating protein needs, a low-body-weight individual who does little physical exercise has a daily requirement on the order of 50 grams, while a high-body-weight individual who does a lot of physical exercise has a daily requirement on the order of 100 grams (with others falling somewhere in between, based on body weight and physical activity). IEP makes available Narula-Soy powder as an easy-to-digest soy protein powder that provides 13 grams of protein per ounce (one serving is one ounce) in a pleasantly flavored form. High protein foods include egg whites and seafood, as well as most meats; the main vegetable sources are legumes (including soy beans, peanuts, and lentils).

Fat consumption is usually adequate and sometimes excessive, especially if processed foods and restaurant foods are consumed. Fats rich in omega-3 fatty acids are considered potentially beneficial and are obtained mainly from fish and from seeds (notably, flax seeds). Those who cannot obtain significant levels of omega-3 fatty acids can take supplemental capsules that contain these oils (usual dosing recommendations are 3 grams of encapsulated oil per day). There are frequent literature recommendations to utilize olive oil over other vegetable oils in food preparation; olive oil contains some compounds, such as oleanolic acid, that may be beneficial for cancer patients and others. Foods that have been stored for too long may contain rancid fats which are considered potentially harmful and should be avoided.

Carbohydrates are usually adequate in the diet and sometimes excessive. Carbohydrates are present in substantial quantities in fruits and vegetables, the foods that are deemed to be of particular benefit because of their trace and non-nutrient components, such as vitamins, flavonoids, and fiber. Starch, as obtained from grains, is rapidly converted to sugar: a high grain diet (which may include bread, pasta, rice, etc.) corresponds to a high carbohydrate diet. In my article, The role of dietary and herbal flavonoids on gastro-intestinal health, I present a modified food pyramid that places more emphasis on fruits, vegetables, and proteins, and somewhat less emphasis on grains than the highly publicized food pyramid of the U.S. Department of Agriculture. This dietary approach may be useful for cancer patients. Some poorly supported dietary recommendations, such as strictly avoiding carbohydrates either to aid weight loss or to "starve" the cancer of needed sugars (which can not actually work), simply force the patient into unnecessary dietary restrictions when, in fact, good nutritional status should be the focus.

There may be some benefit to providing vitamins and minerals in quantities that significantly exceed usual dietary intake. For example, some research indicates a potential benefit for cancer patients by consuming selenium in amounts on the order of 100-300 micrograms per day, while dietary intakes are usually less than 50 micrograms per day. Antioxidants, which include vitamins C and E, may have a role in protecting the non-cancer cells from damage due to cancer therapies and do not appear to interfere with the potent cancer-killing effects of chemotherapy or radiation. Patients undergoing cancer therapies may have restricted exercise routines (due to fatigue or other factors), which contributes to osteoporosis, so increased calcium and magnesium intake may be helpful. B-vitamins may aid the nervous system to help with anxiety and nervous agitation, as well as to help alleviate fatigue that occurs during cancer therapies (vitamin B12 and folic acid contribute to red blood cell production). IEP provides most patients with a comprehensive vitamin/mineral mixture called Calmagnium (White Tiger). This formula also helps new patients replace a "shopping bag" full of individual nutrition supplements with a single one, which can improve compliance with taking needed supplements, such as the herb tablets previously described.

Non-nutrient components of natural foods and beverages include some substances that are ingested in the diet but are also manufactured by the body as well as other substances that have a role in health but are not immediately required for survival. As examples, coenzyme Q10 is an essential compound that is found in the diet but is also manufactured by the body (so, if dietary sources were excluded, there would still be enough to live on). Fiber is a component of food that is not manufactured by the body, but is important to maintaining good health: it does not provide a substance that is of immediate need for survival. Long-term deficits in these two non-nutrient substances are associated with increased risk of cardiovascular disease and cancer.

Several non-nutrient substances have been implicated in preventing the development of cancer when ingested with some frequency over many years. The list of protective compounds includes flavonoids (including isoflavones, flavonols, anthocyanidins, and polyphenols), fiber (and accompanying phytic acid), coenzyme Q10, and sulfur compounds (found in garlic, broccoli, cabbage, brussel sprouts, etc.). At high doses, these same substances may have direct anti-cancer activity, though their effects are far weaker than those of standard oncology therapies (chemotherapy, radiation, surgery).

A diet rich in natural foods from several categories, including fruits, vegetables, legumes, meat, fish, dairy products, and grains, can provide considerable quantities of the desirable nutrient and non-nutrient substances. Certain foods are especially noteworthy for their content of substances that may prevent the occurrence of cancer, including apples and onions (quercetin and related compounds), soy beans (genistein and daidzein), tea (especially green tea, for its polyphenols), broccoli (sulforaphane), tomatoes (lycopene and other carotenoids), etc. These foods can be suggested for inclusion in the diet. Some of the compounds in these foods have been isolated and provided as supplements. For example, soy isoflavones are available in Narula-Soy (mentioned above) and in the tablet Genistemma (White Tiger). Tea polyphenols are present in the tablet formula Quercenol (White Tiger) along with quercetin, carotenoids, and other antioxidants; the same polyphenols are also present in Genistemma.

A number of substances found in plants have been found to protect cardiac cells and bone marrow from adverse effects of chemotherapy. Among the substances of interest are coenzyme Q10 (derived from bovine cardiac muscle, though now produced synthetically), theanine (an alkaloid from tea, now derived enzymatically from other sources), polysaccharides from mushrooms (and a few flowering plants), matrine and oxymatrine (alkaloids from Sophora species), and withanolides (from the Indian herb ashwaganda). Coenzyme Q10 is commonly available as an over the counter health care product and it is an ingredient of the circulatory formula Cartaequin (White Tiger); theanine is included in the sedative formula Nardova (White Tiger); matrine and oxymatrine are available together in tablet form, called Oxymatrine (White Tiger); and withanolides are present in Ashwador (Herbs from India), an immune enhancing and adaptogenic formula.

Overall, these nutrient and non-nutrient substances can be considered as helpful in stabilizing the cancer patient, improving general health conditions, and, possibly, improving the effects of standard medical therapies while reducing the adverse effects. Their impact may be subtle and largely unnoticed; in fact, a sudden and dramatic change in health and an improvement in cancer status should not be expected by adding these to the therapeutic regimen. Some care must be taken in having patients alter their dietary practices or having them take large amounts of dietary supplements: there are a number of factors that influence the ability and willingness of patients to comply. If this nutrition information is provided to patients, most will learn something about nutrition that they didn't know before and they may opt to adjust their diet accordingly-if they are in a position to do so. By contrast, demanding a restrictive diet that is based solely on consuming "favored" ingredients and avoiding unfavorable ingredients can be counterproductive. Similarly, expensive and complex supplement regimens may also provide minimal benefits while being disruptive to the pursuit of more important therapies. The ability of patients to take supplements-whether powder, liquid, capsule, or tablet form-may be limited as a result of the effects of cancer or its treatment. Therefore, careful judgment must be used in giving dietary recommendations and determining whether or not to prescribe additional nutrient or non-nutrient materials.

Digestive system disturbances, including poor appetite, weak digestion, and abdominal distress, can sometimes be addressed by dietary changes and acupuncture without resorting to herbs or other supplements. Some cases of digestive system disturbance, such as those caused by a tumor or ascites pressing against the stomach, may not be benefited by giving supplements that are intended to increase the production of gastric juices and promote digestive functions, even if they would be effective in other situations. Indeed, adding more volume of material to the digestive system in such cases could be counterproductive by limiting the intake of essential nutrients via food. Therefore, before prescribing herbs and supplements to aid in treatment of digestive system disturbance, one should carefully consider what may be the root cause of the problem. If a supplement is administered, the anticipated beneficial effects ought to be noted with the use of a single bottle in most cases when the correct dosage is taken, and sometimes with a slightly longer period. Examples of formulas aimed at promoting digestion and alleviating digestive distress are Gallus-Malt Tablets (Seven Forests), Shen-chu 16 (Seven Forests), Kang Ning Pian (Pine Mountain), Bao He Wan (Pine Mountain), Hingwastaka (Herbs from India), and Galletaine (White Tiger).

In addition to herbs given to improve the digestive functions, a potentially valuable supplement is glutamine powder (bulk powder to be added to water or juice; especially useful for post-surgical intestinal inflammation), which has been described in a separate article (see: Amino acids I: glutamine). Briefly, glutamine is the dominant amino acid in the body, it is stored in the muscles, may contribute to immune functions, and is important in repair of damage to the intestinal tract. Glutamine levels may fall with low food intake and with muscular wasting. Dosage of glutamine to get beneficial effects is on the order of 10-30 grams per day (an amount that can not be attained when purchasing encapsulated glutamine). However, glutamine is not known to have any benefits for simple gastric distress, diarrhea due to infections, and other situations where there is not intestinal damage. Some chemotherapy agents are harmful to the intestinal tract; surgery for colon cancer is a situation where glutamine is recommended to be provided as part of the hospital follow-up.

Symptom Relief
It is common for patients to present symptoms that are not only those physically related to the cancer and the cancer therapies, but also associated with other factors, such as mental distress and disorders that exist separate from the cancer, such as injuries, chronic illnesses, etc.

While herbs are available to address each of the symptoms that might be presented, it is quite difficult to add anything to the herbal protocol already outlined. One should, to the extent possible, rely on herbs that have dual effects. As an example, Oxymatrine has a sedative effect and could substitute for use of an additional remedy aimed at treating insomnia and nervous agitation; Nardova (White Tiger) has a sedative effect (see: Valerian and nardostachys) and provides the protective agent theanine (see: Amino acid supplements IV: theanine).

Symptom relief should be addressed as much as possible by frequent acupuncture, as described previously. In addition, IEP offers its patients a form of shiatsu (see: Zen shiatsu) that can aid in providing symptom relief. Although such massage sessions cannot be offered frequently enough or of long enough duration to have the full effect that they might otherwise have, when used in conjunction with acupuncture therapy (either on the same day or as alternative sessions during the treatment period), the massage sessions can provide substantial symptom relief. I have focused on Zen shiatsu because I believe it is one of the few massage therapy techniques that integrates very well with acupuncture and, therefore, can contribute complementary and additive effects. Other massage techniques may be beneficial for the patients, but are not offered at IEP.

Sometimes the use of herbs for alleviating individual symptoms can be futile (i.e., they may have minimal impact on the severity) and the additional materials may disrupt compliance with the efforts to counteract side effects of cancer therapies. As an example, bone pain due to cancer metastasis in unlikely to respond to common blood vitalizing and pain relieving herbs unless the dosage is increased to the level that causes side effects and toxicity. It may be much better to have that pain managed by proper use of morphine (in China, the opium poppy is an herb that is available for treatment of pain; in addition, the toxic herb datura is used for pain). According to Chinese reports (see: Prognosis after diagnosis of liver cancer), the constipating side effect of morphine can be overcome by a rhubarb-based laxative therapy (at high dose) which may help the patient use this drug effectively. Also, severe ascites due to advanced liver cancer or other cancer, usually will not respond to common herbal diuretic formulas. Although ascites is reported to be alleviated in some Chinese medical reports, this is often accomplished with very high dosage decoctions which our patients seem unable to consume if they have this symptom. In China, patients who have difficulty consuming herbs may obtain herb extracts by IV administration or other methods that are not suitable for use here.

Preventing Cancer Recurrence
Some patients at IEP learn from their oncologists that they no longer show signs of having cancer, as a result of successful therapy; they usually wish to make a strong effort to avoid recurrence of cancer. There is an extensive literature on risk factors for getting cancer. This literature points to certain things one can do to minimize experiencing a first diagnosis of cancer, including:
  1. Avoid exposure to carcinogens, such as tobacco products (chewed or smoked), excessive alcohol, estrogen (in women), industrial chemicals (e.g., benzene), radiation (e.g., radon), niter-compounds in food (e.g., in preserved meats), hepatic infections (viruses), etc.
  2. Have a high intake of fruits and vegetables which contain cancer-protective substances including fiber and non-nutrient substances (e.g., flavonoids and other antioxidants) and drink healthful teas.
  3. Avoid repeated irritation and inflammation, such as sun burns, repeated rubbing against a part of the skin, chronic inflammatory disease.

There is much less known about preventing cancer recurrence. The vast majority of cases of recurrence involve the cells of the initial cancer, though they may grow at a different site. This means that some cancer cells were not eliminated in the otherwise successful therapy, and they begin to multiply later. The recurrence of cancer most often arises within 5 years, which is why many doctors do not consider their patients to be cured of cancer who otherwise appear cancer free until they have lived for 5 years without recurrence.

It is certainly possible that many of the same factors that lead to the initial cancer (or that reduce risk of getting such a cancer) influence the dormant cancer cells that were left behind after the initial therapy. Therefore, many of the strategies used to lower cancer risk for an initial diagnosis of cancer may help prevent cancer recurrence. On the other hand, the strategies that lower cancer risk are usually followed for decades, whereas the time available to prevent recurrence is relatively short, so their effect may be more limited. For substances that are ingested to protect against cancer, a higher dosage may be needed to inhibit recurrence. Working with the limited knowledge of how to prevent recurrence, the following strategies may be suggested:

  1. Work towards optimum health. A healthy body is more likely to control residual cancer cells if they can be controlled at all. This means proper diet, exercise, regulating work and rest, and control of emotions (see the article: Disease prevention and harmony: control the emotions). Although the effect may not be well documented, recurrence of cancer appears to arise frequently in persons who are emotionally distressed or who suffer from depression. Putting in place a procedure for responding to stress would be of potential benefit; antidepressant drug therapy may prove helpful in some cases where natural approaches are inadequate.
  2. Take antioxidants and substances that are considered cancer-protective in quantities somewhat higher than available through the diet. IEP provides supplements such as Quercenol (a mixture of antioxidants) and Genistemma (a mixture of flavonoids) that may be of benefit. A combination of herbs that include several of those recommended in Chinese medical literature for preventing cancer or its recurrence are in Baicalcumin (White Tiger).
  3. Promptly address any health problems that arise, including infections, inflammatory diseases, and mental disorders. At IEP, these may be addressed by undertaking a series of acupuncture treatments and taking herbs specific for the disorder; standard medical therapies may need to be pursued as well.

Some of these procedures suggest a more active role for the person who wishes to prevent cancer, rather than a passive role of taking some prescribed pills and expecting the supplements to take on the full burden of inhibiting cancer growth.

Many cancer patients are above age 40, and the majority of patients are above age 50. In these patients, the Chinese diagnostic category of yin deficiency syndrome may be present, following the classical theory that yin deficiency develops with aging. Chinese researchers and doctors have proposed the Rehmannia Six Formula, the classic yin nourishing prescription, and similar formulations may help prevent cancer development and recurrence, especially in this age group. Formulas of this nature are available at IEP, including:

  1. Seven Forests: Rehmannia 16, Restorative Tablets, Tremella 14
  2. Pine Mountain: Rehmannia Six Formula, Rehmannia Eight Formula
  3. White Tiger: Iridoid Complex (iridoids are one of the main active components in Rehmannia Six Formula)

In Korea, the daily use of ginseng is thought to be cancer preventive, and there is some laboratory evidence supportive of this view. Gynostemma is an herb that has active ingredients that overlap with those found in ginseng. Ganoderma and cordyceps are famous mushrooms that are thought to confer similar benefits. Eleuthero is a popular herb reputed to have effects similar to those of ginseng, and ashwaganda is a traditional herb from India said to have similar properties. All of these herbs are known as adaptogens; substances that help the body adapt to stresses and, thereby, prevent diseases. Ginseng, and these substitutes, may be obtained in the following materials available at IEP:

  1. Seven Forests: Ginseng 6, Eleuthero 10+, Ganoderma 18
  2. Pine Mountain: Ginseng-Royal Jelly, Cordyceps Tablets
  3. White Tiger: Genistemma Tablets, Pantosterone
  4. Herbs from India: Ashwador

In Japan, soy products are thought to be cancer preventive. There are numerous soy foods available and IEP can provide the active constituents, soy isoflavones, in Narula-Soy and Genistemma Tablets. Whenever possible, practitioners should help patients select the smallest number of supplements to take that would be consistent with their constitution and what they may already get from their diet.

Therapies and Supplements Summary
The following table summarizes some of the therapeutic interventions used at IEP for various conditions presented by cancer patients.

Condition to Treat
Therapies
Anxiety, nervousness, stress acupuncture, massage, meditation, exercise; Nardova, Oxymatrine
Immune suppression Gynostemma Tablets, Astragalus-Oldenlandia Tea, Coricepium, Ashwador, Oxymatrine
Cardiac protection coenzyme Q10, Cartaequin
Nutritional deficiency dietary adjustments, Narula-Soy, Calmagnium, Quercenol, glutamine
Anticancer effects Oldenlandia-Scutellaria granules, Paris 7, Chih-ko/Curcuma, Oxymatrine
Digestive distress acupuncture, massage, dietary adjustments, Gallus-Malt Tablets, Shen-chu 16, Kang Ning Pian, Bao He Wan, Hingwastaka, Galletaine, glutamine
Low Red Blood Cells Antler 8, Pantosterone, Millettia 9
Preventing Recurrence exercise, good diet (fruits, vegetables, etc.), acupuncture, stress-reduction, Quercenol, Genistemma, Baicalcumin, Rehmannia Six Formula, Ginseng-Royal Jelly Tablets, Ashwador, Ganoderma 18, green tea, etc.

© October 2004

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