TCM Treatment and Dietary Regulation for Cancer Patients with Concomitant Diabetes
In treating cancer, I have found that oncology knowledge alone is not enough; many cancer patients have a great number of complications. The most complicated case I have seen carried seventeen major conditions, including cancer, diabetes and pulmonary tuberculosis, and was dying, bedridden; the complexity left the physician with almost no place to begin. Yet after an in-person visit and TCM pattern differentiation, the patient improved considerably, at one point regaining his pre-illness weight, recovering his strength substantially, and being able to move about normally.
Cancer with concomitant diabetes is the most common pattern of cancer plus another major disease I have seen; it occurs in many cancer patients, and I have treated several. This brief essay offers a few humble thoughts on TCM treatment and dietary regulation in such cases.
Diabetes belongs in TCM to the category of "xiaoke" (wasting-thirst), clinically characterized by excessive drinking, eating and urination, emaciation, or sweet urine. Clinically it is divided into upper, middle and lower wasting-thirst. Generally, upper wasting-thirst features excessive drinking, middle excessive eating, and lower excessive urination. Records of the Grand Historian, in the biography of Lian Po and Lin Xiangru, tells that the king of Zhao wanted to re-employ Lian Po; an enemy of Lian Po asked the envoy to slander him, mentioning that Lian Po ate a great deal but had to defecate three times during one meal. If this account is true, Lian Po most likely had what we today call diabetes.
The Inner Canon holds that xiaoke arises from rich, sweet, fatty food, emotional imbalance, and weakness of the five viscera; it explicitly forbids patients from eating rich, fatty, flavorful foods and aromatic or mineral drugs that are drying and injure fluids. Treatment should focus on sweet-cold nurturing of yin and engendering fluids to stop thirst. The Zhubing Yuanhou Lun (General Treatise on Causes and Manifestations) attributes the disease to kidney dryness, yin deficiency and deficiency-heat in the lower burner, and already recognized that xiaoke readily triggers complications such as ulcers and swellings (i.e., the benign and malignant tumors of today) and edema.
In the Tang dynasty, Sun Simiao's Qianjin Yaofang (Essential Prescriptions Worth a Thousand Gold), discussing xiaoke, held that patients often drank immoderately, producing fierce heat in the triple burner and dryness of the five viscera, with urine exceeding fluid intake. Treatment centered on heat-clearing, fluid-engendering herbs such as Tianhuafen (Trichosanthes root), Dihuang (Rehmannia), Maidong (Ophiopogon) and Huanglian (Coptis), and explicitly called for dietary control, advocating small, frequent meals.
Since then, physicians of successive dynasties mostly held that the mechanism of diabetes is scorching fire attacking the triple burner, and treatment should nourish yin and clear heat. In short, xiaoke consumes lung yin, spleen yin and kidney yin; treatment must address all three, and warming, drying herbs are strictly forbidden.
In my experience, cancer patients with concomitant diabetes tend to be anxious by disposition, timorous, prone to insomnia and cowardice—showing clear signs of emotional imbalance. They are gaunt, their fluids are exhausted, their faces are dark and sallow, they are deficient and prone to colds, short of breath and given to sighing, and their condition fluctuates sharply with mood. When the mood sours, the body declines at once. When lung-yin deficiency produces marked upper wasting-thirst, a single cold can readily trigger severe complications and put life at risk. At such a life-or-death juncture, a moment's negligence in treatment can easily bring profuse sweating and the collapse of both yin and yang.
In treating such patients, neither doctor nor patient should harbor unrealistic hopes of a cure; the focus should be on improving quality of life and prolonging survival. Treatment should primarily support righteous qi; when the patient improves, moderately dispel evil, but never rush, or life and death may be decided on the spot.
For such severe patients, hoping to manage them through the current outpatient model is almost a luxury. In clinic, the physician has only a few minutes to understand the case and writes a prescription before the history is even known in detail; results can hardly be guaranteed. Patients should follow one TCM physician long-term so he can know their condition well. When possible, hospitalization—not outpatient visits—should be considered.
Sweet-cold yin-nourishing is central in treating these patients. But sweet-cold, yin-nourishing herbs tend to be cloying and generate phlegm, while cold herbs tend to congeal blood; one of the mechanisms of cancer is the互结 of phlegm and stasis. Treatment must therefore simultaneously dissipate phlegm and soften masses while nourishing yin with sweet-cold formulas. In my experience, cancer-diabetes patients most often show "exuberant heat obstructing, qi mechanism in disharmony." Treatment should pair heat-clearing with moving the qi mechanism; once qi flows, the heat in the triple burner naturally eases.
Sleep disturbance is another important symptom in cancer-diabetes patients. Poor sleep worsens constitution and accelerates disease progression. Sleep deprivation is both a cause and an effect of triple-burner fire. In treating such patients, therefore, sleep quality must be addressed; the inquiry should include sleep. If the patient is chronically prone to insomnia, treatment should, while clearing fire, emphasize calming the spirit. With adequate sleep, the exuberant heat is markedly relieved.
Emotional regulation is equally important. Cancer-diabetes patients readily become anxious and worried. I often borrow the approach of Guipi Tang (Restore the Spleen Decoction) to calm the spirit, with good results.
To be honest, for the great majority of cancer-diabetes patients, whether with TCM or Western medicine, only symptomatic supportive care is possible; a cure can hardly be hoped for. A very few fortunate patients, on top of supportive care, get a chance at evil-dispelling treatment and can live a substantially longer time. But the timing and intensity of such treatment must be mastered well; otherwise it backfires and shortens life.
Dietarily, food intake should be controlled, with small, frequent meals as far as possible, and high-protein, high-fat foods minimized. Patients should also be encouraged to take light exercise such as walking; when strength allows, time in bed should be minimized.