Application of the Clearing Method Among the Eight Therapeutic Principles in Treating Cancer
The clearing method is a very important therapeutic principle in Chinese medicine. It is the mainstream school among contemporary Chinese practitioners treating cancer. Gao Bingjun, author of Yangke Xinde Ji and the representative figure of the "Xinde school"—one of the three great schools of Chinese surgery—is an outstanding exponent of using the clearing method for the fire-toxin of various tumors. In contemporary Chinese medicine, patients with the yang pattern in cancer treatment are mainly treated with the clearing method.
The Suwen · Zhizhenyao Dalun says "what is hot should be cooled"—this is the original source of the clearing method. Today the clearing method is also called the heat-clearing method, and it is the main approach for treating warm diseases. Gao Bingjun was a contemporary of such warm-disease school masters as Ye Tianshi, Xue Xue, and Wu Jutong; the thought of the warm-disease school deeply influenced him. The Yangke Xinde Ji can be seen as the extension of warm-disease thinking to external-medicine diseases such as welling-abscesses and toxic swellings.
The so-called heat-clearing method uses cold-natured formulas to release heat evil through fire-purging, detoxifying, and blood-cooling actions. This school was mainly influenced by Liu Wansu's theory of fire-and-heat disease mechanisms, holding that treatment should primarily attack the evil with cold and cool. Its indications are: any interior excess-heat pattern; for any febrile disease, whether the heat evil lies in the qi aspect, the construction aspect, or the blood aspect, as long as the exterior evil has already been resolved and the interior heat is exuberant without any solid accumulation, it may be used.
There are several key points in the indications: first, interior excess-heat pattern; second, the exterior evil has been resolved; third, there is no interior solid accumulation. Such a patient looks outwardly just like a normal person—normal skin temperature, no pathological signs such as constipation—but the patient himself feels bodily heat and irritability, or steaming bone heat, or mouth and tongue sores, or thirst and dry throat, or dusky purple lips, or scanty, dark, frequent urination.
This constitutional feature exists in many cancer patients. Giving heat-clearing, detoxifying formulas to such patients genuinely works. I saw a late-stage colorectal-cancer patient who took heat-clearing, detoxifying medicine based mainly on Puji Xiaodu Yin for nearly six years, without any other treatment, and his quality of life was not bad; he ultimately died, of course, from multiple cancer metastases. The physician who treated him was Kong Sibo, son of Kong Bohua.
The concrete application of the heat-clearing method requires finer pattern differentiation. According to the warm-disease school's classification of heat, there is heat in the qi aspect and heat in the blood aspect. Ye Tianshi said of warm diseases: "Only after the defense aspect may one speak of the qi aspect; only after the construction aspect may one speak of the blood aspect. In the defense aspect, sweating may be induced; when it reaches the qi aspect, only then may one clear qi; having entered the construction aspect, one may still out-thrust the heat to the qi aspect; having entered the blood aspect, one fears consumption and stirring of the blood, and must directly cool the blood and disperse it." Thus the treatment principles differ at different stages of a warm disease's development.
Based on my own experience, the defense aspect mostly corresponds to exterior patterns, like colds with fever. What Chinese medicine calls "heat in the qi aspect" resembles swelling, congestion, and ulceration of the mucosal lining of the digestive and respiratory tracts due to inflammation. "Heat in the blood aspect" means the inflammation has penetrated deeper, into the muscle layer and blood vessels, with some subcutaneous or internal bleeding—for example, hematemesis and melena in gastric-cancer patients, hemoptysis in lung-cancer patients, or purpura in leukemia patients. Heat in the "construction aspect" is the transitional stage between the qi and blood aspects. When examining patients in the clinic, if one carefully distinguishes the signs, treatment can be more precisely targeted.
The warm-disease school avoids using acrid, dry, blood-stirring herbs. Thus, when treating cancer, it tends to reject strongly acrid and hot herbs such as aconite (Fuzi), dried ginger (Ganjiang), cinnamon bark (Rougui), and evodia (Wuzhuyu). But long use of cold and cool herbs injures the stomach, so when treating cancer along warm-disease lines one must protect the patient's stomach and intestines. Especially in patients who are ordinarily of the vacuous-cold type (author's note: such patients are mostly what Western medicine calls chronic gastroenteritis patients, with usually loose stools and a cold abdomen), taking cold and cool herbs easily causes gastrointestinal dysfunction and reduced appetite.
For such patients, when prescribing one should protect the patient's stomach qi: when using cold and cool herbs, start from as small a dose as possible, appropriately add hot herbs such as ginger and evodia as counter-assistants, pair them with damp-drying herbs such as phellodendron (Huangbo) and coptis (Huanglian), and add herbs such as bupleurum (Chaihu), atractylodes (Baizhu), and poria (Fuling) that have a lifting, spleen-yang-strengthening action. Chaihu should be used in small doses; Baizhu and Fuling in medium doses, to lift yang and fortify the spleen and stomach, ensuring that stomach qi is not damaged while the patient takes heat-clearing herbs.
Supporting the righteous qi must never be forgotten at any stage of cancer treatment. In the early stage the force of support may be appropriately lightened, but in the middle and late stages a certain degree of support is indispensable. For cancer patients differentiated as yang pattern or half-yin-half-yang pattern, one should, when choosing supporting herbs, avoid those that help heat—red ginseng (and even white sun-dried ginseng), aconite, cinnamon, deer antler, and dry-fried atractylodes all help heat generate fire. Supporting therapy for such patients should lean toward sweet-cool herbs, such as maidong (Ophiopogon), tiandong (Asparagus), huangjing (Polygonatum), shengdi (Raw rehmannia), shashen (Glehnia), taizishen (Pseudostellaria), dazao (Jujube), xiyangshen (American ginseng), and ginseng rootlet—supporting herbs that nourish yin and generate fluids.
One must have a direction in selecting herbs. Influenced by the warm-disease school's triple-burner pattern differentiation, Gao Bingjun, based on the characteristics of welling-abscess development, proposed: "Those in the upper region all belong to wind-warmth and wind-heat, because wind acts upward; those in the lower region all belong to damp-fire and damp-heat, because water tends downward; those in the middle region mostly belong to qi depression and fire depression, because both qi and fire issue from the center." He also described the features of "toxin attacking the five zang": "When toxin enters the heart, there is coma; entering the liver, convulsion and syncope; entering the spleen, abdominal pain and distension; entering the lungs, wheezing and cough; entering the kidneys, dim eyes and cold hands and feet."
Gao Bingjun's triple-burner/five-zang differentiation has high clinical value: heat in the upper burner is treated as wind-heat; heat in the middle burner as qi depression and fire depression; heat in the lower burner as damp-heat pouring downward. One may also judge the affected zang-fu organ from the patient's particular discomforts and prescribe the corresponding formula.
The great majority of academically trained contemporary Chinese physicians treating cancer are influenced by the heat-clearing method, for which they have been fiercely criticized by the classical-formula school. But the clinical efficacy of the heat-clearing school for yang-pattern and half-yin-half-yang-pattern cancer patients is worth affirming. In my own clinical observation, among early- and middle-stage cancer patients, yang-pattern and half-yin-half-yang-pattern patients constitute the great majority. In late-stage, especially terminal patients, yin-pattern patients predominate.
"Long illness necessarily leads to vacuity, long illness necessarily leads to stasis, and long illness necessarily leads to heat." At any stage, cancer patients have vacuity, stasis, and heat to varying degrees—heat being especially obvious. Dusky purple lips are often taken as stasis; personally I read them as heat, and if the lip mucosa is visibly swollen, it should be differentiated as internal heat. One should act on both the qi and blood aspects; in severe cases, give raw gypsum (Shigao), coptis (Huanglian), phellodendron (Huangbo), anemarrhena (Zhimu), honeysuckle (Jinyinhua), forsythia (Lianqiao), water buffalo horn (Shuiniujiao), bezoar (Niuhuang), red peony (Chishao), moutan (Danpi), raw rehmannia (Shengdi), scrophularia (Xuanshen), and infant's urine (Tongbian) to clear both qi and blood, preventing further ulceration and internal bleeding.
Heat-clearing herbs with detoxifying action are also widely used in cancer treatment; especially the anti-cancer herbs Scutellaria barbata (Banzhilian), Lobelia (Banbianlian), oldenlandia (Baihuasheshecao), Paris rhizome (Chonglou), Viola (Zihuadiding), and honeysuckle (Jinyinhua) are popular among clinical Chinese physicians.
To clear the body of heat-toxin, one has no choice but to work through three routes: sweating, vomiting, and purging. For chronic cancer patients, long-term use of vomiting and sweating methods is inappropriate, and purging should also be cautious. Comparatively, the safest route is diuresis. Thus phlegm-dissolving and dampness-draining herbs such as coix seed (Yiyiren), poria (Fuling), polyporus (Zhuling), and pinellia (Banxia) are frequently used in cancer treatment.
Blood-activating and stasis-resolving, and especially blood-breaking, herbs must be used cautiously. If a cancer patient's heat has receded and stasis resolved, there is no need to continue blood-activating treatment unless stasis is clearly present. Representative formulas of the heat-clearing method for cancer include Puji Xiaodu Yin, Xianfang Huoming Yin, Qingying Tang, and Xijiao Dihuang Tang. When composing a formula, one may follow the rationale of these prescriptions and select herbs according to the patient's specific symptoms.