How Clinical TCM Physicians Can Improve Cancer Treatment Outcomes
An old piece, written in 2013.
Zhang Jingyue said that a physician must have "the eye of an eagle and the courage of a lion." What he meant was: first, the physician must pattern-differentiate accurately; second, he must have sufficient daring. I believe this is the key to improving cancer treatment outcomes for clinical TCM physicians.
Accurate pattern differentiation requires reading widely, doing extensive clinical work, thinking carefully at the bedside, and accumulating clinical competence. Clinical competence and the ability to differentiate patterns cannot be captured in a sentence or two; they are the result of a physician reading medical books diligently and practicing, thinking, and summarizing tirelessly.
A crucial point in accurate differentiation is learning to grasp the principal contradiction. Many patients show me prescriptions written by clinical TCM physicians they have consulted, and after reading them I can only laugh or cry. For example, a prescription for treating a tumor that consists entirely of kidney-tonifying herbs is sheer nonsense. When a tumor is present, one should attack the tumor; when there is no tumor, one should actively fight cancer. Can a kidney-tonifying formula alone treat or fight cancer?
Though it is said that if you go south but drive your chariot north, you can in theory still reach your destination, because the earth is round. But cancer progresses how fast? Such roundabout treatment can only delay the patient's limited remaining years.
When clinical TCM physicians pattern-differentiate a patient, they must not fall into a sophistical circle, must not confuse themselves. Patients usually have a number of underlying chronic diseases. When treating the disease that threatens the patient's life, one should set aside the interference of the underlying diseases, go straight to the heart of the problem, and strike at the dragon's lair. As long as the underlying disease is not itself fatal, there is no need to dwell on it.
At most, when prescribing, consider whether the side effects of the herbs might cause the underlying disease to become life-threatening, and moderately add a few herbs to address it. If the underlying disease can be managed, manage it; if it cannot, set it aside and tell the patient plainly. Otherwise, circling into that tangle will inevitably lead to confused differentiation, delay the patient's treatment window, and cause the patient to die quickly.
This is one of my greatest insights from treating patients this year. Last year I was often confused by patients' underlying diseases, trying to cover both the primary and secondary conditions, with poor results. Sometimes I was even pulled around by the various symptoms of the underlying disease, falling into a vicious circle in differentiation.
In fact, in treating disease one only needs to grasp the principal contradiction and deal with it. If the underlying diseases are not cured, the patient may suffer, but his life is ultimately preserved. As the saying goes, keep the green hills and you need not fear running out of firewood. Once the threat to the heart is resolved, gradually deal with the other underlying diseases. Each specialty has its own expertise; if we cannot treat those other underlying diseases, let the patient go to more specialized specialists. This is the essence of the physician's life-saving art.
To have great daring, the physician's thinking when treating must be broad and sweeping; he must be able to let his hands go and prescribe strong medicines.
For a serious illness such as cancer, do not be fooled by the patient's deficiency signs, tremble in fear, and dare only to supplement, never to attack. For such patients, if you do not attack but merely steep them in ginseng soup, they will not survive.
When attacking, the dosage must be increased step by step, continuously, until effect is obtained. With experience, the very first prescription should use an appropriate dose, so that effect is rapid. My own position is special—I have no famous-master background—so I am extremely demanding of my own results. I aim for effect with the first dose, so as to establish the patient's confidence in taking the medicine. Therefore in the clinic I pay special attention to having sufficient daring in dosing, and the effect is often immediate.
For Chinese herbs to have an immediate effect, the side effects may sometimes frighten the patient, the family, or even the physician himself. Some patients, after taking the medicine, feel pain, dizziness, heart palpitations, or hand tremors. If the differentiation is accurate and the patient's main symptoms have been substantially relieved—even visibly, with the tumor shrinking and survival in sight—there is no need to be afraid.
A physician must be ruthless and decisive. The ancients said, "Small kindness is the thief of great kindness." To be a physician who saves lives, one need not have the tenderness of a woman. Confucius said, "I have never seen anyone who loves virtue as he loves beauty." In my clinical work I have never seen anyone who fears pain as much as they fear death. If the patient is told in advance that there will be side effects, the great majority can bear them and are not alarmed.
Using medicine is like deploying troops. A TCM physician treating disease often feels as if going into battle. To strike the enemy down, one must be good at and dare to use brave, powerful soldiers. The physician must also learn to turn a deaf ear to the patient's various complaints. Many cancer patients have piles of underlying diseases and, when describing their suffering, dissolve into tears. The physician may listen, but if he harbors womanly tenderness and exhausts himself responding to every small ailment, thinking only of letting the patient take his medicine comfortably, then he need not be in oncology at all—he could go to another department to treat headaches and fevers. But one point is very important: although the patient may suffer while taking the medicine, his constitution should improve. If it does not, the treatment must be wrong.