Quality, Dosage, and Preparation of Herbs Are the Key to Effective TCM Treatment of Cancer

For TCM to achieve results in treating cancer, one must first guarantee the quality of the medicinal materials. Currently the herb market is a mixed bag; the quality of herbs sold by different pharmacies varies greatly, and some even sell fake or substandard materials. Often the same prescription from the same TCM doctor works very well for patient A but has little effect for patient B. While this is partly because the TCM doctor's pattern differentiation is not one hundred percent accurate, it is also greatly related to the quality of the herbs sold in the pharmacy where the patient buys them.

So after I write a prescription, I generally advise patients to buy herbs at a reliable, trustworthy pharmacy or hospital dispensary, rather than casually finding a small shop. I once wrote a prescription for a patient who had the hospital purchase the herbs on his behalf; the cooperating pharmacy the hospital found not only sold poor-quality herbs, but the herbal dispensers did not even separate the herbs requiring "first decocting" and "later adding" as the doctor's prescription required.

This is extremely dangerous. Some herbs—such as raw Fuzi (Aconite) and raw Banxia (Pinellia)—if not first decocted, easily cause drug poisoning. Other herbs, such as raw Shigao (gypsum), if not first decocted, do not work well. And some herbs, such as Dahuang (Rhubarb), if used for purgation, must be added later; if not added later, the purgative effect is much weaker, leaving only the blood-invigorating and stasis-resolving effect. Faced with an irresponsible pharmacy and a patient unfamiliar with the basics of Chinese herbs, there is not only no therapeutic effect but also a great risk of a medical accident.

An herb's efficacy is also related to its place of origin. In the past, TCM emphasized using authentic, regionally-correct herbs (daodi). An authentic herb means that a given medicine, only when from a certain place of origin, has the ideal efficacy. For example, Sanqi (Panax notoginseng) is best from Wenshan, Yunnan; and Qinghao (Sweet wormwood) is most effective only from Youyang, Chongqing. Basically every herb has an authentic origin; herbs not from that origin do not have the same efficacy. But when pharmacies sell herbs, it is hard to guarantee they are authentic, so efficacy is hard to guarantee.

My own family's herbalist heritage: when my ancestors treated disease, many of the herbs they used were effective when gathered from our own county; gathering the same herbs, by their scientific names, from elsewhere and then using them clinically was ineffective. I have personally confirmed this through practice, and the impression is especially deep. The same plant growing in different places may belong to different subspecies, and its constituents are not entirely the same; different clinical efficacy is normal. So truly guaranteeing the best efficacy is quite hard. The ideal TCM doctor would gather some of his own herbs.

The dosage of Chinese herbs is also crucial to TCM's therapeutic effect. Modern pharmacological studies confirm that, when the blood concentration of certain drugs is too low, they cannot reach anticancer efficacy; only when the blood concentration reaches a certain level can they have an anticancer effect. And to reach the relevant blood concentration, most dosages exceed the amounts stipulated in the national pharmacopoeia; if a medical accident occurs, the doctor bears legal responsibility.

This is how I myself solve the problem: I generally have the patient start from the smallest dose and gradually increase it, observing the bodily reaction; if the body can tolerate it, I use the large dose for a period. Generally, mild or even moderate side effects sometimes have to be borne. TCM has the saying, "If the medicine does not cause a momentary vertigo, the stubborn disease will not be cured," meaning that if taking medicine has no side effect at all, it may not have a good therapeutic effect.

Exceeding the usual dosage is very common in oncology. When I use Xihuang Wan, I often use a single dose as high as 12 g; according to the package insert the usual dose is 3 g, but in fact 3 g does nothing. When using Danshen (Salvia), I once saw an old TCM doctor's usual dose of 40 g; my own highest single-day dose reached 90 g, and once the dose went up, the effect was immediate. When using Kushen, I saw a patient who used it himself, usually over 100 g at a time, whereas the textbook dose is generally 10 g; yet this patient, using such a large amount, saw no side effects and the effect was miraculous. When my father treated appendicitis and similar diseases, the common herbal medicines he used were generally measured by the jin (catty), and patients were often cured with one dose.

Nowadays, fearing legal responsibility, few clinicians dare exceed the conventional dose; the result is that most prescriptions are "safe" formulas—the patient won't die, but the disease is not helped either. This greatly delays the patient's treatment. So, to raise TCM efficacy, one really needs to put some thought into the use of herbs.