Studying TCM Anticancer Therapy with Evidence-Based Medicine Methods

Everyone except God must speak with data.

—Siddhartha Mukherjee, The Emperor of All Maladies: A Biography of Cancer

After more than ten years of treating cancer according to traditional TCM pattern differentiation, I am deeply disappointed in the efficacy rate of relying on TCM observation, auscultation/olfaction, inquiry, and palpation, and on pattern differentiation, to treat cancer. This is not to say that such treatment has no effect; it is simply that my own experience and what I have witnessed of how academic and folk TCM physicians treat cancer this way have such low efficacy that I can no longer build confidence in it.

In recent years I have come into contact with evidence-based medicine (EBM). Because of my science and engineering background, I readily accept the EBM philosophy, rather than rejecting this new medical idea as some TCM researchers who are overly obsessed with traditional culture do.

The core idea of EBM is that medical decisions should be based as much as possible on objective research results. When a doctor writes a prescription, devises a treatment plan or clinical guideline, or when a government agency makes health policy, it should all be based on the best available research evidence. The epidemiologist Professor David Sackett defined EBM as "the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients."

EBM is a medical revolution built on clinical data, and its influence on medicine is profound. Through large amounts of data it has overturned many outdated, long-accepted plans that were thought correct but were not actually optimal. While benefiting patients, EBM has also greatly reduced doctors' professional risk.

Strictly speaking, EBM is only an idea, a way of clinical thinking. It can be borrowed not only by modern medicine but equally by ancient TCM. When TCM physicians treat disease, using the EBM mode of thinking to conduct clinical research on traditional TCM formulas and herbs and to collect clinical data can improve therapeutic efficacy and the safety of medication.

Personally, in recent years I have been studying TCM anticancer therapy with EBM thinking, and have benefited greatly; the success rate of treatment has improved considerably. On one side I read widely, studying the basic theory of TCM and the effects and usage of Chinese herbs (now also gradually learning about the natural medicines used by various other peoples) and formulas; on the other side I collect data in clinical work and subject it to statistics and analysis. Then, on this basis, I design new herb combinations and compare the efficacy and safety of new versus old regimens. Through comparison I can continually generate better-optimized regimens.

For example, I recently published some medical cases of treating lung cancer. In treating these lung cancer patients, every half month I make modest adjustments to the medication of some patients, and through their feedback compare which regimen—before or after adjustment—works better and has fewer side effects. Over time this has accumulated a great deal of data.

I refine my formulas based on these data. The regimen I have now worked out, formerly used specifically for lung cancer, not only works in some lung cancer patients but also has some effect in some patients with gastric cancer, leukemia, lymphoma, esophageal cancer, breast cancer, and nasopharyngeal cancer. For example, I recently used this regimen on a patient from Sichuan with metastatic nasopharyngeal cancer; after six or seven days of medication, the tumor began to soften and shrink. After treating a leukemia patient in Hubei for four or five days, the patient's clinical symptoms began to ease. After treating a gastric cancer patient for one course, his body weight rose and his strength returned. I will publish these cases one by one when I have time. The efficacy in these patients shows that the same regimen, used in different patients, can have repeatable results, proving that TCM anticancer therapy is scientific and can stand up to testing.

Every effective TCM prescription from ancient times to the present should have been continuously explored and modified through countless trials. If we sink into dogmatism or rest on the achievements of our predecessors without moving forward, TCM can hardly progress.

Mendel recorded hundreds of thousands of data points in his pea experiments and discovered the laws of genetics. If TCM's treatment data for a certain disease were this rich, there is no reason convincing scientific evidence could not be found. So TCM and EBM are not in conflict; TCM practitioners can absolutely use EBM methods to study TCM.

Cancer is very hard to treat. Even though my efficacy is now somewhat higher than before, it is still not ideal; there are still many patients I have not treated with good results. Sometimes, watching these patients' disease progress, I feel both ashamed and anxious. Because most patients who come to me are, in effect, already at the last stop; they have basically exhausted every method of Chinese and Western medicine without effect before finding me. If my treatment is ineffective, it means their next stop is death.

The pressure I am under keeps forcing me to explore new viable regimens. Compared with the "the physician's intuition matters" valued in traditional TCM, I trust data more; data does not take things for granted and does not lie. So in future I will certainly keep reading TCM classics to improve my own TCM literacy, but more importantly I will carry out TCM anticancer research on the basis of data. Following EBM thinking, I will design controlled trials, seek better medication regimens, and continually improve clinical efficacy.