Some Reflections on TCM Treatment of Pediatric Solid Tumors (1) — Insights from Zhou Zhiyuan's TCM Anti-Cancer Research

TCM has achieved quite good results in treating pediatric leukemia, but in treating pediatric solid tumors it is almost a blank. Works on TCM pediatrics do not address tumors; works on TCM oncology do not address pediatric tumors—everyone seems to be avoiding the problem of pediatric solid tumors.

Over the past twenty years, with significant progress in China's health care, the diagnosis and treatment of pediatric infectious diseases, communicable diseases, malnutrition, and congenital malformations have continuously improved, and the fatality rates of these diseases have dropped markedly. At the same time, pediatric tumors have become increasingly important in the modern pediatric disease spectrum.

Pediatric tumors have become the leading cause of disease death among Chinese children. Western medicine has made rapid progress in pediatric oncology, but the TCM community seems universally to be avoiding the problem.

Pediatrics is high-risk, low-reward, and problem-ridden, with sharp doctor-patient conflict; so in our country pediatricians are in extremely short supply, to the point that in recent years some internal-medicine doctors have been pulled into pediatrics as an emergency measure. Pediatric oncologists are even scarcer, and TCM doctors who treat pediatric tumors are rare as phoenix feathers.

Pediatric tumors are hard to treat, first because children are "tender yin and tender yang" bodies, not yet fully developed, with low immune function and great sensitivity to drugs, food, and various external infections. With the slightest discomfort, or if parents feed and care improperly, children easily develop all kinds of frightening symptoms—high persistent fever, bleeding, pain, diarrhea, convulsions, seizures, even sudden death. So most doctors avoid pediatrics as if it were plague.

But actually the prognosis of pediatric tumors is better than that of adult tumors; pediatric tumors are tumors that can be cured. Compared with adults, many pediatric diseases, such as asthma and tumors, are curable. As the Ming-dynasty physician Zhang Jingyue said, children have "clear and delicate zang-qi, responding to any pull"; many childhood diseases are very sensitive to medication and very easy to effect. Coupled with the child's natural development, immunity grows day by day; so pediatric tumors, like other pediatric diseases, are easier to cure than adult ones.

Needless to say, in the era before modern medicine, child mortality was high; once various infectious and communicable diseases became epidemic, they easily caused mass child deaths. Traditional medicine has no advantage against infectious and communicable diseases, and in treating pediatric tumors it has almost no experience to speak of.

Most pediatric works contain only records of experience treating common pediatric diseases. These records are of limited use in treating pediatric tumors, but they are of considerable reference value to a doctor who treats pediatric tumors in caring for his pediatric patients.

Because what we treat is not just a disease but individual patients. Pediatric tumor patients, apart from the tumor itself, resemble ordinary children in many ways. Some common and frequently occurring pediatric diseases are also easily confused with complications of pediatric tumors. If one is not familiar with these common and frequent pediatric diseases, it is hard to become a good pediatric oncologist.

In recent years I have treated over a thousand pediatric tumor patients; apart from less contact with leukemia children, I have encountered almost all other pediatric solid tumors. Pediatric neuroblastoma, Ewing sarcoma, rhabdomyosarcoma, brain tumors, lymphoma, soft-tissue sarcoma, kidney tumors, retinoblastoma, liver tumors, and others have all come my way.

Pediatric tumors are mostly embryonal tumors and small round-cell tumors, and most children have multiple primary tumors occurring simultaneously, so treatment is quite tricky. Modern medicine treats children with tumors mainly by surgery, radiotherapy, chemotherapy, and immunotherapy.

TCM has accumulated too little experience in treating pediatric tumors, so its participation in modern pediatric oncology is low; most TCM doctors are unwilling to take tumor children. I myself once also held the line of not accepting pediatric patients, but later more and more children came seeking treatment, and I could not refuse them all.

Initially, when treating pediatric tumors, my medication was basically similar to that for adult tumor patients, only with greatly reduced doses. But as I treated more and more children, I gradually realized that treating tumor children cannot entirely follow adult medication strategies.

Pediatric and adult diseases differ essentially; children's constitutional characteristics also differ greatly from adults', and the two differ greatly in medication. So now I am gradually developing approaches in tumor children's medication that differ from adults'.

Overall, for TCM to achieve tumor-eliminating effects in treating cancer, it cannot avoid the two paths of inducing cancer-cell apoptosis and inhibiting tumor angiogenesis. Although in TCM theory there are many formulations of the anti-cancer strategy, modern pharmacology research shows that TCM anti-cancer action is achieved mainly through inducing cancer-cell apoptosis and inhibiting tumor angiogenesis.

The human body is a very precise biochemical machine; whether food or medicine is ingested, after entering the body it exerts various effects through a series of biochemical reactions with the body. Chinese medicine is no exception once it enters the body.

For a tumor to shrink, on one hand it depends on apoptosis of cancer cells, and on the other on the suppression and destruction of intratumoral blood vessels. Intratumoral vessels are important channels supplying nutrients to the tumor; only when these vessels are suppressed or destroyed can the tumor atrophy and die from lack of nutrient supply.

So many TCM herbs that eliminate tumors and scatter masses have cytotoxic effects and inhibit tumor angiogenesis. Herbs like Sanleng (Sparganium), Ezhu (Curcuma zedoaria), Jianghuang (Curcuma longa), Danshen (Salvia), Chishao (red Paeonia), Banzhilian (Scutellaria barbata), Jiangcan (Bombyx), Haizao (Sargassum), Kunbu (Ecklonia), Wugong (centipede), Quanxie (scorpion), Banmao (Lytta), Qingniangchong, Sanjiane (Cephalotaxus), which suppress pediatric tumors, all have some cytotoxic or tumor-angiogenesis-inhibiting action.

In anti-cancer treatment, such herbs must certainly be used. Over the years I have been continually trying the strategy of combining multiple anti-cancer drugs at low doses; this approach has the characteristics of controllable toxicity and side effects, multiple targets, and high efficacy.

At the same time, pediatric tumors must also take into account the physiological characteristic of children "easily deficient and easily replete." Because children have irregular diet and uncertain cold and warmth, they are especially prone to replete or deficient patterns. Some parents, lacking sufficient experience in raising children and using improper upbringing methods, easily cause children to develop various acute emergencies at any time. So when treating such children, one must communicate patiently with parents and guide them toward the parenting idea: "To keep a child safe, always leave a bit of hunger and cold."

Food stagnation, improper dressing, or frequently taking children into crowded children's play areas during peak epidemic seasons can all cause acute emergencies in the child. Once an acute emergency occurs, treatment is interrupted or various accidents arise.

In addition, there are too many industrial foods today, most designed to children's tastes, which children find very hard to resist; parents, to get the child's cooperation in treatment, also like to use such foods as bargaining chips. All this leads to various uncertainties in the course of treating pediatric patients.

Children's self-control is limited, so parental care is also critical. Slightly older children have stronger understanding and self-control and are better at cooperating with treatment and controlling diet than younger ones; very young children can only rely on parental care. Generally speaking, well-cared-for children have much better treatment outcomes.

So overall, a TCM doctor of pediatric oncology must have a very broad knowledge base in order to comprehensively control every detail of a child's treatment and care.

Although some TCM fans who are deeply infatuated with traditional TCM still rigidly adhere to traditional TCM theory, believing that only by following traditional TCM approaches can better efficacy be obtained, my own practical experience tells me that a good TCM doctor must not only be well-versed in medical classical Chinese, able to read a large body of ancient medical literature and understand, absorb, and memorize its essence, but also master modern biochemical knowledge and have a deep understanding of modern oncology and biology, in order to better serve patients.