On the Treatment of Advanced Cancer Patients
Advanced cancer patients, in TNM staging, generally have distant-organ metastasis—that is, M-positive—and clinical stage IV. Such patients have already passed the best treatment window; neither TCM nor Western medicine can do much. For these patients, the hope of cure is already slim. Adjusting psychological expectations—pursuing not cure but improved quality of life and a modest extension of survival—is the most realistic plan. The median survival of advanced cancer patients is hard to exceed six months. But if the patient and family are rational, the attending physician handles things well, and with some luck, survival can be extended far longer and the various torments of advanced cancer can be reduced.
Given China's current medical conditions, treatment of advanced cancer should rely mainly on TCM conservative care, with Western radiotherapy and chemotherapy as adjuncts. Advanced patients in poor economic or physical condition may even consider pure TCM treatment and forgo Western medicine. Of course, such pure TCM treatment should be carried out by professional TCM physicians of professional ethics, not by various quacks.
TCM treatment of advanced cancer focuses on supporting the upright and rooting the foundation (fuzheng peiben). Once cancer enters the terminal stage, the patient's general condition is poor, body and spirit both exhausted; the rampaging cancer cells produce cachexia, poor appetite, obstruction of urination and defecation, and weak stamina. From the TCM viewpoint, the entire jing-qi-shen is impaired, qi movement is disordered, and yin-yang and qi-blood are both deficient; the patient lives in extreme suffering.
From what I have seen, treatment of most advanced cancer patients should fully emphasize supporting the upright and rooting the foundation, secondarily preventing cancer fever and cancer pain, protecting liver and kidney function as much as possible, and maximizing quality of life. Advanced cancer patients are no longer suitable for a heat-clearing and toxin-resolving approach; treatment should focus on warming and tonifying, unless some patients show obvious heat signs, in which case heat-clearing and toxin-resolving may continue.
Advanced cancer patients, due to long-term consumption by the tumor, often show signs of anemia and malnutrition. Food supplementation alone is of little help; medicinal supplementation should be considered. Moreover, qi and blood, liver and kidney, spleen and stomach, and lung should all be tonified comprehensively. Therefore formulas should be based on classic TCM formulas such as Shiquan Dabu Tang (Ten-Ingredient Fully-Building Decoction), Guipi Tang (Spleen-Returning Decoction), and Bazhen Tang (Eight-Treasure Decoction). The tonifying herbs may be somewhat more numerous, accompanied by appropriate qi-moving herbs (when regulating qi movement in terminal patients, qi-moving and nodule-dispersing herbs should not be too harsh, lest they damage the upright), so that the patient's constitution can recover.
Tonifying herbs such as raw Huangqi (Astragali Radix), Danggui (Angelicae Sinensis Radix), Dihuang (Rehmanniae Radix), Heshouwu (Polygoniflori Multiflori Radix), Huangjing (Polygonati Rhizoma), Nüzhenzi (Ligustri Lucidi Fructus), Gouqizi (Lycii Fructus), Wuweizi (Schisandrae Fructus), Mohanlian (Ecliptae Herba), Fuzi (Aconiti Lateralis Radix), Rougui (Cinnamomi Cortex), Tusizi (Cuscutae Semen), Shayuanzi (Astragali Complanati Semen), Bajitian (Morindae Officinalis Radix), Duzhong (Eucommiae Cortex), Niuxi (Achyranthis Bidentatae Radix), Buguzhi (Psoraleae Fructus), Xuduan (Dipsaci Radix), Yinyanghuo (Epimedii Herba), Maidong (Ophiopogonis Radix), Tiandong (Asparagi Radix), Renshen (Ginseng Radix), Taizishen (Pseudostellariae Radix), Dangshen (Codonopsis Radix), Shashen (Glehniae/Adenophorae Radix), Danshen (Salviae Miltiorrhizae Radix), Jixueteng (Spatholobi Caulis), Xianhecao (Agrimoniae Herba), Lingzhi (Ganoderma), and Dazao (Jujubae Fructus) are all genuinely useful for advanced cancer patients. But while tonifying, these herbs also have the side effect of being cloying and obstructive to the diaphragm and stagnating qi movement. Therefore, when using them, one should pair spleen-fortifying and qi-moving herbs such as Muxiang (Aucklandiae Radix), Sharen (Amomi Fructus), Chenpi (Citri Reticulatae Pericarpium), Baizhu (Atractylodis Macrocephalae Rhizoma), Cangzhu (Atractylodis Rhizoma), Houpo (Magnoliae Cortex), Huoxiang (Agastachis Herba), and Peilan (Eupatorii Herba) to smooth qi movement, so that the patient's qi flows freely up and down. On the importance of qi movement, see my article 'The TCM Theory of Qi Movement and Its Clinical Application'; smoothing qi movement best ensures that the patient's own body can still function normally, helping to improve quality of life.
For advanced cancer patients with bleeding, hemostatic herbs should also be included in the formula—such as Baiji (Bletillae Rhizoma), Sanqi (Notoginseng Radix), Puhuang (Typhae Pollen), Diyu (Sanguisorbae Radix), and Qiancao (Rubiae Radix). Advanced cancer patients often experience tumor ulceration and bleeding; generally this is chronic oozing rather than major hemorrhage. Adding hemostatic herbs to the TCM prescription can effectively improve this.
Advanced cancer patients also often have cancer fever caused by inflammatory secretion and excessive histamine release; even if cancer fever has not yet appeared, it should be prevented. I saw an old TCM physician in Beijing who, when treating advanced cancer patients, regardless of whether cancer fever was present, added Chaihu (Bupleuri Radix) 12 g and Huangqin (Scutellariae Radix) 12 g to the prescription, with very good results.
Advanced cancer patients also often have cancer pain. Cancer pain is not just pain; there is an indescribable whole-body discomfort—neither quite pain nor quite itch, impossible to dispel and hard for TCM formulas to resolve. At such times, Western sedatives or analgesics should be considered to improve quality of life; one should not fear morphine and opioid analgesics because of hearsay about their side effects. Remember that at this point the patient is living worse than dying, in great misery; moderate anesthesia and pain relief are the most humane course.
Both advanced cancer patients and their families, at the final moment, should try to set aside unrealistic fantasies and use extreme therapies with great caution, to avoid causing the patient excessive suffering. To date, human medicine has not advanced to the point of solving the problems of terminal cancer patients. Performing overly traumatic or risky treatment only adds to the patient's suffering and leaves the family with indelible painful memories; it is neither rational nor humane.