Yu Rencun: In Treating Cancer, Pay Attention to Five Combinations

Professor Yu Rencun was a towering veteran physician of integrated Chinese-Western cancer treatment in China. He first studied Western medicine, then, in response to the 'Western doctors study Chinese medicine' call, took up TCM. In practice he gradually focused his work on the field of TCM anticancer therapy.

The oncology department of Beijing Hospital of Chinese Medicine was founded by veterans such as Yu Rencun and Bai Xiaoshan. Because of its outstanding clinical results and wide acclaim, from 1971 Professor Yu was dispatched by the Beijing municipal government to give regular consultations to senior leaders in the South Building (the 'general's building') of the PLA General Hospital (301 Hospital), until 1983.

Alongside clinical practice, Professor Yu summarized theory and built a theoretical system for TCM anticancer treatment. His most famous doctrine was the 'internal-deficiency theory.' Inspired by the Huangdi Neijing saying, 'Where pathogen gathers, qi must be deficient,' he held that cancer patients develop cancer mainly because of the decline of righteous qi.

Of course this view, though reasonable to a degree, may not be entirely correct. Large amounts of data show that many cancer patients in modern society develop cancer not so much from righteous-qi decline as from the unhealthy lifestyles of modern society. Obese people—from rich, greasy diets and lack of exercise—clearly get cancer and diabetes more easily than those who eat plainly and exercise more. At least a third of cancers can be prevented by improving lifestyle, so these patients may not, as in Professor Yu's day, have cancer triggered mainly by internal deficiency.

Professor Yu summed up his academic views in five combinations: combining Chinese and Western medicine; supporting righteous qi and expelling pathogen; whole-body and local treatment; pattern-differentiation and disease-based treatment; and medical treatment with self-nurturing. These five points hit the mark and are precisely the key to clinical TCM treatment of cancer.

Professor Yu held that Chinese and Western medicine each have strengths and weaknesses; cancer is a very stubborn disease, and relying on either alone is impractical. One should bring out the strengths of both, each using its forte to complement the other. For early-to-mid cancer patients with surgical options, surgery should be prioritized, followed by TCM to stabilize results and prevent recurrence. For middle-to-late patients who have lost surgical options, the focus should be combining chemoradiotherapy with TCM to create future surgical opportunities.

The early oncology department of Beijing Hospital of Chinese Medicine once surveyed cancer patients treated under various TCM approaches and found that those treated by TCM alone—whether guided by pattern differentiation or by toxin-attacking therapy—had a very low success rate. Patients treated by Western medicine alone also had lower survival and quality of life than those treated by integrated Chinese-Western medicine. Thus most in academia support integration.

How to integrate is the key and the difficulty of treating cancer; it requires a doctor of rich clinical experience to guide patients in reasonable choices, and a firm trust between patient and doctor so the patient can cooperate.

Combining support and expulsion means that, during cancer treatment, one supports righteous qi and consolidates the root on one side while expelling pathogen on the other. The proper weight of each is hard to judge. On this point I think Li Zhongzi's summary is apt: when the patient's strength and righteous qi are still fair, expelling pathogen should predominate; when strength and righteous qi are poorer but still present, combine expulsion and support; when strength and righteous qi are weak—as in late and end-stage patients with emaciation, fatigue, and abnormal urination and defecation—supporting righteous qi should predominate. In short, individualized treatment is essential; one prescription cannot be applied to all.

Combining whole-body and local treatment rests on the fact that cancer is a systemic disease presenting as a solid tumor locally. Thus treatment must adjust the patient's overall condition to maintain the yin-yang balance of 'yin calm and yang well-anchored, the spirit at harmony,' while also targeting the local lesion.

There are many ways to eliminate a local lesion: Western surgery and chemoradiotherapy, and TCM internal medicines and external therapies, may all remove a tumor. But the medical world has long debated whether the tumor should be removed at all, by what method, and whether to choose extended surgery. Many tumor patients, after their local tumor is removed, rapidly relapse and spread everywhere; folk liken this to cutting chives—they grow back, and sometimes cutting makes them grow faster.

So the choice of local treatment remains controversial. But from my own experience, most cancer patients now coming to TCM are late- and end-stage patients who have already lost the conventional options for local lesion removal. Most have already undergone repeated surgery and chemoradiotherapy and no longer wish to try local treatments. In modern society, TCM is usually the patient's last resort.

Combining pattern differentiation and disease-based treatment means valuing both pattern differentiation through the traditional four examinations (inspection, listening-smelling, inquiry, and palpation) and disease-based treatment under the new medical technology of the new era. One needs both pattern-based prescriptions for the patient's various 'patterns' and an awareness of treating specific diseases specifically—approaching from disease-based treatment with targeted anticancer herbs.

Combining medicine and nurturing means the doctor's treatment and the patient's self-cultivation go together: while we provide a treatment plan, we also propose a self-nurturing plan for the patient to follow. Self-nurturing is broad in scope—improving the home environment, adjusting relationships, changing lifestyle, and increasing exercise all fall within it.

Professor Yu's five combinations can be called the core of TCM cancer treatment, though each contains a wealth of content. They are worth learning from not only by clinical TCM physicians but by clinical Western physicians as well. My own feeling is that, in treating cancer, an oncologist can raise results only by steadily improving one's foundational skill, reading widely, broadening knowledge, and holding fast to these five combinations.