Using Chinese medicine to treat the side effects of radiatio

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Using Chinese medicine to treat the side effects of radiation in cancer therapy
Bob Flaws
According to Isaac Cohen, et al. in "Traditional Chinese Medicine in the Treatment of Breast Cancer:"
The current trend in China is to integrate, or combine, Western
therapies with TCM [Traditional Chinese Medicine] in the treatment of
breast cancer. There are no available statistics on the proportion of
women using this approach. Our collaborators in China estimate that
about 70%-80% of women diagnosed with breast cancer in the
metropolitan areas, where Western medicine (WM) is favoured, are using
the combined approach at some point during their treatment of breast
cancer while a very small fraction of women use TCM as a sole
therapy ... The treatments employed by the TCM physicians are aimed at
controlling side effects and toxicities attributed to cancer
therapies, improving quality of life, preventing recurrence, and
prolonging survival. (1)
This is likewise my experience of cancer care in the People's Republic of China across the board. Zhang Dai-zhao, a famous Chinese oncologist and author of The Treatment of Cancer by Integrated Chinese-Western Medicine, says that integration in treatment means "the organic cooperation between Chinese medical therapy and Western medicine by bringing the strong points of both parties into full display ..." (2) Although this may not be the most elegant English, I believe it underscores the fact that Chinese and Western medicine can beneficially complement each other when it comes to the treatment of cancer. In fact, most issues of Chinese medical journals published in China contain at least one article describing a clinical trial utilizing integrated Chinese-Western medicine (zhong xi yi jie he) in the treatment of various cancers. As an example of this relatively voluminous but also relatively unknown literature (at least in the West), I would like to present a summary of an article by Zhang Liying, et al. recently published in Shi Yong Zhong Yi Nei Ke Za Zhi (Journal of Practical Chinese Medical Internal Medicine. 2006;1:53-43). The title of the article was "Clinical Observations on San Shen Tang (Three Sengs Decoction) in Oncological Radiation Therapy." However, before immediately proceeding to that article, I would first like to say something about the process of radiation therapy and its adverse reactions or side effects.
How Radiation Works in Oncology
Radiation therapy, a.k.a. radiotherapy, is a highly targeted, highly effective way to destroy cancer cells. In radiation therapy, high-energy beams of radiation are focused on the cancer or the area from which a cancer has been previously removed surgically. Over time, this focused radiation damages cells that are in the path of its beam. These include both cancer cells and normal cells. However, cancer cells tend to grow and reproduce rapidly--two activities that are very vulnerable to radiation damage. In addition, because cancer cells are less well organized than healthy cells, they are less able to repair such damage and recover. Therefore, cancer cells are more easily destroyed by radiation, while healthy, normal cells typically repair themselves and survive. (3,4)
Side Effects of Radiation
Because radiation is a local treatment, its side effects usually appear in the area being treated. The early effects of radiation may be seen a few days or weeks after the start of treatment and may continue for several weeks after treatments are completed. (5) Side effects include fatigue, bodily weakness, anemia, leukopenia, bone marrow suppression, (6) dryness, itching, darkening, and peeling of the skin, dryness, loss of taste, and inflammation of the lining of the mouth, memory loss, decreased sexual desire, or poor tolerance for cold weather (due to radiation of the brain), shortness of breath or cough (due to radiation of the chest), swelling and inflammation of the esophagus, stomach or intestines, causing nausea, vomiting, or diarrhea (due to radiation of the abdomen), vaginal tenderness and inflammation, thinning of the vaginal lining, and bleeding after intercourse (due to radiation of the pelvis in women), and erectile dysfunction (due to radiation of the pelvis in men). (7) According to Chinese medical theory, these side effects are due to damage by externally contracted heat causing 1) the accumulation of heat toxins, 2) qi vacuity, and 3) yin-blood-fluid-essence insufficiency.
Cohort Description
Altogether, there were 130 patients enrolled in the above-mentioned, two-wing comparison study: 78 males and 52 females, 36-84 years of age. These patients had an average age of 63.5 years. Twenty-seven suffered from lung cancer; 13 suffered from nasopharyngeal cancer; 31 suffered from esophageal cancer; seven suffered from stomach and/or colon cancer; 21 suffered from breast cancer; three suffered from kidney cancer; five suffered from malignant lymphoma; 14 suffered from various gynecological cancers, including ovarian, cervical, and uterine cancers; and nine suffered from various other cancers. Thirty-nine of these patients were post-surgical. Six were stage I; 23 were stage II; 67 were stage III; and 34 were stage IV. These 130 patients were randomly divided into a single therapy group and a combined therapy group. The 57 patients in the single therapy group were only treated with radiation therapy, whereas those in the combined therapy group received the same radiation plus internally administered Chinese herbal medicine.
Treatment Method
All those in the single therapy group received a total of between 5000-7000 CGy in doses of 180-200 CGy once per day. Five such treatments were administered per week for five to eight weeks. At the same time, these patients were also administered vitamins C and B6 and gentamicin (A broad-spectrum antibiotic derived from an actinomycete used in the treatment of various infections).
All those in the combined therapy group received the same therapy as above plus the following basic Chinese medicinal formula:
Ren Shen (Radix Ginseng), 6-10g
Huang Qi (Radix Astragali), 20-30g
Bai Zhu (Rhizoma Atractylodis), 20-30g
Sheng Di Huang (uncooked Radix Rehmanniae), 15-20g
Xuan Shen (Radix Scrophulariae), 15g
Mai Men Dong (Tuber Ophiopogonis), 15g
Fu Ling (Poria), 15g
Yi Yi Ren (Semen Coicis), 15g
Dang Gui (Radix Angelicae Sinensis), 15g
Dan Shen (Radix Salviae Miltiorrhizae), 12g
Jin Yin Hua (Flos Lonicerae), 12g
Bai Hua She She Cao (Herba Hedyotis Diffusae), 12g
Chen Pi (Pericarpium Citri Reticulatae), 12g
Gan Cao (Radix Glycyrrhizae), 6g
One packet of these medicinals was decocted in water per day and the resulting medicinal liquid was administered in two divided doses, morning and evening.
If there was severe qi vacuity, Dang Shen (Radix Codonospitis) and Xi Yang Shen (Radix Panacis Quinquefolii) were added.
If there was blood vacuity, Shu Di Huang (cooked Radix Rehmanniae), Ji Xue Teng (Caulis Spatholobi), and E Jiao (Gelatinum Corii Asini) were added.
If fluids and humors were depleted and had suffered detriment, Sha Shen (Radix Glehniae), Tian Hua Fen (Radix Trichosanthis), and Lu Gen (Rhizoma Phragmitis) were added.
If heat toxins were burning and exuberant, Huang Qin (Radix Scutellariae), Chi Shao (Radix Paeoniae Rubrae), Pu Gong Ying (Herba Taraxaci), Ban Zhi Lian (Herba Scutellariae Barbatae), and Shan Dou Gen (Radix Sophorae Subprostatae) were added.
If there was liver-kidney yin vacuity, Shu Di Huang (cooked Radix Rehmanniae), Gou Qi Zi (Fructus Lycii), Han Lian Cao (Herba Ecliptae), Huang Jing (Rhizoma Polygonati), and Bai Shao (Radix Paeoniae Albae) were added.
If there was kidney yang insufficiency, Zhi Fu Zi (Radix Lateralis Praeparatus Aconiti Carmichaeli), Rou Gui (Cortex Cinnamomi), Suo Yang (Herba Cynomorii), Yin Yang Huo (Herba Epimedii), and Ba Ji Tian (Radix Morindae Officinalis) were added.
If there was kidney essence insufficiency, Bu Gu Zhi (Fructus Psoraleae), Tu Si Zi (Semen Cuscutae), and Shan Zhu Yu (Fructus Corni) were added.
If blood stasis was severe, Chuan Xiong (Rhizoma Chuanxiong), Hong Hua (Flos Carthami), and Tao Ren (Semen Persicae) were added.
If there was poor appetite, scorched San Xian (Three Immortals, i.e., Shan Zha, Fructus Crataegi, Mai Ya, Fructus Germinatus Hordei, and Shen Qu, Massa Medica Fermentata), Sha Ren (Fructus Amomi), and stir-fried Lai Fu Zi (Semen Raphani) were added.
If pain was relatively severe, Yan Hu Suo (Rhizoma Corydalis) and Chuan Lian Zi (Fructus Toosendam) were added.
If there was sore, swollen throat, Shan Dou Gen (Radix Sophorae Subprostratae), She Gan (Rhizoma Belamcandae), Lu Gen (Rhizoma Phragmitis), and Bo He (Herba Menthae Haplocalycis) were added.
If there was lung cancer, Bai Bu (Radix Stemonae) and Zhe Bei Mu (Bulbus Fritillariae Thunbergii) were added.
If there was liver cancer, Bie Jia (Carapax Trionycis), Chuan Shan Jia (Squama Manitis), and Mu Li (Concha Ostreae) were added.
If there was stomach cancer, Shi Hu (Herba Dendrobii) and E Zhu (Rhizoma Zedoariae) were added.
If there was breast cancer, Ju Luo (Fascularis Vascularis Citri Reticulatae), Lu Feng Fang (Nidus Vespae), and Zi Hua Di Ding (Herba Violae) were added.
If there was colon cancer, Bai Jiang Cao (Herba Patriniae) and Hong Teng (Caulis Sargentodoxae) were added.
If there was cervical cancer, Chuan Lian Zi (Fructus Toosendam) and Wang Bu Liu Xing (Semen Vaccariae) were added.
If there was nasopharyngeal cancer, Long Kui (Herba Solani Nigri) and She Mei (Herba Duchesneae Indicae).
Study Outcomes
Clinical cure was defined as complete disappearance of any toxic reactions to radiotherapy and the ability to complete the entire course of treatment. Marked effect was defined as a marked decrease in the signs and symptoms of radiotherapy and the ability to continue such therapy, and there was no shortening of the course of treatment. Some effect meant that 1) any toxic reactions to the radiotherapy improved, 2) other medicines had to also be used, and/or 3) the course of treatment was shortened by three to nine days. No effect meant that there was no improvement in any toxic side effects or that the course of treatment had to be shortened by two weeks or more. Table 1 shows the outcomes of the two groups based on these criteria.
Therefore, the cure rates in the two groups were 50.7% and 14.0%, respectively, while the total effectiveness rates were 100% and 80%, respectively. (8) Hence, it was deemed that the combination of radiation and the above internally administered Chinese medicinals was more effective than the radiotherapy in terms of the administration of the radiotherapy.

Discussion
According to Dr. Zhang, et al., within San Shen Tang, Ren Shen greatly supplements the original or source qi, engenders fluids, and moistens dryness. It is Chinese medicine's most important medicinal for supporting the righteous and banking or cultivating the root. Huang Qi, Bai Zhu, Fu Ling, and Yi Yi Ren fortify the spleen, boost the qi, and bank and supplement the latter heaven root, the source of engenderment and transformation of the qi and blood. Xuan Shen, Sheng Di Huang, and Mai Men Dong enrich yin, engender fluids, and moisten dryness. Their use is in order to clear and eliminate radiotherapy's damage to yin and consumption of fluids resulting in yin vacuity and dry heat evils. Jin Yin Hua and Bai Hua She She Cao clear heat, resolve toxins, and disperse swelling. Dang Gui supplements the blood, and Dan Shen quickens and nourishes the blood. Thus the combination of these two dispels stasis and engenders new or fresh blood. Chen Pi fortifies the spleen and rectifies the qi and regulates and eases the flow of the qi dynamic or mechanism. Therefore, when all these medicinals are used together, their effect is to boost the qi and nourish the blood, engender fluids, and moisten dryness, clear heat, resolve toxins, and disperse swelling.
Besides rationalizing the use of the above Chinese medicinals by pure Chinese medical theory, Dr. Zhang, et al. also briefly recounts these medicinals' salient biomedical pharmacodynamics vis a vis oncology and radiotherapy. For instance, Ren Shen increases T- and B-lymphocyte function as well as natural killer (NK) cell, lymphokine-activated killer (LAK) cell, and reticulo-endothelial system (RES) functions, all important parts of the immune system in preventing and combating malignant tumors. Ren Shen also prevents the aging and death of healthy cells. Ren Shen and Mai Men Dong are both able to decrease the expression of matrix metalloproteinase 2, an enzyme associated with tumor genesis, and to protect the integrity of blood vessel basement membranes. This helps prevent recruitment and growth of tumor blood supplies necessary to the growth and development of cancer. Huang Qi's polysaccharides increase the phagocytosis function of the RES and increase T-, NK-, and LAK-cell and interleukin-2 anti-tumor functions. In addition, it contains the F3 fraction (a cancer-targeting peptide), which effectively increases the apoptosis or death of tumor cells. Yi Yi Ren has broad anticancer pharmacodynamics that both control and kill cancer cells. It is also able to markedly increase the body's immune function and decrease the toxic reactions to radiotherapy. Dan Shen and Hong Hua are able to improve the microcirculation and thus reduce the ratio of anaerobic cancer cells. Further, by improving the blood circulation of the lungs, they can decrease radiation pneumonitis and pulmonary fibrinosis. Xuan Shen, Mai Men Dong, and Sheng Di Huang can increase the resistance of the salivary glands to damage due to radiation, promote the growth of the oral mucus membranes, and restore their secretory functions. Jin Yin Hua and Bai Hua She She Cao are markedly effective for the treatment of radiation-induced pharyngitis, esophagitis, and pneumonitis. Thus, the combination of these medicinals with radiotherapy is able to improve the anticancer effects of the radiation at the same time as preventing and treating radiotherapy's side effects and improving the body's overall health and well-being.
Bob Flaws, LAc, FNAAOM (USA), FRCHM (UK)
c/o Blue Poppy Press
5441 Western Ave. #2
Boulder, Colorado 80301
Copyright [c] Blue Poppy Press, 2006. All rights reserved.
Notes
1. Isaac Cohen, LAc, OMD, Mary Tagliaferri, MD, LAc & Debu Tripathy, MD. Available at: http://www.cancersupportivecare.com/chinesemedicine.html.
2. Zhang Dai-zhao. The Treatment of Cancer by Integrated Chinese-Western Medicine, trans. By Zhang Ting-liang & Bob Flaws. Boulder, Colorado: Blue Poppy Press, 1989, p. 132.
3. Anonymous. Available at: http://www.breastcancer.org/tre_rad_howWrk.html.
4. Before the advent of radiotherapy, Chinese doctors used large cones of moxa burned directly over the cancerous tumor in order to burn away the cancer cells. This must have been excruciatingly painful. Nevertheless, it is essentially a low-tech version of the same approach to treatment. Therefore, I refer to radiation therapy as a high-tech form of moxibustion.
5. Anonymous. Available at: http://www.cancer.org/docroot/MBC/MBC_2x_RadiationEffects.asp.
6. Zhang Li-ying, et al. Clinical observations on San Shen Tang (Three Sengs Decoction) in oncological radiation therapy. Shi Yong Zhong Yi Nei Ke Za Zhi (Journal of Practical Chinese Medical Internal Medicine). 2006; 1: 53-54.
7. Anonymous. Available at: http://www.cancer.org/docroot/ETO/content/ETO_1_4X_Side_Effects_of_Radiation_Therapy.asp?site area=ETO.
8. Please note that the cure rate means cure of the radiation side effects, not of the cancers themselves.
abstracted & translated by Bob Flaws, LicAc, FNAAOM (USA), FRCHM (UK)
www.bluepoppy.com
Table 1: Study Outcomes

Group Clinical cure Marked effect Some effect No effect

Combined therapy 37 26 7 0
group
Single therapy 9 17 20 11
group
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