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Seven stages of living with cancer

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Andrew Flower

on 19 September 2017

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Transcript of Seven stages of living with cancer

Using Chinese medicine for seven stages of living with cancer

Andrew Flower PhD

Seven stages of living with cancer
1. After diagnosis
2. Pre-treatment
3. During treatment
4. Post treatment
5. Maintaining good health
6. Living with cancer
7. Palliative care

5. Maintaining good health
Support Zheng Qi
Helping patient to find their 'path'
Address any current health problems

Stage 3 During Treatment
Fatigue
Pain/discomfort
Side effects of treatment
Depression
Anger
Fear etc.

Stage 2
Before treatment

fear
resistance
dis-empowerment
breaking of integrity
relief
Stage 1
After diagnosis...

shock
trauma
denial
fear
uncertainty
anger
depression
Chinese medicine
a re-framing of the disease (mediastinum)
conventional / holistic treatment options (lifestyle, life-orientation, acupuncture, herbs etc)
re-empowerment
counseling
Case 3
44 year old man with advanced bowel cancer with metastases in liver, lung, stomach and lymph nodes. No surgery-only chemo (Cetuximab + 5FU).
Side effects: fatigue, neutropenia, itchy, pustular rash over whole body, depression
Case 1
Case 2
A 49 year old woman presents with Stage 4 Endometrial cancer. She has had a hysterectomy but is still in constant pain in the sacrum, down GB channel of the leg and in the groin. She is due to start palliative chemo in 2 weeks. T: pale, swollen, red dots at side, yellow fur. SLV +4.
P: Wiry -liv/kd yin empty

Tx Invigorate Qi, Nourish Blood
Move blood reduce pain
Clear Fire Poison
Acupuncture

GB 34/ St 36, SP9, SP6 Liv3 LI 4 Yin Tang Du 20


Herbs
Huang Qi 30
Dang Gui 6
Ji Xue Teng 15
Nu Zhen Zi 15
Tai Zi Shen 15
Ling Zhi 15
(Chao) Bai Zhu 12
Xia Ku Cao 12
Dan Shen 15
E Zhu 12
Pu Gong Ying 12
Bai Hua Cao 15
Ku Shen 9
Gan Cao 6
Damp Heat

Toxic heat

Liver qi stagnation

Yin Xu
Acupuncture
St36 Sp9 SP6 LI 11
Liv 3 LI 4 St 25
Yin Tang Du 20
Herbs
Huang Qi 30
Bai Zhu 15
Ling Zhi 15
Nu Zhen Zi 15
Han Lian Cao 12
Bai He 15
Ji Xue Teng 15
Dan Shen 12
Pu Gong Ying 12
Bai Hua She She Cao 15
Qing Hao 20
Xia Ku Cao 15
Che Qian Zi 12
Fu Ling 12
Ku Shen 9
Huang Qin 9
Yu Li Ren 12
Huo Ma Ren 12
Chen Pi 9
Gan Cao 6
Stage 4 Post treatment recovery
Ongoing side effects
Ongoing benefits (eg free radicals)
Relief vs apprehension over results
Case 4
A 53 year old osteopath presents with a newly diagnosed breast cancer. She has had an initial surgical excision but is waiting for to find out about lymph node results and the need for chemo/radiotherapy. She has no appetite, insomnia and feels understandably anxious. T: sl mauve, red sides, thin yellow coat Dark blue SLV + 5.
P:wiry
Rx Move Liver Qi
Move Blood stasis,
Resolve Phlegm,
Eliminate Fire toxin.
Invig Zheng Qi
Calm the mind
and promote sleep
GB 34, ST 40, SP 6,
Liv 3, P 6, Yin Tang

Chai Hu 9
(Chao) Bai Shao 15
Yu Jin 9
Gua Lou Shi 15
Wang Bu Liu Xing 15
Si Gua Lou 9
Pu Gong Ying 15
Huang Qi 15
Ling Zhi 15
Mei Gui Hua 6
(Chao) Suan Zao Ren 20
Gan Cao 6
A 63 year old woman with throat cancer presents after having radiotherapy Tx. She has burns on the skin over the site, and severe mouth ulcers.

T: Swollen, dark red, yellow fur
P: Slippery and sl rapid
Rx Clear Fire toxin
Nourish Yin and Qi
Move Blood
Sheng Di Huang 15 Huang Qin 9
Xuan Shen 15 Zhi Mu 12
Jin Yin Hua 20 Lian qiao 15
Tai Zi Shen 30 Ling Zhi 15
Dan Shen 15 Bai He 15
Zi Cao 15 Gan Cao 6

+ Zi Cao Shui Gao

Herbs
Acupuncture
Lu 7-Kid 6 LI 11, St 36
St 44-LI 4 SP6
Case 5
Woman with endometrial cancer responded v well to chemo. Now
3.5 years post diagnosis. Doing Qi Gong, working less, staying balanced...can get stressed, abdominal discomfort, sleep disturbed, Bowels 2 x/day + loose stool
T: red sides+ yellow fur
P: wiry/thready+ xu
Rx Regulate Qi
Soften & harmonise the Liver
Move Blood
Nourish Qi and Yin
Calm the Shen

Herbs
Zhi Xiang Fu 12
Wu Yao 9
Qing Pi 9
Chai Hu 9
Chao Bai Shao 15
Yu Jin 12
Yi Mu Cao 12
Chao Bai Zhu 12
Fu Ling 12
Bai He 15
Huang Qi 15
Ling Zhi 12
Nu Zhen Zi 12
Yuan Zhi 9
Gan Cao 6
Acupuncture
St36/ GB34 SP 9 SP 6

LI 11, St 25, Ren 6

P6 LI 4 Yin Tang
Stage 6: Living with cancer
Time for deep reflection...or not !
Take your lead from your patient
Chinese medicine a piece in the puzzle
Treat symptoms as they arise
Balance between targeting the cancer and supporting the Zheng qi

Case 6
A 74 year old man with bilateral localised renal cancer. Has recently developed ongoing haematuria. Has narcolepsy, insomnia, creatinine raised.
T: Swollen, deep central crack, sticky yellow fur, v red sides + tip
P: slippery

Tx Cool & Move the Blood + stop bleeding
Clear Heat & Drain Damp
Invigorate Qi + Blood
Tonify Kidney Yin and Yang
Herbs
Bai Mao Gen 30
San Qi 9
Pu Huang (tan) 15
Xian He Cao 30
Xiao Ji 15
Bai Hua She She Cao 15
Pu Gong Ying 15
Huang Bai 9
Shi Wei 15
Qu Mai 12
Ku Shen 9
Huang Qi 24
Dang Gui 6
Ling Zhi 15
Qing Hao 12
Gan Cao 6
Stage 7: Palliative care
being present
taking your lead from the patient
helping to alleviate symptoms
supporting the Qi
calming the Shen

Case 7
A 58 year old man presents with oesophageal cancer. He has had surgery and radiotherapy, and chemo, which unfortunately have not worked. He is tired and has dysphagia , nausea and vomiting. He develops secondaries in the brain and lymph nodes and abdomen. After a long fight he refuses any more conventional treatment.
T: swollen, pale, red tip, sticky yellow fur. SLV + 5. P: Thready and xu.
Rx: support the Qi & Blood
Regulate the middle jiao
Clear Fire poison and move Blood
Acupuncture
St 36 SP 6 Ren 6 Ren 12
P 6 Yin Tang Du 20
Herbs
Zhi Huang Qi 24
(Chao) Bai Zhu 12
Huang Jing 9
Ling Zhi 15
Chen Pi 9
Sha Ren 6
Hou Po 9
San Qi 6
Ru Xiang 6
Qing Hao 15
Bai Hua Cao 15
Pu Gong Ying 15
Da Huang 6 (Hou)
Gan Cao 6
Acupuncture
Herbs
"I am not what has happened to me...I am what I choose to become." Carl Jung
Thanks to my patients
flower.power@which.net
© Andrew Flower 2016
Cancer in Chinese Medicine
'liu' (tumour) appears on bones and shells in Shang dynasty (16-11 century BC)
Cancer-like conditions and clear differentiations of different types of cancer and progression of untreated cancer were made in the Su Wen (Lahans 2007)
• xia ge-masses below the diaphragm

• shi jia-uterine masses

• chang liu-intestinal tumour

• ru yan-breast rock (or ru shi yong-breast stone abscess)


'ai zheng'- cancer (first mentioned in 12th century CE)

‘Ai’ contains an old form of yán 'rock' and is composed of (pǐn) three rocks over (shan) 'mountain' .


"tumours are formed due to accumulations, or violent changes brought about by anger, joy, sorrow, pensiveness or fear"
(Zhang Cong Zheng 1156-1228)
'When sorrow, anger and depression accumulate day and night, Spleen Qi will be dispersed and dejected and Liver Qi disrupted. In consequence a concealed node will gradually form...decades later it will appear as ru yan (breast rock)...by then it is too late to be treated' (Zhu Dan Xi: Ge Zhi Yu Lun 1347)
Accounts of cancer-like conditions:
Pathology of cancer
4 Excesses
Stagnation of Qi
Blood stasis
Phlegm accumulation
Fire-toxins
Zheng Qi Xu
Qi xu
Blood xu
Yin xu
Yang xu
eg
Digestive problems
Mental-emotional problems
Asthma
UTIs
etc
Co-morbidities
Treatment principles
vs
'Bu'-Repair
Key treatment principles
Support Zheng Qi
Address individual pathology
Eliminate Fire Poison
Move Blood and circulate Qi
Resolve Phlegm
Empirical anti-cancer herbs
Eliminate Fire Poison
direct effects:
pro-apoptosis, cytotoxic compounds, inhibits cell cycle / anti-proliferative

indirect effects:
activates immune response. anti-angiogenesis, anti-inflammatory, inhibits cell invasion
Clear Fire Poison-secondary actions
Drain Damp

Move Blood stasis

Cool Blood

Eliminate Wind

Resolve Phlegm
Drains Damp
Bai Hua She She Cao
Ban Zhi Lian
Pu Gong Ying
Bai Xian Pi
Yi Mu Cao
Ban Bian Lian
Move Blood
Hu Zhang
Bai Jiang Cao
Hong Teng
Dong Ling Cao
Ba Yue Zhi (moves Qi)
Cools Blood
Da Qing Ye
Qing Dai Fen
Xuan Shen
Eliminates Wind
Chong Lou
Xu Chang Qing
Jiang Can
Teng Li Gen
Quan Xie / Wu Gong

Resolves Phlegm
Shan Ci Gu
Huang Yao Zi
Jiang Can
Shan Dou Gen
Yu Xing Cao
Cancer specific actions
Pu Gong Ying (Liv/ St)- Ca Breast / Liver
Shan Dou Gen (Lu/LI)-
Ca Throat
Long Kui (Lu/St/Bl)-
Ca Lung
Yu Xing Cao (Lu/LI)-
Ca Lung
Bai Jiang Cao (LI, Liv/St)-
Ca Colon
Chong Lou (Liv)-
Ca Liver
Hu Zhang (Liv/GB/Lu)-
Ca Liver
Shan Ci Gu (Liv/St)- Lymphoma
Da Qing Ye (Ht/Lu/St)- Leukaemia
etc
Move Blood
Primary action...secondary actions...empirical use
Commonly used herbs
Ji Xue Teng
Dan Shen
Jiang Huang
Ru Xiang
Tou Gu Cao
San Qi
E Zhu
San Leng
Shui Zhi
Tu Bie Chong
etc
Blood stasis herbs may:
promote micro-circulation,
improve the speed and volume of blood flow and reduce the ‘stickiness’ of the blood as measured by eg ESR,
reduce inflammation and prevent fibrosis.

Blood moving herbs are also able to regulate altered humoral (IgG, IgA, IgM etc) and cellular immune parameters (NK cells / macrophages/ PGF2 etc.).:


Blood moving herbs may therefore:
enable the effects of chemo/ radiotherapy,
help prevent metastases,
have a direct (eg curcumin) and indirect (via the immune system) anti cancer action.
San Qi-Panax Notoginseng
Sweet, Sl Bitter, warm.
Enters Liv & Stomach
moves Blood and stops Bleeding
reduces swelling and stops pain
Cytotoxic
Promotes-apoptosis
Anti-proliferative
Immune enhancing
Resolve Phlegm
Xia Ku Cao
Jiang Can
Ban Xa
Zhe Bei Mu + Xuan Shen + Mu Li
Shan Ci Gu
Huang Yao Zi
Zao Jiao Ci
Gua Lou Ren/Pi
Kun Bu
Hai Zao
Xia Ku Cao
Prunella vulgaris
Bitter, Pungent + Cold
Enters Liv and Gall Bl
Quells Fire, resolves Phlegm disperses clumps and dissipates nodules
Anti-oestrogenic (Ca breast/endometrium: fibroids: fibrocystic breast disease etc)

Modifies micro-environment: inhibits growth promoting signals and angiogenic factos

Promotes apoptosis
Phlegm resolving herbs
induce apoptosis
anti-proliferation
prevent tumor invasion and metastasis
reduce resistance to chemotherapy
anti-inflammatory
BUT...
often related to isolates and in vitro testing
few clinical trials
not as easy as it sounds...
eg Chen Pi, Jie Geng, Ban Xia, Kun Bu, Zhe Bei Mu
Invigorate Qi
(Sheng) Huang Qi
(Sheng) Bai Zhu
(Yu Ping Feng San)
The Shen Family
Ling Zhi
Hong Jing Tian
Digestive herbs (Chao Shan Zha 15-30,
Mai Ya 15-30, Chao Lai Fu Zi 15, Shen Qu)
Ling Zhi
Ganoderma lucidum
Sweet + Neutral
Enters Heart, Liver, Lung
Invigorates Qi and Blood and calms the Shen
Immune regulating

promotes apoptosis

? anti-angiogenic
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