Chinese medicine and cancer : Introduction
One of the things I would like to do as a physician is help people who have various types of cancer. I realize that even this statement will be regarded by some as problematic. Some say that Chinese medicine doesn’t recognize “cancer” as such and that Chinese medicine physicians shouldn’t “specialize” in treating any particular condition. I recognize the points in that argument. However, my partner and I feel a great affinity towards people who have had their lives touched by what Western medicine calls “cancer” in all its variations. It is an affliction that creates great hardship in the lives of many, regardless of what we call it.
I will write a series of posts detailing what I learn as I investigate the range of syndromes that we commonly call cancer. I will be looking at it from different angles. I am fortunate in that I have a variety of approaches to directly observe. Apart from what I will be able to observe in clinic and learn directly from professors, I will be doing literature searches and conversing with my many colleagues flung across the world via the Internet. I hope this series will be helpful for many types of people including my peers and other people who are seeking information about herbs, acupuncture and cancer. I am particularly interested in starting conversation around this issue, so I will try to end every post with a question - please leave your answers (however tentative) in the comments.
What is cancer? Basic Western and Chinese perspectives
From a Western perspective, the most basic way to describe cancer is simply as a disease process in which body cells begin to grow out of control. In general, this happens because of DNA in a cell that becomes damaged and is either (a) repaired, or (b) mitigated by controlled death of the damaged cell. This can happen for many reasons. Further, cancers in various parts of the body grow at different rates, in response to different environmental triggers. This, of course, results in the variable survival rates, symptoms and other features of different cancers. You can have cancer in virtually every part of the body. Causes range from inherited damage to DNA to inhaled toxins to accumulation of toxic by-products in the body and countless other factors. Western medicine has begun to understand cancer fairly well, but the fact is that there is still a ton of work to do. There are a huge number of foundations and government agencies working on finding “cures” for various types of cancer. If you want to learn more about Western perspectives on cancer, or to find resources in that realm - a great starting point is the American Cancer Society. You might also want to check out the National Cancer Institute.
In Chinese medicine, cancer is most often described as either a phlegm or a blood stasis accumulation (or both). Ultimately, cancer is not talked about as such - instead there is a description of masses or tumors. In this way, treatment generally progresses in a manner very similar to other masses and tumors. It is interesting that early on in Chinese medical history, a fairly nuanced way of classifying tumors emerged, based on the color, size, location, painfulness and other features of the mass and its local effects.
As with any other disease, we should start with the basics when we are looking at cancer. Using the essential Ba Gan (Eight Pillar) differentiation can help us get a handle on the disease process we are confronting. Is the imbalance of a Yin or Yang nature? Is it primarily hot or cold? Does it seem to be external (as in a cold) or internal? Is it deficiency or excess? While I’ve heard many simplistic answers to these questions when discussing cancer, I think the truth is probably more complicated. While masses are undeniably Yin in nature, a festering tumor or one in metastasis clearly has Yang qualities. While many cancers have the cold and cooling quality we would expect from a Yin-like disease, others burn brightly and cause great heat both superficially and internally. Regarding the internal or external nature, I think it goes without saying that all cancers are internal - regardless of whether we want to think of them of having been ultimately caused by a penetrating external pathogen. Cancers, too, may have deficient and excess qualities. I’ve obviously answered no questions here, but I’m starting to clarify for myself the deep complexity in a disease with such far reaching effects.
What are the standard approaches to treatment of cancer? Western and Chinese perspectives
Many of us know that the standard treatment options for cancer in the Western medical model are surgery, chemotherapy and radiation. Some folks choose all three of these options, some only one or two. Some people have reported that Western medical doctors (especially at forward-thinking cancer specific research centers) are doing more recommendation of dietary and lifestyle adjustment as a way to manage both the disease and the side effects of the strong Western treatments. This points out the deepest problem with Western medical treatment of cancer - the side effects. Surgery itself has its own recovery process which can be quite difficult for some - particularly those who are quite weak, elderly, or fighting some other disharmony in their body. Radiation and chemotherapy both use agents that are quite toxic for the body. The side effects are many, including the very visible loss of body hair, thinning of the skin surface and often debilitating loss of appetite, nausea and fatigue. Some people consider these to be necessary evils, since these treatments can be quite effective in eradicating some cancers. Still, many people yearn for alternatives - regardless of whether their particular cancer is effectively treated by these methods. Avoiding side effects, improving quality of life and increasing the effectiveness of Western treatments top the list of desired outcomes when people seek Chinese medicine and other natural therapies when treating their cancer.
Chinese medicine uses the basic set of powerful and versatile tools to treat all disease. A full treatment protocol from a Chinese medicine physician will include a Chinese herbal formula, an acupuncture prescription (perhaps involving cupping, needling, moxibustion or a combination of these and other manual therapies) and may also include lifestyle counseling, dietary advice and prescribed Qigong or Taiji movements appropriate for the presenting condition. For phlegm and blood stasis accumulations, the standard treatments will involve both resolving/dissolving the masses directly, promoting general movement throughout the Qi and Blood flow of the body and supplementing any deficiencies that might be accompanying the condition. The dietary advice will be specific for the person, but will probably advise against refined foods, fatty foods and very cold foods - as is the case for most serious conditions. Obviously, a variety of approaches exist - which is what I hope to investigate and communicate as this series progresses.
The many dimensions of the human being and their relationship to cancer
Yesterday, a patient remarked to me how disregarded she felt in the conventional Western medical world as she struggled with serious illness. She felt as though the patient had no interest in her as a person and saw her primarily as a carrier of some “target” to be measured and attacked by the physician. This most certainly impacted her healing process. She remarked how different naturopathic and Chinese medicine practitioners feel to her - she believes they/we see her as a complete person. Most of all, she feels like we treat her as a person at all. With a disease like cancer that is still one of the top 3 causes of death in most industrialized nations, I feel that it is easy for physicians to become detached. This may be a form of self-preservation. To become deeply connected with a patient and then have them die is certainly a difficult occurence. However, I believe as a physician of any modality you have a responsibility to learn how to take care of yourself in such a way that you are able to handle the diverse pressures involved.
Like any disharmony, cancer impacts people on as many levels as they have. Cancer certainly has profound physical effects, any Western treatments they are using have their own physical impacts as well. Cancer also impacts people emotionally. This is true of course in the sense that people are having to reckon with their mortality and the range of issues that comes along with that reckoning. But, from a Chinese perspective, the blockages that come about because of the actual existence of the mass and its Qi and Blood disturbing effects will almost surely be detrimental to the emotional balance of the human being. There are also social and spiritual effects on the person. All of these need to be addressed by the physician and patient in concert if true healing is to take place.
Hope, quality of life and survival
A frequently terminal disease like cancer brings up so many questions, it boggles the mind. There’s nothing simple about it. For instance, should survival be pushed for at any cost? That certainly seems to be the mindset of many people in the medical profession and beyond. What about quality of life? What is included in quality of life? If a person cannot feed themselves or use the bathroom by themselves, but can still engage in lively conversation and interact with loved ones - do they have a decent quality of life? While our focus must always be on promoting balance and well-being regardless of a patient’s disease state, we need to be thinking about these questions if only for ourselves. How do we provide a sense of hope and groundedness when the prognosis seems dire? On a more base level, what responsibilities do we have legally and socially when it comes to treating or not treating patients based on the severity of their condition? These are all questions we should be ruminating and discussing with eachother as a community. I’m sure you have ideas of your own, or perhaps have more questions.
A question for the readers: In your work with people who have cancer (or, if you are not a practitioner, in your personal experience with people with cancer) what are the most important things to keep in mind as you interact with the person? How can you create a healing atmosphere for people who are facing a disease that is often (often erroneously) considered to be a death sentence? Go ahead and share your thoughts in the comments. Don’t worry - thinking out loud isn’t penalized here. :)
Thanks for reading.
Eric
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Tags: Cancer, compassion, cure, death, disease, patient care, quality of life, western-scienceRelated posts
With compassion
I have a lot to write today about the visit of Dr. Liu Lihong, and will be releasing those posts over the next few days. I also have a guest post from Yael over at Chinese medicine notes on the topic of pregnancy in texts of Chinese medicine. However, I didn’t want to let any more time go on without acknowledging the terrible tragedy still unfolding in China. The area hit by the earthquake includes Chengdu, where many of my professors learned and practiced medicine. I do not know how they will personally be impacted by this event, but I do know that we are all affected when great suffering occurs in the world. This, so hot on the heels of the cyclone in Burma/Myanmar, truly should make all of us pause to - at the very least - send our energy and compassion to those who suffer.
I am reminded of the Guan Yin chant we do at school - excellently done on the chanting CDs that Heiner Fruehauf offers over at his site. I will be chanting this as much as I can for many days. It seems fitting… I believe the Chinese for the chant is…
南无觀世音菩薩
nā mó guān shì yīn pú sà
I believe this roughly translates as I pay homage to Guan Yin (the most perfect Compassionate one). But when I have chanted it I have always felt that I can send healing and internal power to those who need it, including myself. I feel the world needs plenty of that right now.
If you feel moved to donate to help those in need, please follow this link to Mercy Corps, who have a team in Sichuan and are already attempting to mobilize resources to help. Mercy Corps is, without any doubt, one of the most efficient and honest international aid organizations currently operating. If you give them money, they will get it to people who need it.
May the suffering lessen soon.
Eric
Tags: china, compassion, eventsRelated posts
Why should doctors cultivate compassion?
Three excellent blogs, Urbanmonk.net, The Middle Way.net, and kentonwhitman.com have collaborated to create a group writing project around the topic of compassion. They have titled the project “Spread the love NOW,” an imperative statement for an imperative topic! It’s a great time of year to be thinking deeply about compassion and other related topics, so I thought I would add some thoughts of my own. If you have an online journal or blog, consider visiting that link and participating in the project yourself. Entries need to be posted by the 5th of January, 2008. As if joining your voice with so many others to talk about such a worthy subject isn’t enough benefit alone, there’s also a prize involved. Visit the Urbanmonk.net link above to learn more.
Compassion is a natural theme for a blog about medicine. However, it is too seldom discussed explicitly in medical settings. Sometimes it seems that it is assumed that people come to medicine naturally aligned with the principles of compassionate living and that their medical practice will be informed by those principles. Unfortunately, this is not the case. Some come to medicine because of family tradition, others because of hopes of monetary gain, still others sort of by accident - they choose it out of a book or from some career counseling service’s list. Of course there are many, particularly in the natural medicine fields, who do come for all of the right reasons. Further, even people primarily motivated by some of the above can be exceptionally compassionate individuals. Regardless of one’s motivation for entering the medical field or one’s natural tendency with regards to compassion, it is a topic that should be carefully considered and a trait that should be vigorously cultivated.
The philosophical roots of Chinese medicine are full of descriptions of the necessary attitude for a good physician. While Chinese medical science should not be equated with the philosophical systems that gave rise to it, we can look to those systems to understand the medicine more fully. Interestingly, all three of the major Chinese spiritual systems - Daoism, Confucianism and Buddhism - take compassion to be one of the highest virtues. In Daoism, compassion is one of the three jewels that all good people should seek to cultivate. Compassion is at the very heart of Buddhist thought, no doubt about it. In Confucianism, too, compassion is a most sought virtue and some sources indicate that Confucius believed that all other virtues flowed from this one. I’d like to briefly explore the Confucian understanding of Compassion and suggest some ways that physicians and physicians-in-training can incorporate this vital virtue into their own lives and medical practices.
The word for compassion is Ren 仁 and can also be translated as benevolence, humility, humanity and mercy. The character is composed of the person radical on the left and the symbol for “2″ on the right. It indicates either a cluster of two persons or the relationship between two people. It is my understanding that this virtue has been explained in many ways by different Confucian philosophers. One of the major points of contention concerns towards whom we are meant to have this special attitude. Some contend that it should be shown to all people (universal love) others indicate that it is reserved for those we owe some filial debt - such as our parents. Despite these differences, the essence can be agreed upon by anyone. When taking action in the world, we must always consider how our actions will impact other human beings. We must act in such a way that it does not support the desires/wishes of one person at the detriment of others. In essence, we must think of the humanity of others and act in such a way that we respect and honor the core of humanness within every person.
What does this mean in medicine? Simply this - that your primary concern is a doctor is to respect the humanness of each patient. They are not your experimental laboratories, they are not marks to push your products on, they are not intentionally being difficult or any of those other petty little things we all think at one time or another. Thus, they shouldn’t be treated as such. They should be always and everywhere treated in exactly the same manner as you would have yourself treated, with respect, openness - and yes, even a kind of love.
How can we learn to embody this principle? Well, any of the basic self-cultivational practices will certainly help. Meditation helps our minds to quiet and this in turn will help us to notice when our thoughts turn to less than compassionate directions. One practice I can suggest is to stop immediately any speech or thought about any person, patient or not, that you would not want them to hear you thinking or saying. You might also want to look into volunteering your time to a local charity, particularly one that serves sectors of the public that you traditionally find difficult. In exposing yourself repeatedly to people you find difficult, you may be more able to work through your troubling feelings.
In general, I believe that thinking carefully about our relationship with the virtue of compassion is one of the most important practices we can work with as physicians and future physicians. How does compassion play out in your daily life? Learned any particularly poignant lessons about this virtue? Share your thoughts and experiences with us in the comments. If you would like to read more articles like this one, be sure to subscribe to this blog via RSS feed or via email.
Eric
Tags: Character, compassion, Cultivation, meditation, professional-development, virtueRelated posts
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