Late Stage Cancer and the 3 Yin Conformations

Like most practitioners of Chinese medicine, I consider my job as not so much treating diseases as treating people with diseases.  This is a key concept in Chinese medicine.  It is the lack of proper functioning in our bodies that gives rise to illness and our eye, as Chinese medical practitioners, is trained to identify the way the body is not functioning properly and to restore that which is normal.  What we see in our practices is that diseases get better or go away when the body functions properly.  A focus on diagnosing and treating diseases rather than on re-establishing physiological function will more often than not prove to be ineffective at best.

This is the way many of us think about and treat people who have cancer.  In my own practice, most of these patients are under the care of their oncologists and are undergoing allopathic therapies such as surgery, chemotherapy and radiotherapy.  It is rare that a patient diagnosed with cancer will want to use Chinese medicine as their sole treatment option.  Hence, I often find myself treating patients to help them cope with the difficult and damaging effects of their allopathic therapies so that they can continue these therapies, make good use of them, survive them and then thrive.

The following article describes very clearly the general tendency of the patterns we see in our clinics if we are treating patients with cancer.  As in my own practice, there is very little or no emphasis on attacking or treating the cancer itself.  This very much reflects the way I have learned to work in my practice.  I have found that a focus on the underlying pattern the patient is presenting gives really excellent results in terms of well being, being comfortable during and after therapies and in helping attacking therapies be effective.  Some of my patients with cancer have expressed that they feel better than they did before the cancer diagnosis!

During the Graduate Mentorship Program, we take a good amount of time in our last weekend (coming up this March) learning about the ins and outs of treating patients with cancer.  There is so much we can do to help!  Just by the way, there is a new Graduate Mentorship Program starting in April.  In addition, White Pine Institute offers a wonderful online course with Professor Huang Huang on the treatment of cancer and autoimmune disorders with classic formulas.  If you are particularly interested in classic formulas, please look into the course on classic formulas I am teaching around the country this winter.  Some of these venues will stream the course live.

Please note that the translation of “late stage tumor” may also be read as “late stage cancer.”

An Inquiry into the Relationship Between the Differentiation of Patterns and Treatment of Late Stage Tumors and the Three Yin Illness Patterns of the Shang Han Lun.  By Professor 高振华 Gao Zhen-Hua (马鞍山十七冶医院,安徽 马鞍山243000)
Translated by Sharon Weizenbaum © 2014

Summary: This article analyses and concludes that the special pathological characteristics, patterns and treatments for late stage tumors match many of the patterns of the Shang Han Lun 3 Yin illness patterns.  In the clinic, using 6-channel theory for differentiating the pattern guides treatment and, in many cases, is able to achieve remarkable treatment results.

Patients with late stage tumors (stages 3 or 4) have suffered long term debilitation due to the tumor and damage from treatment.  Many of their biological markers are low.  I have observed the disease mechanisms, characteristics and symptoms [in my own practice].  These conform to the Shang Han Lun 3 Yin patters.  When the treatment proceeds from the 3 Yin pattern differentiation, this can truly lead to an increase in the quality of life for the tumor patient.  It can also function to increase the length of life.  I report on my exploration of both the characteristics of the patho-mechanism and the pattern treatment guidelines below:

1. Tai Yin Illness in late stage tumor with spleen and stomach deficiency cold.

Shang Han Lun [Clause 273] says, “In disease of Tai Yin, there is abdominal fullness and vomiting, inability to get food down, severe spontaneous diarrhea, and periodic spontaneous abdominal pain, and if purging is used, there will be hard bind below the heart.”  This is guiding principle points out the special characteristics of the Tai Yin illness and how it is changed with mistaken treatment.  Shang Han Lun [Clause 277] says “When there is spontaneous diarrhea with a lack of thirst, this belongs to Tai Yin disease because there is cold in the storehouse.  One should warm and a formula from the Si Ni  family should be given.”  This goes a step further by explaining the essential points of pathology, treatment and formula.  Tai Yin is the protective screen for the 3 Yin.  When the 3 Yang are not treated or are mistreated, the Yang Qi is damaged.  The disease evil is easily transmuted into the Tai Yin.  Alternatively, when the central Yang is weak the cold evil can make a direct hit to the Tai Yin.  This creates a spleen and stomach deficiency cold pattern.  Patients with late stage tumors who have been attacked with surgery and chemotherapy, will have central Yang damage. This is especially true when there are tumors of the stomach and intestines.  This leads to lack of harmony in the spleen and stomach so that there is abnormality of the nourishment and movement.  Cold and damp can accumulate internally.  The normal rising and falling counterflow.  Clinically this will often manifest as abdominal distention and fullness and sometimes there is abdominal pain that prefers warmth and pressure.  There is poor appetite, thirst without a desire to drink, vomiting and diarrhea.  The tongue is pale and fat with slippery moss and the pulse is deep and weak.  This is identical to the pattern and patho-mechanism of Tai Yin.  According to the Tai Yin illness pattern treatment, the principle formulas are Si Ni Tang and Li Zhong Tang.  The goal of warming the middle, fortifying the spleen, scattering cold and transforming damp is achieved remarkably quickly.

1. 
   Shao Yin Illness in late stage tumor with Yin accumulation and Yang depletion. 

The modern doctor Lu Yun-Leiyun said, “When there is Shao Yin illness, there is a lack of strength in the heart.  It is an illness in which the strength of the whole body is depleted.”  [Clause 281] of the Shang Han Lun says, “When there is Shao Yin Illness, the pulse is faint and fine and there is only a desire to sleep.”  One can see from this that this is Yin

accumulation with Yang depletion.  The key location of Shao Yin illness is in the vitality and enthusiasm.  It is the desire to live or die that determines if the Shao Yin prognosis is

favorable.  It is as Cao Ying-Fu said: “When there is Shao Yin illness and yet there is one thread of Yang, life can once again be generated.”  The clauses 287-290, 292, 293 are all clear in regard to the principle that “preserving Yang causes life.”  On the other hand, clauses 294-296 and 298-300 put forward that “when Yang is lost, there is death.”  For patients with late stage tumors, the true Yang dissipates as the illness progresses.

In addition, the long term use of intravenous fluids forces cold and damp into the interior.

Also the misuse of cold medicinals to defeat toxins will damage the Yang, creating a grave condition of Yin accumulation and Yang depletion.  Clinically this will manifest as an aversion to cold with a desire to curl up and sleep.  The spirit is feeble and there is weak

speech, cold reversal of the hands and feet, vomiting, diarrhea and lack of thirst.  Alternatively there may be thirst with a desire for warm liquids and there may even be drenching cold sweats with shortness of breath upon movement.  The face is red as if wearing make-up.  The tongue is pale with white moss and the pulse is thin and faint.  Clinically one will often determine treatment based on Shao Yin illness patterns, using Tong Mai Si Ni Tang with Gui Zhi Gan Cao Long Gu Mu Li Tang as the principle formulas.  This may be combined with venoclysis of human serum albumin, blood plasma and long chain fatty acids and it

will lead to the return and rescuing of the Yang.  By raising the functional mechanism of life, this will raise the quality of the patient’s life as well as their life expectancy.

1. Jue Yin illness in late stage tumor in which the correct and evil are mutually contending

Jue Yin illness is the last of the 3 Yin illnesses.    It is the final stage in Shang Han 6 channel illness patterns.  When the illness arrives at Jue yin the correct and the evil fight with each other.  The unique characteristic is that cold and heat are mixed together.  Zhu Wei-Ju 祝昧菊named this as “ the last resistance and the last struggle of the life force.”  Jue Yin depends on the generation and proliferation of the Yang Qi to recover.  When the negative pole emits Yang, the Jue returns and heat is generated and then there can be recovery.  It is as clause 329 of Zhang Jing’s work says:  “When there is Jue Yin illness with thirst and a desire to drink warm water, give a small amount of water and there will be recovery.”  Meanwhile, in clause 330 Zhong Jing admonishes doctors that in Jue Yin illness “there is counterflow of the 4 limbs and one cannot purge.  This is also true of deficiency patients.”  This is committing the error of treating “excess within deficiency.” It is unreasonable to attack and purge and thereby further plunder the Yang.  This is confusing excess and deficiency.  For patients with late stage tumors with the correct and evil contending with each other, deficiency and excess are mixed.  This is also a key opportunity to turn the correct Qi around to score a success.  Due to the fact that a tumor can relapse of change, the correct Qi can wane and the evil Qi can remain, creating weakened resistance and a set up for the evil Qi to attach itself.  Clinically one will see a white facial complexion and weak spirit, emaciation, lack of strength, poor appetite, heart palpitations, insomnia, sweating with movement, pale tongue and soft pulse.  These are all signs that the correct Qi is weak and loosing the battle.  At the same time, because the tumor has grown, infiltrated and constricted, there is blockage.  This evil Qi blockage pattern manifests ad distention and pain, constipation and low-grade fever.  One can use Zhang Zhong’s modified Dang Gui Si Ni Tang.  This will generate blood and benefit the Yang.  It is also a good formula to return the correct and consolidate the root.  It is reasonable to use modern medical surgical procedures to remove the tumor, place stents or use moderate chemotherapy in order to control the cancer and prolong life, renew the function of the organs and bowels.  In regard to the tumor patient’s life with the tumor, this knowledge is, without a doubt clinically significant.

Case Example

This female patient, age 49, came for a consultation on June 8, 2005.  She had undergone surgery a year previously for stomach cancer, which removed most of her stomach.   She had suffered from diarrhea for more than 4 months.  After the surgery the pathology report indicated mucous gland cancer that had invaded into the seromuscular layer.  She had undergone 6 cycles of HDF chemotherapy.  At the third cycle, she began to suffer from watery stool, which at times was serious.  This had gone on for 4 months up until now.  Observation of the illness:  Diarrhea 3-4 X each day containing undigested food particles, poor appetite, fatigue, lack of strength, cold in the 4 limbs, pale tongue body with slippery moss and a deep weak pulse.  The stool exam showed watery yellow stool with food particles (+), no white, red or pus cells.  The western diagnosis was functional diarrhea.  The Chinese medical diagnosis was diarrhea due to spleen and stomach deficiency and cold with internally stranded damp turbidity.  The treatment was to warm the middle, fortify the spleen, dispel dampness and stop diarrhea.

Take Zao Xin Tu and Boil in 1000 ml.  Use this water, divided into two, to cook the above herbs.  1 package/day cooked twice.  Drink 300 ml twice a day.  3 packages.  The diarrhea stopped and the appetite increased.  I continued with the original formula for 15 days and the illness was cured.

Discussion:

Stomach cancer surgery damages the stomach Qi.  In addition, chemotherapy substances are cold in nature.  Using these methods, it is easy to damage the spleen Yang, causing spleen and stomach deficiency cold.  The digestion is unable to transport and transform the grains and water or separate the clear and the turbid.    This is the cause of the diarrhea.  The treatment used Si Ni Tang and Li Zhong Wan as the principle formulas.  The warm the middle, fortify the spleen, scatter cold and transform dampness.  It hit the bull’s eye of the patho-mechanism and so there was a quick effect.

Further Discussion:

Many tumor patients undergo surgery, radiotherapy and chemotherapy as a means to attack the tumor.  Meanwhile their bodies and bodily functions become weak.  Clinically this is often seen as a cold/ heat mixed pattern as well as a deficiency/excess combination pattern.  This makes differentiation of the pattern and determining treatment especially difficult.  This makes it especially important to study and grasp the special characteristics of the patho-mechanism and laws governing the patterns and treatments of late stage tumor illnesses.  Accurate differentiation of the pattern and precision in determining treatment has special significance for the late stage tumor patient.  It has bearing on the length as well as the quality of life.

Cold evils are the cause of externally contracted cold damage.  Cold evils are also the most important causative factor for tumor illnesses.  Li Dong-Yuan said, “All of the 6 Qi can cause illness but cold poison is the most serious. Yin is, therefore, the killer.”    The deceased tumor expert, Sun Bing-Yan 孙秉严also said “There is a close relationship between malignant tumors and cold accumulation and hardness.  Actually, cold stasis is the basis and then there is the internal cancer-causing toxin factor that then forms the mass and toxic knotting.  This then goes a step further and becomes cancer.”  This is what he observed in the clinic for all varieties of cancer and cancers in all generations of people.  Among all of these cold stasis patterns were the majority.    He also said “It is very obvious that cold type patients as well as emaciated patients do very poorly with radiation and chemotherapy.  They decline very quickly.  Decoctions and pills must be given over a long period of time; otherwise they will very easily have a relapse.”  Because of this, warming the Yang and scattering cold methods are not only in accordance with the 3 Yin channel patterns of the Shang Han Lun, they also fit the differentiation and treatment of tumor patients.  This is a very important treatment for late stage tumor patients.

The 3 Yin illness patterns of the Shang Han Lun are formed due to either lack of proper treatment or mistaken treatment of the 3 Yang illness patterns.  Alternatively these illness patterns can form when there can be a direct strike into the 3 Yin when there is Yang deficiency with a cold evil.  The foundation is a change in the 5 Zang.  In the clinic this can also manifest with a mixed cold and heat pattern and a mixed excess and deficiency pattern.  The 6-channel differentiation of patterns consists of the 3 Yang and the 3 Yin channels.  These are Zhong Jing’s formula methods for the differentiation and treatment of external contraction illnesses.  Although tumor illnesses are not considered external contraction illnesses, in terms of their process of occurrence, growth and evolution, they frequently syndromes that appear in response to a 6 channel illness pattern.  Following the adage “different illnesses have the same treatment.” I often see that I achieve very good results in the clinic using the 6 channel formula differentiation.  This is because the characteristics of the illness and the manifesting symptoms are many times identical to the 3 Yin channel formula presentations.  Therefore one should use the 6-channel differentiation of patterns theory to determine treatment and you will be capable of achieving great results.