Journal of Acuherb in Medicine


Colorectal Cancer

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Colorectal Cancer

 

Colorectal cancer is a Western medical term and is not specifically discussed in classical TCM texts. However, the main symptoms and signs of the disease are recorded in the following conditions:

Intestinal mass ‘chang ji’: refers to movable abdominal mass accompanied by pain or distention.
Bloody stools ‘chang pi’: refers to projectile bleeding from the rectum during defecation. This is due to the attack of wind evils in the stomach, leading to prolonged accumulation of dampness evils in the large intestine. It affects the distributing areas of Shao Yin meridians finally.
Abdominal mass ‘zheng ji’: the mass seen over the abdomen. When it is always palpable and immovable, accompanied by localized pain is named as “zheng”, and that with intermittent occurrence, movable and accompanied by wandering pain is named as “ji”.
Organ intoxication ‘zang du’: refers to a dark reddish bloody discharge due to prolonged organ damage. This causes inflammation of the lining of the large intestine due to accumulation of toxic material in the organs.
Hematochezia ‘bian xue’: passage of bloody stools; due to heat evils damaging the vessels and letting blood escape into the surrounding tissues. It also present when there is accumulation of virulent dampness evil in the large intestine, deficiency of spleen yang and stomach yang, or accumulation of wind evil at the yinfen level (the deeper level of the body).
Diarrhea ‘xia li’: Excessive and frequent evacuation of watery feces, usually indicating gastrointestinal distress or related disorder.
Rectal carcinoma blocking the anus ‘suo gang zhi’: a carcinoma causing narrowing of the rectum and anus, resulting in the discharge of slender feces and foul fluid, and accompanied by tenesmus (painful, ineffectual straining to empty the bowel).

All these TCM conditions present similar symptoms to colorectal cancer. The TCM physicians usually consider all of the above conditions during consultation.

Causes

According to TCM, formation of cancer is generally due to the depletion of disease preventing factors and yin-yang disharmony of the body, which can result in different types of pathological phenomena, such as qi stagnation, blood stasis, phlegm condensation, toxic heat accumulation, and dampness collection. These morbid conditions interact with each other and cancer may form when they further interact with external pathogenic factors.

The usual causative factors are as follows:

Improper Diet
TCM takes food very seriously and regards the middle burner  (body region where the spleen and stomach are located) as the area for digestion. The digestive organs are vulnerable to inappropriate and unbalanced dietary habits, for example, excessive eating, greasy diet, over consumption of alcohol, and unclean foods. When the transportation and transformation processes are affected, undigested foods remain too long in the region and brew into dampness and heat evils. These evils accumulate and infuse downward into the large intestine, causing qi stagnation, and blood stasis in the intestines. The dampness, heat, stasis, and toxic materials all blend together and may cause cancer over time.

Emotional Problems
Extreme emotional conditions like pensiveness and anxiety leads to under-functioning of the liver and affects the movement of qi (vital energy) mainly, causing the formation of internal pathogenic factors such as dampness and phlegm. When these evils further stagnate, they transform into toxic heat evils, which then infuse downward and invade the intestines. This gives rise to qi stagnation and blood stasis in the intestines. Cancer may occur after a long period if the condition persists.

Uncontrolled Chronic Dysentery or Diarrhea
Persistent diarrhea leads to depletion of qi (vital energy) in the body which affects the spleen. In TCM, when the spleen cannot perform its transportation and transformation functions to send the pure nutrient essence upward to the heart and lungs where it is transformed into qi and blood for body nourishment, qi (vital energy) movement becomes abnormal and results in a morbid state. Impure substances or retention of phlegm and static fluid then build up. When this condition lasts for long periods, the internal equilibrium is disturbed, and cancer can easily form.

Symptoms

In TCM, colorectal cancer has a similar clinical presentation to Western medicine; however physicians also focus on changing symptoms, the individual’s constitution, and the order in which symptoms appear. TCM practitioners first carry out a comprehensive consultation to gather an accurate picture of the internal disharmonies before implementing treatment. See article on“What to Expect from a TCM Doctor’s Examination”. The usual disharmony patterns caused by colorectal cancer are as follows:

1. Downward migration of damp-heat
Individuals present with abdominal cramps, diarrhea with mucous and bloody stools and tenesmus (painful, ineffectual straining to empty the bowel). There is a burning sensation in the anus and a palpable abdominal mass. Other associated symptoms include fever, aversion to cold, thirst, mouth dryness and general weakness.

3. Interior retention of blood stasis2. Excessive accumulation of poisonous pathogens
The main presentations are poor appetite, feverish sensation accompanied with chest oppression, thirst, abdominal distention and cramping and severe diarrhea with mucous stools (which are dark purple in color).

Individuals present with an abdominal mass accompanied by fixed and persistent pain, abdominal distention, straining when defecating, diarrhea with pus and blood, a grayish complexion and a skinny appearance.

4. Deficiency in qi (vital energy) and blood
Individuals present with a pale complexion, light-colored lips and nails, general weakness, shortness of breath, bland taste in the mouth, poor appetite, full sensation in the epigastric region, tenesmus (painful, ineffectual straining to empty the bowel) or anal prolapse  in severe cases, malnutrition and a skinny appearance.

5. Yang deficiency in spleen and kidney 
Individuals present with a pale complexion, general malaise, apathy, aversion to cold temperatures, limb coldness and poor appetite. There can also be abdominal pain and distention, diarrhea in the morning and weakness and soreness in the lumbar (lower back) and knee regions.

6. Yin deficiency in liver and kidney
Individuals have a skinny appearance, dizziness, ringing in the ears, hot sensation in the chest, palms and soles, insomnia with nightmares, lumbar soreness, leg weakness and constipation with or without abdominal pain.

Diagnosis

Diagnosis in TCM places importance on determining the circumstances and manifestations of a disease through inquiry and observation of symptoms. Diagnosis is based on the four traditional examination techniques:

Questioning: The TCM practitioner will establish the medical history of both the patient and his family.

Observation: Examination of the physical features of the body, such as the face, tongue, hair, nails, sputum (mucus that is coughed up), and location of pain, all offer clues to the problem. The tongue is a particularly useful indicator of the functioning of the internal organs.

Listening and Smelling: The odor of sputum and breath and listening to chest sounds offer additional clues to the patient’s health.

Touching: Feeling the pulse is a cornerstone of TCM diagnosis and gives the practitioner much information about any bodily imbalance.

TCM practitioners will usually begin with a full investigation of the patient and categorize symptoms under special syndrome groups known as “disharmony patterns.” Certain disharmony patterns are present at different stages of a disorder. See article on “Principles of Diagnosis” In addition to manifestations of colorectal cancer as mentioned previously, practitioners also use pulse and tongue examination to obtain a diagnosis.

1. Downward migration of damp-heat
The major diagnostic presentations are abdominal cramps, diarrhea with mucous and bloody stools, tenesmus (painful, ineffectual straining to empty the bowel and bladder), and a burning sensation in the anus. On examination, the tongue is red, and covered by yellow and greasy fur. The pulse is rolling and rapid.

2. Excessive accumulation of poisonous pathogens
The major diagnostic presentations are poor appetite, fever with dysphoria (an emotional state characterized by anxiety, depression, or unease), thirst, abdominal distention and cramping, diarrhea with mucous feces (which are copious and dark purple in color). On examination, the tongue is red, and covered by yellow or dried yellow colored fur. The pulse is surging  and rapid.

3. Interior retention of blood stasis
The major diagnostic presentations are fixed and persistent abdominal pain and grayish complexion. On examination, the tongue is dark and purple in color, and covered with brusied spots. The pulse is hesitant or taut or knotted and intermittent.

4. Deficiency in qi (vital energy) and blood
The major diagnostic presentations are pale complexion, light-colored lips and nails, general weakness and shortness of breath. On examination, the tongue is pale with a thin and white coating; the pulse is deep and thready.

5. Yang deficiency in spleen and kidney
The major diagnostic presentations are pale complexion, aversion to cold temperatures, limb coldness and diarrhea in the morning. On examination, the tongue is bulky and the pulse is deep, thready, and weak.

6. Yin deficiency in liver and kidney 
The major diagnostic presentations are constipation, wasting of body tissue, dizziness, ringing in the ears, and a feverish sensation in the chest, palms, and soles.
On examination, the tongue is dark red and covered by scanty fur. The pulse is thready and taut, or rapid and thready.

Treatment

Various TCM therapies can be used at any stage of the disease or in combination with Western treatment at any time. Individuals can benefit from its preventative effects, improve their quality of life or boost the immune system, relieve or eliminate adverse effects caused by chemotherapy, and even help in the palliative care of terminal cancer patients. The following methods are for general information only; a qualified physician should always be consulted for treatment options. Self-treatment is not recommended.

Treatment based on TCM differential diagnosis

Physicians select the treatment method according to TCM differential diagnosis, the “disharmony patterns” made by analyzing the collected data. All these remedies are adjusted to suit specific individual conditions.

Downward migration of damp-heat
Therapeutic aim: 
to clear away heat in order to drain dampness. Commonly used prescriptions are huaihua diyu tang,qingchang yin, or baitouweng tang.

Sample prescription:
 baitouweng tang 
(白頭翁湯)

bai tou weng Root of Chinese Pulsatilla
huang lian Rhizome of Chinese Goldhread
huang bai Bark of Chinese Corktree
qin pi Chinese Ash Bark

 

Excessive accumulation of poisonous pathogens
Therapeutic aim: to clear away heat to cool blood, remove stasis, and detoxify the body. Commonly used prescriptions arewuwei xiaodu yi and huanglian jiedu tang.

Sample prescription: huanglian jiedu tang(黃連解毒湯)

huang lian Rhizome of Chinese Goldhread
huang qin Root of Baikal Skullcap
huang bai Bark of Chinese Corktree
zhi zi Fruit of Cape Jasmine

 

Interior retention of blood stasis 
Therapeutic aim: to clear away heat to cool blood, remove stasis, and detoxify the body. Commonly used prescriptions arewuwei xiaodu yi and huanglian jiedu tang.

Sample prescription:
 xiefu zhuyu tang (血府逐瘀湯)

dang gui Chinese Angelica Root
sheng di Dried Rehmannia Root
tao ren Peach Seed
hong hua Safflower Flower
zhi ke Bitter Orange
chi zhao Common Peony Root
niu xi Twotooth Achyranthes Root
jie geng Balloonflower Root
chuan xiong Szechuan Lovage
chai hu Chinese Tororwax Root
gan cao Liquorice Root

 

Deficiency in vital energy (qi) and blood 
Therapeutic aim: to replenish qi and nourish the blood. Commonly used prescriptions are guipi tang and bazhen tang.

Sample prescription:
 guipi tang (歸脾湯)

bai shu Large Head Atractylodes Root
fu ling Indian Bread
huang qi Mongolian Milkvetch Root
long yan rou Logan Aril
suan zao ren Spine Date Seed
ren shen Ginseng Root
mu xiang Root of Common Aucklandia
zhi gan cao Liquorice Root (processed with honey)
dang gui Chinese Angelica
yuan zhi Root of Thinleaf Milkwort
sheng jiang Rhizome of Common Ginger
da zao Common Jujube Fruit

 

Yang deficiency in spleen and kidney
Therapeutic aim: to warm and tonify the spleen and kidneys. Commonly used prescriptions are zhenling baishu san andsishen wan.

Sample prescription: shenling baishu san(參苓白術散)

ren shen Ginseng Root
fu ling Indian Bread
bai shu Large Head Atractylodes Root
bai bian dou White Hyacinth Bean
huai shan Chinese Yam
lian zi Seed of Hindu Lotus
sha ren Fruit of Villous Amomum
yi yi ren Seed of Job’s Tears
jie geng Balloonflower Root
gan cao Liquorice Root

 

Yin deficiency in liver and kidney
Therapeutic aim: to nourish and tonify the liver and kidney. A commonly used prescription is zhibai dihuang wan.

S
ample prescription: zhibai dihuang wan(知柏地黃丸)

shu di Processed Rhemannia Root
shan yu rou Asiatic Cornelian Cherry Fruit
huai shan Chinese Yam
dan pi Tree Peony Bark
fu ling Indian Bread
ze xie Oriental Water-plantain Root
zhi mu Common Anemarrhena Rhizome
huang bai Bark of Chinese Corktree

 

External Treatment

Treatments other than the oral drugs include acupuncture, plasters, sauna, and massage. These methods are commonly applied to localized lesions according to the presentation of symptoms.

Acupuncture
To relieve pain and vomiting, selected acu-points are:
zu-san-li, tian-shu, he-gu, xia-ju-xu, nei-guan, and da-chang-shu.


Topical application of drugs 
Moxibustion
This is suitable for colorectal cancer patients who have complications such as ascites (free fluid accumulating in the abdominal cavity). Selected acu-points are:
tian-shu, zhong-wan, xia-wan, guan-yuan, shen-quel. 
Recommended treatment is 2-3 times daily.

This refers to local application of pounded fresh medicinal herbs or moisturized medicinal powder over the affected part. They are applicable for local infections, ulcers, swelling, pain and injuries. In this case, individuals can apply to relieve pain caused by cancer, e.g. toad paste.

Enema
This refers to the introduction of a liquid into the bowel via the rectum, to be either expelled or retained. It is suitable for individuals with bloody stools. For example, a TCM decoction is prepared using the bark of Chinese Corktree (huang bai), root of Baikal Skullcap (huang qin), root of Redroot Growwell (zi cao), rhizome of Japanese Fleeceflower (hu zhang), common Picria herb (ku shen), and fruit of Japanese Apricot (wu mei).

TCM patent drugs or simple folk remedies

TCM has many patent drugs or simple folk remedies for relief of symptoms. Physicians usually prescribe these to complement other treatments.

Qi-gong

This method is beneficial for regulating the body and mind, strengthening the constitution, and relieving the adverse effects of radiotherapy or chemotherapy. Patients select relevant exercises in consultation with their physician. A desirable result can only be achieved by long-term and persistent practice.

For example:

  • First prepare by adopting a half standing and half sitting posture; hold the arms tight at the side with the each hand in a fist; the two feet are a shoulder’s width apart and the eyes are slightly closed.

    Slowly start to inhale, grab the ground with the toes, contract the groin area, and lift up the anus.

    Concentrate on making the breath (qi) si

Prevention

TCM methods of prevention and management are similar to Western medicine, please see Western section for reference; nursing management is a characteristic of TCM. TCM physicians concentrate on the following:

Psychological consultation and reassurance
Both the physician and family members should try to relieve the patient’s mental burden through language and behavior, so as to build up the patient’s self-confidence to fight the cancer. Patients can also help by practicing qigong. Keeping good personal hygiene, eating a moderate diet, avoiding cigarettes and alcohol, and keeping stress to a minimum, are also important ways to prevent disease progression.

Food and dietary therapy
Patients should have multiple small meals everyday; the food should be light and easily digested, and cover all essential nutrients. The daily diet should include an increased intake of fiber and fruit. TCM functional food has a long history, and the use of tonics taken with food pre-date their use as medicine. Combined with food, tonics are absorbed better and are seen as an ideal way to keep bodily functions in check.

Porridge of Water Caltrop
Therapeutic benefits
: used as a tonic to invigorate the stomach and nourish the intestines.
 
Ingredients:
10-20 pieces water caltrop  
1 tablespoon honey
about 1 cup glutinous rice
 
(Job’s tears, lotus seed or the seed of Golden Euryale (qian shi) can replace water caltrop with the same results.)

Method:
Peel off the skin of the water caltrop and cook in a pot with sufficient water; when it turns into a semi-paste, add the glutinous rice and further cook into porridge. Add one tablespoon of honey before serving.

Other functional foods like dried mushrooms, white and black fungus, and fresh mushrooms are also recommended. These foods enhance the immune system and improve the body’s constitution.

 

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