Journal of Acuherb in Medicine


Lung Cancer

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By Dr. Ken.  Wang

Lung cancer is the most comm only fatal of all cancers, killing more than half a million people worldwide every year. A majority of lung cancers are linked to tobacco use. As this habit becomes more prevalent, lung cancer numbers rise. It is the leading fatal cancer among adult males and is rapidly increasing in women, as more and more take up smoking.

Lung cancer develops when lung cells change into abnormal cancer cells after being continually irritated by something in their environment, known as a carcinogen. The most common lung carcinogens are the toxins in cigarette smoke, to which both smokers and those breathing other people’s secondhand smoke are exposed. The Cancer Society of New Zealand reports that second-hand smoke is the third largest killer in the country, after active smoking and alcohol use. Industrial chemicals and dusts can also act as carcinogens and contribute to the development of lung cancer. 

Cancer cells are cells able to divide very rapidly and do not follow the regular patterns of normal healthy cells. They form colonies or tumours of tissue that do not help the lungs to function normally. Some cancer cells break off and travel in the blood to different parts of the body to form new cancer colonies known as “metastases.” When these cancer colonies grow so large that they interfere with normal lung function or the healthy functioning of other parts of the body, symptoms like pain, bleeding, loss of function (i.e. difficulty breathing), and /or weight loss may appear. 

Types of Lung Cancer 
Lung cancers are grouped according to the type of cells they contain. Because each cancer cell type behaves differently, selected treatment will also be different. 

Squamous cell carcinoma is the most common type of lung cancer (30 percent of cases) and is almost always associated with tobacco smoking. It develops in the lung cells lining the main bronchi (the largest air passages). This tumour often grows out into the airway and blocks it, leading to symptoms like breathlessness, chronic cough, and bloodstained (rusty) sputum. It usually spreads into the chest wall and local lymph nodes before metastasizing (sending cancerous cells to distant parts of the body). When this happens, it may be discovered and diagnosed early enough for effective surgical removal.
   
Adenocarcinoma is the form of lung cancer most commonly found in non-smokers and accounts for 29 percent of all lung cancers. There is a high rate of this kind of cancer among non-smoking Hong Kong women. It develops in the glands supplying the lungs with mucous of the airways and is often found in the outer areas of the lung.
   
Small cell carcinoma, another common cancer, (17 percent of lung cancer cases), is also strongly linked to cigarette smoking. This type is sometimes referred to as oat cell carcinoma because the cancer cells look oat-shaped. Small cell carcinoma can cause a rapid early death because it spreads or metastasizes quickly and is “silent,” meaning it does not have early warning symptoms.
   
Large cell carcinoma is responsible for 15 percent of lung cancer cases. It has large, rounded cells and grows in the airways eventually making it difficult to breathe.
   
Bronchioloalveolar cell carcinoma is a rare tumour found in less than two percent of cases.
   
Unknown cell types: Nine percent of tumours contain cancer cells which pathologists cannot identify or classify either because the cells are “mixed” (containing a range of different types of cells), undifferentiated (do not have characteristics belonging to any particular cell line) or come from another part of the body.
   

Mesothelioma is not always classified as lung cancer because it develops in the membranes (pleura) covering the lung and the inside of the chest walls. A rare tumour, mesothelioma is strongly linked with exposure to asbestos. This is the reason asbestos is now considered to be a very dangerous material.

 

According to Traditional Chinese Medicine (TCM) theory, lung cancer is included under the categories describing “lung-masses”, “expanding-masses”, “cough”, “cough blood” and “chest pain”. Several ancient medical books make reference to it. For example, in the book “Summary from the Golden Chest ” (Han Dynasty 206-220AD) under the five organs section, it states “the [lung] mass cannot be easily removed.” In the Huang Di Nei Jing Su Wen , another famous book written during the Han dynasty, it refers to “difficulty breathing [with lung cancer] without having difficulty eating.” TCM believes lung cancer results from having a lack of healthy energy and from the accumulation of exogenous evils (outside influences that invade the body and cause illness).

 

 

Causes

Retention of Wetness and Phlegm evil Hypofunction (under functioning) of the  spleen causes a disturbance in body-fluid metabolism and failure of fluid transportation, which are part of this organ’s main functions in TCM. Untransformed body fluid turns into phlegm and wetness, which are toxic materials. These toxic materials flow upward and interfere lung function. 

Stagnation of Vital Energy 
Under normal conditions, the vital energy (qi) circulates smoothly in and out, up and down and all over the body. If an internal injury occurred, for example, depression of the seven emotions will cause deficiency and impairment of vital qi and derangement of yin and yang, it may cause breathing syndromes due to the improper lung function. TCM believes yin and yang disharmony is the cause of disease and physiological disorders. Disharmony means the proportions of yin and yang are unequal and unbalanced. When one aspect is deficient, the other is in excess. Lung cancer is induced by an overall deficiency of qi and yin in the body, which leads to an excess syndrome in the lungs. The excess syndrome generally manifests as pathological lung changes such as a stagnation of qi flow, blood stasis (lack of easy blood flow) and accumulation of phlegm and toxins.

Blood Stasis
Vital energy (qi) acts as the commander of blood. It means that vital energy is the motivating force of the blood circulation. Therefore blood stasis is usually accompanied by stagnation of vital energy. Coagulation and stagnation of qi and blood flow can contribute to the formation of a tumour. 

Pathogenic evils (substances causing disease) invade the lung 
When the healthy energy is deficient due to body dysfunction or structural damage. Some pathogenic evils such as wind and cold take advantage of this imbalance and invade the lung. Over time these evils accumulate in the lungs and can cause cancer.

How do these factors contribute to the development of lung cancer? 
As a result of lung dysfunction and improper qi flow, body fluids cannot be properly distributed. They begin to accumulate in the lungs and eventually turn into phlegm. Over time, the phlegm, stagnant blood and qi flow, and the remaining toxins trapped in the lungs form into a lump, which would be known in western medicine as a lung cancer mass. 

Other Factors Associated with the Development of Lung Cancer:

1. Smoking
2. Occupational Exposure to Carcinogens
(substances that can cause cancer) i.e. inorganic arsenic, asbestos, chrome, nickel, radon, hydrocarbon in coal smoke, coal tar, and fossil oil
3. Air pollution
4. Ionizing Radiation
5. Diet and Nutrition

Symptoms

Lung cancer can be divided into 5 different syndromes. The symptoms will differ depending on the syndrome each individual has.

1. Yin Deficiency and Interior Heat Syndrome 
Symptoms include a cough without sputum or a cough with thick sputum. The sputum can appear blood stained. Breathlessness, chest pain, a dry mouth and throat, a hoarse voice, mild fever and night sweats may also be present. Individuals may feel distracted or have insomnia. The tongue appears flushed or dark red and has a little or no coating. The pulse feels rapid and thready.

2. Spleen Deficiency and Phlegm Dampness Syndrome 
Symptoms include a cough that produces a lot of sputum and chest tightness accompanied by shortness of breath. These individuals usually feel weak and fatigued and have pale complexions. Weight loss and loose stools are also common. Their tongues appear pale and bulging and have an indented margin. A white and greasy fur coating may also be present. The pulse feels soft and moderate or soft and rolling.

3. Deficiency of Qi and Yin Syndrome 
Symptoms include a low and weak sounding cough, which produces a small amount of sputum, which can be bloodstained. These individuals can experience shortness of breath, fatigue and weakness. They are thirsty but lack the desire to drink and may sweat spontaneously or have night sweating. The tongue appears light red or red with an indented margin, and the pulse feels thready and weak.

4. Deficiency of Yin and Yang Syndrome 
Respiratory symptoms include a cough, shortness of breath, dyspnea (difficulty breathing) and/or tachypnea (rapid breathing) with exercise. Tinnitus (ringing in the ears), body aches, lower back (lumbar) or knee weakness, urinary frequency at night may also be present. Individuals can have an aversion to cold and have cold limbs. General fatigue and weakness are also not uncommon. The tongue appears light or dark red with a thin fur coating, and the pulse feels deep and faint.

5. Stagnation of Qi and Blood Stasis Syndrome 
Symptoms include difficulty coughing and expectorating bloodstained sputum, chest tightness, tachypnea (rapid breathing), chest pain and distension and abdomen pain located in a fixed position. Purple veins show on the neck and chest. Lips and nails are dark coloured. Constipation with dry and hard stools may also be present. The tongue appears dark red and may have either ecchymosis (bruise) or petechiae (pinpoint bruises) with a yellowish thin coating. The pulse will feel taut or uneven. 

Diagnosis

Development of lung cancer comes from a weakening of the healthy energy that flows through the body. As previously stated, this mainly occurs when there is a deficiency of vital qi and imbalance of yin and yang. It manifests itself as one of the five syndromes previously described under the “symptoms” section.

Diagnosis in TCM is based on four important examination techniques. The first is “questioning.” The TCM practitioner will want to know important information such as what your current complaints are, your past medical history, and family health history. The second technique is “observation.” Looking at the physical features of the body such as the face, tongue, hair, nails, sputum and area of pain all give clues as to what the problem may be. The third technique is “hearing and smelling.” Smelling the sputum and breath and listening to the sounds coming from the chest are important when evaluating lung cancer. The last technique used in examination includes “touching.” Feeling the pulse is one of the cornerstones of TCM diagnosis and gives the TCM practitioner a lot of information about the imbalance occurring in the body.

If the TCM practitioner, suspects there might be a serious problem that Chinese medicine alone cannot treat, he or she may recommend that the individual see a western doctor for further follow up. It is also not uncommon for a TCM practitioner to ask to see the blood work or x-rays that you have had performed to give the practitioner more information when forming a TCM diagnosis. The syndromes that are most commonly diagnosed with lung cancer include: 

1. Yin Deficiency and Interior Heat Syndrome
2. Spleen Deficiency and Phlegm Dampness Syndrome
3. Deficiency of Qi and Yin Syndrome
4. Deficiency of Yin and Yang Syndrome
5. Stagnation of Qi and Blood Stasis Syndrome

When evaluating someone for lung cancer, it is important to make sure that it can be differentiated from the following health problems.

Pneumonia 
This is an acute and febrile disease which is caused by a wind-heat pathogen (substance causing a disease). According to TCM, it develops in four stages: the defense (wei) stage, vital energy (qi) stage, nutrient (yin) stage, and blood (xue) stage. At the beginning there will be a fever and cough which are the defenses against the pathogens. As chest pain, coughing, and yellow thick sputum develop, the pneumonia goes into the qi stage. When the pathogens interfere with the body receiving nutrients, the pneumonia enters the nutrient stage, and symptoms such as a high fever or convulsions may occur. Finally, when the pathogenic factors enter the blood, lethargy, coma and even death may occur if it is not treated properly. 

Lung abscess
It is usually caused by a pathogen that originates form outside of the body and also has an acute onset. Symptoms like sudden chilling, high fever, chest pain, increased sputum production with a fishy smell or thick bloodstained sputum, and a cough are usually present. 

Lung tuberculosis 
It is caused by weakness, a deficiency of qi and blood, and the bacteria Mycobacterium tuberculosis. Its main active manifestations are a chronic cough, heamoptysis (coughing up blood or bloody sputum), fever, night sweating, fatigue and weight loss. 

Treatment

Treatment of lung cancer is complex and can benefit from a complementary western and TCM approach. Often the combined treatment of western medicine and TCM produces better outcomes than using either method alone.

A lot of traditional TCM treatments increase the body’s resistance to invading pathogens (substances that cause disease) in order in to increase a person’s lifespan. TCM treatments aim to relieve symptoms, stop the disease’s progression and restore healthy functioning of the individual rather than curing (in the western sense) a disease completely. While herbs are commonly used, other methods of treatment may include acupuncture, meditation and qi gong.

Recently, with the advances in western research techniques, there has been a lot of research into anticancer mechanisms of Chinese herbs. Studies have shown that certain TCM herbs can work in the following ways to help slow down or stop the progression of cancer by: 

1. Inducing the cancer cell to differentiate into a normal cell.
2.. Promoting apoptosis of cancer cells. Apoptosis, also sometimes called programmed cell death, means that a chemical signal is triggered within the cell telling it to die. In cancer cells this chemical signal seems to be turned off, which is why they multiply rapidly.
3. Helping to block the chemical messages in cancer cells that tell them to grow, multiply and form into tumours.
4. Improving the efficacy of chemotherapy. Currently many cancers are developing drug resistance to chemotherapy regimens because of their high expression of P-polysaccharides(PGP). Some TCM herbs can interfere with this expression or offer new ways to attack cancer cells.
5. Activating blood circulation and eliminating blood stasis. It is thought better blood circulation can limit the tumour spread and allow chemotherapy to reach the cancer cells more effectively.
6. Supporting the body’s own immune system by activating macrophages, increasing antibody production, and regulating lymphocytes so it can fight cancer cells more efficiently and limit the growth of the tumor. Some mushrooms such as yunzhi (Coriolus versicolor) and lingzhi (Ganoderma lucidum) are known for their ability to support healthy immune system function.
7. Killing the cancer cells directly.

Because there are many, TCM prescriptions and products that may possess one or more of the above properties, it is best to get the advice of a TCM practitioner who knows what’s best for you and your condition. 

The treatments described below are some approaches that may be taken to treat the different TCM syndromes associated with lung cancer. 

1. Yin Deficiency and Interior Heat Syndrome
Therapeutic aim: Nourish yin and clear away lung-heat, soften the hard mass found in the chest and remove toxins from the body. 

Prescription: Yangyin Qingfei Xiaojie Tang Jiajian Decoction.

Nanshashen Fourleaf Ladybell Root
Beishashen Coastal Glehnia Root
Tiandong Cochinchinese Asparagus Root
Maidong Dwarf Lilyturf Tuber
Baihe Lily Bulb
Xingren Almond
Baibu Stemona Root
Yuxingcao Heartleaf Houtuynia Herb
Shengyiren Raw Coix Seed
Quangualou Whole Snakegourd Fruit
Bayuezha Akebia fruit
Shishangbai Selaginella Herb
Shijianchuan Chinese Sage Herb
Baihausheshecao Hedyotis Diffusa Herb
Chanpi Dry skin of Toad
Xiakucao Spike of Prunella
Shenmuli Raw Oyster Shell

Addition for individuals with sputum mixed with blood: 

Xianhecao Hairyvein Agrimonia Herb
Baimaogen Lalang Grass Rhizome

Addition for individuals with low grade fever: 

Yinchaihu Starwort Root
Digupi Chinese Wolfberry Root-bark

Addition for individuals with insomnia: 

Zaoren Date Seed
Hehuanpi Silktree Albizia Bark
YeJiaoteng Fleece-flower Stem

Addition for individuals with night sweating:

Rudaogen Glutinous Root
Fuxiaomai Blightened Wheat

2. Spleen Deficiency and Phlegm Dampness Syndrome 
Therapeutic aim: Replenish qi and invigorate the spleen, disperse lung-qi and help break up and expel phlegm. 

Dangshen Tangshen
Baizhu Largehead Atractylodes Rhizome
Fuling Indian Bread
Chenpi Dried Tangerine Peel
Banxia Pinellia Tuber
Xingren Almond
ShengnanXing Rhizome of Arisaema
Shanhailuo Codonopsitis Root
Shishangbai Selaginella Herb
Shijianchuan Chinese Sage Herb
Yiren Coix Seed
Ziwan Tatarian Aster Root
Kuandong Common Coltsfoot
Jiaoshanzha Hawthorn Fruit (charred)
Jiaoshenqu Leavened mixture of almond, sweet wormwood herb etc.(charred)

Addition for individuals with an abundant expectoration of sputum

Baijiezi Seed of Sinapis Alba
Tianjiangke Shell of Metaplexis fruit

Addition for individuals with loose stool and cold limbs

Buguzhi Malaytea Scurfpea Fruit
Huluba Common Fenugreek Seed
Tusizi Dodder Seed

3. Deficiency of Qi and Yin Syndrome 
Therapeutic aim: Supplement qi, nourish yin, break up and expel phlegm and remove toxic substances from the body.

Prescription: Combination decoction of Sijunzi Tang and Shashen Maidong Tang Jiajian

Huangqi Raw Milkvetch Root
Baizhu Raw Largehead Atractylodes Rhizome
Beishashen Coastal Glehnia Root
Tiandong Cochinchinese Asparagus Root
Maidong Dwarf Lilyturf Tuber
Wuweizi Chinese Magnoliavine Fruit
Xingren Almond
Baibu Stemona Root
Gualoupi Snakegourd Fruit peel
ShengnanXing Rhizome of Arisaema
Shijianchuan Chinese Sage Herb
Baihausheshecao Hedyotis Diffusa Herb
Xiakucao Spike of Prunella
Shengmuli Raw Oyster Shell
Chuanbeimu Tendrilleaf Fritilary Bulb

Addition for individuals with yellow sputum

Huangqin Baical Skullcap Root
Sangbaipi White Mulbery Root-bark
Yeqiaomaigen Wild Buckwheat Root

Addition for individuals with more yin deficiency 

Xiyangshen American Ginseng
Nuzhenzi Glossy Privet Fruit

Addition for individuals with more Qi deficiency

Shengshaishen Sun-dried ginseng
Taizishen Heterophylly Falsestarwort Root

4. Deficiency of Yin and Yang Syndrome
Therapeutic aim: Nourish yin, warm the kidney, subdue swelling and dissolve lumps or masses. 

Prescription: Shashen Maidong Tang Decoction and Zan Yu Dan (fertility promoting pill) 

Beishashen Coastal Glehnia Root
Tiandong Cochinchinese Asparagus Root
Shengdi Rehmannia Root (unprocessed)
Xianmao Common Curculigo Rhizome
Xianlingbi Epimeddium
Congrong Cistanche Deserticola Stem
Chuanbeimu Tendrilleaf Fritilary Bulb
Shoudi Rehmannia Root (processed)
Shandougen Vietnamese Sophora Root
Shishangbai Selaginella Herb
Huangbuliuxing Cowherb seed
Shijianchuan Chinese Sage Herb
Furongye Cottonrose Hibicus leaf
Xueliguo Climbing Fig Fruit

Addition for individuals with an aversion to cold and who have cold limbs 

Fuzi Prepared Common Monkshood Daughter Root

Addition for individuals with frequent urination at night

Yizhiyen Sharpleaf Glangal Fruit Seed

Addition for individuals with difficult and fast breathing

Shengesan Powder of Ginseng and Gecko
Zishiying Fluorite
Tusizi Dodder Seed

5. Stagnation of Qi and Blood Stasis Syndrome
Therapeutic aim: Replenish Qi to resolve blood stasis, soften hard mass and dissolve lumps or masses.

Prescription: Fuyuan Huoxue Tang Jiajian Decoction (for recuperation and promoting blood circulation)

Taoyen Peach seed
Huangbuliuxing Cowherb seed
Danshen Danshen Root
Sanleng Common Burreed Tuber
Ezhu Zedoray Rhizome
fengfang Honeycomb
Bayuezha Akebia fruit
Chuanyujin Curcuma stem
Quangualou Whole Snakegourd Fruit
Shengbiejia Raw Turtle Shell
Xiakucao Spike of Prunella
Haizao Seaweed
Kunbu Tangle
Shandougen Vietnamese Sophora Root
Shijianchuan Chinese Sage Herb
Baihausheshecao Hedyotis Diffusa Herb
Shancigu Common Pleione Pseudobulb
Shengmuli Raw Oyster Shell

For individuals with bloodstained sputum 

Deduct:
Taoyen Peach seed
Danshen Danshen root
Huangbuliuxing Cowherb seed
And Add:
Xianhecao Hairyvein Agrimonia Herb
Qiancaogen India Madder Root
Shensanqi Radix Notoginseng

Addition for individuals with a puffy face and head 

ShengHuangqi Raw Milkvetch Root
Fangji Fourstamen Stephania Root
Cheqianzi Plantain Seed

Addition for individuals with severe pain

Yanhu Yanhu
Ruxiang Frankincense
Moyao Myrrh
Xuchangqing Paniculate Swallowwort Root

 

 

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