The experience of Professor Sun Gui Zhi in preventing and treating the recurrence and metastasis of stomach cancer.

Abstract

Professor Sun Guizhi chief doctor of Guang An Men Hospital affiliated to the China Academy of Traditional Chinese Medicine, is a famous Chinese specialist who applies traditional Chinese medicine (TCM) or the integration of TCM and Western medicine in the treatment of cancer. For the past 30 years Professor Sun has exclusively studied tumours in the digestive tract and specialises in the treatment of stomach cancer according to the differentiation of patterns in TCM. Professor Sun's clinical experience in preventing and treating the recurrence and metastasis of stomach cancer is summarised in this article.

Keywords: Stomach, cancer, prevention, Chinese medicine, herbs, metastasis.

Aetiology and pathology of the occurrence, recurrence and metastasis of stomach cancer

In traditional Chinese medicine, there is no such term as "stomach cancer." However the symptoms belonging to this disease were discussed in the classics under disease categories such as acid reflux, epigastric pain, food retention in the stomach etc. Professor Sun is influenced by the ideas of Zhu Dan Xi who wrote: "There are four kinds of acid reflux: blood deficiency, qi deficiency, heat and phlegm," and the ideas of Zhang Jingyue: "All kinds of consumption of the Stomach qi are due to severe internal injuries."

After many years of research and clinical experience, Sun developed a coherent aetiology and pathology for the occurrence, recurrence and metastasis of stomach cancer. Sun believes that in the early stages of stomach cancer, the main disease patterns are as follows. Disharmony of the Liver and Stomach, with prolonged Liver depression and qi stagnation produces fire and Stomach heat which consumes the yin. Alternatively, fire condenses the body fluids into phlegm and dampness. The obstructing and cloying nature of phlegm and damp results in stagnation of qi thereby producing concomitant blood stasis. Phlegm and damp accumulate in the middle jiao and the normal transportation and transformation functions of the Spleen are affected, resulting in qi and blood deficiency. Chronic Spleen deficiency will eventually affect the Kidneys and damage the vital fire. At the end stage of the disease pathology, the anti-pathogenic qi becomes weak while the pathogenic qi grows stronger and becomes centralised in the epigastric region. This scenario creates an environment conducive for the pathogenic qi to develop unchecked thereby resulting in the development of Stomach cancer.

At different stages of the course of the disease, a stomach cancer patient usually presents with different patterns. Generally speaking, at the beginning, the body's upright (zheng) qi is still relatively strong, becoming increasingly deficient as the disease progresses. In other words, the early stage is characterised mainly by excess and the advanced stage by the co-existence of excess and deficiency patterns. At the advanced stage, however, deficiency (of the upright qi) is primary and excess (of evil/ xie qi) is secondary.

In the early stages of the disease, when excessive pathogenic factors are the main problem, the treatment protocol requires the use of integrated Chinese and Western medicine. Western therapies are often drastic and involve surgery, chemotherapy and radiation, and used on their own will consume the primary qi of the body. As a result, the body's primary qi will be unable to fight against any remaining or recurring malignant cells. The use of Chinese medicine can help counteract this.

Therefore in order to control the recurrence and transformation of the cancer the following treatment principles should be followed: the anti-pathogenic qi must be strengthened, the pathogenic qi must be removed, and the immune function of the body should be improved in order to prevent recurrence or metastasis.

The application of herbal medicine to prevent recurrence and metastasis of stomach cancer Basic herbal formula

Dang Shen (Codonopsitis Radix) 12g, Chao Bai Zhu (Atractylodis macrocephalae Rhizoma) 10g, Fu Ling (Poria) 10g, Chao Chen Pi (Citri reticulatae Pericarpium) 6g, Sheng Huang Qi (Astragali Radix) 15g, Dang Gui (Angelicae sinensis Radix) 10g, Chao Lu Feng Fang (Vespae Nidus) 6g, Xue Yu Tan (Crinis Carbonisatus Hominis Hominis) 10g, Bai Zhi (Angelicae dahuricae Radix) 10g, Ban Zhi Lian (Scutellariae Barbatae Herba) 15g, Bai Hua She She Cao (Hedyotis Herba)15g.

Formula principles

This formula is derived from the modification of Yi Gong San (Special Achievement Powder) and Dang Gui Bu Xue Tang (Angelica Blood-Supplement Decoction). Dang Shen, Chao Bai Zhu, Fu Ling, Chao Chen Pi and Sheng Huang Qi function to strengthen the Spleen qi, limit the formation of phlegm and damp, and strengthen the anti-pathogenic qi. Chen Pi is added to course the qi in the Spleen and Stomach, thereby preventing the tonic herbs from producing stagnation. Dang Gui can nourish and invigorate blood, thereby relieving pain due to blood stasis. Bai Hua She She Cao and Ban Zhi Lian are added to clear heat and toxic pathogens. Bai Zhi, Chao Lu Feng Feng and Xue Yu Tan are added based on modern clinical experience in the treatment of stomach cancer. The formula can harmonise the Spleen and Stomach, promote qi and blood circulation, stop the formation of phlegm and damp, and clear pathogenic toxins thereby preventing and delaying the recurrence and metastasis of stomach cancer.

Formula modifications

* If the patient has such symptoms as epigastric distension and pain radiating to the hypochondria, vomiting and hiccup, all these symptoms belong to disharmony of the Liver and Stomach. The following herbs may be added: Bai Shao (Paeoniae Radix alba), Chai Hu (Bupleuri Radix), Fo Shou (Citri Sarcodactylidis Flos), Xiang Yuan (Citri Medicae seu Wilsonii Fructus) and Chao Zhi Qiao (Aurantii Fructus Praeparata).

* If the patient has such symptoms as burning heat in the stomach, dry mouth, thirst, acid regurgitation, a red tongue body with scanty coating or no coating and a thready and rapid pulse, all these symptoms belong to the type of yin deficiency due to Stomach heat. The following herbs may be added: Mai Men Dong (Ophiopogonis Radix), Shi Hu (Dendrobii Herba), Tian Hua Fen (Trichosanthis Radix), Sheng Shi Gao (Gypsum) and Zhi Mu (Anemarrhenae Radix).

* If the patient has such symptoms as stabbing pain in the stomach which worsens with pressure, tightness of the chest, vomiting blood, a dark sooty complexion, dry or rough skin and nails, all these symptoms suggest blood stasis. The following herbs can be added: Yan Hu Suo (Corydahs Rhizoma), Bai Qu Cai (Chelidonii Herbs cum Flore), Tao Ren (Persicae Semen), Hong Hua (Carthami Flos), Chuan Xiong (Ligustici Rhizoma), Chi Shao (Paeoniae Radix Rubra), Yu Jin (Curcumae Tuber), Jiang Huang (Curcumae Longae Rhizoma).

* If the patient has such symptoms as vomiting, thin phlegm, abdominal distention and loose stool, a yellowish face, obesity, copious thick sputum, a flabby tongue with teeth marks and a sticky tongue coating, all these symptoms belong to the type of accumulation of phlegm. The following herbs may be added: Qing Ban Xia (Pinelliae Tuber Depuratum), Zhu Ru (Cauhs Bambusae in Taeniis), Zhi Shi (Aurantii Fructus Immaturus), Shi Chang Pu (Acori tatarinowii Rhizoma), Huo Xiang (Pogostemonis / Agastaches Herba), Sha Ren (Amomi Fructus), Sheng Yi Yi Ren (Coicis Semen), Bai Kou Ren (Amomi Cardamomi Fructus).

* If the patient has such symptoms as dull pain in the stomach that improves with pressure and warmth, vomiting of undigested food, a pale complexion, fatigue, cold extremities, loose stools and oedema, all these symptoms suggest Stomach cold and Spleen yang deficiency. The following herbs can be added: Ren Shen (Ginseng Radix), Gan Jiang (Zingiberis Rhizoma), Gui Zhi (Cinnamomi Ramulus), Xiao Hui Xiang (Foenicuh Fructus), Zhi Gan Cao (Glycyrrhizae Radix Praeparata) etc.

* If the patient has such symptoms as fatigue, spontaneous sweating, night sweats, palpitations and shortness of breath, these suggest both qi and yin deficiency. The following herbs can be added: Huang Qi (Astragali Radix) 30g, Rou Gui (Cinnamomi Cortex), Bai Shao (Paeoniae Radix alba), Shu Di Huang (Rehmanniae Radix preparata), Gou Qi Zi (Lycii Fructus), Nu Zhen Zi (Ligustri lucidi Fructus), Shan Yu Rou (Corm Fructus), Shan Yao (Dioscoreae Rhizoma), E Jiao (Asini Corii Colla) and so on.

* In addition, the following herbs can be utilised according to the differentiation of symptoms. Bai Qu Cai (Chehdonii Herba cum Flore), Lai Fu Zi (Raphani Semen), Teng Li Gen (Actinidiae Chinensis Radix), Hu Zhang (Polygoni cuspidati Rhizoma), Wei Lian (Coptidis Rhizoma), Shang Ci Gu (Shancigu Bulbus), Gan Chan Pi (Bufo Siccus), Sheng Yi Yi Ren (Coicis Radix), Chao Yi Yi Ren (Coicis Radix Praeparata), Di Long (Pheretima) and so on.

Case Studies

A. Mr. Chen, 63 year old male

On October 21st, 2003, the patient was sent to the emergency room for acute abdominal pain. He had recently lost weight and experienced stomach discomfort with foul belching. Examination revealed a superficial ulcer with protruding edges in the duodunem. An operation was performed and the pathology tests revealed adenocarcinoma. The test also revealed that the cancerous cells were present in the distal part of the stomach.

In December of the same year, the patient was admitted to the oncology department of Guang An Men hospital with the following symptoms: poor appetite, bloating and distension after meals, weight loss, fatigue, spontaneous sweating, thready and rapid pulse, slightlyred tongue body with teeth marks and thin white coating. The symptoms suggested Spleen qi deficiency and the treatment principle was to strengthen the Spleen qi in order to fight the cancer. The formula given was: Dang Shen (Codonopsis Radix) 12g, Chao Bai Zhu (Atractylodis macrocephalae Rhizoma Praeparata) 10g, Fu Ling(Poria) 10g, Chao Chen Pi (Citri reticulatae Pericarpium Praerparata) 6g, Sheng Huang Qi (Astragali Radix) 15g, Dang Gui (Angelicae sinensis Radix) 10g, Chao Feng Fang (Vespae nidus Praeparata) 6g, Xue Yu Tan (Crinis carbonisatus) 10g, Bai Hua She She Cao (Hedyotis diffusae Herba) 15g. Ban Zhi Lian (Scutellariae barbatae Herba) 15g, Ji Nei Jin (Gigeraiae galli Endothelium corneum) 10g, Chao Gu Ya (Oryzae Fructus germinatus Praeparata) 10g, Chao Mai Ya (Hordei Fructus Germinatus) 10g. The patient took one package of this formula with water every day, and 25 packages altogether. Afterwards, the symptoms were greatly improved.

On Feb. 20th, 2004, the patient was hospitalised. His treatment was: 4mg Mitomycin intravenous injection, once a week; 500mg 5-Fluorouracil intravenous injection, twice a week; Vincristine (VCR) intravenous injection, once a week; 5 weeks as one treatment. The chemical treatment was combined with herbal treatment to tonify the Spleen and the Kidney: Dang Shen (Codonopsis Radix) 15g, Bai Zhu (Atractylodis macrocephalae Rhizoma) 10g, Gou Qi Zi (Lycii Fructus) 15g, Nu Zhen Zi (Ligustri lucidi Fructus) 15g, Tu Si Zi (Cuscutae Semen) 15g, Bu Gu Zhi (Psoralea) 10g, Qing Ban Xia (Pinelliae ternatae Rhizoma) 10g, Dan Zhu Ru (Caulis Bambusae in Taeniis) 10g, Jiao San Man (Fructus Crataegi Praeparata, Massa Fermentata Medicinalis Praeparata, Fructus Hordei Germinatus Praeparata) 10g each, Gan Cao (Glycyrrhizae Radix) 6g. The above herbs were cooked with water and taken orally, one package a day. After the chemical treatment was completed, the formula was changed back to the original formula. The patient attended the hospital in March 2004, July 2004 and May 2005 and received the same treatment. He was finally checked in October of 2005. He had no discomfort, his appetite and sleep were good and his urination and bowel movement were normal. The result of the blood examination, the liver and the kidney function tests, ultrasound examination, and X-ray examination were all normal. The patient had gained four kg in weight.

B. Mrs Chang, 47-year-old female

In June 2001, the patient was diagnosed with stomach cancer and had surgery. She presented with general lassitude, numbness of the four limbs, restless sleep, slight difficulty in passing dry stools, pale tongue with a thin white coating and a weak pulse. White blood cell count: 1800 / mcL and haemoglobin: 8.5g/l. Chinese medicine diagnosis: deficiency of both Heart and Spleen with Stomach blood stasis. Treatment principle: tonify qi, strengthen the Spleen, nourish the Heart, calm the spirit, augment the Stomach and break up stasis. Chinese herbal formula: Sheng Huang Qi (Astragali Radix) 30g, Yuan Zhi (Polygalae Radix) 10g, Tai Zi Shen (Pseudostellariae Radix) 15g, Chao Bai Zhu (Atractylodis macrocephalae Rhizoma) 15g, Long Yan Rou (Longan Arillus) 10g, Chao Suan Zao Ren (Ziziphi spinosae Semen) 30g, Ye Jiao Teng (Polygoni Multiflori Caulis) 10g, Pao Chuan Shan Jia (Manitis Squama) 10g, Tu Bie Chong (Eupolyphaga/ Steleophaga) 6g, He Shou Wu (Polygoni multiflori Radix) 15g, Lu E Mei (Mume Fructus) 10g, Ju He (Semen Citri Reticulatae) 10g, Shui Hong Hua Zi (Tribuli Fructus) 10g, Chao Zhi Ke (Aurantii Fructus)10g, Sheng Mai Ya (Hordei Fructus germinantus) 30g, Gan Cao (Glycyrrhizae Radix) 10g. The above was cooked with water and taken orally, one bag a day.

On January 7, 2002, the patient finished her chemotherapy, and presented with distending pain in the costal and hypochondriac regions, belching, a red tongue margin, and a wiry, fine pulse. Her appetite, digestion and bowel movement were normal. Chinese medicine diagnosis was disharmony between the Liver and Stomach. The prescribed herbal formula was Yi Gong San (Special Achievement Powder) and Xiao Yao San (Rambling Powder) with modifications: Chai Hu (Bupleuri Radix) 10g, Mu Dan Pi (Moutan Cortex) log, Chi Shao Yao (Paeoniae Radix rubra) 12g, Bai Shao Yao (Paeoniae Radix alba)12g, Chao Zhi Zi (Gardeniae Fructus) 10g, Tian Hua Fen (Trichosanthis Radix) 12g, Ku Shen (Radix Sophorae Flavescentis) 15g, Xiang Fu (Cyperi Rhizoma) 10g, Di Long (Pheretima) 10g, Tian Long (Scolopendra) 10g, Xiao Hui Xiang (Foeniculi Fructus) 10g, Wu Yao (Linderae Radix) 10g, Bai Hua She She Cao (Hedyotis diffusae Herba) 30g, Ban Zhi Lian (Scutellariae barbatae Herba) 15g, Sheng Mai Ya (Hordei Fructus germinantus) 30g, Gan Cao (Glycyrrhizae Radix) 10g. The usage instruction was same as above.

On May 12, 2002, the patient came complaining of slightly apathy, soreness and weakness of the low back, reduced appetite and loose stools. She had a pale tongue with a thin, white coating, and a fine pulse. Deficiency of the Spleen and Kidney was the main diagnosis and the herbal formula was the combination of Si Jun Zi Tang (Four Gentlemen Decoction) and Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia): Tai Zi Shen (Pseudostellariae Radix) 12g, Chao Bai Zhu (Atractylodis macrocephalae Rhizoma) 12g, Tu Fu Ling (Smilacis glabrae Rhizoma) 15g, Sheng Di Huang (Rehmanniae Radix) 12g, Shu Di Huang (Rehmanniae Radix preparata) 12, Shan Zhu Yu (Corni Fructus) 12g, Ji Xue Teng (Spatholobi Caulis) 15g, Sang Ji Sheng (Taxilli Herba) 15g, Bai Shao (Paeoniae Radix alba) 15g, Lian Zi Rou (Semen Nelumbinis Nuciferae)15g,ShengLong Gu (Fossilia Ossis Mastodi) 15g, Sheng Mu Li (Ostreae Concha) 15g, Yi Mu Cao (Leonuri Herba) 15g, Niu Xi (Achyranthis bidentatae Radix) 12g, Jin Jiao Mai (Fagopyrum dibotrys(D.Don) Hara) 15g, Li Zhi He (Semen Litchi Chinensis) 12g, Wang Bu Liu Xing (Vaccaraie Semen) 12g, Chao Bing Lang (Arecae Semen) 15g, Ji Nei Jin (Gigeraiae galli Endothelium corneum)15g, Gan Cao (Glycyrrhizae Radix) 10g. She was instructed to cook the above herbs with water and take twice per day, one bag for a day.

On her last visit in August 2002, her condition was improved and stable. She was prescribed Xiao jian Zhong Tang (Minor Construct the Middle Decoction) and Liu Wei Di Huang Tang (Six-Ingredient Decoction with Rehmannnia), in the form of tea pills, to strengthen her pre-heaven and post-heaven qi.

Summary

Clinical practice has shown that the integration of Western and traditional Chinese medicine can offer optimal results when dealing with complex cases such as cancer. Western treatments can be used to resolve the tumour, kill the cancerous cells and prevent metastasis. Traditional Chinese medicine is used to adjust the balance of yin and yang in the body, prevent recurrence and metastasis of cancer cells, reduce the side effects of surgery and chemotherapy and hasten the recovery of the body's immune system. If the body's resistance is healthy and resilient, the pathogenic qi (cancer cells) can be eliminated and removed from the body with minimal side effects. This therapy follows the principle of: "when anti-pathogenic qi is strong, pathogenic qi cannot invade the body."

Dr. Yu Cai, Ph.D. is a professor in Jinan University, China. Dr. Cai holds a bachelor's degree from Liaoning Institute of TCM, a master's degree from Zhejiang Institute of TCM, and his Ph.D from Guangzhou University of TCM. After working as a postdoctoral fellow in Zhejiang University for two years he is now specialising in the treatment of tumours with Chinese traditional medicine. emailto:[e-mail]