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Chinese medicine: pairing medicinals in Chinese medical oncology for best therapeutic effects.

Keywords: Chinese medicine, Chinese herbal medicine, oncology, dui yao, medicinal pairing

While acupuncture is the best-known Chinese medical modality in the West, in China, internally administered multi-ingredient, water-based decoctions are overwhelmingly the main modality. We can say that such polypharmacy decoctions are the de facto standard of care within professional Chinese medicine.


When it comes to the Chinese medical treatment of cancer, there is a whole separate repertoire or materia medica of medicinals that are empirically known to be effective. In the case of many, if not most, of these, their pharmacodynamic methods of action have also been proven via laboratory and clinical research. However, even though certain special Chinese medicinals are used when treating cancer, the main prescriptive methodology is still bian zheng lun zhi, "treatment based on pattern discrimination." This means that the guiding or base formula is chosen based primarily on the patient's presenting Chinese medical patterns, not on his cancer diagnosis. As an extension of this, such base formulas are made up from Chinese medicine's more standard materia medica. In other words, when treating cancer with internal Chinese medicine, one typically starts with a standard, well-known formula based on the patient's Chinese medical patterns and then adds a number of specifically anticancer medicinals to that base. This means that at least half of the ingredients of the final formula are none other than Chinese medicine's standard ingredients.

Therefore, when treating cancer with Chinese medicine, one must know not only how and what specifically anticancer medicinals to prescribe but also how to best prescribe standard Chinese medicinals in the context of Chinese medical oncology. (Note: Within professional Chinese medicine, zhong liu ke, or oncology, is its own specialty.) When a Chinese doctor looks at a typical 12- to 20-ingredient cancer formula, he or she should immediately know the treatment principle for which each ingredient of group of ingredients is included. In a Chinese medical formula, different ingredients are meant to do different things. These different intentions are called the treatment principles. Commonly, for each treatment principle within a formula, Chinese doctors prescribe two complementary or synergistic medicinals. This combining of two (or sometimes three) medicinals is referred to in Chinese medicine as dui yao, "medicinal pairing." The special efficacy of many of these combinations has been proven over more than 1,000 years of clinical experience. However, individual doctors also have their own unique approaches. On page 7 of issue 12, 2009, of Si Chuan Zhong Yi (Sichuan Chinese Medicine), Zhang Yi-min published an article about the special medicinal pairings of his teacher, Prof. Guo Zhi-xiong, titled "Lifting the Borders on Guo Zhi-xiong's Medicinal Pairings in the Treatment of Cancer." Prof. Guo works at the Integrated Chinese-Western Medical Hospital in Sichuan and has over 30 years' clinical experience in Chinese medical oncology. Below are discussions of some of Prof. Guo's special medicinal pairings that he commonly uses in cancer patients. As someone who has practiced Chinese herbal medicine for 30 years, I can say that there are some real lesser-known gems of prescribing within Prof. Guo's pairings.

Huang Lian (Rhizoma Coptidis) and Gui Zhi (Ramulus Cinnamomi)

Huang Lian is bitter in taste and cold in nature. Its functions are that it clears heat and dries dampness. It is commonly used to treat damp heat glomus and fullness, vomiting, and diarrhea. Gui Zhi is acrid and sweet in flavor and warm in nature. It can strengthen the transformation of yang qi. It also levels and downbears thrusting counterflow. When Prof. Guo uses these two medicinals together, it is mainly to treat heat in the chest with cold in the stomach resulting in nausea, abdominal pain, borborygmus, and diarrhea. In this case, Prof, Guo uses Huang Lian to drain the heat from the chest and Gui Zhi to scatter the cold within the stomach. Thus he is able to eliminate cold and heat at the same time and harmonize both above and below. The result is that nausea is leveled, pain is eliminated, and diarrhea is stopped.

In Prof. Guo's experience, many cancer patients already have disease evils in the middle burner, or the middle burner has suffered damage from cancer treatment. Hence stomach and intestinal function has often lost its regulation. Gui Zhi has a predilection for upbearing the fallen but also for downbearing counterflow. However, it also warms Huang Lian's cold, thus preventing Huang Lian from damaging the spleen-stomach. In this case, one medicinal is acrid and upbearing, and the other is bitter and downbearing. Hence the qi obtains both upbearing and downbearing. The net result of this is that the spleen is automatically fortified, while the stomach is automatically harmonized. The spleen and stomach are the latter heaven root, the source of the engenderment and transformation of the righteous qi. Therefore, insuring their function is vital to insuring the health of the patient. When Prof. Guo uses this combination, he usually uses Huang Lian at a dose of 6 grams to Gui Zhi's 15 grams.

Huang Qi (Radix Astragali) and Zhi Mu (Rhizoma Anemarrhenae)

Huang Qi's flavor is sweet and it is slightly warm. Its functions are that it supplements the qi and upbears yang, nourishes the blood and secures the exterior. While this medicinal only has slight anticancer effect, it boosts the immune system. In Prof. Guo's experience, most cancer patients exhibit righteous qi depletion and vacuity. Therefore, Prof. Guo likes to use this medicinal at a dose of 30 to 40 grams. However, Huang Qi can warm, upbear, and strengthen fire, and most cancer patients also suffer from yin vacuity. To control Huang Qi's warmth, Prof. Guo combines it with Zhi Mu. Zhi Mu's flavor is bitter and sweet and its nature is cold. Its functions are to clear heat and downbear fire, enrich yin and moisten dryness. This means that Zhi Mu controls and offsets any negative effects of Huang Qi. When Prof. Guo uses this combination to treat qi vacuity downward falling, he prescribes 30 to 40 grams of Huang Qi. If neither cold or heat is marked, he prescribes 15 to 20 grams of Zhi Mu; that is, a ratio of Huang Qi to Zhi Mu of 2:1. If, on the other hand, there is yin vacuity with heat, then he prescribed 30 to 40 grams of Zhi Mu, or a ratio of 1:1.

Xia Ku Cao (Spica Prunellae) and Ban Xia (Rhizoma Pinelliae)

Xia Ku Cao is acrid, bitter, and cold, and it enters the liver and gallbladder channels. Its functions are to clear the liver and drain fire, resolve depression and scatter binding. It is commonly used to treat phlegm fire depression and binding in the case of tumors in the neck region. Ban Xia is acrid and warm. Its functions are to dry dampness and transform phlegm, downbear counterflow and stop vomiting, disperse glomus and scatter binding. It is commonly used to treat welling and flat abscesses and phlegm kernels. When these two medicinals are used together, scattering and binding go hand in hand, and Xia Ku Cao's cold is controlled by Ban Xia's warmth. Hence cold and warm are used simultaneously. They regulate and harmonize the liver and gallbladder, level and balance yin and yang. Many cancer patients suffer from insomnia, and, dating from the Qing dynasty, the combination of these two medicinals has been known to treat insomnia. This is because the combination promotes the interpenetration of yin and yang. In this context, it is said that Ban Xia promotes the engenderment of yin, while Xia Ku Cao promotes the growth of yang. Prof. Guo commonly uses this combination to treat thyroid cancer, breast cancer, and lymphoma. He typically uses Ban Xia at a dose of 10 to 15 grams and Xia Ku Cao at a dose of 15 to 20 grams.

Zi Wan (Radix Asteris) and Dang Gui (Radix Angelicae Sinensis)

Zi Wan is acrid, bitter, and warm, and gathers in the lung channel. Its functions are to moisten the lungs and descend the qi, transform phlegm and stop coughing. Dang Gui is sweet, acrid, and warm. Its functions are to supplement and quicken the blood, moisten the intestine and free the flow of the stools. Zi Wan's nature is warm but not hot and is moistening and not drying. Because its color is purple, it is believed to start or work from the blood aspect from which it then moves upward to moisten the lungs and stop coughing. The lungs and large intestine share a mutual interior-exterior relationship. The lung qi promotes movement so that the bowel qi is automatically free flowing. Because cancer is an enduring condition, many patients suffer from blood vacuity. Therefore, Prof. Guo uses Dang Gui along with Zi Wan to nourish the blood and moisten the intestines in cancer patients with constipation. If there is also qi vacuity, he also adds Huang Qi. If there is also yang vacuity, he adds Rou Cong Rong (Herba cistanchis). If there is also yin vacuity, he adds Xuan Shen (Radix scrophulariae). If blood vacuity is severe, he adds He Shou Wu (Radix polygoni multiflori). In Prof. Guo's experience, the constipation of cancer patients is mainly due to vacuity. Therefore, it is prohibited to attack and drain.

In sum, when Prof. Guo uses this combination to treat constipation in cancer patients, it is because Dang Gui supplements the blood, while Zi Wan descends the qi. Thus the qi and blood are both regulated and constipation is automatically eliminated. For this purpose, Prof. Guo prescribes 30 to 40 grams of Zi Wan to 10 to 15 grams of Dang Gui.

Zhi Shi (Fructus Immaturus Aurantii) and Bai Zhu (Rhizoma Atractylodis Macrocephalae)

Bai Zhu is warm, sweet, and bitter, and enters the spleen and stomach channels. Its functions are to fortify the spleen and boost the qi, dry dampness and disinhibit water. Zhi Shi is bitter, acrid, and slightly cold. It also gathers in the spleen and stomach channels. Its functions are to break the qi and disperse accumulation, transform phlegm and disperse glomus. However, based on a passage from the Shen Nong Ben Cao Jing (Divine Husbandman's Materia Medica Classic) which says that this ingredient boosts the qi, he believes that it has some ability to also supplement the qi and upbear the clear. Prof. Guo combines these two medicinals to treat the pattern of qi stagnation and water stopped below the heart with hardness and fullness. In this case, he uses a large dose of Zhi Shi to a smaller dose of Bai Zhu in order to primarily disperse and secondarily supplement. However, in the pattern of qi stagnation and food stopped in the chest and duct with glomus and fullness, he uses a large dose of Bai Zhu to a smaller dose of Zhi Shi to primarily supplement and secondarily disperse. While fullness and glomus are repletions, he agrees with the Ming dynasty statement that "[In] glomus, there is repletion within vacuity." In cancer patients, it is his experience that it is qi vacuity that leads to the symptom of glomus. Therefore, to treat glomus and fullness in such patients, he uses one medicinal to supplement and the other to disperse. Depending on the relative proportions of vacuity and repletion, he adjusts his relative doses of these two medicinals accordingly. His dose range for each is 10 to 20 grams.

Bai Zhu (Rhizoma Atractylodis Macrocephalae) and Che Qian Zi (Semen Plantaginis)

Che Qian Zi is sweet, bland, and slightly cold. Its functions are that it clears heat and disinhibits urination, seeps dampness and stops diarrhea. In this latter case, it disinhibits the small intestine to replete the large intestine. Bai Zhu is bitter, sweet, and warm, and enters the spleen and stomach channels. After being stir-fried, its functions of fortifying the spleen and drying dampness are markedly increased. This combination is called Fen Shui Dan (Separating Water Elixir). Within this formula (since it is a named formula in its own right), the ratio of Bai Zhu to Che Qian Zi is 2:1. This formula mainly treats watery diarrhea. It is a statement of fact within Chinese medicine that, if dampness is overwhelming (or victorious), this leads to the engenderment of "duck-stool" diarrhea. In this combination, one medicinal dries and the other seeps dampness. Thus their overall effect in eliminating dampness is synergistic and supplemental. However, for watery diarrhea, Prof. Guo prefers to use this combination at a ratio of 1:2, Bai Zhu to Che Qian Zi. This is because Che Qian Zi disinhibits urination without damaging the righteous. As stated previously, in cancer patients, the righteous qi is already typically insufficient. Nevertheless, because Che Qian Zi does not make this vacuity even more vacuous, Prof. Guo uses the double dose of this medicinal to more quickly and effectively rid the body of excess water. For the treatment of watery diarrhea where neither cold or heat are marked, he uses 15 grams of Bai Zhu to 30 grams of Che Qian Zi.

Readers should note that all the above doses are for one day when these medicinals are administered in water-based decoctions.

Copyright [c] Blue Poppy Press, 2009. All rights reserved.

by Bob Flaws, L.Ac., FNAAOM (USA), FRCHM (UK)
COPYRIGHT 2009 The Townsend Letter Group
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2009 Gale, Cengage Learning. All rights reserved.

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Author:Flaws, Bob
Publication:Townsend Letter
Article Type:Clinical report
Geographic Code:9CHIN
Date:Aug 1, 2009
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