The Use of Acupuncture in the Management of Cancer
In TCM hospitals throughout China, herbs are considered the treatment of choice with cancer patients (see other article1). However, in the West not all cancer patients are able or willing to take Chinese herbs, for reasons such as these:
• concern about toxicity
• some patients are not able to tolerate herbs (particularly if their digestive system has already been compromised by chemotherapy)
• concern over the interaction between the herbs and other drugs. Some consultants prohibit their patients from taking herbs during chemotherapy, due to concern over the high level of antioxidants in some herbs
• sometimes a fully qualified and experienced herbalist will not be in the local area.
For all these reasons it is important that acupuncture is offered to those with cancer, because a huge amount can be done with acupuncture to support those with cancer. This article will discuss what acupuncture can realistically achieve.
We will look at two distinct areas:
1. managing the side effects of conventional treatment (chemotherapy, radiotherapy and surgery)
2. addressing the underlying patterns of cancer
Acupuncture treatment usually involves working with both aspects. During conventional treatment, one often has to focus on dealing with its side effects. When this treatment is finished, one can begin to focus more on treating the underlying patterns which led to the cancer developing, in order to help the patient back to full health, and to lessen the chance of recurrence.
Contra-indications and cautions
I have heard it said by several people that cancer patients should not receive acupuncture, as it can “spread the cancer”. There is, as far as I can tell from a fairly extensive literature search, conversations with others, and many years of experience, absolutely no grounds for such an assertion. In my experience, cancer is far more likely to metastasise (spread) when the patient’s overall health deteriorates. If we can give regular, sustained, long term acupuncture, the effects are invariably positive.
Sometimes breast cancer spreads to the underarm lymph tissue, and lymph nodes are removed in this area (indeed they are often removed for cautionary reasons, and to examine the tissue for signs that cancer may have spread). In these cases most consultants will instruct the patient not to receive any needles in the arm on the affected side, in case of infection. Opinion varies as to how long this prohibition stands, so one needs to receive approval from the consultant before needling in this arm.
Opinion also varies about needling around scars following surgery. If in any doubt, one must seek approval from the consultant.
Managing the Side Effects of Conventional Treatment
There are many different kinds of chemotherapy. It can be administered in various ways: a typical protocol is one intravenous dose every three weeks, for six doses. Sometimes chemotherapy is used to try and shrink a tumour, to make it easier to remove by surgery later. Sometimes, surgery is used to take out the tumour first, then chemotherapy is used afterwards, just in case cancer cells have spread around the body. Sometimes chemotherapy is used in “terminal” cases, in order to try and slow down the growth of the tumour and prolong life as much as possible.
Often chemotherapy requires the use of other supporting drugs to attempt to neutralise its side effects: many patients are on a huge cocktail of medications. This makes many herbalists nervous about prescribing herbs in case of interactions: the beauty of acupuncture is that it does not interact with drugs as herbs do.
The energetic effects of chemotherapy
The chemotherapy drugs which are used to kill cancer cells are highly toxic to normal cells too. They affect particularly those cells which have a rapid turnover, such as hair cells, red blood cells, immune cells, and epithelial cells. The latter line the digestive tract, which explains why chemotherapy can induce severe nausea. If we think of soft mucosa as yin tissue, it is easy to see why chemotherapy can cause yin xu. This is reflected in the fact that many patients receiving chemotherapy develop a peeled tongue very quickly. Sometimes the peeling will heal itself, and sometimes it will not.
In terms of TCM, chemotherapy causes toxic heat. This heat destroys the yin, and can also dry the blood. By affecting the spleen, it can also cause qi xu.
Some patients are unable to complete their course of chemotherapy due to its high level of toxicity. Chemotherapy can even prove fatal in some cases. Acupuncture can sometimes help patients complete their course of chemotherapy, which they may otherwise have not been able to do. It can certainly help them to cope with the often severe effects of chemotherapy.
The destruction of digestive epithelial cells we can think of as causing spleen qi xu. In fact, the old category of “spleen yin xu”, which is rarely used now, is very relevant here. It is vital to treat the spleen, because if the spleen is weak the patient cannot generate enough qi to recover. Most cancers involve some degree of spleen qi xu to begin with, making this a crucial area to support.
The weakening of the spleen causes food stagnation. This can result in nausea, constipation, or diarrhoea. Acupuncture is generally quite effective at treating nausea: the Cochrane Collaboration has undertaken a systematic review of acupuncture for nausea, and found electro-acupuncture to be the most effective treatment.2 If treatment is started early, before the spleen becomes too weak, it can be very effective. If the spleen is already weakened by chemo, acupuncture is less effective at treating nausea, constipation and loose stools. If there is little improvement after five treatments, herbs should be considered, although it may be necessary to wait until chemo therapy is over.
Nausea: Neiguan (PC 6) – Daling (PC 7) (electro), Zusanli (ST 36) – Shangjuxu (ST 37) (electro), Sanyinjiao (SP 6) Zhongwan (REN 12) Qihai (REN 6) Pishu (BL 20) Weishu (BL 21) Neiting (ST 44) (nourish spleen and stomach yin)
In addition, choose points depending on the TCM pattern:
Liver invading spleen/ stomach
T: maybe purple sides
Nausea worse with stress
Nausea tends to come and go, and be more severe when present
Taiching (LIV 3) Zhangmen (LIV13) Ganshu (BL 18)
Spleen qi xu
T: swollen and pale
Nausea tends to be more constant, but not so severe
Lack of appetite
Use moxa on Zusani (ST 36) Pishu (BL 20) Weishu (BL 21) and Qihai (REN 6)
Constipation: Yanglingquan (GB 34) Zhigou (SJ 6) Tianshu (ST 25) Qihai (REN 6) Hegu (LI 4)
Diarrhoea: Zhaohai (KID 16) Qihai (REN 6) Zusanli (ST 36) Sanyinjiao (SP 6)
If toxic heat is predominant (smelly, explosive stools, P: wiry/ T: red): add Quchi (LI 11) to clear heat.
If the predominant pattern is spleen not holding (P: weak/ T: pale & swollen): use moxa on Zusanli (ST 36) Pishu (BL 20) Weishu (BL 21) and Qihai (REN 6)
Chemotherapy kills the white blood cells, which provide immunity. Often this effect is so pronounced that the chemotherapy has to be stopped, otherwise the patient’s life can be endangered. Studies undertaken in the US, Japan and elsewhere show that acupuncture can help to maintain and restore white blood cell count.3, 4, 5 Blood samples have been taken before and after acupuncture, and it has been shown that higher levels of certain immune cells exist in the blood after acupuncture.
In terms of TCM, we can say that chemotherapy harms the lung “wei qi” (defensive qi). In such cases it is important to strengthen the lungs. It is also important to boost the spleen and kidneys, as these contribute to the strength of the wei qi. If white blood cells counts are very low, treatment should be given twice or even three times per week until they return to normal. It is important to remember that a severely weakened immune system is a potentially life threatening situation.
Basic treatment protocol:
Zusanli (ST 36) (moxa) Taiyuan (LU 9) Hegu (LI 4) Feishu (BL 13)
If spleen weak, add: Qihai (REN 6) Taibai (SP 3) Sanyinjiao (SP 6) Pishu (BL 20) Weishu (BL 21)
If kidneys weak, add: Guanyuan (REN 4) Taixi (KID 3) Fuliu (KID 7) Shenshu (BL 23)
Common contributory factors in the development of many cancers are liver qi stagnation and toxic heat in the liver. These imbalances are exacerbated by chemotherapy, which can have a very damaging effect on liver function. During chemo it is common to see red spots appearing on the side of the tongue, indicating that liver heat is developing. If the heat is severe the tongue coating can start to become yellow or even brown. This heat can transform into liver blood stasis, and the tongue starts to appear purple. In such cases it is vital to support the liver during chemotherapy. A diagnosis of cancer, as well as the whole process of orthodox treatment, can cause huge stress, so for this reason to, it is vital to soothe the liver. I have found acupuncture to be effective in supporting liver function when it starts early in the process of chemotherapy, preferably several weeks before the chemo is administered. Once the patient has received several doses of chemo, it is much harder to recover function and herbs are usually required.
Toxic heat in the liver
T: red sides/ maybe dirty yellow or brown coat
Ligou (LIV 5) Taichong (LIV 3) Ganshu (BL 18) Quchi (LI 11)
Cupping is recommended, to draw out the toxins. This can be done as slide cupping along the bladder channel, from Fengmen (BL 12) to Dachangshu (BL 25)
Liver blood stagnation
P: wiry/ choppy
Ququan (LIV 8) Taichong (LIV 3) Geshu (BL 17) Ganshu (BL 18)
Chemo commonly kills nerve cells, resulting in numbness/ tingling/ pain in the hands and feet. In TCM terms, this can correspond to blood deficiency. Even where there are no other signs of blood deficiency one should still select points to nourish the blood. Acupuncture can be surprisingly effective at treating the symptoms of neuralgia. However, treatment is often ongoing for many months. Ear acupuncture points can enhance the effectiveness considerably. Again, the earlier in the process the treatment starts the more effective it will be.
Points for blood xu: Ququan (LIV 8) Taichong (LIV 3) Geshu (BL 17) Ganshu (BL 18) Pishu (BL 20) Weishu (BL 21) Zusanli (ST 36)
For the hands use: ba xie; finger tips; PC7; PC8; relevant auricular acupuncture hand points (see Oleson p275 for example6)
For the feet use: ba feng; relevant auricular acupuncture feet points (see Oleson p275 for example)
The energetic effects of radiotherapy
Radiotherapy can be thought of as toxic heat. It can cause severe reddening of the skin and even burns. It has a very heating, drying effect. In TCM terms, it damages yin, body fluids and blood. It can cause heat in the blood. This can interrupt the smooth flow of the blood, causing blood stagnation.
It can cause genetic mutation of normal cells, and in fact can cause cancer itself. In TCM terms, the kidneys are responsible for growth and reproduction, and this includes at the cellular level. Radiotherapy can therefore be said to deplete the kidneys, especially their yin aspect.
Rather than presenting a detailed discussion of the various diseases which can be caused by radiotherapy, which are far too numerous to mention, it is more helpful to present the energetic patterns which one commonly sees, and general treatment principles. Following that, we shall briefly discuss only two common problems, erythema (skin reddening) and lack of salivation (xerostomia).
General Treatment principles
Obviously, one must make a proper TCM diagnosis, to see which particular patterns need addressing. Usually radiotherapy will have a profound effect on the tongue and pulse, and diagnosis is therefore relatively easy.
Clear toxic heat and cool the blood
Quchi (LI 11) Xuehai (SP 10) Geshu (BL 17) Ganshu (BL 18) Taiching (LIV 3); slide cupping along the back shu points
Clear heat from the heart & calm the shen
Often the heat from radiotherapy will overheat the heart. This may affect the shen, causing insomnia, agitation and anxiety. This will worsen the already traumatic emotions resulting from a cancer diagnosis.
Neiguan (PC 6) Daling (PC 7) Shenmen (HT 7) Xinshu (BL 15)
Invigorate the blood
It is crucial to keep the blood moving, in order to prevent any further development or relapse of the cancer.
Geshu (BL 17) Ganshu (BL 18) Ququan (LIV 8) Taiching (LIV 3) Hegu (LI 4) Xuehai (SP 10) Tongli (HT 5)
Nourish yin (liver, kidney and heart)
The yin is often severely depleted by radiotherapy, and one often sees a peeled tongue in such cases. The yin has a nourishing function, so it is vital to support it during radiotherapy and beyond. One must identify which organs have been most affected, and treat accordingly.
Taichong (LIV 3) Zhaohai (KID 6) Shenmen (HT 7) Sanyinjiao (SP 6) Xinshu (BL 15) Ganshu (BL 18) Shenshu (BL 23) Qihai (REN 6)
This is a manifestation of the patient overheating due to the radiotherapy. It can cause considerable distress and discomfort, as well as severe itching and pain. One can distinguish between the shi pattern of heat in the blood, and the xu pattern of liver/ kidney yin deficiency.
Heat in the blood
Sanyinjiao (SP 6) Xuehai (SP 10) Geshu (BL 17) Ganshu (BL 18) Quchi (LI 11)
Liver/ kidney yin deficiency
Zhaohai (KID 6) Sanyinjiao (SP 6) Taiching (LIV 3) Geshu (BL 17) Ganshu (BL 18) Shenshu (BL 23) Quchi (LI 11) Qihai (REN 6)
Xerostomia (dry mouth)
Radiotherapy is commonly used where the tumour is near the surface of the body, and therefore accessible. It is therefore often used in head and neck cancers.
One unfortunate effect is that it kills all or part of the salivary glands. This can be very debilitating, with patients often unable to eat properly. Many have to carry around a bottle of water at all times otherwise their mouth becomes unbearably dry. I have treated people who have to sip water every half hour, which means they are awake for much of the night. This can lead to total exhaustion.
An acupuncture protocol has been developed which is effective at treating this condition. Studies show that around 70% of people respond positively to the treatment8, and this has been my experience too. Several hospitals in the South West of England (Torbay, Plymouth & Exeter) are now using this protocol with cancer patients with this condition, and also reporting good results.
Ear points: shenmen; point 0; salivary point (located at the inter-tragic notch)
Extra point on large intestine channel, on the radial aspect of the distal inter-phalangeal joint of the index finger
This can lead to blood stagnation in the area where the surgery was performed. Often the cancer developed because of blood stagnation, so it is vital to treat this aspect. It is particularly important to address if major meridians have been cut during surgery.
I have found that patients who receive a course of acupuncture before surgery tend to have few complications, and recover quickly. After the surgery, one should continue to ensure that no blood stasis develops.
General points to move blood
In most cases this should be done as a preventative measure before surgery:
Geshu (BL 17) Ganshu (BL 18) Xuehai (SP 10) Ququan (LIV 8)
Following surgery it is important to keep qi flowing in the area. Scar tissue is a block to smooth qi flow, so acupuncture should be used to address this. Needles are placed in a circle around the scar, facing inwards. They should be about 3cm away from the scar, and 3cm away from each other.
If a meridian has been cut, a needle should be placed on the meridian, either side of the scar, about 3cm away from the scar.
One should check with the consultant that they are happy for scar needling to take place, as some are concerned about possible infection. It is obviously especially important to follow correct sterile needling procedures in any case.
Needling can generally be done within a few days of surgery, generally the earlier the better.
A day or two before surgery, a plaster is soaked in capsicum (chilli pepper) tincture and placed on ST36. One South Korean blind controlled trial found that patients who had such plasters needed less morphine and anti nausea drugs following surgery.8
Addressing the Underlying Patterns of Cancer
As with any disorder, various TCM patterns can be identified for each type of cancer, so an accurate diagnosis is essential. However, it is particularly important to address the factors listed below. In addition, one must try to identify which meridian the cancer is on, and clear the channel. We will look in more detail at breast cancer, but the principles are similar for any cancer.
Emotional factors are often important. One should pay particular attention to treating this aspect, using the seven emotions, and the five element correspondences.
A Shi (excess) factors
In modern terms this can correspond to a high level of chemicals, environmental pollutants, oestrogen in the water supply and in meat, and food toxins such as refined food and saturated fats. The presence of such toxins may cause genetic mutations, thus contributing to cancer. It is vital to clear these toxins to allow the body to recover, and prevent recurrence of cancer.
One of the best ways to clear toxins is by slide cupping along the bladder channel on the back, covering all the back shu points. In addition one can needle Quchi (LI 11) Hegu (LI 4) and Ligou (LIV 5).
This is a major contributory factor with many cancers. It can correspond to platelet aggregation, and impairment of the micro-circulation. This prevents cells releasing toxins, and also prevents them taking in adequate nutrients and oxygen, thus contributing towards the development of cancer. One should use standard points to move blood:
Xuehai (SP 10) Daling (PC 7) Geshu (BL 17) Ganshu (BL 18) Taiching (LIV 3) Ququan (LIV 8)
The accumulation of phlegm contributes to many cancers. If this is caused by a weak digestion (spleen), then tonification is also necessary. One can use:
Jianshi (PC 5) (indicated for phlegm in the upper body) Zusanli (ST 36) Sanyinjiao (SP 6) Yinlingquan (SP 9) Fenglong (ST 40) Pishu (BL 20) Weishu (BL 21)
B Xu (deficiency) factors
Cancer is often considered to be a disease of excess, and indeed the tumour itself is an excess by definition. However, there is always an underlying deficiency too. It is therefore vital to apply appropriate tonification.
Many, perhaps most, cancers develop against a background of exhaustion, implying qi xu. I have seen numerous cases of people who developed cancer after prolonged periods of overwork and a lack of proper rest. It is vital to educate people that overwork may have contributed to the development of their cancer, and that they must learn to slow down and take proper rest. Some kind of spiritual practice is very helpful to allow the person to “switch off” from everyday concerns, and find some kind of peace.
Spleen qi deficiency can lead to the accumulation of phlegm based cancers. This corresponds to the digestive system not extracting nutrients properly, and waste products being stored in the cells. Over time, phlegm can block the flow of qi, causing stagnation and toxic heat to accumulate.
The kidneys are responsible for growth and reproduction, and this can be thought of on a cellular level. If there is deficiency of the kidneys, the cells cannot reproduce accurately, and mutation occurs.
It is important to identify the most qi deficient organ, which is usually either the spleen or the kidneys.
This pattern is often involved in cancers of the upper body, such as lung, head and neck. Yin has a nourishing, moistening function, and when it is weak the tissues become irritated, dry, and inflamed.
Key points to nourish the yin include:
Sanyinjiao (SP 6) Kongzui (LU 6) Zhaohai (KID 6) Qihai (REN 6)
It is important to identify the cause of the blood xu: is it inadequate nutrients in the diet, or spleen qi deficiency? Unless proper nutrients are taken in, one cannot properly tonify the blood. In the absence of herbs, diet is crucial. My book provides lists of key foods to strengthen the blood.
Blood deficiency can lead to blood stagnation, a common pattern in many cancers.
Key points to nourish the blood include:
Geshu (BL 17) Ganshu (BL 18) Pishu (BL 20) Weishu (BL 21) Xuehai (SP 10) Ququan (LIV 8)
Treating the channel
As well as identifying which organs are involved, one must identify the channel affected. It is a question of looking at the site of the cancer and seeing which channel it is on. Obviously this is much easier for cancers near the surface, such a breast cancer. In some cases it is obvious by the type of cancer, for example lung and liver cancers involve the lung and liver respectively.
Channels commonly affected in breast cancer include the stomach, liver, and spleen.
Channels commonly affected in cancers of the head and neck include the kidney and stomach.
Points should be selected which clear the appropriate channel.
Electro – acupuncture can be used at a frequency of 2Hz, at which cancer cells do not thrive.
Some common patterns seen in breast cancer
We have not the space to discuss the various patterns of all kinds of cancers. However, by discussing one kind of cancer we will illustrate the general principles which can be followed. It is assumed that the reader can identify these patterns using standard TCM disease differentiation, and knows the standard points to use to treat them. Obviously in real life cases there will probably be a combination of more than one pattern. In addition, one must also treat the symptoms caused by the conventional therapy. There is always a balance to be struck between fighting symptoms and relieving short term suffering on the one hand, and addressing the underlying patterns on the other.
Kidney yang deficiency
Remember that the kidney meridian passes between the breasts. In addition, the kidneys govern reproduction, growth, and development, so are often involved in cancer. This pattern in commonly seen where there is total exhaustion. This may have been a cause of the cancer developing, or it may be a result of the weakening effect of the cancer, or of chemo/ radio therapy. It is often seen in late stage cancer, and is particularly difficult to address. This is partly because the “zhi”, the will, is undermined when the kidneys are weak, undermining the patient’s motivation to recover.
When the yang is weak, the kidneys are unable to metabolise the fluids properly, leading to the build up of phlegm. The yang also loses its ability to move, and can contribute to blood stagnation.
Kidney yin deficiency
This pattern is often seen in post menopausal women. Often the upper body, including the breasts, is over heated, dry, and undernourished.
Liver yin deficiency
As with kidney yin deficiency, this is often seen in post menopausal women. It is often seen in cases of prolonged stress, frustration, anger, or emotional upheaval. The liver channel crosses the breasts, and has a major influence on them.
Liver qi stagnation
This can result from the liver yin deficiency just mentioned, or it can cause the liver yin deficiency. The qi stagnation can, in turn, cause blood stagnation in the breast area. Breast cancers involving blood stagnation tend to be hard to the touch (as opposed to phlegm based breast cancers, which are softer).
When the liver qi is stagnant it can invade the spleen and/ or stomach, whose channels also traverse the breast. With this pattern there is sometimes a history of soft lumps appearing before the menses: the liver qi stagnation has prevented the proper dispersal of fluids, causing phlegm. This pattern is more likely when the spleen/ stomach qi is weak.
Spleen/ stomach qi deficiency
This can cause the build up of phlegm in the breasts. In addition, it causes a general lack of qi, undermining the body’s vitality. The spleen is involved in the production of the defensive qi (“wei qi”), and when this is weakened the body’s ability to fight the cancer is undermined. Often, the spleen does not produce enough blood, causing liver blood deficiency, and/ or liver yin deficiency, leading to the pattern discussed above. This in turn can cause liver stagnation, which in turn causes the liver to invade the spleen, weakening it still further.
If the liver is stagnant over an extended period, toxic heat can accumulate. Stagnation interferes with the proper movement of toxins out of the cells, and of nutrients and oxygen into the cells. The lack of nutrients and oxygen, combined with the build up of chemicals which can cause cellular mutation, can predispose the individual to cancer.
Kate is aged 52. In January 2009 she was diagnosed with a malign breast tumour of about 15mm. In the two years leading up to the cancer she had been working very hard, involving a lot of international travelling. She had become obsessed with working hard and succeeding in her career. She has a son aged 18, and was divorced from the father about 10 years ago. She has suffered from depression at times.
The tumour was on her liver channel. Her pulse was thin and wiry, and weak in the kidney position. Her tongue was purple, and became peeled during chemotherapy. Her TCM diagnosis was liver blood deficiency and liver qi stagnation, leading to blood stagnation in the breast. There was also kidney qi and yin deficiency.
She immediately began chemotherapy, which made her feel very nauseous. The acupuncture was quite effective at treating this however (SP6 LV3 Ren6 Ren12 PC6; auricular points: stomach, liver, shen men, point zero).
She also experienced kidney ache, but again this subsided following each acupuncture treatment (Shenshu BL 23 Mingmen DU4 Taixi KID 3).
The chemo was successful in reducing the size of the tumour considerably, and a lumpectomy was performed in September 2009.
The lumpectomy, combined with the hair loss from chemotherapy, led to her feeling depressed. This was treated with an auricular acupuncture protocol which I have found to be very effective for depression: brain, excitement, master cerebral, nervousness, shen men, point zero. Her mood lifted considerably after only one treatment, whereas in the past her depression usually lasted for months.
Throughout the time of treatment, when the symptoms were not too severe, I used points to tonify the liver and kidneys, and points to move qi and blood (Ququan LIV 8 Taiching LIV 3 Fuliu KID 7 Taixi KID 3 Xuehai SP 10 Ximen PC 4 Neiguan PC 6 Geshu BL 17 Ganshu BL 18 Pishu BL 20 Weishu BL 21 Shenshu BL 23 Qihai REN 6 Mingmen DU 4).
The consultant was very pleased with the speed of her recovery following surgery. However, following further investigation it was found that she had a small tumour on one of her ribs. The consultant viewed this very negatively, and told her in cases where the breast cancer which has spread the mean survival time is only five years.
This “prognosis” had a very negative effect on her and sent her into a state of shock and depression.
Note: certain minor details have been changed, including the name, to protect the identity of the patient.
There is much that we can do with acupuncture to help relieve the suffering of those with cancer. We can both help control the side effects of conventional medicine, and help to address the underlying patterns which led to the cancer developing. We strive to help people maximise their life span, and also to make that life of the best possible quality.
Henry McGrath lives in Bristol, UK, where he runs his own practice and also works at Penny Brohn Cancer Care. He is the Acupuncture Course Director for the College of Naturopathic Medicine. He has been studying and practicing oriental medicine since the early nineties, and has undertaken placements in the herbal medicine oncology departments of several Chinese hospitals in Nanjing and Beijing. His book “Traditional Chinese Medicine Approaches to Cancer: Harmony in the Face of the Tiger”, is published by Jessica Kingsley Publishers, priced £12.99. Henry can be contacted at: firstname.lastname@example.org
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