Integrative Tumor Board
6. Tisdale MJ. Wasting in cancer. J Nutr. 1999;129(1S Suppl):243S-
246S.
7. Crown J. Evolution in the treatment of advanced breast cancer.
Semin Oncol. 1998;25(5 Suppl 12):12-17.
8. Brugnatelli S, Riccardi A, Danova M, et al. Sequential docetaxel
and vinorelbine for patients with advanced breast cancer previ-
ously treated with anthracyclines: a phase II study. Oncol
Rep.2001;8(4):801-805.
9. Kornek GV, Ulrich-Pur H, Penz M, et al. Treatment of advanced
breast cancer with vinorelbine and docetaxel with or without
human granulocyte colony-stimulating factor. J Clin Oncol.
2001;19(3):621-627.
10. Perkins JB, Fields KK, Elfenbein GJ. Ifosfamide/carboplatin/
etoposide chemotherapy for metastatic breast cancer with or
without autologous hematopoietic stem cell transplantation:
evaluation of dose-response relationships. Semin Oncol.
1995;22(Suppl 7):5-8.
11. Tisdale MJ. Cancer anorexia and cachexia. Nutrition.
2001;17(5):438-442.
12. al-Majid S, McCarthy DO. Cancer-induced fatigue and skeletal
muscle wasting: the role of exercise. Biol Res Nurs. 2001;2(3):
186-197.
13. Roubenoff R, Wilson IB. Effect of resistance training on self-
reported physical functioning in HIV infection. Med Sci Sports
Exerc. 2001;33(11):1811-1817.
14. Roubenoff R. Acquired immunodeficiency syndrome wasting,
functional performance, and quality of life. Am J Manag Care.
2000;6(9):1003-1016.
15. Agin D, Gallagher D, Wang J, et al. Effects of whey protein and
resistance exercise on body cell mass, muscle strength, and
quality of life in women with HIV. AIDS. 2001;15(18):2431-
2440.
16. Quella SK, Loprinzi CL, Barton DL, et al. Evaluation of soy
phytoestrogens for the treatment of hot flashes in breast can-
cer survivors: a North Central Cancer Treatment Group Trial. J
Clin Oncol. 2000;18(5):1068-1074.
17. Allred CD, Allred KF, Ju YH, et al. Soy diets containing varying
amounts of genistein stimulate growth of estrogen-dependent
(MCF-7) tumors in a dose-dependent manner. Cancer Res.
2001;61(13):5045-5050.
18. Nakagawa H, Yamamoto D, Kiyozuka Y, et al. Effects of
genistein and synergistic action in combination with
eicosapentaenoic acid on the growth of breast cancer cell lines.
J Cancer Res Clin Oncol. 2000;126(8):448-454.
19. Messina MJ, Loprinzi CL. Soy for breast cancer survivors: a criti-
cal review of the literature. J Nutr. 2001;131(11 Suppl):3095S-
108S.
20. This P, De La Rochefordiere A, Clough K, et al. Phytoestrogens
after breast cancer. Endocr Relat Cancer. 2001;8(2):129-134.
21. Petilli M, Fiorelli G, Benvenuti S. Interactions between
ipriflavone and the estrogen receptor. Calcif Tissue Int.
1995;56(2):160-165.
22. Kuiper GG, Lemmen JG, Carlsson B, et al. Interaction of estro-
genic chemicals and phytoestrogens with estrogen receptor
beta. Endocrinology. 1998;139(10):4252-4263.
23. Chen I, McDougal A, Wang F, et al. Aryl hydrocarbon receptor-
mediated antiestrogenic and antitumorigenic activity of
diindolylmethane. Carcinogenesis. 1998;19:1631-1639.
24. Ge X, Yannai S, Rennert G, et al. 3,3¢-diindolylmethane
induces apoptosis in human cancer cells. Biochem Biophys Res
Commun. 1996;228:153-158.
25. Meng Q, Goldberg ID, Rosen EM, et al. Inhibitory effects of
indole-3-carbinol on invasion and migration in human breast
cancer cells. Breast Cancer Res Treat. 2000;63(2):147-152.
26. Recchia F, Sica G, de Filippis S, et al. Interferon-beta, retinoids,
and tamoxifen in the treatment of metastatic breast cancer: a
phase II study. J Interferon Cytokine Res. 1995;15:605-610.
192
27. Fraker LD, Halter SA, Forbes JT. Growth inhibition by retinol of
a human breast carcinoma cell line in vitro and in athymic
mice. Cancer Res. 1984;44:5757-5763.
28. Charpentier A, Simmons-Menchaca M, Yu W, et al. RRR-alpha-
tocopheryl succinate enhances TGF-beta 1, -beta 2, and -beta 3
and TGF-beta R-II expression by human MDA-MB-435 breast
cancer cells. Nutr Cancer. 1996;26:237-250.
29. Dai J, Ram PT, Yuan L, et al. Transcriptional repression of ROR
alpha activity in human breast cancer cells by melatonin. Mol
Cell Endocrinol. 2001;176(1-2):111-120.
30. Eur J Cancer. 1996;32A;1340-1343.
31. Liao S, Umekita Y, Guo J, et al. Growth inhibition and regres-
sion of human prostate and breast tumors in athymic mice by
tea epigallocatechin gallate. Cancer Lett. 1995;96(2):239-243.
Timothy C. Birdsall, ND
Shauna Rey, ND
Julie Martin, ND
Michelle Rogers, ND
Department of Naturopathic Medicine
Cancer Treatment Centers of America at Midwestern
Regional Medical Center
2520 Elisha Avenue
Zion, IL 60046
Traditional Chinese Medicine Analysis
The current case study of a female, age 51, with breast
cancer, is especially well suited for a Traditional Chi-
nese Medicine (TCM) approach because the clinical
data provided is relatively detailed; enough relevant
symptoms and clinical signs are described to permit
differential assessment of at least the major categories
of TCM syndromes with a high level of certainty. Most
of the TCM syndromes typical of individuals with
cancer1 are present to some degree in the present case,
making this a nearly textbook example of common el-
ements involved in designing a clinical strategy and
herbal formula for such individuals. One should note,
however, that wide variations in the manifestation of
cancer from this textbook-like case are possible; in
such cases, the correct strategy may differ considerably
from that outlined here. For readers unfamiliar with
TCM terminology, the authors’ article elsewhere in
1
this issue may provide some clarification.
TCM Syndrome Assessment
TCM syndromes relevant to this case of a female, age
51, with breast cancer, are listed below, followed in pa-
rentheses by a magnitude estimate from 0 to 7, fol-
lowed by a list of specific symptoms that provide
evidence for the syndrome according to the rules and
definitions of traditional Chinese health care. Magni-
tude estimates are scalar indicators related to both the
likelihood that a syndrome validly describes aspects of
the case and its relative magnitude or intensity; the
higher the number, the more probable is the syn-
drome and the greater its intensity. Rules of inference
INTEGRATIVE CANCER THERAPIES 1(2); 2002

based on correlation of individual symptoms and
symptom clusters with specific syndromes provides the
2
basis for deriving these estimates.
Notes
(1) terminology used in a TCM context is generally capitalized to
distinguish from ordinary colloquial or medical usage; (2) in the fol-
lowing analysis of syndromes, parenthetical comments preceded by
question marks call attention to symptoms and clinical signs for
which the TCM interpretation may not be clear, due either to inade-
quate detail in the original case history or to lack of confirming
evidence.
Deficiency Qualities or Syndromes
(a1). Deficiency of Yang (magnitude 7): Fatigue; feels
“cold to the bone”; prefers room temperature or warm
drinks; frequent, profuse urination, sometimes leaks
urine when coughing; chemotherapy gives her loose,
watery stools; sensation of chills at night; voice quality
low, soft, and slow; tongue tissue pale and thin; tongue
coating very thin, white; pulses generally weak; L1, R1,
R3 pulse positions are weak-wide-fuzzy in quality;
hypothyroidism.
(a2). Deficiency of Qi (magnitude 6): Fatigue; voice
quality low, soft, and slow; tongue tissue pale and thin;
tongue coating very thin, white; pulses generally weak;
L1, R1, R3 pulse positions are weak-wide-fuzzy in qual-
ity; hypothyroidism.
Predominant Organs Affected by
Deficiency of Yang and of Qi
(1) Kidney/Urinary-Bladder: Frequent, profuse uri-
nation, sometimes leaks urine when coughing; hypo-
thyroidism; R3 pulse weak-wide-fuzzy.
(2) Spleen: Poor appetite, has to force herself to eat;
chemotherapy gives her loose, watery stools; R2 pulse
weak-wide-fuzzy.
(3) Probably Lungs: Chemotherapy depresses immune
system—weakened Protective Qi.
(b). Deficiency of Blood (magnitude 7): Lost 10
pounds in the last year (?currently underweight?); fin-
gertips crack and bleed after chemotherapy; painful
intercourse due to dryness, without relief from lubri-
cating gels; dizziness (?if due to anemia, it is likely that
this type of “dizziness” is due to the faintness associ-
ated with orthostatic hypotension, in contrast to rota-
tory vertigo or disequilibrium); difficulty falling
asleep; tongue tissue pale, dry, and thin; tongue coat-
ing very thin, white; pulses generally weak; L2, L3, R2
pulse positions are weak-narrow-distinct in quality.
INTEGRATIVE CANCER THERAPIES 1(2); 2002
Advanced Breast Cancer
Predominant Organs Affected
by Deficiency of Blood
(1) Liver: Painful intercourse due to dryness, and
without relief from lubricating gels; orthostatic
hypotension due to anemia; plus the consideration
that TCM theory indicates Liver to be primary organ
affected by a significant Deficiency of Blood.
(2) Middle Burner (includes Organs of Liver, Stomach,
Spleen, and Gall Bladder): L2, R2 pulse positions are
weak-narrow-distinct in quality.
(3) Heart: L1, R1 pulse positions are weak-wide-fuzzy
in quality; difficulty falling asleep.
(c). Deficiency of Yin (magnitude 4): Sensation of
excessive body warmth, only during chemotherapy
treatments; lack of perspiration for last 3 years—even
when hot outside cannot sweat; excessive thirst previ-
ous 2 years, drinks a lot; lost 10 pounds in the last year
(?currently underweight?); fingertips crack and bleed
after chemotherapy; painful intercourse due to dry-
ness, without relief from lubricating gels; sleeps rest-
lessly only 6 hours per night, claims to have no dreams,
but difficulty falling asleep and tendency to reawaken;
tongue tissue dry and thin; tongue coating very thin,
white with longitudinal yellow bands on both sides of
the midline; pulses generally weak; L2, L3, R2 pulse
positions are weak-narrow-distinct in quality.
Predominant Organs Affected
by Deficiency of Yin
(1) Kidney: Excessive thirst; underweight; painful
intercourse due to dryness; plus the consideration
that TCM theory indicates kidney to be primary organ
affected by a significant deficiency of yin; L3 pulse
position is weak-narrow-distinct in quality.
(2) Heart: Sleeps restlessly only 6 hours per night,
tendency to reawaken.
(3) Stomach: Poor appetite; has to force herself to
eat; tongue tissue dry and thin; tongue coating very
thin; R2 pulse position is weak-narrow-distinct in
quality.
Comments: Deficiency of Yin was assigned a magni-
tude of only 4 relative to the Deficiency of Yang, Qi,
and Blood, because several important indicators of
severe Deficiency of Yin are absent: night sweats,
noticeable fissures of tongue tissues, reddish hue to
tongue tissue, rapid pulse. Additionally, the sensations
193
 Integrative Tumor Board
of heat are felt only during the chemotherapy, and not
at other times.
Excess Qualities or Syndromes
(a1). Stagnation of Blood (magnitude 7): Dark red
small dots appear after chemotherapy (where on body
surface?—location may have significance related to
internal organs and acupuncture meridians affected,
similar to phenomena of referred pain); hip pain due
to tumor; prior history of irregular periods,
premenstrual bloating, breast tenderness and swell-
ing, and anger; occasionally angers easily; pulse posi-
tion L2 choppy in quality; sciatica.
Predominant Organs Affected
by Stagnation of Blood
Liver: Premenstrual bloating, breast tenderness
and swelling, and anger; occasionally angers easily;
pulse position L2 choppy in quality; plus the consider-
ation that TCM theory indicates Liver to be primary
Organ affected by significant Stagnation of Blood.
(a2). Stagnation of Qi (magnitude 7): Lack of perspira-
tion for last 3 years —even when hot outside, cannot
sweat; prior history of irregular periods, premenstrual
bloating, breast tenderness and swelling, and anger;
occasionally angers easily; pulse position L2 is choppy
in quality, and position R1 palpated pulse duration is
short; nausea, vomiting, and cramping during men-
ses; sciatica.
Predominant Organs Affected
by Stagnation of Qi
Liver: Premenstrual bloating, breast tenderness and
swelling, and anger; occasionally angers easily; pulse
position L2 choppy in quality; nausea and vomiting
during menses—suggests “Liver Invading Stomach/
Spleen” syndrome; cramping during menses; plus the
consideration that TCM theory indicates Liver to be
primary Organ affected by significant Stagnation of
Blood.
(b). Excess-Heat (magnitude 3): Sensation of excessive
body warmth, only during chemotherapy treatments;
excessive thirst previous 2 years, drinks a lot; tongue
coating with longitudinal yellow bands on both sides
of the midline.
Predominant Organs Affected by Excess-Heat: In this
case, the Excess-Heat is difficult to localize to any spe-
cific subset of Organs or body regions, because of the
194
lack of symptoms characteristic of specific Organs or
body locations. The distribution of the yellow tongue
coating, by itself, suggests that the Excess-Heat is sys-
temic but low-grade. This conclusion would be consis-
tent with the presence of chronic systemic infections
(bacterial, viral, fungal, parasitic) in people with can-
cer who have received radiation and conventional che-
motherapy, which are very destructive to the immune
system as well as other body systems.
Comments: Excess-Heat was assigned a magnitude of
only 3, because several important indicators of Excess-
Heat are absent: reddish tongue tissue, thick tongue
coating, continual feverishness or sensation of heat,
rapid pulse rate.
(c). Dampness/Phlegm (magnitude 2): Fatigue; nau-
sea and vomiting during chemotherapy only; chronic
sinus problems—copious, clear, thin, runny mucous
during chemotherapy; L1, R1, R3 pulse positions have
fuzzy or indistinct boundaries to the pulse pressure
profiles.
Comments: Dampness/Phlegm was assigned a magni-
tude of 2, because although the preceding listed symp-
toms are not reliable indicators of Dampness/
Phlegm, the weakness of Spleen Qi and Yang would
make this a likely possibility; weak Spleen function is a
common etiologic factor in the development of
Dampness/Phlegm syndromes. Fatigue can also be
explained in this case by Deficiency of Yang and of Qi,
and sinus discharge can be present in allergic condi-
tions or during onset of upper respiratory infections
without necessarily indicating a true condition of Inte-
rior Dampness/Phlegm. More typical symptom-sign
indicators of Phlegm include slippery pulse quality
and a tongue coating that is thick and greasy or slimy
in appearance. It is possible, however, that in cases of
severe exhaustion, for which the various Deficiency
syndromes will predominate, that manifestations of
Phlegm may become “hidden” and only manifest as
clear symptoms and signs once the Deficiencies are
resolved and the individual’s vitality improves.
Assessment Summary
Deficiency Aspects
(a) Deficiency of Yang (magnitude 7) and Deficiency of
Qi (magnitude 6): of Kidney/Urinary-Bladder, Spleen,
Lungs.
(b) Deficiency of Blood (magnitude 7): of Liver, Middle
Burner, Heart.
(c) Deficiency of Yin (magnitude 4): of Kidney, Heart,
Stomach.
INTEGRATIVE CANCER THERAPIES 1(2); 2002

Excess Aspects
(a) Stagnation of Blood (magnitude 7) and Stagnation of
Qi (magnitude 7): of Liver.
(b) Excess-Heat (magnitude 3): possibly systemic.
(c) Dampness/Phlegm (magnitude 2).
Recommended Clinical Strategy
There is a general principle in TCM theory that one
must resolve Excess conditions before tonifying or re-
solving Deficiencies. If physical blockages prevent nu-
trients or other substances from reaching target cells
or tissues, overloading the body with nutrients may
place an added burden on excretory systems of the
body as the surplus is metabolized and excreted. As an
example of this type of misguided strategy, if an indi-
vidual with cancer is characterized by severe Deficien-
cies including weight loss and a weakened digestive
system, it makes no sense to force feed them rich meat
dishes when they will only get indigestion; such a strat-
egy risks creating additional systemic toxicity and in-
creased tumor growth. Another common example is
the problem of dealing with systemic staphylococcus
infections, which have a tendency to sequester them-
selves in encapsulated pockets that are difficult to
reach with antibiotics. In such cases, it makes sense to
supplement antibiotics (either medicinal or herbal)
with herbs that help to break through the encapsula-
tions, such as Myrrha and Cx Moutan Radicis, which
are classified as “blood-invigorators” and can help to
safely resolve blood clots and soften scar tissue and tu-
mors.
In this clinical case, there are severe Deficiency
aspects combined with severe excess aspects, primarily
Stagnation of Blood and of Qi, and to a lesser degree,
systemic Excess-Heat. Applying the rule of removing
Excess before resolving Deficiency, in practice means
that we must place greater emphasis on removing
Stagnation of Blood and Qi, but if we ignore the Defi-
ciencies altogether, the body may become danger-
ously weakened, and we cannot afford to do this
either. Chemotherapy is an example of what would be
classified as an “attacking” (clearing Excess) strategy
in TCM, and the debilitating side effects of nausea,
vomiting, weakness, livers, and kidney damage are well
known. Ideally, supportive strategies to tonify the Qi,
Blood, and Yin can help to counteract many of these
severe side effects. The recommended initial strategy
at this point will be to use herbs that resolve Stagnation
of Blood and Qi, but simultaneously and to a some-
what lesser degree, support the Yang, Qi, Blood, and
Yin in the approximate proportions (see magnitude
estimates in “Assessment Summary”) in which they are
Deficient. To a lesser degree, we must also clear and
resolve the Excess-Heat.
INTEGRATIVE CANCER THERAPIES 1(2); 2002
Advanced Breast Cancer
Recommended Herbal Formula
Doses of each recommended ingredient are in grams/
day. For optimal effectiveness, most of the herbs below
would be combined and water decoctions (slow cook-
ing) prepared for several days at a time. Abbreviations
used include Cx = cortex or bark; Hb = herb (whole
plant); Rx = root; Rz = rhizome; S = seed; Rml = branch
or twigs (see Note below regarding herb names.
For complete listings of botanical species that are
considered equivalent for purposes of clinical usage
and for optimal preparation and cooking, see refer-
3-5
ences by Bensky and Wicke.
Goals and Composition of Herbal Formula
The following tonify Yang (magnitude 7) and Qi (mag-
nitude 6) of the Kidney/Urinary-Bladder, Spleen, Lungs
and warm Interior:
Rx Astragali (huang qi), 18 g,
Rx Aconiti Carmichaeli Praeparata (fu zi), 5 g,
Rx Codonopsis (dang shen), 6 g.
The large dose of Rx Astragali will support the Pro-
tective Qi and enhance immune response. Rx Aconiti
Carmichaeli Praeparata strongly warms the interior
and counteracts feelings of cold that penetrates “to
the bone”; the specially processed variety recom-
mended here has a much reduced toxicity relative to
untreated aconite root; aconite stimulates adrenal
hormone secretion and is a cardiotonic. Rx Codonopsis
tonifies Qi and improves vitality levels.
The following tonify Blood (magnitude 7) of the
Liver, Middle Burner, and Heart:
Rx Angelicae Sinensis (dang gui), 5 g,
Rx Rehmanniae Glutinosae Conquitae (shu di huang),
4 g.
Both Rx Angelicae Sinensis and Rx Rehmanniae
Glutinosae Conquitae strongly tonify Blood. Tonifying
the Blood and the Yin should help improve sleep; the
insomnia in this case is associated with Deficiency of
both Blood and Yin of the Heart. The large dose of Rx
Astragali will assist Rx Angelicae Sinensis in tonifying
the blood; these two herbs constitute a traditional for-
5
mula called “Tangkuei Decoction to Tonify the Blood”.
The following tonify Yin (magnitude 4) of the Kid-
ney, Heart, and Stomach:
Rx Trichosanthis (tian hua fen), 5 g,
Carapax Amydae (bie jia), 15 g.
Rx Trichosanthis will moisten Fluids, alleviate thirst,
and also help to channel the effect of other herbs to
195
 Integrative Tumor Board
the breast region. Carapax Amydae tonifies Kidney
Yin and softens tumors and hard masses.
The following invigorate the Blood and circulate Qi
(magnitude 7) of the Liver:
Rx Bupleuri (chai hu), 5 g,
Tuber Curcumae Zedoariae (e zhu), 3 g,
Rz Sparganii (san leng), 3 g,
Eupolyphaga (di bie chong), 3 g,
Myrrha (mo yao), 3 g,
Rx Sausurreae (mu xiang), 4 g,
Pseudoginseng (san qi), 3 g.
Rx Bupleuri is said to “dredge” the Qi of the Liver,
and is also useful when Liver Qi is stagnant due to emo-
tional factors, such as tendency to anger easily. Tuber
Curcumae Zedoariae and Rz Sparganii are commonly
used together in many different types of cancer, espe-
cially in those cases where Stagnation of Blood is a
major factor. Eupolyphaga and Myrrha also invigorate
Blood circulation and help to resolve tumors.
Pseudoginseng, although it also invigorates Blood, is
added to buffer the possibly harsh effects of the other
Blood-invigorating herbs and to counteract a ten-
dency toward bleeding. The symptom of frequent
nosebleeds suggests a pattern called “Spleen Not
Holding Blood”, which will hopefully be minimized by
the herbs listed under “Tonify Yang and Qi”; but if this
is not adequate, pseudoginseng should further dimin-
ish the likelihood of bleeding, as it enhances the nor-
mal clotting mechanism at the same time that it
promotes lysozymal activity necessary to break down
blood clots. (For this reason, and its relative safety and
low toxicity, it is commonly used before and during
surgical procedures in China.)
For examples of Blood-invigorating formulas that
have similar properties and/or ingredients to the
Blood-invigorating section of the formula recom-
mended in this case, see “Rhubarb and Eupolyphaga
Pill”, “Tonify Yang to Restore Five Decoction”, “drive
Out Stasis in the Mansion of the Blood Decoction”,
and “Corydalis Decoction”.5
The following clear Excess-Heat (magnitude 3):
Rx Anemarrhenae (zhi mu), 4 g,
Hb Solani Nigri (long kui), 5 g,
Hb Oldenlandiae Diffusae (bai hua she shi cao), 25 g.
Rx Anemarrhenae is the herb of choice whenever
there is deficiency of yin in combination with systemic
Excess-Heat; it possesses antimicrobial activity against
Staphylococcus aureus, Salmonella typhi, E. coli, Bacillus
subtilis, Vibrio cholerae, and many pathogenic derma-
tomycoses. Hb Solani Nigri and Hb Oldenlandiae
Diffusae help to clear Heat; both have significant
196
anticancer effects. Hb Oldenlandiae Diffusae acts pri-
marily by stimulating white blood cell activity rather
than directly attacking cancer cells.
Additional herbs for occasional or optional use
include:
S Coicis (yi yi ren), 12 g,
S Vaccariae (wang bu liu xing), 5 g,
Cx Albizziae (he huan pi), 6 g,
Rml Cinnamomi (gui zhi), 4 g,
Hb Annona Muriata, 5 g.
S Coicis may be used to gently firm up the stools
when these are loose; it strengthens Spleen Qi and
gently drains Damp Heat; it also has mild but signifi-
cant effects in preventing certain types of cancers if
taken regularly over long periods of time. It would be
especially useful during and immediately after chemo-
therapy, as it is bland tasting and easily digested, is sim-
ilar to rice in cooking procedure and texture, can be
eaten with other food, and will help to counteract the
severe diarrhea that sometimes results from
chemotherapy.
S Vaccariae and Cx Albizziae both invigorate Blood.
S Vaccariae is specific for Stagnation of Blood in the
breast region. Cx Albizziae also has a calming action
and improves sleep in conditions of Stagnation of
Liver Qi associated with suppressed emotions, resent-
ment, and anger.
Rml Cinnamomi may be added to the formula if a
stronger action of tonifying the Heart Yang, improv-
ing peripheral circulation, and warming the extremi-
ties is desired.
Hb Annona Muriata (graviola) is a South American
herb that would probably be classified in the TCM cat-
egory of herbs that “clear Heat and Toxicity”, and
might be used here to complement Hb Solani Nigri
and Hb Oldenlandiae Diffusae. Data published within
6
recent years suggest that this may be a promising
anticancer herb. The authors’ limited experience with
this particular herb suggests that it should be used
intermittently to give the Spleen Qi a chance to recover,
as it tends to inhibit digestive Qi, which is a common
side effect of other herbs in the “Clear Heat and Tox-
icity” category.
Comments and Precautions
At least several effects of this formula would typically
be evident within several days. At that time, the total
clinical picture should be reevaluated for the follow-
ing possibilities:
(a) If digestive complaints develop, such as abdominal
bloating or nausea, or development of thick tongue
coating, the tonification aspects probably need to be
INTEGRATIVE CANCER THERAPIES 1(2); 2002

Table 1. Complete Herbal Formula
Quantity to
Be Taken
Herb (grams/day)
Rx Astragali (huang qi) 18
Rx Aconiti Carmichaeli Praeparata (fu zi) 5 (c) Avoid all sources containing soy and soy derivatives,
Rx Codonopsis (dang shen) 6
Rx Angelicae Sinensis (dang gui) 5
Rx Rehmanniae Glutinosae Conquitae (shu di huang) 4 concerning the purported health benefits of soy, we
Rx Trichosanthis (tian hua fen) 5 have witnessed soy consumption to frequently result
Carapax Amydae (bie jia) 15
Rx Bupleuri (chai hu) 5
Tuber Curcumae Zedoariae (e zhu) 3
Rz Sparganii (san leng) 3 of cancers.7 From a TCM perspective, soy products
Eupolyphaga (tu bie chong) 3 tend to aggravate or induce Stagnation of Qi and
Myrrha (mo yao) 3 Blood, Phlegm/Dampness, and Deficiency of Qi and
Rx Sausurreae (mu xiang) 4
Pseudoginseng (san qi) 3
Rx Anemarrhenae (zhi mu) 4 (d)Avoid eating late at night. The last meal of the day
Hb Solani Nigri (long kui) 5 should be relatively light and no later than 6 PM. It is
Hb Oldenlandiae Diffusae (bai hua she shi cao) 25
reduced. In any case, the formula should be taken
warm, on an empty stomach, preferably at least one
hour before a meal, and definitely not in the evening
or before bed to minimize the likelihood of digestive
complaints.
(b) If bleeding develops, nose bleeds are aggravated, or
fatigue is aggravated, the dosage and number of
herbs in the “Invigorate Blood and Circulate Qi” cate-
gory should be reduced. These herbs are somewhat
harsh and may be too aggressive in nature, and must
either be countered by adequate tonification herbs
or the dosages be reduced to where they are tolerated
well.
(c) The symptoms of fatigue, feeling “cold to the bone”,
and insomnia would probably be the first symptoms
to be alleviated, and this would typically occur to a
noticeable degree after the first week.
Diet and Other Supportive Strategies
For any person with cancer, taking herbs alone is not
sufficient. Also necessary are a pure diet tailored to the
individual’s body type and TCM syndromes, avoidance
of toxic chemicals and environmental hazards, espe-
cially those known to cause cancer, and the promotion
of healthy activities. General recommendations we
have found to be crucial, and that are also appropriate
for the clinical case under consideration:
(a) Include regular amounts of oily fishes (sardines, jack
mackerel, herring, salmon) and freshly ground flax
seed in diet for their essential fatty acid (EFA) con-
tent. Flax seed also contains lignans, and both lignans
and EFAs enhance the immune system’s ability to
accurately distinguish between foreign cells, includ-
ing cancers, and the body’s normal, healthy cells.
These food substances would be classified in TCM as
INTEGRATIVE CANCER THERAPIES 1(2); 2002
Advanced Breast Cancer
Blood tonics and possibly as Yin tonics, which are
highly indicated in the present clinical case.
(b) Avoid all sources of hydrogenated and poor quality
fats and oils; use sparingly only olive, almond, and ses-
ame oils, and organically produced butter.
except for miso. Although there is much propaganda
in numerous health problems, including digestive
difficulty, hypothyroidism, and possibly development
Yang.
important for the digestive system to be relatively
empty at night when, according to the TCM theory of
circadian rhythms, the detoxification cycle (“regulat-
ing and harmonizing the Qi”) of the Gall Bladder and
Liver reaches its peak (11 PM to 3 AM).
(e) Avoid coffee, tea, and chocolate; all of these contain
xanthine alkaloids, which may promote growth of
certain tumors. From a TCM perspective, these sub-
stances overstimulate the Yang and the Qi, leading to
eventual exhaustion. Caffeine, being a diuretic, can
also lead to Deficiency of Yin if consumed regularly.
(f) Eliminate or minimize use of pharmaceutical prod-
ucts, recreational drugs, alcohol, and tobacco. Opi-
ates, marijuana, and many other drugs act as immune
system suppressants. Most drugs tend to place a toxic
burden on the liver and kidneys and lead to aggra-
vated Stagnation of Qi and Blood as well as aggra-
vated Deficiency syndromes.
(g) Using appropriate lab tests, check for the possibility
of heavy metal (mercury, cadmium, lead, arsenic, etc)
exposure and contamination. Although the absence
of a lot of neurological symptoms and signs in this
case makes heavy metal contamination less likely,
there are a number of symptoms for which it remains
a possibility, including her work in a dental office
(possible mercury exposure). Anytime a clinical case
presents with a broad spectrum of TCM syndromes,
for which it appears that many major body systems
have degenerated simultaneously, as in this case, heavy
metal contamination should always be considered
and eliminated as a possibility. If heavy metals are
found in the body, their presence may severely sup-
press the immune system, place excessive burden on
the antioxidant capacity of the body, and may be a
major factor in the development of cancers. TCM
assessment methods, as exemplified in this article,
are not especially suitable for revealing heavy metal
contamination; in addition, the traditional, historical
TCM herbal protocols are not that effective in remov-
ing heavy metal contamination from the body. The
authors have developed special dietary and herbal
197
 Integrative Tumor Board
methods for handling this problem to supplement
TCM methods.
(h)Avoid drinking contaminated water (most tap water)
without filtration to reduce heavy metal content,
organic chemicals (pesticides and solvents), and
microbes. Preferably drink spring water from a certi-
fied clean source. Strictly avoid fluorinated water.
Unlike chloride, fluoride is difficult to remove; it is
carcinogenic and suppresses immune function, and
there is no excuse for including it in any water for
human consumption. Note that green and black tea
(Camellia sinensis) contain extremely high concen-
trations of natural fluoride and should be avoided for
this reason.
(i) Get plenty of fresh air, moderate exercise, and expo-
sure to sunlight.
(j) Avoid cooking or heating of food or drink in micro-
wave ovens. Microwave ovens not only emit danger-
ous radiation, but alter the food chemically and
severely reduce its food value; consumption of
microwaved food may induce pathological changes
8,9
in the appearance of red and white blood cells.
(k) Avoid fluorescent lights, television viewing, and all
media with a negative emotional content. Fluores-
cent lighting may induce migraines and seizures in
susceptible individuals, and it induces unhealthy
brain-wave patterns in otherwise normal individuals.
Both the flickering and the color spectrum have been
shown to be factors in creating unhealthy effects.
From a TCM perspective, habitual exposure to fluo-
rescent lighting exhausts the Kidney Qi.
(l) Get plenty of sleep, and go to bed by 10 PM. Undis-
turbed sleep at nighttime is essential for the body to
perform much of its restorative functions. In this clin-
ical case, the insomnia is a key symptom that should
be monitored; the success of the clinical strategy dur-
ing the first few weeks will depend upon how effec-
tively the insomnia can be relieved.
The following recommendations are specific to the
syndrome patterns of the present case.
(a) All foods and liquids should be taken warm or hot;
cold foods and liquids should be strictly avoided. The
Deficiency of Yang will be aggravated by exposure to
cold, either by cold weather or by ingestion of cold
substances. Digestion and the activity of digestive
enzymes is significantly impaired by low tempera-
tures; most digestive enzymes have maximal activity at
close to normal body temperature. Consumption of
warm and hot foods will specifically help to alleviate
Deficiency of Spleen Yang and Qi.
(b) Exercise, such as by walking uphill, to the point of
sweating and mild exertion if possible, followed by
hot baths alternating with a brief cold rinse to stimu-
late circulation and open pores to promote sweating
(alternate 10 minutes comfortably hot water, 30 sec-
onds cold shower, repeat at least once). Simmer 1/2
198
ounce of rosemary leaves for 20 minutes and add
decocted liquid to hot bath water to help stimulate
sweating. Be sure to drink plenty of warm (not cold)
liquids while in the hot bath. Perspiration is an impor-
tant mechanism for elimination of toxins and waste
products, and the lack of perspiration in this case is of
concern. Inclusion of a large dose of Rx Astragali in
the herbal formula may also help to normalize perspi-
ration. Lack of perspiration in this case is probably
due to both disruption and disharmony of Protective
Qi and Deficiency of Yin and of Fluids.
(c) Increase consumption of steamed vegetables, espe-
cially of cruciferous vegetables: broccoli, kale, col-
lards, mustard greens. These vegetables in raw form
are too “cold” and may suppress thyroid activity and
aggravate Deficiency of Yang and Qi, but in steamed
form are a valuable source of phytochemicals known
to inhibit cancer cells; from a TCM perspective they
also help to regulate the Qi and Blood. Also useful are
the yellow vegetables, including carrots, squashes,
yams and sweet potatoes, and pumpkins; these tonify
the Qi and are an important source of vitamin A
which helps to support the function of Protective Qi.
Tomatoes and eggplant are helpful in resolving stag-
nation of Blood; plants in the Solanaceae (night-
shade) family have been shown to have anticancer
activity, including Solanum nigrum, which is included
in the herbal formula. Note, while drinking raw vege-
table juices is reputed be a helpful method in many
types and patterns of cancer, these tend to be not as
beneficial for people with severe Deficiency of Yang
and Deficiency of Spleen Qi, as in the present case,
for reasons similar to why consuming cold foods
should be avoided in such cases.
(d)Coffee enemas may be useful to help detoxify the liver
and digestive system. From a TCM perspective, coffee
enemas have a dredging action on the Liver, similar to
Rx Bupleuri and Tuber Curcumae Zedoaria; they can
also aggravate Deficiency syndromes if done to excess
or without adequate supportive or tonifying mea-
sures. Coffee administered by enema has very differ-
ent physiological effects from drinking coffee, and it
is a common practice in many successful cancer pro-
10
tocols. The coffee should be certified organically
grown; steep up to 1/4 cup of ground coffee in 8 cups
of hot boiling water (filtered or spring water) for 30
minutes, carefully strain liquid using unbleached fil-
ter paper, let cool to slightly above body temperature
(warm), then administer by enema and retain fluids
in colon for 10 to 20 minutes if possible.
Use of Music to Resolve Emotional/
Psychosomatic Disharmonies
The pattern of Stagnation of Liver Qi and Blood with
emotions of anger often benefits by supplementing
herbal formula with counseling and with use of spe-
cific music to resolve emotional imbalances and improve
health. While popular prejudice may consider music
INTEGRATIVE CANCER THERAPIES 1(2); 2002

generally as amusing but harmless background noise,
research literature, ancient writings, and clinical expe-
rience of the authors indicate otherwise. Certain types
of music have been shown to induce chaotic, cancer-
like growth in the dendritic structure of neurons in
mice, to induce seizures in susceptible individuals,
and to cause plants to shrivel and die within weeks.11-13
In contrast, the music of Mozart and other classical
composers has been used to demonstrate a wide variety
of beneficial effects, including improved learning abil-
ity and seizure reduction in humans, and significantly
increased growth rates in plants. Thus, it is important
that the individual with cancer or any severe illness
strictly avoid all types of music and audio-visual media
that might result in such negative effects. In general,
the most potent healing effects are obtained using
classical music, such as the music of Bach, Mozart,
Haydn, Schubert, Beethoven, and Brahms. In the
authors’ experience, when pronounced emotional
imbalances are present, such as chronic anger, the
most potent strategy is to take a homeopathic-type
approach: begin with music that mirrors the individ-
ual’s current emotional state, then gradually lead into
a resolution of this state, and end with emotionally bal-
anced music. This is somewhat analogous to the TCM
principle of clearing Excess, or in this specific case,
dredging the Liver Qi, before tonifying and resolving
the Deficiency patterns. For example, a bright and
cheerful Mozart sonata may not necessarily be well
received by someone experiencing frustration and
anger; it may bounce off the auric field like a tennis
ball. For the specific combination of syndromes in this
clinical case, the following music might be especially
appropriate, subject to personal preferences:
(a) String Quartet No. 8 (op 110), by Dmitri Shostakovich.
This piece is an intense emotional roller coaster, but
especially appropriate for victims of physical or sex-
ual abuse with repressed anger. It strongly dredges
the emotional field that corresponds to Liver Qi, and
should be first listened to under the supervision of
the health practitioner or a trusted friend. It should
also be immediately followed by more emotionally
balanced music, such as the next piece.
(b) Cello Suites Nos. 1-6 (BWV 1007-1012), by J. S. Bach
(especially the recording by Mstislav Rostropovich,
EMI Classics, 1995). This collection of pieces pro-
vides a gentler, but more sustained dredging and har-
monizing of the Liver Qi, is somewhat tonifying to the
Kidneys, has a calming action, and is suitable for
before bedtime to deepen and prolong sleep. This
individual’s sleep is crucial, and anything that will
improve the sleep quality should be tried.
(c) “Vespers” (op 37), by Sergei Rachmaninoff: tonifies
Heart and Kidney Yin, promotes deeper sleep.
INTEGRATIVE CANCER THERAPIES 1(2); 2002
Advanced Breast Cancer
(d)“Miserere”, by Gregorio Allegri: tonifies Heart and
Kidney Yin, promotes deeper sleep.
(e) “Geistliche Chormusik: Zwei Moteten (op 74)”, by
Johannes Brahms: tonifies Heart and Kidney Yin, pro-
motes deeper sleep, and is especially appropriate
before bedtime to gently reveal unresolved emo-
tional issues and induce appropriate dreaming.
(f) Trio in E flat major for piano, violin, and cello (op
100), by Franz Schubert: this piece provides a com-
plex combination of emotional resolution, introspec-
tion, and motivation, and is generally optimistic in
mood; in TCM terms, it restores communication
between Heart and Kidneys, tonifies Kidney Yi and
Qi, and enhances one’s will to live. It is appropriate in
the recuperative phases after emotional and physical
crises have been resolved.
Summary
Close monitoring of the individual’s tongue appear-
ance and pulse from week to week will reveal whether
the formula and overall strategy recommended is hav-
ing the desired, expected results. In cases similar to
the case presented here, the vitality level, sleeping pat-
terns, and body thermal regulation would typically be
expected to improve within the first two weeks. As the
recommended formula is strong, the practitioner
should monitor the case frequently to check for possi-
ble side effects.
Each herb in the recommended formula was cho-
sen with the primary goal of normalizing major TCM
syndromes constituting this individual’s overall meta-
bolic characteristics. Many of the herbs and recom-
mended diet and support methods also happen to
have anticancer effects, but this consideration must
always be secondary to satisfying TCM criteria for
appropriateness, for if herbs are chosen primarily for
their reputed anticancer effects, one risks inducing
side effects, weakening the body’s core functions, and
ultimately risking recurrence of the cancer, which is
the very problem with conventional chemotherapy.
Note
Chinese herbal medicines are given Latinized pharmaceutical
names, based on the plant part and the scientific name of each
medicinal plant species. They are also referred to using Chinese
names, transliterated (Pin Yin transliteration of the Mandarin pro-
nunciation) and shown in parentheses in the discussion of the
herbal formula. In some herbal prescriptions, eg Rx Astragali, the
most accurate designator of an herb is a combination of the
Latinized pharmaceutical name and the Pin Yin transliteration. For
these herbs, there are 2 or more botanical species that have been
determined to be close enough pharmaceutically to be considered
practically interchangeable for clinical purposes. For other species,
eg Rx Angelicae Sinensis, a single species is used, whose botanical
name is discernable in the pharmaceutical name. In addition to the
plants, some animal species, eg Eupolyphaga, are given in the
formula.
199
 Integrative Tumor Board
References
1. Wicke R. Principles for applying Traditional Chinese Medicine
to cases of cancer. Integrat Cancer Ther 2002;1(2):175-178.
2. Wicke R. Traditional Chinese Herbal Science: The Language and Pat-
terns of Life. Hot Springs, Montana: Rocky Mountain Herbal
Institute; 1994. (Also available at <http://www.rmhiherbal.
org/ai/pharintro.html>. Accessed January, 2002.)
3. Bensky D, Gamble A, ed. Chinese Herbal Medicine: Materia Medica.
Seattle, Wash: Eastland Press; 1986.
4. Wicke R. Traditional Chinese Herbal Science: Herbs, Strategies, and
Case Studies. Hot Springs, Montana: Rocky Mountain Herbal
Institute; 1994. (Also available at <http://www.rmhiherbal.
org/ai/pharintro.html>. Accessed January 2002.)
5. Bensky D, Barolet R, ed.Chinese Herbal Medicine: Formulas and
Strategies. Seattle, Wash: Eastland Press; 1990.
6. Taylor L. Herbal Secrets of the Rainforest. Roseville, Calif: Prima
Publishing; 1998. (Also available at <http://www.rain-tree.
com/graviola.htm>. Accessed January, 2002.)
7. Fallon S, Enig MG. Tragedy and Hype: The Third International
Soy Symposium. Townsend Letter for Doctors and Patients. 2000;
204:66-71; 205/206 :56-58. (Also available at: <http://www.
tldp.com/issue/11_00/soy.htm>. Accessed January 2002.)
8. Wayne A, Newell L. The hidden hazards of microwave cooking.
Available at <http://www.mercola.com/article/microwave/
hazards.htm>, Optimal Wellness Center, c1997. Accessed Janu-
ary 2002.
9. Wild M. Are microwave ovens a source of danger? Truth Cam-
paign Magazine 1998;49(11). Available at <http://www.
vegan.swinternet.co.uk/articles/health/mw_danger.html>.
Accessed January, 2002.
10. Moss R. Coffee: the royal flush. The CancerChronicles. 1990:6;7.
(Also available at <http://www.ralphmoss.com/coff.html>.
Accessed January 2002.)
11. Wicke R. Effects of music and sound on human health. Hot
Springs, Montana: Rocky Mountain Herbal Institute; 2002.
Available at <http://www.rmhiherbal.org/review/2002-1.
html>. Accessed January 2002.
12. Tompkins P, Bird C. The Secret Life of Plants. New York:
HarperCollins; 1989.
13. Retallack, DL. The Sound of Music and Plants. Santa Monica,
Calif: DeVorss & Co; 1973.
Roger W. Wicke, PhD
C.S. Cheung, MD
Rocky Mountain Herbal Institute
PO Box 579
Hot Springs, Montana 59845
E-mail: rww@rmhiherbal.org.
Qigong Analysis
1. The Challenge
Recurrent breast cancer with postsurgery metastasis to
bone (BCMB)is a problematic challenge to the medi-
cal field. Clinically, there has been no effective treat-
ment or therapy available for this particular cancer
condition. The first author has helped 18 cases of
BCMB since his appointment as director of the Na-
tional Qigong Anti-Cancer Research Project in China
in the early 1990s. Most of these cases were in stage IV
and were regarded as being of “no medical value” (be-
200
yond the reach of medical treatment) by the local hos-
pitals or their doctors. However, through intensive
training in the Taiji Five-Element Self-Recovery Sys-
tem (TFESRS), a medical-Qigong-based comprehen-
sive anticancer program together with other comple-
mentary Qigong therapies, these patients experienced
dramatic improvements. Twelve of these patients have
completely recovered from BCMB. Moreover, the clin-
ical assessment after Qigong treatment showed that
the tumor had, in most cases, disappeared, and that all
clinical indicators are normal.
Example: Ms Y.L., a 52-year-old high school teacher
from Guangxi, had BCMB. She was initially diagnosed
by biopsy, with malignant breast cancer in 1991. She
was treated with 3 surgeries in 4 months, with both
breasts removed and multiple sessions of radiotherapy
and chemotherapy. Then in February 1993, she was
informed by the tumor hospital (after a whole body
bone scan) that metastatic cancer of bone had spread
to the entire body, and was turned away by the hospital
for further treatment due to her late-stage condition
and lack of effective treatment. She started practicing
TFESRS in April 1993 and stopped all other medica-
tion and therapies. Six months later, her condition
had changed dramatically—the bone scan showed
that her metastatic cancer had disappeared com-
pletely, and other chronic diseases she had before
(such as diabetes, fatty liver, prolapse of lumbar
intervertebral disc, etc) had all disappeared as well.
She has since enjoyed full health for the past 8 years.
Regular checkups have found no new metastases or
recurrences.
The successful results of this case and others indi-
cate that the TFESRS combination of “energetic Bigu”
(Fu Qi Bi Gu) and “shattering tumor by strong Qi”
(Qiang Qi Ji Liu) can help patients with BCMB, as well
as other late-stage cancers, to full recovery. The follow-
ing is our experience in treating BCMB with compre-
hensive Qigong therapy, to be shared with other
professionals.
2. Basic Philosophy of TFESRS
The TFESRS and many medical Qigong therapies are
designed with a different approach from conventional
medicines in their treatment of cancer. They tend to
take the whole-body system rather than the specific or
localized treatment approach. The main focus of
TFESRS is to activate the patients’ deteriorated im-
mune system, suppressed self-recovery power, and
concealed self-regeneration capabilities, which are
the main ingredients for BCMB recovery. Therefore,
we usually pay less attention to the detailed diagnosis
or medical history, but more to the patient’s current
physical and mental status. We do not develop individ-
ualized therapeutic procedures for each patient, but
INTEGRATIVE CANCER THERAPIES 1(2); 2002