In the field of cancer therapy, tradi-tional Chinese medicine has long been seen as "alternative medicine." But when used in combination with Western medicine, it is now accepted as "adjuvant therapy." When these two systems of medicine are used together to fight cancer, can they really complement each other?

In Western medicine, the word "cancer" refers to "malignant tumors." The latter term does not appear in China's traditional medicinal canon. But this does not mean the disease was unknown to the ancient Chinese. Professor Lin Chao-keng of China Medical College, who is qualified in both Chinese and Western medicine, observes: "In the 'Canon of Acupuncture,' which forms part of China's earliest surviving medical book, The Yellow Emperor's Canon of Internal Medicine, there is a classification of 'tumors' [_F liu], with accounts of what are mostly terminal abdominal cancers. They are described as foci of disease which are as hard as stone and do not respond to the drugs usually used to reduce masses or swelling." Lin notes that the character ai (?_), which refers to cancer in modern Chinese medical usage, appears in a medical work for the first time in Wei Ji Bao Shu by Juxuan Jushi of the Song dynasty (960-1279).

Lin writes that from the Ming dynasty (1368-1644) onwards, there was growing recognition in Chinese medicine of cancer as a disease, and a growing number of treatises on the causes, diagnosis and treatment of tumors. For instance, Yang Shiying of the Ming dynasty, in his Renzhai Zhi Zhi Fang, says clearly: "Cancers are protruding or sunken, as hard as stone, and grow rapidly. . . . In men they occur mainly in the abdomen, in women, mainly in the breasts." Other medical works also refer, by a variety of names, to various cancers such as gastric, esophageal, intestinal and bone cancer. Their descriptions of the symptoms are almost identical to the observations of modern anatomical medicine.

Western to cure, Chinese to aid recovery

As far as diagnosis is concerned, doctors of traditional Chinese medicine (TCM) may be able to detect the presence of cancer in a person's body by the four traditional diagnostic methods (observation; auscultation and olfaction; interrogation; and pulse feeling and palpitation)-for instance, by feeling the strength and rhythm of the pulse and observing the presence of "cold" or "heat." But these methods are not as precise as modern techniques such as biochemical tests, X-ray examinations, CT scans or blood work. Hence nowadays most TCM practitioners in Taiwan recommend that patients rely mainly on Western medicine for diagnosis.

In principle, TCM treatment relies on methods such as strengthening the patient's overall constitution, promoting blood circulation and boosting the body's immune system. "These all take time and are part of a process of gradually nursing someone back to health. This is one of the weaknesses of traditional medicine-it can't compare with Western procedures such as surgery, chemotherapy and radiotherapy for quickly bringing about remission of disease," says Lin Chao-keng, who is also president of the National Association of Chinese Medical Doctors.

Hence, although TCM is seen as having tremendous potential as a source from which to develop new drugs to treat cancer, in clinical practice in Taiwan it is assigned to the auxiliary role of alleviating the side effects of cancer therapies, assisting post-operative recovery and promoting general good health, in particular by preventive means. This role is consistent with the consensus among TCM practitioners and doctors qualified in both traditions on how Chinese and Western medicine should be used together to combat cancer.

"Once a tumor has been discovered, whatever surgery and Western therapies are necessary should be carried out," says Lin Chao-keng. "But during and after such therapies, TCM can be used to regulate and fortify the bodily functions in order to ensure a better quality of life for the patient. Traditional Chinese dietary principles, along with therapeutic diets, massage and exercise, can also be used routinely to promote health and prevent disease." Lin notes that today those hospitals which offer both TCM and Western medicine, such as China Medical College Hospital or Chang Gung Memorial Hospital, all provide coordinated programs along these lines.

Reduce side effects, boost resistance

"What we mean by 'combining Chinese and Western medicine' is finding the strengths in each and using them to complement each other. Only then do patients benefit." Lin Yi-hsin, director of Linkou Chang Gung Memorial Hospital's Department of Chinese Medicine, who is also qualified in both TCM and Western medicine, actively seeks to combine the two traditions in both clinical practice and research.

He notes that in therapeutic terms, each tradition has its strengths. With respect to different illnesses, and at different times, each may take the lead role or a supporting role by turns. For instance, Western medicine is clearly more effective for treating infectious and microbial diseases. But when it comes to treating functional disorders (such as functional gastroenteritis, infertility or persistent diarrhea), delaying the onset of aging, promoting general health, treating immune and rheumatic disorders (such as allergies, allergic rhinitis and atopic dermatitis), repairing the damage to the immune system caused by cancer, or alleviating the side effects of cancer therapies, TCM is highly effective.

"In the case of cancer, we tackle the disease itself largely by Western methods, but we rely mainly on TCM to assist recovery," says Lin Yi-hsin. To illustrate this, he describes his approach to treating nasopharyngeal carcinoma, with which he is currently conducting clinical trials. Radiotherapy can control or even completely eliminate the cancer cells, so this Western medical procedure is the treatment of first choice.

"But during radiotherapy, patients' hair falls out, their gums become swollen and painful, their mouths become dry and they have difficulty swallowing, and with longer treatment they may suffer hearing loss. All that doctors of Western medicine are able to do is to advise them to get plenty of rest, take vitamins and exercise frequently. But some people's resistance is so weakened that they may die." For these patients, says Lin, he prescribes TCM remedies such as ganluyin ("sweet dew drink") which moisten the mouth, relieve pain and boost immunity, to build up their strength and alleviate the harmful effects of the radiation.

Lin Yi-hsin says that if people consult both a TCM doctor and a Western doctor for the same condition, and take TCM drugs at the same time as Western ones, in many cases they are unlikely to suffer any serious ill effects. But they should tell their doctors clearly what problems they have and what medicines they are taking, and he suggests that at least they should choose a doctor who understands both Chinese and Western medicine-someone who is licensed in both disciplines, and has clinical experience in both. In this way they can avoid the problem of doctors trying to forbid them to see practitioners of the other tradition, which may cause avoidable suffering by delaying appropriate treatment.

An ounce of prevention

People today hope that as well as alleviating side effects, TCM can play a preventive role in everyday health maintenance. Using traditional Chinese methods of promoting health on a daily basis is surely a more positive approach than merely seeking treatment once one becomes ill.

Professor Emeritus Tung Ta-cheng of National Taiwan University, who is working to develop drugs to prevent and treat cancer, and who recently aroused much public attention with his claim that jack beans have anticancer properties, says that if a tumor has already formed, it is very unlikely that it can be treated effectively using TCM alone. But the ability of Chinese medicines to help prevent cancer is something he is already very sure of. For instance, such things as ginseng, astragalus root (Astragalus membranaceus), swiftlet nests, reishi mushrooms (Ganoderma lucidum) and Chinese wolfberry (Lycium barbarum) do indeed contain constituents which enhance the body's immunity, and this is the basic concept behind pharmaceutical cancer prevention.

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Lin Yi-hsin (second from left), director of the Department of Chinese Medicine at Linkou Chang Gung Memorial Hospital, is collaborating with the hospital's radiation oncology department in clinical trials to test the ability of the herbal remedy ganluyin to alleviate the side effects of radiotherapy in patients with nasopharyngeal cancer. (photo by Hsueh Chi-kuang)