The integration of Fu Zheng Gu Ben theory and Master Tung's acupuncture in advanced-stage oncology patients undergoing metronomic-dosed chemotherapy.

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! ! ! ! ! ! The Integration of Fu Zheng Gu Ben Theory and Master Tung’s Acupuncture in Advanced-Stage Oncology Patients Undergoing Metronomic-Dosed Chemotherapy Darin J. Bunch, MTCM, L.Ac.


© 2014 Darin J. Bunch, MTCM, L.Ac.

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Contents Foreword

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Introduction to Fu Zheng Gu Ben Theory and Its Application in Oncology

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General Pattern Differentiation Guidelines of Fu Zheng Gu Ben Theory

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Introduction to Master Tung

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Advantages of Master Tung’s Acupuncture

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Master Tung’s Location of Extra Points and Naming of the Points

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Body Correspondence, Angle and Depth of Needle Insertion, and Needle Retention

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Master Tung’s and Dr. Wei-Chieh Young’s Essential Needling Methods

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Traditional Chinese Medicine and the Etiology and Pathology of Tumors

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The Seven Emotions Damaging the Body’s Internal Environment

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Zang-Fu Organ Deficiency

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Dietary Irregularities, Toxic Foods, and Inappropriate Diet Regimen

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Metronomic-Dosed Chemotherapy

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Master Tung’s Acupuncture in Advanced-Stage Oncology Patients Undergoing MetronomicDosed Chemotherapy

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Chinese Herbal Medicine in Fu Zheng Gu Ben Theory

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Chinese Herbal Formulas Used in Fu Zheng Gu Ben Theory

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Congees That Help Strengthen and Support Advanced-Stage Oncology Patients Undergoing Metronomic-Dosed Chemotherapy

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Lifestyle, Qigong, Meditation, and Nutrition for Advanced-Stage Oncology Patients Undergoing Metronomic-Dosed Chemotherapy

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Support Networks, Patient’s Mental Attitude and Conclusion

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References

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Foreword Cancer is certainly a complex disease and no individual is untouched in the Western world without knowing someone—a friend, loved one, family member—who has not been diagnosed with some type of cancer. Certainly it is a disease not fully understood even with all the technology that we have available today and all the brilliant scientists working to eradicate the disease. I have always noted that the disease is brilliant in one way in keeping our scientists still guessing about the origins, mechanisms and pathways of the disease process while also being not so intelligent as to inevitably (in most circumstances) terminate its host which will end even cancer’s proliferation. This paper will address my decade of experience as an acupuncturist and Chinese medicine practitioner for the Seattle Cancer Treatment & Wellness Center/Cancer Treatment Centers of America known to specialize in managing advanced-stage oncology patients receiving metronomic-dosed chemotherapy utilizing Fu Zheng Gu Ben Theory and Master Tung’s style of acupuncture in an integrated clinical setting.

! Introduction to Fu Zheng Gu Ben Theory and Its Application in Oncology In what is commonly referred to as traditional Chinese medicine (TCM), Fu Zheng Gu Ben or alternately, Fu Zheng Pei Ben refers to supporting the healthy Qi and optimizing the body’s innate natural resistance to disease. In this paper, I will use Fu Zheng Gu Ben (FZGB). Broken down, Fu Zheng translates as “support the upright” Qi of the body and Gu Ben translates as “consolidate the root” to strengthen the resistance to illness (Pan, Cai, Chen, Webb, & Chen, 1992).

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Chinese medicine and allopathic medicine agree that cancerous tumors are a localized manifestation of a pathology that exists in the entire body. This pathology can result from exposure to toxins such as radiation or carcinogenic chemicals, or owing to exogenous pathogens, a malfunctioning immune system or immunodeficiency, poor nutrition, hereditary tendencies, weakness or damage to the organs, prolonged Qi and/or Blood stagnation, prolonged Blood or Yin deficiency, emotional factors and more. Combinations of these factors may be involved as well, such as hereditary tendencies combined with poor nutrition, or immune deficiency with sufficient exposure to carcinogenic toxins. When applying FZGB theory, it is essential to properly evaluate the patient’s constitution and differentiate the syndrome so that the proper support can be executed. Treatment of symptoms should be subordinate to accurate pattern identification in order to provide the best care to the patients in counteracting adverse reactions to harsh allopathic treatment modalities and increase a patient’s quality of life before, during and after such therapies—predominantly therapies such as, chemotherapy, radiation, and surgery (Heuertz, 2006).

General Pattern Differentiation Guidelines of Fu Zheng Gu Ben Theory FZGB theory when applied therapeutically to advanced-stage oncology patients should be adjunct to primary allopathic oncology treatments. Firstly, it should address the underlying constitutional root of the pathology. Secondly, it should address the clinical manifestations directly or compensating for the imbalances and the clinical adverse reactions caused by aggressive allopathic treatments (Heuertz, 2006).

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Two pairs of opposing principles, representing four of the “eight principles” of TCM diagnosis are commonly used to determine underlying constitutional root in cancer patients. The first category distinguishes between the opposing but interdependent principles of Yin and Yang; the second between excess and deficiency. It is of utmost importance to make appropriate distinctions. For example, deficient Yin is treated by nourishing the Yin using herbs of Yin nature. Alternately, excessive Yin is treated with herbs of a Yang nature which either boost the Qi, actively drain or dry, warm or invigorate the circulatory system—all of which are Yang actions. Failure to distinguish between the Yin or Yang nature of the patient’s condition can result in the selection of herbs that are counter-productive. This can be extended to acupuncture, though typically it is considered by TCM practitioners that acupuncture is far more forgiving than Chinese herbal medicine in that it is not putting a supplement into the body with complex chemistry. This can be determined used as what is commonly referred to as the “four examination techniques” used in TCM. They are as follows: (a) looking/inspection, (b) listening and smelling, (c) asking/inquiring, and (d) touching/palpation. For example, if there is only excess in the pulse, if the cancer is in the early stages, and the constitution is otherwise strong with sufficient, smooth-flowing Qi, a focused, localized intervention is recommended. However, if the pulse reveals some underlying weakness, such as Yin, Qi, or Blood deficiency, if the cancer has already progressed beyond the early stages, or if the constitution shows immunodeficiency, then it is best to include a formula and acupuncture treatment strategy that boosts or nourishes the weakened energy in order to attempt to bring the body into equilibrium (Heuertz, 2006). In addition to the underlying root of the patient, there is often a particular clinical manifestation or several manifestations involved. These manifestations may be caused by the

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toxicity of the tumor, a malfunctioning immune system, the physical blockage resulting from the tumor, or they can arise as an adverse reaction of the allopathic treatment. Often, a patient may experience depression from the chemotherapy or diagnoses of cancer, loss of appetite, or the physical location of the tumor may interfere with breathing, swallowing, or urination. These are all considered branch symptoms. Adjunct FZGB can help alleviate the patient’s symptoms, strengthen their body, enhance the effects of chemotherapy, radiotherapy, and speed healing after surgery. In my own clinical experience I have found that both acupuncture and Chinese herbal medicine can greatly offset the adverse reactions of allopathic treatment modalities in patients diagnosed with advanced-stage cancer (Heuertz, 2006).

! Introduction to Master Tung The Tung family lineage of acupuncture can be traced back to the Han Dynasty (206 BCE - 220 CE). It was passed orally always from the father to the eldest son and never to a daughter residing in the Tung family due to the implications that if she possessed the Tung style of acupuncture and married, her new family would be taught the Tung’s style of acupuncture, thus breaking the lineage. Not until the 20th century where the last Master Tung, Tung Ching Ch’ang, then residing in Taiwan decided to train outside of his family in order to preserve his family’s acupuncture lineage to benefit future generations. The world was changing and so did Master Tung Ching Ch’ang. It is documented that through the rest of his life from July 1, 1962-1975, he trained 73 students (McCann & Ross, 2012, p. 11).

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Advantages of Master Tung’s Acupuncture Those that pursue the ongoing didactic and clinical training and practice of Master Tung’s acupuncture techniques know that the needling is conducted away from the diseased area(s). One advantage of this needling approach is that local areas, which may be quite sensitive, do not need to be needled directly. For example, often in the case of advanced-stage oncology patients, the tissue may be inflamed and painful, or necrotic. TCM acupuncturists would not typically needle the breasts either. However, they may surround the breast, adjacent to the necrotic tissue which can be both painful and emotionally traumatic to the patient due to the erosive effects tumors can have. Additionally from my experience, often the oncologist and nursing staff needs access to the port placed below the clavicle, and the clinicians may need to palpate and examine the site of disease during their acupuncture session. Acupuncture needles inserted away from the site of disease is very logical for this reason when working in a multidisciplinary facility. Various scholars of Master Tung have repeatedly enforced that contralateral needling from the area of the disorder is done based on classical TCM channel theory. A general rule of thumb and written in Dr. Wei-Chieh Young’s book, Lectures On Tung’s Acupuncture Points Study states in Biao You Fu’s poetry on Cross Channel Needling: “Treat problems on the left with points on the right. Treat local problems with distal points (to drain away the problem). Treat disorders on the head with points on the feet” (2008, p. 12). “Never underestimate the power of one needle!” One of my mentors repeatedly said this in various seminars I had throughout the years and I continuously remind myself of this important lesson. Master Tung and his acupuncture points strategy uses fewer needles that have often profound and quick results when done correctly. It is less invasive to the patient when

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using fewer needles away from the site of pain or disharmony and far less traumatic both from a psychological as well as physical perspectives. For the acupuncturist, as one becomes more skilled, they are able to select a treatment strategy that requires only a few needles to be punctured on the body which will have a more focused treatment with greater therapeutic results. Furthermore, many problems can be addressed by needling only one point. Having an extensive understanding of Channel theory, classical acupuncture texts, and Master Tung’s applications of points will allow for the selection of less points to be used with a far more extensive and potent acupuncture treatment.

! Master Tung’s Location of Extra Points and Naming of the Points In the Master Tung acupuncture system, there are over 740 points located on the hands, arms, feet, legs, ears, head and face. A system was developed to help organize and locate the points. Points on the fingers are defined as “11.00,” point on the hand are “22.00,” points on the forearm “33.00,” points on the upper arm “44.00,” points on the plantar side of the foot “55.00,” points on the medial and dorsal side of the foot “66.00,” points on the leg “77.00,” points on the thigh “88.00,” points on the ear “99.00,” points on the head and face “1010.00,” points on the back “DT.00,” and points on the chest “VT.00” (Wang & Vasilakis, 2013, p. 20). Master Tung’s points have never been named using their own name by any of the Tung lineage nor senior practitioners of Tung-style acupuncture. For example, Master Tung did not name point FuKe (11.24) as “Tung’s Gynecology Point.” It is named “Female Gynecology” because of the profound effects it has in treating gynecological issues. Points are named according to their locations such as CeSanLi (77.22) which means “beside-sanli” in reference to

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it being lateral to Zusanli (ST-36). Some points are named according to their actions or after the five elements such as ShuiJin (1010.20). ShuiJin’s (1010.20) name “implies the connection between the Water (Kidney) and Metal (Lung). It strengthens both the Lung and Kidney, promoting the descending function of the Lungs and the receiving function of the Kidney. This has excellent outcomes for treating and regulating respiration. So it has very good effect in regulating respiration” (Young, 2008a, p. 240). Others are named after the Zang-Fu such as Dan (11.13) which means “Gallbladder.” The indications for this two-point unit is for palpitations and morbid night crying of babies. “With the extraordinary connection of the Heart and Gallbladder, it is also effective for infantile night crying and fright due to deficiency of the Gallbladder. This point is located on the Pericardium channel. Since the Pericardium has the connection with the Stomach, and disharmony of the Stomach may disturb the sleep, and therefore the point can treat the above disease. This is the same reason for the indications related to the Gallbladder” (Young, 2008a, p. 54). Some are named after indications that they treat such as GanMen (33.11) which translates to “Liver Gate.” This point is most effective for acute hepatitis. Some are named after the location and action like ZhiShen (11.15) which translates to “Finger Kidney” as it is located on the fourth metacarpal which is the San Jiao channel. The San Jiao connects to the Kidney so therefore this point is indicated for treating dry mouth, Kidney deficiency and back pain. Some are named according to number such as SanZhong (77.07) which is named “Third Weight” after YiZhong (First Weight, 77.05) and ErZhong (Second Weight, 77.06). These points are frequently

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needled simultaneously to treat hyperthyroidism due to heart diseases or for lumps and cranial tumors (Young, 2008a).

! Body Correspondence, Angle and Depth of Needle Insertion, and Needle Retention Body correspondence that Master Tung employed corresponds to the following:

! • Skin to treat skin • Muscle to treat muscle • Tendon to treat tendon • Vessel to treat vessel • Bone to treat bone (Young, 2008a, pp. 15-16).

! This can be applied in theory to any acupuncture points, including those on the 14 channels to enhance therapeutic effects. Examples are: When a disease such as urticaria, which has a component of Wind lodged in the skin, superficial shallow needling at XueHai (SP-10) can be performed. If it is deeper lodged in the muscle, the same point can be needled to a depth that reaches the muscle layer. Needling YangLingQuan (GB-34) close to the tendon or into the tendon has a more profound effect on the sinews and tendons than needling in its common location just slightly anterior and inferior to the head of the fibula. Another example is in the case of whiplash where a patient cannot extend or flex the neck, needling both ZhengJin (77.01) and ZhengZong (77.02) through the tendon has profound and immediate relief. TaiYuan (LU-9) is proximal to the radial artery and is the “Influential Point of Vessels” which treats vascular

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diseases very effectively. RenZong (44.08) is supplied by the cephalic vein and radial collateral artery and DiZong (44.09) is supplied by the post-humoral circumflex artery and the Axillary nerve. Both points are close to large vessels and can effectively regulate blood circulation and help with those patients suffering from arteriosclerosis and heart disease with excellent results. Puncturing ZuSanLi (ST-36) alongside the bone with deep insertion and ShenGuan (77.18) touching the periosteum can tonify the Kidney and treat bone pain (Young, 2008b, pp. 18-20). Attention to needle angle, depth, and location of the points is also necessary to have desired therapeutic efficacy when applying Master Tung’s principles. Again, let’s use the acupuncture point ZuSanLi (ST-36) as an example. Needling it to a fairly shallow depth of 0.5 to 1 cun treats pain and diseases of the leg. When you needle to a depth of approximately 1.25 to 1.5 cun (depending on the size of the patient’s leg), it will treat diseases in the Middle Jiao. With needling to a deeper depth of approximately 2 cun, with long needle retention of 45 minutes or greater, it is effecting for asthmatic breathing and heart diseases. When you needle to a depth of 2.5 to 3 cun, you can treat headache. Alternately, when you needle to a depth of 2 cun needled obliquely against the Foot Yangming Stomach channel upward, the point is more effective for facial paralysis. Additionally, when you needle this point closer to the bone and to a deeper level, you effect the Kidney more as “bone to treat bone.” When you needle ZuSanLi (ST-36) three cun below DuBi (ST-35) and one finger breadth lateral to the tibial bone, it primarily affects the Spleen and Stomach channels. Lateral to the standard location, you affect not only the Spleen and Stomach, but additionally, the Gallbladder as well. Master Tung employed different applications of needle insertion theory, but one of the most important and useful

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clinically is needle shallowly for acute or localized diseases and deeply for chronic, stubborn or distal diseases (Young, 2008b, pp. 18-20). In Lectures on Tung’s Acupuncture Points Study, Dr. Young describes that acupuncture needle retention should be at least 30 minutes based on the Ling Shu, Ying Wei Sheng Hui (The Origin of the Nutrient and Defensive Systems and Qi Circulation in Them, Miraculous Pivot) which describes one whole circulation of Qi and Blood in the body takes 28 min, 48 sec to make its way throughout all the channels. Rounding up, typically retention is at least 30 minutes. Master Tung usually retained the needles for 45 minutes for greater therapeutic effects (2008a, p. 26). In general, it is suggested the needle retention should be for 45 minutes or longer for stubborn and chronic conditions, cold syndromes, acute abdominal pain and severe diseases (pp. 18-20). In modern times, people and many acupuncture practices are busy. Therefore, in these circumstances or a lack of additional space and treatment rooms, needle retention should at least be for at least 30 minutes.

! Master Tung’s and Dr. Wei-Chieh Young’s Essential Needling Methods Dr. Chuan-Min Wang so easily explains Master Tung’s usage of Dao Ma needle technique in his book, Introduction to Tung’s Acupuncture. Dao Ma is the usage of typically two and sometimes three needles spaced 1 to 2 cun depending on the anatomical region and zone the practitioner is working (note: this can also be a smaller space depending on smaller areas such as the thumb and fingers and the desirable therapeutic effects and acupuncture treatment strategy). When utilizing the Dao Ma technique, there is increased therapeutic results as the De Qi sensation is frequently enhanced and the free flow of Qi is more readily mobilized through the

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San Jiao channel to allow for the regulation of all the bowels and viscera, thereby strengthening the overall efficacy of the acupuncture treatment strategy by treating the whole body (Wang et al., 2013, p. 226). For example, if you needle HuoZhu (66.04) and then HuoYing (66.03) which is one cun distal from HuoZhu (66.04) this will have greater therapeutic effects and is just one illustration of Master Tung’s Dao Ma technique. In Dr. Young’s (Young, 2008a) book, Lectures on Tung’s Acupuncture Points Study, he explains the use of Master Tung’s mobilizing Qi technique which is referred to as Dong Qi technique. An example of this technique when treating with Foot Taiyang Urinary Bladder and/ or Foot Shaoyang Gallbladder sciatic leg pain is after inserting LingGu (22.05) and DaBai (22.04) once the desired De Qi sensation has been obtained, ask the patient to move the affected leg which is generally in most instances on the contralateral side to the acupuncture needles. When possible, it is best to rotate the needle with the movement of the affected area being treated. When the pain decreases or entirely ameliorates, this is indicative that the union of the acupuncture point(s) and technique and the affected area have been balanced. For chronic cases, the needle should be retained for longer periods of time typically 30-45 minutes (and in some cases even longer such as stubborn migraines) and rotated at 10-15 minute intervals repeating the Dong Qi application described above. If the patient is having chest pain for example needle NeiGuan (PE-6), using the Dao Ma technique, Neiguan (PE-6) and DaLing (PE-7) and ask them to take several deep breaths. The pain or discomfort will diminish within seconds as it helps circulate and bring the Qi to the area of concern thus, another Dong Qi treatment strategy. A third example: for abdominal and stomach pain needle NeiGuan (PE-6) and JianShi (PE-5) or MenJin (66.05) with NeiTing (ST-44) another two point Dao Ma technique then ask the patient

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to take deep abdominal breaths and massage the area to reduce or entirely relieve the discomfort (pp. 20-21). Dr. Wei-Chieh Young developed a technique which he refers to as Qian Yin (Guiding) needle method after many years of observing Master Tung’s Dong Qi techniques and based on his own clinical experience. In his book, Lectures On Tung’s Acupuncture Therapeutic System, he explains this in detail. For example, we can use the above example of LingGu (22.05) and DaBai (22.04) needled contralateral to the site of pain. The Shu-Stream points are needled on the diseased side as a way to help guide or attract the Qi to the diseased channel. For example, if the pain is along the Foot Taiyang Urinary Bladder channel, you would use ShuGu (BL-65). Alternately, if the pain is along the Foot Shaoyang Gallbladder channel, you would needle ZuLinQi (GB-41). If the pain were to occur in both channels simultaneously, you would use both Shu-Stream points to attract or guide the Qi (2008b, pp. 16-17). Dr. Young (Young, 2008b) explains in his book, Lectures on Tung’s Acupuncture Therapeutic System: It is a needing method that is used to attract the Qi flowing to the desired area. It is based on the theory of “attracting effect.” If we needle two points at the same time and then withdraw one needle, the Qi of the other point will be attracted and flows towards and finally arrives at the area of the withdrawn needle. If you give a short stimulation to one of the two points, the Qi will flow towards the retained needle. This is the basic mechanism of the attracting needling technique. (p. 16)

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Bloodletting was commonly used as a part of Master Tung’s techniques and treatments strategies. The Nei Jing refers to this method of treatment throughout its chapters in treating chronic, recalcitrant diseases. In Tung’s acupuncture point strategies, most of the points on the Back (DT.00) and Chest (VT.00) are bled using a three-edged needle. Other very important areas to bleed are ChiZe (LU-5) for all diseases in the upper body and WeiZhong (BL-40) for all diseases of the lower body and lower extremities, head and back (McCann & Ross, 2012, p. 209).

Traditional Chinese Medicine and the Etiology and Pathology of Tumors It is imperative to understand the fundamental etiologies and pathologies from a traditional Chinese medicine (TCM) perspective before delving into FZGB’s role integrating Master Tung’s acupuncture treatment strategies with oncology patients undergoing metronomicdosed chemotherapies. The six exogenous excesses in TCM are considered to play a major role in tumor formation. In TCM theory, invasion by any exogenous pathogens, including man-made in modern day such as chemicals and environmental pollutants, can impede the Zang-Fu organs, and obstruct the circulation of Qi and Blood, leading to Qi stagnation and Blood stasis. In doing so, if the Wei Qi is weak or deficient, this can create accumulation and congeal non-pathologic fluids into Phlegm-Damp which in turn can lead to the formation of tumors (Li, 2003, pp. 19-27).

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Exogenous Wind Invading the Lungs Exogenous Wind is a external pathogenic factor. The reason for this is it can invade the body on its own or combine with other pathogenic factors such as Cold, Heat, Dampness, Summerheat and Dryness (Li, 2003, pp. 19-27). Exogenous Wind is a Yang pathogenic factor. It penetrates the skin and impairs the movement of Wei Qi. It has a tendency to move upward and outward. Often it invades the upper portions of the body obstructing the Lung channel and then with no predictable course, it can spread to many other regions of the body (Li, 2003, pp. 19-27). Exogenous Wind can combine with Heat and assault the body. If the Heat becomes extreme, it will inevitably generate internal Wind so the two pathogenic factors have a concomitant relationship with one another. If the body is unable to extinguish these pathogenic factors due to Wei Qi deficiency or the endogenous factors are too robust, Heat Toxins will ensue and attack the Zang-Fu as well as the channels and network vessels. This may propagate various pathological mutations within the organism (Li, 2003, pp. 19-27).

! Exogenous Invasion of Pathogenic Cold Exogenous pathogenic Cold primarily injures the skin and flesh but can also affect the Zang-Fu, bypassing the skin and flesh. Cold is a Yin pathogenic factor and impairs Yang Qi. Accumulation of Cold leads to Yin abundance with Yang debilitation. The body’s Wei Qi is responsible for warming and protecting and the Spleen Qi’s role is that of transforming and transporting. When they become impaired, a Yin-Cold pattern will manifest. Cold symptoms associated with cancers of the digestive system are commonly pain in the Middle Jiao and emesis

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or diarrhea caused from exogenous Cold injuring the Yang Qi of the Spleen and Stomach. Additionally, if Cold injures the functions of the Kidney, Kidney Yang will become impaired and its ability to contribute in assisting the Wei Qi is further debilitated as the Ministerial Fire is unable to warm the body at its optimal level (Li, 2003, pp. 19-27). Furthermore, patients will present with cold and pain in the lower back and spine. With complications of cancerous tumors or otherwise, patients may also have ascites, and edema typically in the lower extremities but can be elsewhere such as the face or upper extremities as well (Li, 2003, pp. 19-27). Cold is congealing and stagnant in nature; it causes constriction and tension, leading to discomfort and pain. Cold is sluggish in movement by its very nature. It obstructs and blocks the movement of Qi and Blood. Tumor-induced pain is similar to the mechanism of pain caused by Cold in clinical practice. Therefore, warming Cold and ensuing the free flow of Qi while invigorating Blood concomitantly helps to reduce or ameliorate tumor-related pain (Li, 2003, pp. 19-27). Exogenous Cold invading the skin and muscles directly causes the hair follicles to contract trapping Cold which in turn obstructs the Wei Qi resulting in aversion to Cold and fever. Recalcitrant fever in patients with advanced-stage cancers can often be effectively managed by treating Cold. If Cold affects the joints, stiffness in the channels and network vessels will occur. Numbness, coldness, and a hypertonicity can be observed and palpated with a decrease in flexibility and range of motion to the affected areas of the body. Often the extremities and low back will be cold to the touch and the patient will report that they are experiencing stiffness in the joints and numbness in the extremities, trunk, and/or face and head (Li, 2003, pp. 19-27).

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Exogenous Summerheat Damaging Qi Summerheat is a Yang pathogenic factor. Its very nature is hot and it scorches the Yinfluids within the body causing them to congeal due to the drying nature of Summerheat. With the congelation of the fluids, Qi and Blood are again obstructed. Stagnation of Qi and Stasis of Blood may occur with severe damage to the Yin-fluids of the body and can propagate the formation of tumors (Li, 2003, pp. 19-27). Additionally, Summerheat and Damp often amalgamate particularly in humid climates all over the world. When this happens, Summerheat and Damp intertwine. When extreme, it transforms into Fire and Fire Toxins will attack the body causing a vast variety of clinical pathologies and presentations. Blood cancers such as leukemia patients often present with profuse sweating and high intermittent fevers (Li, 2003, pp. 19-27).

! Exogenous Damp Generating Phlegm-Heat Toxins When Damp penetrates the body, the functional activities of Qi are obstructed as well as the Yang Qi is impaired. A Yin pathogenic factor, Damp is heavy, sticky, and viscous. It has a tendency to linger and is difficult to transform and expel from the body. Damp, when it invades the body, frequently obstructs the Zang-Fu, channels and network vessels. Damp is oppressive and can cause shortness of breath and labored breathing in the chest, distention in the abdomen, and problems with a feeling of complete evacuation with the bowel or difficult urination. When Damp settles and lingers, Heat and Phlegm are generated and this can give rise to Phlegm-Heat Toxins in the body (Li, 2003, pp. 19-27).

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The Spleen loathes Damp. When Damp invades, the Spleen Yang Qi is handicapped; impairing its transportive and transformative abilities. Accumulation will result and ascites in the peritoneum, edema in the extremities and face, and/or diarrhea may occur. Unfortunately, when the skin and tissues are edematous or especially when there is ascites, the prognosis is very poor for advanced-stage cancer patients. Typically, this is observed clinically at the most latentstage of neoplasms and Phlegm-Damp-Heat Toxins are prevailing while the patient’s Zheng Qi is very debilitated. Palliative care is typically the best Eastern medicine can do in this scenario (Li, 2003, pp. 19-27).

! Dryness-Heat Damaging Lung Yin and Body Fluids Dryness is a Yang pathogenic factor. It depletes the body fluids and inevitably leads to Deficiency of the Yin. Dryness has a tendency to attack the Lung Yin which impairs the dispersing and diffusing functions of the Lungs. Lung cancer is often presents with bloody, scanty sputum which is Dryness and Heat smolder the lungs. Additionally, radiation therapy to the head and neck, breast or lungs is an external form of concentrated Dryness-Heat, albeit manmade, it causes the Yin body fluids to become depleted often with permanent dryness issues such as dry mouth and Xerostomia with reduced capacity for mastication (Li, 2003, pp. 19-27).

! Fire Toxins Scorching Yin Fire can attack exogenously and is generally thought of as a more severe form of Heat. Fire blazes upwards. Symptoms of profuse epistaxis, irritability, mental instability, mania, incoherent speech, and high fever with profuse sweating can often present with Fire.

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Additionally, the pulse will be flooding and rapid frequently felt in all three positions. When Fire Toxins are present, the Blood moves in a reckless fashion and damage to the vessels and Yin can no longer contain the Blood causing hemorrhaging or profuse festering tumorous sores such as in the case of certain types of breast cancer presentations. When this happens the Fire scorches the Yin fluids causing congelation and Phlegm-Fire and Toxins are pathologically abundant (Li, 2003, pp. 19-27).

! Additional Exogenous Factors Our world with all its technological advances is not without imperfections. Biological agents, exposure to toxic industrial chemicals or too many chemical agents that have a collective effect, and wreak havoc in our bodies. The air that we breathe unfortunately has pollutants that can cause unequivocal damage often irreversible to our internal environment ("Support PSR!," n.d.). Many laborers and tradespeople that worked around asbestos primarily in the late 19th century inhaled small asbestos fibers. Over the course of a decade or two, a very high percentage developed malignant Mesothelioma, a type of lung cancer (Peto, Seidman, & Selikoff, 2005). Consumption of alcohol especially when in excess can increase our risks of oral, pharynx, esophagus, breast, colorectal, and liver cancers ("Alcohol Use and Cancer," n.d.).

Phlegm-Damp Stagnation not Transformed Phlegm and Fluids can collect and manifest in many ways. If not transformed by the body, it pools and collects and may lead to serious pathogenic health complications. Phlegm, a pathogenic substance, can obstruct the Lungs (known as Substantial Phlegm) causing cough and

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wheezing. Often, the phlegm may be able to be expectorated from the lungs; however, if the phlegm is deep and stuck, it can be difficult to expectorate. Phlegm can block the orifices of the Heart and leads to chest oppression and fullness, heart palpitations, metal confusion or muddled thinking, or withdrawal from the external environment and regular social behavioral patterns. When Phlegm collects in the middle Jiao and Stomach Fu, it can manifest as nausea and/or vomiting accompanied by focal distention, fullness, and abdominal discomfort. When Phlegm and Fluids combine with pathogenic Wind, they have a tendency to ascend leading to dizziness or impairment of vision. Dampness and Fluids can spread beneath the skin and flesh resulting in edematous tissue. Fluids that collect in the chest and hypochondrium will cause local pain that is worse with coughing. Fluids above the diaphragm will present symptomatically with coughing and the patient will not be able to lie in a supine position comfortably. Fluids in the Intestines will manifest as abdominal dissension, decreased appetite, and borborygmus (Li, 2003, pp. 19-27). Phlegm-Fluids stagnating internally manifests as various diseases. Yang Ke Xin De Ji (A Collection of Experiences in the Treatment of Sores) says, “Cancers and tumors are not formed by binding of Yin, Yang or Vital Qi (Zheng Qi), but by Blood stasis in the five Zang organs and stagnation of turbid Qi or Phlegm” (Li, 2003, p. 24). Phlegm, coughing and wheezing, lumps and accumulation of liquids in the body and many solid masses and tumors are frequently treated according to the principles of transforming, dispersing, flushing out, or dislodging Phlegm (Li, 2003, pp. 19-27).

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Phlegm Invading the Channels, Interstices and Network Vessels Over a long period of time if Phlegm accumulates, it will flow into the channels, interstices and network vessels. When this happens and if it is not dispersed properly, it will inevitably transform into Toxic accumulations, resulting in a condition of congealing of Phlegm and accumulation of Toxins that blocks the channels, interstices and network vessels and inhibits the Qi transformation in the San Jiao. Furthermore, congealing of Phlegm due to stagnation can give rise to Heat and combine transforming into Phlegm-Heat Toxic accumulations. This can affect any part of the body and manifest as malignant tumors. The primary methods in dealing with this presentation is addressing Phlegm, dissipating Heat, and resolving Toxins. This has been discussed in the prior section of transforming, dispersing, flushing out, or dislodging according to TCM principles (Li, 2003, pp. 19-27).

! Qi and Blood Stagnation & Stasis Many types of solid cancerous tumors are due to Qi stagnation and Blood stasis. The Liver Channel spans over the entire breast(s) and the Stomach channel goes to the nipple and has an external/internal relationship with the Spleen. When the Liver is affected by irritability and depression, Liver Qi becomes stagnated and constrained damaging the Liver and its functions. Likewise, the Spleen’s ability to transform and transport is impaired by excessive worrying and preoccupation or poor dietary practices giving rise to Phlegm and Damp. These two pathological states of the Liver and Spleen allow for Qi stagnation and Blood stasis to combine with Phlegm and Damp to form masses and tumors. Beginning stage of breast cancer is treated by dredging

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the Liver and regulating Qi. As the tumor becomes firmer, Chinese herbal medicine is often utilized to invigorate the Blood and transform Blood stasis (Li, 2003, pp. 19-27).

! The Seven Emotions Damaging the Body’s Internal Environment The seven emotions can lead to internal damage and contribute to the formation of malignant tumors. Grief, anxiety and irritability, excessive thought and neurotic behaviors damage the Spleen and Stomach, consume the Blood and Body Fluids and cause Qi to stagnate transforming to a more viscous substance in the body known as Phlegm. Once Phlegm is formed anywhere in the body it is stubborn and resistant to transform back to a more fluid state. In the case of breast tumors, Phlegm may lie dormant for several years until tumors gradually develop. These tumors combine with heat toxins and eventually will invade others tissues and organs within the body. Fu Ren Da Quan Liang Fang (Complete Effective Prescriptions for Women’s Diseases) says: “Ru yan (mammary rock) is due to depression and anger in the Liver and Spleen, and depletion of and damage to Qi and Blood.” Dan Xi Xin Fa [Danxi’s Experiential Therapy] says: “A woman who has been in a state of anxiety and depression for a long period will have obstruction of Spleen Qi and transverse counterflow of Liver Qi. This will gradually give rise to dormant nodes” (Li, 2003, pp. 19-27).

Zang-Fu Organ Deficiency The five Zang Yin organs and the six Fu Yang organs denote a functional relationship in that the Zang are paired with the Fu in both a Yin/Yang polarity and an internal/external relationship. The Zang-Fu along with the Extraordinary Vessels, Essence, Qi, Blood and Body

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Fluids forming the material basis via the channels and network vessels functioning as pathways of communication (Li, 2003, pp. 19-27). Zang-Fu deficiency not only means insufficiency of the congenital Pre-Heaven constitution or deficiency of the acquired Post-Heaven constitution due to lack of nourishment, it also includes depletion and damage to the organs’ functions due to the Six Excesses, internal damage caused by the seven emotions and dietary irregularities (Li, 2003, pp. 19-27). During optimal conditions, the functions of the five Zang organs promote and control each other—keeping one another in a state of balance with each Yin Zang paired with its Yang Fu organs with an internal-external organizational relationship. The Zang organs govern the limbs, the five sense organs and the nine orifices. Under normal conditions, this keeps bodily functions harmonious and healthy—making a person’s body resistant to external pathogenic factors. When the body system is compromised becoming depleted, pathological factors can lay the foundation for tumor formation (Li, 2003, pp. 19-27). As we age, the Kidney Qi gradually becomes more debilitated and the Zang-Fu organs inevitably become more vulnerable and weakened giving rise to the increased ability of tumor formation. The Wai Ke Qi Xuan (Revelations of the Mystery of External Diseases) clearly states that: “cancers occur in persons aged 40 and older with depletion of Blood and debilitation of Qi, and a predilection for rich foods” (Li, 2003, p. 11). Likewise, gender also plays a role of the location of tumors. Women are more prone towards tumor formation in the breasts and uterus. Men are more prone to cancers affecting the Spleen such as gastrointestinal tumors and prostate cancer. In the Ling Shu: Shui Zhong (The Miraculous Pivot: On Edema) it was recorded that Qi Bo said, “Shi jia (a stone-like mass) occurs

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in the uterus and therefor only affects women.” Ren Zhai Zhi Zhi Fang (Direct Indications of Ren Zhai’s Formula) says, “In men, cancer is more likely to affect the spleen; in women the breast.” When observing the causes of cancer, consideration should be given to the person’s constitution, age and gender tot eh extent that these may be a factor to deficiency and depletion of the Zang and Fu (Li, 2003, p. 26).

! Summary The expansive scope of Chinese medicine considers that the complex development of cancer is closely related to external pathogenic factors, dietary and emotional irregularities and factors, Phlegm-Damp accumulations, and consumption and deficiency of the Zang-Fu organs. In isolated circumstances, these etiological factors are not typically the cause of extensive disease—being the sole cause of cancerous malignant tumors. However, when combined with the appropriate external and internal factors affecting the body, they can propagate significant Yin and Yang imbalance, disharmony of the Qi and Blood, dis-regulation to the Zang and Fu organs, and local toxic pathogenic components that can lead to malignancies. Therefore, it is essential to apply the methods of FZGB theory in patients diagnosed with cancer to help restore the functions of the Zang-Fu and restore balance of the Yin-Yang relationship in the body.

! Dietary Irregularities, Toxic Foods, and Inappropriate Diet Regimen Food and drink are an essential aspect in helping to maintain optimum health. The old adage, “you are what you eat” is partially true however, the frequency, duration between meals, portion size, variances of the types of foods and beverages, and food and beverage quality all

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play an intricate role as well. The Spleen and Stomach are responsible for rotting and ripening. They have a upward and downward-bearing as well as a transportive and transformative function correlating in part to assimilating the vital nutrients extracted from food and beverages throughout the body. Overconsumption of food, or poor qualities of foods such as deep-fried, greasy, Cold and Damp foods such as french fries and ice-cream can bog the Spleen Qi’s transformative and transportive functions thus generating Heat, Phlegm and Damp in the body. This type of stagnation can lead to impairment of the body’s natural ability to absorb nutrients properly via the Spleen’s impairment of greasy, Cold and Damp foods and beverages. When this arises, Qi and Blood are not properly supplemented. They will over time become weakened resulting in a Deficiency of Zheng Qi. The lowered resistance allows for the external exogenous factors to penetrate the body’s defensive Wei Qi and illness arises. Rotten expired foods that become rancid, moldy, or contaminated can also wreak havoc and damage the middle Jiao leading to Heat Toxins and cancers of the Gastrointestinal tract. Equally important is to have balance of ingesting hot and cold foods and beverages. Overconsumption of thermally warm foods—spicy and Yang in nature, will damage the Spleen Qi. This can further damage other Zang-Fu with the appropriate circumstances (Li, 2003, pp. 19-27). The Jin Kui Yao Lue (Synopsis of the Golden Chamber) says, “Eating spoiled rice, rotten meat and putrid fish will damage the body, as they are toxic.” Contaminated foods enter the Stomach and move downward to the Intestines, they stagnate and bind and are unable to be digested. Under these circumstances they will transform into Heat and lead to Toxic accumulations (Li, 2003, pp. 19-27).

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Metronomic-Dosed Chemotherapy Dr. Ben Chue, whom I had the privilege of working alongside for many years, explains the concept and application of Metronomic-dosed chemotherapy: This treatment concept has been referred to by many names including lowdose continuous chemotherapy. However, the most popular title is likely metronomic chemotherapy. Just as a metronome, used to keep proper time in music, is unvaryingly regular in its rhythm, so too is a metronomic chemotherapy schedule. This nickname has been applied to chemotherapy regimens with low doses scheduled at regular (ideally, very short) intervals over long periods of time. This way, patients receive equal or greater amounts of chemotherapy without the harsh side effects of standard high doses and the long recovery period. Unlike in music, where the tempo may be altered in either direction, the goal with metronomic chemotherapy is to maintain the low dosing frequency at a much higher rate than exists in conventional protocols. Lower-dose, longer-term maintenance chemotherapy protocols have been important components of treatment for certain cancers (such as acute lymphoblastic leukemia) in human oncology. The low dose, metronomic dosing of certain chemotherapy agents such as Paclitaxel is now an acceptable and standard practice of many oncologists. Still, many oncologists fail to grasp that the generally low-cost, high-convenience, and acceptable side effect profiles of these protocols make them innovative and attractive for cancer

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treatment. One reason for the effectiveness of metronomic chemotherapy is because low, continuous doses appear to exhibit anti-angiogenic properties which stop the growth of tumors and progression of cancers by limiting the pathologic formation of new blood vessels. (“Lifespring Cancer Treatment Center," n.d.)

Alternately, standard dose chemotherapy and adjunct agents are typically spaced several weeks apart and are given at much higher dosages ("Planning Drug Doses and Schedules," n.d.). The disadvantage of this type of “traditional” oncologic therapy is frequently the advanced-stage cancer patient is too weak to tolerate the standard dosing regimen. Because the dosing regimen

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is frequently spaced three weeks apart from one another, it gives too much time for the cancer cells to proliferate and continue to weaken the host (the patient) by angiogenesis–creating erratic blood supplies to the tumor (Fidler, 2000). Thus, inevitably it will steal much needed vital nutrients, blood, and fluids that the the person needs to the once healthy organs and tissues. The metronomic-dosed chemotherapy (where applicable to the particular type of cancer the patient has been diagnosed with) is more readily tolerated with advanced-stage oncology patients where the cancer has metastasized to other organs (though not without any adverse reactions) and will not suppress and destroy the individual’s immune system as much or as severely according to what I have been taught through my decade of employment at the center where I worked (Kerbal, 2007).

! Master Tung’s Acupuncture in Advanced-Stage Oncology Patients Undergoing Metronomic-Dosed Chemotherapy With the integration of acupuncture in the West, more and more patients diagnosed with cancers are seeking what is known as “alternative” therapies. Adverse reactions commonly seen with the administration of metronomic-dosed chemotherapy are as follows:

! • Nausea and vomiting • Fatigue • Low appetite • Anxiety • Poor memory aka “chemo-brain” © 2014 Darin J. Bunch, MTCM, L.Ac.

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• Chemotherapy induced peripheral neuropathy (CIPN) • Tumor-related pain • Blood-related disorders

! Acupuncture is most instrumental in helping common adverse reactions associated with metronomic-dosed chemotherapy:

! 1) It integrates with allopathic oncology treatment modalities and does not interfere with the prescribed protocols. 2) It reduces or ameliorates the adverse reactions commonly associated with metronomic-dosed chemotherapy. 3) It supports the body’s natural defenses and helps keep the patients on their weekly fractionated chemotherapeutic dosages to reduce tumor burden and have increased efficacy towards managing cancer.

! Master Tung Points for Nausea and Vomiting ZongShu (1010.07), and/or FengFu (DU-16) can be pricked with either a three edged needle or an acupuncture needle. If a small amount of blood is extracted, even as little as a drop of blood, there will be greater therapeutic effects to decrease or ameliorate nausea and vomiting.

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Managing Nausea and Vomiting in Advanced-Stage Oncology Patients Caused From Metronomic-Dosed Chemotherapy Experiential Master Tung’s Point Strategy Right side upper extremity: NeiGuan (PE-6), JianShi (PE-5) Right side lower extremity: SiHuaShang (77.08), ZuSanLi (ST-36), MenJin (66.05) Left side upper extremity: WaiGuan (SJ-5), ZhiGou (SJ-6) Left side lower extremity: TianHuang (77.17), ShenGuan (77.18), GongSun (SP-4)

! I have needled the above points over 10,000 times with excellent therapeutic effects while patients underwent metronomic-dosed chemotherapy. Many women I treated were receiving Taxol and Carboplatin in metronomic doses for advanced-stage breast cancer. Nausea was a frequent adverse reaction to these agents. Needling the above points were very successful in helping to consistently manage the nausea without having to take large doses of prescription anti-emetics. In fact, many of the women who had oral anti-emetics were able to forego them especially if they were able to have two acupuncture treatments per week in my experience.

! Clinical Case A 47-year-old female diagnosed with advanced-stage breast cancer received 24 weeks of metronomic-dosed chemotherapy using the combined agents, Taxol and Carboplatin. At Week 3 she reported that she was experiencing considerable nausea despite her antiemetic medication her oncologist prescribed for her. At the time of her visit she reported no other adverse reactions with the exception of slight fatigue and looser stools. She reported experiencing nausea 24 to 48 hours after receiving her chemotherapy. On a VAS scale of 1-10, she reported overall that her

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nausea was a 6/10. She stated that it made it difficult to eat during this time, though her appetite was intact. Pulse was moderate with the right guan pulse being slightly Wiry and Slippery. Tongue was somewhat swollen, pink in color, with a thicker white tongue fur in the center.

! TCM Diagnoses Spleen Qi deficiency with rebellious Stomach Qi.

! Acupuncture Point Strategy Treatment was given from week three through week twenty-four during chemotherapy infusion and two days following the infusion with the acupuncture points listed below. Often, I would alternate and reverse the below points between right and left sides. Right side upper extremity: NeiGuan (PE-6), JianShi (PE-5) Right side lower extremity: SiHuaShang (77.08), ZuSanLi (ST-36), MenJin (66.05) Left side upper extremity: WaiGuan (SJ-5), ZhiGou (SJ-6) Left side lower extremity: TianHuang (77.17), ShenGuan (77.18), GongSun (SP-4)

! Patient Report Patient reported that by Week 5 she noticed a dramatic effect and stated that her nausea was a 2-3/10 during the first 24 hours following chemotherapy with acupuncture. She stated that she still was taking her prescription antiemetic medication during this time; however, after the 24 hour period following her chemotherapy infusion, she no longer needed to take her antiemetic medication.

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! Practitioner Report The nausea never completely ameliorated however, it greatly decreased and the patient was able to continue her 24-week chemotherapeutic regimen with no other health concerns regarding adverse reactions to the chemotherapy. Pulse gradually became less Wiry and Slippery in right guan position. Tongue remained swollen; however, the thick white tongue fur had greatly diminished in the center of the tongue.

! Managing Fatigue in Advanced-Stage Oncology Patients Caused From Metronomic-Dosed Chemotherapy Experiential Master Tung’s Point Strategy ZhengHui (1010.01) BiYi (1010.22) on right side for women, left side for men. Upper extremity: SanChaSan (A.04) one or both sides selected. Lower Extremity: ShenGuan (77.18), FuLiu (KI-7) one or both sides selected. Note: Adding ShenGuan (77.18) and FuLiu (KI-7) it further assists in strengthening the Kidney and supporting the Zheng Qi of the body, which is greatly taxed with oncology patients and any combination and dosage of chemotherapy.

! !

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Managing Low Appetite in Advanced-Stage Oncology Patients Caused From MetronomicDosed Chemotherapy Experiential Master Tung’s Point Strategy LingGu (22.05), SiHuaShang (77.08), MenJin (66.05) ShenGuan (77.18). Note: I typically select LingGu (22.05) and ShenGuan (77.18) ipsilaterally and SiHuaShang (77.08) and MenJin (66.05) on the opposite side. When ShenGuan (77.18) is paired with SiHuaShang (77.08), it balances the Spleen and Stomach as ShenGuan (77.18) is on the Spleen channel and it also strengthens the Kidney in supporting the Zheng Qi. Often there is nausea or digestive upset so I will add NeiGuan (PE-6) and JianShi (PE-5) opposite to point LingGu (22.05).

! Managing Anxiety Using Master Tung’s Acupunture Points in Advanced-Stage Oncology Patients With Diagnosis of Cancer and Metronomic-Dosed Chemotherapy ZhengJing (1010.08), HuoYing (66.03) with TaiChong (LV-3) Dao Ma to potentiate HuoYing (66.03). Bleed ear apex.

! Clinical Case A 53-year-old female diagnosed with Stage IV pancreatic cancer with a chemotherapy treatment protocol of 12 consecutive weeks of paclitaxel, oxaliplantin, leucovorin, and 5-fluorouracil (POLF) seeking help to manage her anxiety with acupuncture. She was seen on the first week of her chemotherapy infusion. At that time she had no other main health concerns other than her anxiety on a VAS scale of 1-10 was a 9/10 which affected her ability to fall and stay asleep since being diagnosed with pancreatic cancer 2 weeks prior. Her guan pulse on the left was Wiry and

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rapid and her cun and chi pulses on the left was Deep and Weak with the right cun pulse also being Deep and Weak. Her right guan pulse was slightly Hesitant and Choppy. Her tongue presentation was red tip and sides, pink with slight purple hue tongue body, thin white tongue fur, with the sublingual veins being distended, bifurcated with purple spots on the underside of the tongue body.

! TCM Diagnosis Liver invading the Heart, Blood stasis in the Middle Jiao, and Kidney deficiency.

! Acupuncture Point Strategy Because it was the patient’s first time receiving acupuncture, she was very hesitant and fearful of acupuncture needles. Acupuncture was initiated with: ZhengJing (1010.08), HuoYing (66.03) with TaiChong (LV-3) Dao Ma to potentiate HuoYing (66.03). I bled ear apex on the right side getting about 4-5 small drops of blood on the initial visit.

! Patient Report Patient returned the following week during the chemotherapy infusion and reported that she had noticed that the acupuncture treatment had helped reduce her anxiety somewhat to a 6-7/10 and she slept the evening following acupuncture treatment, for a few hours.

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! Practitioner Report She continued with weekly acupuncture treatments and I gradually added other points such as ShenGuan (77.18), SiHuaShang (77.08), and FuLiu (KI-7) to address her new health concerns of appetite becoming progressively less and her deficient chi pulses both on the right and left sides. Additionally, I eventually omitted bleeding ear apex on a weekly basis and added it back into the acupuncture point strategy if she began experiencing insomnia again. During the next six weeks, her pulse gradually became less Wiry in the left guan position and less Choppy and Hesitant in the right guan position. Additionally, the chi pulses became less deep and were felt easily at the middle depth with moderate pressure. Her tongue became gradually less red on the tip and sides and the sublingual veins became less distended and bifurcated. The purple spots on the underside of the tongue and the slight purple hue on the tongue body never completely dissipated. Patient was originally told by an unaffiliated hospital that she needed to get her affairs in order as she would likely only live 8-10 months from her diagnosis of stage IV pancreatic cancer. She continued several more rounds of POLF therapy (12 sessions per round) for a period of 4.5 years until she passed away.

Managing Poor Memory aka “Chemo-brain” in Advanced-Stage Oncology Patients Caused From Metronomic-Dosed Chemotherapy Experiential Master Tung’s Point Strategy ZhengHui (1010.01) with QianHui (1010.05) Dao Ma, BiYi (1010.22), LingGu (22.05). Alternate from treatment to treatment with XiaSanHuang (77.18, 77.19, 77.21).

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Managing Chemotherapy Induced Peripheral Neuropathy (CIPN) in Advanced-Stage Oncology Patients Caused From Metronomic-Dosed Chemotherapy Experiential Master Tung’s Point Strategy Numbness of the face: DaBai (22.04), HeGu (LI-4). Numbness of the hand and arms: RenHuang (77.21) with ZhongJiuLi (88.25), ShenGuan (77.18) Numbness of the lower extremities: ZhouShui (1010.25) Numbness of the feet: SanCha points (A.02, A.03, A.04) Numbness of the whole body: LingGu (22.05), ZhongJiuLi (88.25) with QiLi (A.01) Dao Ma, ShenGuan (77.18) or XiaSanHuang (77.18,77.19, 77.21). Alternate from treatment to treatment with MuLiu (66.06) and MuDou (66.07) Dao Ma.

! Managing Tumor-Related Pain in Advanced-Stage Oncology Patients Caused From Metronomic-Dosed Chemotherapy With Master Tung’s Acupuncture Points Bone Tumors: WuHu (11.27) Brain Tumors: ZhouLun (1010.04), ShangLiu (55.06) Brain Tumor Pain 1) ShangLiu (55.06) H, Y, ZhengJin (77.01), ZhengZong (77.02) (Hu) (McCann & Ross, 2012, p. 196) 2) San Zhong San Zhen Dao Ma Group: (77.05, 77.06, 77.07) (Hu) (McCann & Ross, 2012, p. 196) 3) ZhouKun (1010.03), ZhouLun (1010.04) (Young) (McCann & Ross, 2012, p. 196)

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Breast Tumors 1) YiZhong (77.05), ErZhong (77.06), SanZhong (77.07) 2) WaiSanGuan (77.27) 3) Prick to bleed upper back Note: Choose from the above list and alternate from treatment to treatment.

! Lung Cancer 1) Prick to bleed around lateral lower leg along Foot Gallbladder Shaoyang channel 2) WaiSanGuan (77.27) 3) SiMaZhong (88.17), SiMaShang (88.18), SiMaXia (88.19) 4) LingGu (22.05), DaBai (22.04) Note: Choose from the above list and alternate from treatment to treatment.

! Tumors: WaiSanGuan (77.27)

! Uterine Cancer and Uterine Tumors 1) HuoYing (66.03), HuoZhu (66.04), ShuiJing (66.13), DiHuang (77.19) 2) JieMeiYi (88.04), JieMeiEr (88.05), JieMeiSan (88.06) 3) MuFu (66.02) 4) Prick to bleed over the lower abdomen and sacrum. Note: Choose from the above list and alternate from treatment to treatment.

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! Managing Blood-Related Disorders With Master Tung’s Acupuncture Points in AdvancedStage Oncology Patients Caused From Metronomic-Dosed Chemotherapy

! Anemia: HuoFuHai (33.07, moxa or needle with moxa most effective), ShenGuan (77.18) Bleeding Disorders: HuaGuSi (55.05) Blood Stasis: YuHuo (1010.21) Generalized Blood Deficiency: TongGuan (88.01), TongShan (88.02), TongTian (88.03) Leukemia: MingHuang (88.12), TianHuang (88.13), QiHuang (88.14) Polycythemia: TuEr (99.04)

! Chinese Herbal Medicine in Fu Zheng Gu Ben Theory The primary support that FZGB therapy that is most beneficial to patients diagnosed with cancer is to support the Zheng Qi in strengthening the body’s resistance to pathogens and further disease progression. This is accomplished with regulating the Qi and supporting the Blood, regulating the Zang and Fu organs, and optimizing immunity. Below are some herbs commonly used with the administration of Chinese herbal formulas given to oncology patients. Herbal dosages and usage of the lists below should adhere to pattern differentiation within a TCM framework utilizing a reputable Chinese herbal Materia Medica (Chen, Chen, & Crampton, 2004).

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Herbs Used for Breast Cancer Chuan Bei Mu / Bulbus Fritllariae Cirrhosae Dang Shen/ Radix Codonopsis Pilosulae Fu Ling/ Poria Cocos Sclerotium Gua Lou/ Fructus Trichosanthis Jin Yin Hua/ Flos Lonicerae Ling Zhi/ Rhizoma Gynostmmatis Pentaphylli Pu Gong Ying/ Herba cum Radice Taraxaci Tian Men Dong/ Radix Asperagi Wang Bu Liu Xing/ Semen Vaccariae Segetalis Xia Ku Cao/ Spica Prunellae Vulgaris

! Herbs Used for Carcinoma of the Brain Che Qian Cao/Herba Plantaginis Dan Shen/ Radix Salviae Militiorrhizae Fu Ling Pi/Cortex Poriae Ling Zhi/ Rhizoma Gynostmmatis Pentaphylli Quan Xie/Buthus Martensi/Scorpion Wu Gong/Scolopendra/Centapede Ze Xie/Rhizoma Alismatis

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Herbs Used for Cervical Carcinoma Zi Cao/ Radix Lithospermi Bai Hua She She Cao/ Herba Oldenlandia Diffusae Bai Jiang Cao/ Herba Patrinia Ban Zhi Lian/ Herba Scutellaria Barbatae Bei Sha Shen/ Radix Glehniae Littoralis Fu Ling/ Poria Cocos Sclerotium Huang Qi/ Radix Astragali Jin Yin Hua/ Flos Lonicerae Ling Zhi/ Rhizoma Gynostmmatis Pentaphylli Mai Men Dong/ Radix Ophiopogonis Ren Shen/ Radix Ginseng Tian Nan Xing/ Rhizoma Arisaematis Tu Fu Ling/ Rhizoma Smilacis Wu Mei/Fructus Pruni Mume Yi Yi Ren/ Semen Coicis Yu Jin/ Tuber Curcumae

! Herbs Used for Dermatological Carcinomas Ban Xia/ Radix Pinelliae Bi Ma Zi/Semen Ricini Chan Tui/ Cicada Periostractum

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Ku Shen/Radix Sophoriae Flavescentis Nu Zhen Zi/ Fructus Ligustri Lucidi Shi Shang Bai/ Herba Selaginellae Doederleinii Shui Zhi/Leech/Hirudu Tai Zhi Shen/Hai Er Shen/ Radix Pseudostellariae Ya Dan Zi/Fructus Brucae Javanicae (Topical Only) Yu Zhu/ Rhizoma Polygonati Odorati

! Herbs Used for Esophageal Carcinoma Bai Hua She She Cao/ Herba Oldenlandia Diffusae Bai Zhu/ Rhizoma Atractylodis Macrocephalae Ban Xia/ Radix Pinelliae Dan Shen/ Radix Salviae Militiorrhizae Dang Shen/ Radix Codonopsis Pilosulae Dong Ling Cao/Radix Rabdsiae Rubescenti Fu Ling/ Poria Cocos Sclerotium Huang Qi/ Radix Astragali Huang Yao Zi/ Radix Dioscoreae Ji Xing Zi/ Semen Impatientis Jiao Gu Lan/ Ganoderma Lucidum Qu Mai/Herba Dianthi Ren Shen/ Radix Ginseng

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San Qi/ Tian Qi/Radix Notoginseng/Pseudoginseng Tu Fu Ling/ Rhizoma Smilacis Wei Ling Xian/ Radix Clemetidis

! Herbs Used for Gastric Carcinoma Bai Hua She She Cao/ Herba Oldenlandia Diffusae Bai Zhu/ Rhizoma Atractylodis Macrocephalae Bei Sha Shen/ Radix Glehniae Littoralis Dang Shen/ Radix Codonopsis Pilosulae Dong Ling Cao/Radix Rabdsiae Rubescenti Fu Ling/ Poria Cocos Sclerotium Gou Qi Zi/ Fructus Lycii Chinensis Gua Lou/ Fructus Trichosanthis Huang Qi/ Radix Astragali Ji Nei Jin/ Endothelium Corneum Gigeriae Galli Ren Shen/ Radix Ginseng San Qi/ Tian Qi/Radix Notoginseng/Pseudoginseng Tu Fu Ling/ Rhizoma Smilacis Wei Ling Xian/ Radix Clemetidis Wu Jia Pi/ Cortex Radicis Acanthopanacis Yi Yi Ren/ Semen Coicis

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Herbs Used for Hepatic Carcinoma Bai Hua She She Cao/ Herba Oldenlandia Diffusae Bai Jiang Cao/ Herba Patrinia Bai Zhu/ Rhizoma Atractylodis Macrocephalae Ban Bian Lan/ Herba cum Radix Lobeliae Chinensis Che Chian Cao/ Herba Plantaginis Fu Ling/ Poria Cocos Sclerotium Jiang Huang/ Rhizoma Curcumae Ling Zhi/ Rhizoma Gynostmmatis Pentaphylli Mai Men Dong/ Radix Ophiopogonis Ren Shen/ Radix Ginseng San Leng/ Rhizoma Sparganii Shi Hu/ Herba Dendrobii Tai Zhi Shen/Hai Er Shen/ Radix Pseudostellariae Xi Yang Shen/ Radix Panacis Quinquefolii Yu Jin/ Tuber Curcumae Zhi Mu/ Rhizoma Anemarrhenae Zhu Li/ Succus Bambusae

! Herbs Used for Leukemia Bai Hua She She Cao/ Herba Oldenlandia Diffusae Bai Zhu/ Rhizoma Atractylodis Macrocephalae

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Da Qing Ye/Folium Isatidis Dang Shen/ Radix Codonopsis Pilosulae Gou Qi Zi/ Fructus Lycii Chinensis Gui Ban/Plastrum Testudinis Huang Qi/ Radix Astragali Huang Qin/Radix Scutellariae Jiao Gu Lan/ Ganoderma Lucidum Mai Men Dong/ Radix Ophiopogonis Mu Dan Pi/ Cortex Moutan Radicis Sheng Di Huang/ Radix Rehmannia Shi Hu/ Herba Dendrobii Shu Di Huang/ Radix Rehmannia (Prepared) Tai Zhi Shen/Hai Er Shen/ Radix Pseudostellariae Tian Men Dong/ Radix Asperagi Zhi Mu/ Rhizoma Anemarrhenae

! Herbs Used for Lung Cancer Bai He/ Bulbus Lilii/ Lily Bulb Bai Lian/ Radix Ampelopsis Bai Wei/ Radix Cynanchi Atrati Bai Xian Pi/ Cortex Dictamni Dasycarpi Bai Zhu/ Rhizoma Atractylodis Macrocephalae

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Dan Shen/ Radix Salviae Militiorrhizae Han Lian Cao/ Herba Ecliptae Hai Zao/ Herba Sargassi Qing Hao/ Herba Artemisiae Annuae Ren Shen/ Radix Ginseng Tian Nan Xing/ Rhizoma Arisaematis Xian He Cao/ Herba Agimoniae Pilosae Xie Bai/ Bulbus Allii/ Bakeri Yu Xing Cao/ Herba Houttuyniae Cordatae Zi Wan/ Radix Asteris Tatarici

! Herbs Used for Nasopharyngeal Carcinoma Bai Hua She She Cao/ Herba Oldenlandia Diffusae Bai Mao Gen/ Rhizoma Imparatae Ban Zhi Lian/ Herba Scutellaria Barbatae Jin Yin Hua/ Flos Lonicerae Ling Zhi/ Rhizoma Gynostmmatis Pentaphylli Mai Men Dong/ Radix Ophiopogonis Ren Shen/ Radix Ginseng Sheng Di Huang/ Radix Rehmannia Shi Hu/ Herba Dendrobii Shi Shang Bai/ Herba Selaginellae Doederleinii

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Shu Di Huang/ Radix Rehmannia (Prepared) Tai Zhi Shen/Hai Er Shen/ Radix Pseudostellariae Tian Hua Fen/ Radix Trichosanthes Xuan Shen/ Radix Scrophularia Yu Zhu/ Rhizoma Polygonati Odorati Zhi Mu/ Rhizoma Anemarrhenae

! Herbs Used for Ovarian Carcinoma Bai Zhu/ Rhizoma Atractylodis Macrocephalae Ban Zhi Lian/ Herba Scutellaria Barbatae Cao He Che/ Rhizoma Polygoni Bistortae Che Chian Cao/ Herba Plantaginis Dang Shen/ Radix Codonopsis Pilosulae Fu Ling/ Poria Cocos Sclerotium San Leng/ Rhizoma Sparganii Tai Zhi Shen/Hai Er Shen/ Radix Pseudostellariae Yi Yi Ren/ Semen Coicis Yu Jin/ Tuber Curcumae

! Herbs Used for Pancreatic Carcinoma Da Huang/ Radix et Rhizoma Rhei Fu Ling/ Poria Cocos Sclerotium

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Gua Lou/ Fructus Trichosanthis San Qi/ Tian Qi/Radix Notoginseng/Pseudoginseng Ye Ju Hua/ Flos Chrysanthemi Indici Yu Jin/ Tuber Curcumae Zhi Zi/ Fructus Gardeniae Jasminoidis

! Herbs Used for Prostatic Carcinoma Bai Zhu/ Rhizoma Atractylodis Macrocephalae Bei Sha Shen/ Radix Glehniae Littoralis Dan Shen/ Radix Salviae Militiorrhizae Fu Ling/ Poria Cocos Sclerotium Gou Qi Zi/ Fructus Lycii Chinensis Huang Qi/ Radix Astragali Ling Zhi/ Rhizoma Gynostmmatis Pentaphylli Mu Dan Pi/ Cortex Moutan Radicis Shu Di Huang/ Radix Rehmannia (Prepared) Tai Zhi Shen/Hai Er Shen/ Radix Pseudostellariae Tao Ren/ Radix Persicae Yi Yi Ren/ Semen Coicis Yu Zhu/ Rhizoma Polygonati Odorati Zhu Ling/ Sclerotum Polypori Umbellati

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Herbs Used for Rectal and Colonic Carcinoma Bai Hua She She Cao/ Herba Oldenlandia Diffusae Bai Jiang Cao/ Herba Patrinia Bai Zhu/ Rhizoma Atractylodis Macrocephalae Ban Zhi Lian/ Herba Scutellaria Barbatae Da Huang/ Radix et Rhizoma Rhei Dang Shen/ Radix Codonopsis Pilosulae Di Yu/ Radix Sanguisorbae Officinalis Fu Ling/ Poria Cocos Sclerotium Gua Lou/ Fructus Trichosanthis Huang Lian/ Radix Coptidis Ren Shen/ Radix Ginseng Tai Zhi Shen/Hai Er Shen/ Radix Pseudostellariae

! Herbs Used for Renal Carcinoma Ban Bian Lan/ Herba Cum Radix Lobeliae Chinensis Ban Zhi Lian/ Herba Scutellaria Barbatae Che Chian Cao/ Herba Plantaginis Fu Ling/ Poria Cocos Sclerotium Gou Qi Zi/ Fructus Lycii Chinensis Jin Yin Hua/ Flos Lonicerae Ling Zhi/ Rhizoma Gynostmmatis Pentaphylli

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Nu Zhen Zi/ Fructus Ligustri Lucidi Ren Shen/ Radix Ginseng Tai Zhi Shen/Hai Er Shen/ Radix Pseudostellariae Xi Yang Shen/ Radix Panacis Quinquefolii

! Herbs Used for Testicular Carcinoma Fu Ling/ Poria Cocos Sclerotium Jin Yin Hua/ Flos Lonicerae Ju He/ Semen Citri Reticulatae Nu Zhen Zi/ Fructus Ligustri Lucidi Xiao Hui Xiang/ Fructus Foeniculi Vulgaris Yu Jin/ Tuber Curcumae Yu Zhu/ Rhizoma Polygonati Odorati

! Herbs Used for Thyroid Carcinoma Chan Tui/ Cicada Periostractum Dan Shen/ Radix Salviae Militiorrhizae Fu Ling/ Poria Cocos Sclerotium Hai Zao/ Herba Sargassii Huang Yao Zi/ Radix Dioscoreae Ling Zhi/ Rhizoma Gynostmmatis Pentaphylli Mu Li/ Concha Ostreae

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San Leng/ Rhizoma Sparganii Xia Ku Cao/ Spica Prunellae Vulgaris Zhe Bei Mu/ Bulbus Fritillariae Thunbergii

! Herbs Used for Tongue and Oral Cavity Malignant Tumors Bai Mao Gen/ Rhizoma Imparatae Bei Sha Shen/ Radix Glehniae Littoralis Feng Fang/Lu Feng Fang/ Nidus Vespae Fu Ling/ Poria Cocos Sclerotium Huang Lian/ Radix Coptidis Jin Yin Hua/ Flos Lonicerae Ling Zhi/ Rhizoma Gynostmmatis Pentaphylli Mai Men Dong/ Radix Ophiopogonis Qing Dai/ Indigo Pulverata Shi Hu/ Herba Dendrobii Tai Zhi Shen/Hai Er Shen/ Radix Pseudostellariae Tian Men Dong/ Radix Asperagi

! Herbs Used for Urinary Bladder Carcinoma Bai Jiang Cao/ Herba Patrinia Ban Bian Lan/ Herba cum Radix Lobeliae Chinensis Che Chian Zi/ Semen Plantaginis

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Da Huang/ Radix et Rhizoma Rhei Fu Ling/ Poria Cocos Sclerotium Ling Zhi/ Rhizoma Gynostmmatis Pentaphylli Qian Cao Gen/ Radix Rubiae Cordifoliae Tai Zhi Shen/Hai Er Shen/ Radix Pseudostellariae Xi Yang Shen/ Radix Panacis Quinquefolii Xiao Ji/ Herba Circii Segeti Zhu Ling/ Sclerotum Polypori Umbellati

! ! Chinese Herbal Formulas Used in Fu Zheng Gu Ben Theory Formulas can be utilized to support patients diagnosed with advanced-stage cancers while they undergo metronomic-dosed chemotherapy. The formulas listed below can be modified with individual herbs from the previous section for a more targeted approach following stringent pattern differentiation guidelines (Scheid & Bensky, 2009).

Common Formulas to Support the Interior for Management of Metronomic-Dosed Chemotherapy Patients

Category

Formula

Formulas to Boost Qi

Bu Zhong Yi Qi Tang Liu Jun Zi Tang Si Jun Zi Tang

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Category

Formula

Formulas to Supplement Blood

Dang Gui Bu Xue Tang Qi Bao Mei Ran Dan Si Wu Tang

Formulas to Supplement Qi and Blood

Ba Zheng Tang Gui Pi Tang Ren Shen Yang Ying Tang Sheng Yu Tang Shi Quan Da Bu Tang

Formulas to Boost Qi and Sheng Mai San Nourish Yin Formulas to Enrich Yin

Da Bu Yin Wan Liu Wei Di Huang Wan Sha Shen Mai Men Dong Tang Zhi Bai Di Huang Wan Zuo Gui Wan

Formulas to Warm Yang

Ba Wei Di Huang Wan You Gui Wan

! Cancer is a complex disease with various forms of etiologies and pathologies as mentioned previously. With the presentation of accumulation of toxins and/or heat gives rise to stagnation and obstruction, the stagnation and obstruction leads to further heat or toxin accumulations. To ensue a change in this vicious cycle one uses herbs to clear heat, resolve toxin, move blood, and dispel stasis. In China, this approach is seldom used alone but usually in combination with chemotherapy or surgery. Anti-neoplastic herbal therapy is only used alone if the patient is too weak to accept western medical treatments or for some other reason is unable or unwilling to undergo such treatment.

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Because Bai Hua She She Cao and Ban Zhi Lian are used to manage most cancers, some practitioners prepare a separate formula of these two herbs as a syrup and have the patient take it with a specific herb formula (Heuertz, 2006).

! Bai Hua She She Cao Ban Zhi Lian Gao Bai Hua She She Cao (60 grams) Ban Zhi Lian (60 grams)

! 1) Place the above herbs in a large pot and add enough water to cover the herbs and soak for one-half hour (It is good to grind the herbs coarsely so that they are less bulky). 2) Bring the herbs to a boil then lower the heat to a simmer and cook for 25 minutes. 3) Strain out the herbs and return the liquid to the pot. Continue to cook on a low flame until the liquid reduces to about one quarter of the volume it was when it was returned to the pot. 4) Add honey to the remaining liquid and cook on a low flame until mixture thickens into a syrup. The amount of honey required varies according to the viscosity of the herb liquid and the type of honey. Typically, at least a 1:1 ratio of honey to herb liquid is used, but this ratio can be increased up to 3:1. This syrup can be stored in the refrigerator for several weeks. The usual dose is two tablespoons dissolved in a cup of hot water 3 times per day (Heuertz, 2006).

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Formulas Used in Modern-Day to Manage Oncology Patients Given Metronomic-Dosed Chemotherapy

Formula Ba Zheng San

Application Bladder and urinary tract cancers

Explanation with Examples of Herbal Additions Treats Damp-Heat in the Lower Jiao. Add herbs in the UB carcinoma list above when appropriate to strengthen the effects.

Long Dan Xie Gan Thyroid cancer with Heat signs Tang

Add Shan Dou Gen and herbs for Thyroid cancer list above such as Xia Ku Cao, Zhe Bei Mu and Dan Shen.

Mai Men Dong Tang

Lung cancer

Qi and Yin Xu. Add Chi Shao, Yu Xing Cao or other herbs in the list above for lung cancer such as Bai Wei, Xian He Cao, Zi Wan, Tian Nan Xing when appropriate.

San Zhong Kui Jian Tang

Lymphatic and thyroid cancers

Add herbs to dispel stasis in the appropriate areas. Use guiding herbs if there are tumors in various regions of the body such as in the upper extremities add Jiang Huang and Gui Zhi or lower extremities add Chuan Niu Xi. If Dampness in lower extremities, add Si Miao Wan.

Xue Fu Zhu Yu Tang

Lung cancer with Qi and Blood Stagnation & Stasis

Add Xia Ku Cao and or other appropriate herbs like Gua Lou Shi or herbs in lung cancer list when appropriate.

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Formula

Application

Explanation with Examples of Herbal Additions

Zi Cao Gen Mu Li Tang

Breast cancer involving the lymphatic For Excess Heat-Toxin patterns ducts with malignant tumors at or near the nipple. Add Lu Lu Tong, Mo Yao, Qing Pi, Wang Bu Liu Xing and Pu Gong Ying.

Dang Gui Si Ni San

Abdominal masses including tumors in the spleen, pancreas, liver, intestines and gynecological tumors

!

Ge Xia Zhu Yu Tang

!

Bai Hua She She Cao, E Zhu, San Leng, Ban Zhi Lian should be added to dispel Toxic-Heat accumulations and move Blood. Many other herbs can be considered when appropriate.

Gui Zhi Fu Ling Wan

!

Shao Fu Zhu Yu Tang

!

Zhe Chong Yin Shi Liu Wei Liu Qi Breast cancer with Toxic swelling of Yin the breast and pus. Use when there is an underlying deficiency of Qi and Blood.

Add Pu Gong Ying, Wang Bu Liu Xing, and Yu Jin.

! The individual herbs and Chinese herbal formulas listed above are in no way intended to be a primary form of treatment for patients diagnosed with cancer. Rather, they can be implemented in an integrative modality to help offset the adverse reactions of patients undergoing metronomic-dosed chemotherapy or other standard primary treatments given to oncology patients such as standard-dose chemotherapy, radiation, surgery, hormonal therapy, targeted therapies etc. Furthermore, many of the individual herbs and Chinese herbal formulas are designed to support the Zheng Qi and strengthen the body’s natural defenses in optimizing

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immunity, harmonize digestion, reduce toxicity and clear toxins, regulate the Qi and invigorate the Blood etc. The herbs and formulas should be used in accordance with TCM theory, principles and texts under a trained Chinese medicine practitioner. Granules or bulk (i.e., raw or crude) herbs are generally thought the most therapeutically effective by various senior practitioners I have had the privilege with being mentored by them however, bulk herbs can be problematic in several ways such as having the space for them in a small clinic, maintaining potency if they remain on the shelf for a prolonged period of time, and with patient compliance in properly preparing them and tolerating the smell when they are decocted by the patient. In today’s modern western society, often granules are used for compliance, stringent quality assurance and preparation methods. Patents in pill form can be used when patient compliance is not well tolerated for drinking herbs—especially when certain formulas may be given for a long duration of time such as Liu Wei Di Huang Wan as one example.

! Congees That Help Strengthen and Support Advanced-Stage Oncology Patients Undergoing Metronomic-Dosed Chemotherapy Congees are a porridge-like nutritious food. Typically, made from a base of rice, sorghum, corn, or other grains or seeds. They are easy to digest and applicable to cancer patients when their appetite and digestion have been impaired from the chemotherapeutic agents such that they cannot properly absorb and assimilate nutrients from standard foods they typically are accustomed to ingesting (Li, 2003, pp. 385-391). It is a preferred method, and a beneficial substitute to the allopathic B.R.A.T. (bananas, rice, applesauce, and toast) diet and can be varied

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adding different foods and medicinal herbs to promote health and aid in digestion. Below are a few of literally hundreds of recipes that are easy for the patients in America to tolerate and enhances compliance with supplementation of medicinal congees. Chinese Materia Medica such as Astragalus root (Huang Qi), Chinese Wolfberry (Gou Qi Zi), ginseng (Ren Shen) and Reishi mushroom (Ling Zhi) can be given to the patient so that it will make it easier for them not trying to locate those items. Additionally, granules may be substituted using appropriate conversions at the practitioner’s prescribing discretion.

! Shan Yao Er Mi Zhou (Chinese Yam, Rice, and Millet Congee) Ingredients: Chinese Yam (Shan Yao) 50-100 grams Rice (Geng Mi) 25 grams Millet (Su Ya) 25 grams Rock candy 20 grams

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! Preparation: Peel the Chinese yam (Shan Yao) and cut into pieces. Add the yam (Shan Yao), rice (Geng Mi) and millet (Su Ya) to 4 cups of water. Bring to a boil and reduce heat to simmer for 40 minutes until the congee is ready. Properties: Sweet and neutral. Channels entered: Spleen, Stomach, Lung, Kidney, Large Intestine. Functions: Fortifies the Spleen, supplements the Lungs, enriches the Kidneys, and nourishes the Stomach. Indications: Debility and poor appetite in cancer patients resulting from surgery, radiation or chemotherapy (Li, 2003, pp. 385-391).

! Hei Zhi Ma Er Mi Zhou (Black Sesame Seed, Rice and Millet Congee) Ingredients: Rice (Geng Mi) 50 grams Millet (Su Ya) 50 grams Black sesame seed (Hei Zhi Ma) 50 grams

! Preparation: Stir-fry to the point of when the black sesame seeds (Hei Zhi Ma) are fragrant. Then, crush the seeds. Add the rice (Geng Mi) and millet (Su Ya) to 6 cups of water, bring to a boil and reduce to simmer for about 40 minutes. Mix in the sesame seeds (Hei Zhi Ma) and serve. Properties: Sweet, aromatic, and neutral.

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Channels entered: Spleen, Stomach, Kidney, and Large Intestine. Functions: Fortifies the Spleen, increases the appetite, aids digestion, moistens the intestines, and has anti-cancer properties. Indications: Deficiency patterns in the middle-aged and elderly, and in cancer patients (Li, 2003, pp. 385-391).

! Ling Zhi Hong Zao Zhou (Ganoderma Mushroom and Chinese Date Congee) Ingredients: Reishi mushroom (Ling Zhi) 15-20 grams Chinese dates (Da Zao/Hong Zao) 15-30 grams Rice (Geng Mi) 50 grams

! Preparation: Put the Reishi mushrooms, dates (Da Zao/Hong Zao) and rice (Geng Mi) in 6 cups of water, bring to a boil and simmer for approximately 40 minutes until the congee is thick, then serve. Properties: Sweet, bland, warm. Channels entered: Spleen, Lung, and Kidney. Functions: Greatly supplements Deficiency. Indications: Leukopenia (low white blood cell count) in the early, middle or late stages of radiation or chemotherapy (Li, 2003, pp. 385-391).

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Ren Shen Zou (Ginseng Congee) Ingredients: Ginseng (Ren Shen) 5 grams Fresh ginger (Sheng Jiang) 15 grams Rice (Geng Mi) 50 grams

! Preparation: Use powdered ginseng (Ren Shen) and press the fresh ginger (Sheng Jiang) to squeeze out the juice. Add 4 cups of water and boil down until it is approximately 2 cups of liquid. Add the rice (Geng Mi) and simmer over a low heat for 30 minutes until the congee is in a porridge state. Take a little at frequent intervals on an empty stomach. Properties: Sweet, salty, bland, warm. Channels entered: Spleen, Stomach, Heart, and Kidney. Functions: Greatly supplements the Zang organs, augments Original Qi (Yuan Qi), nourishes the Spirit, and has anti-cancer properties. Indications: Cachexia, anemia, debility, emaciation, palpitations, shortness of breath, insomnia, poor appetite, and chronic diarrhea in cancer patients. Also, can relieve side-effects of surgery, radiation, and chemotherapy (Li, 2003, pp. 385-391).

! Niu Rou Zhou (Beef Congee) Ingredients: Beef 100 grams Cornstarch 10 grams

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Rice (Geng Mi) 25 grams Millet (Su Ya) 20 grams Coix seeds (Yi Yi Ren) 20 grams Beef stock/bouillon cube

! Preparation: Cut the beef into thin slices and coat with the cornstarch mixed with water. Put the rice (Geng Mi), millet (Su Ya) and Coix seeds (Yi Yi Ren) in 2 cups of water and bring to a boil and simmer for 20 minutes. Add the beef and simmer for another 30 minutes. Add the beef stock cube and salt if desired. Serve hot. Properties: Salty, sweet, warm. Channels entered: Spleen and Stomach. Functions: Supplements Spleen-Earth, fortifies the Spleen and Stomach, and has a similar function to Astragalus root (Huang Qi) in supplementing Deficiency of Post-Heaven Qi and Blood. Indications: Cachexia due to malignant tumors, especially tumors in the digestive tract with loose stool or diarrhea (Li, 2003, pp. 385-391).

! Qi Qi Ling Fen Zhou (Astragalus, Wolfberry and Water Caltrop Starch Congee) Ingredients: Astragalus root (Huang Qi) 30 grams Chinese Wolfberry (Gou Qi Zi) 20 grams Rice (Geng Mi) 20 grams

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Millet (Su Ya) 20 grams Chinese dates (Da Zao/Hong Zao) 10 grams Water caltrop starch (or water chestnut starch) 15 grams

! Preparation: Decoct the Huang Qi in 1.5 to 2 cups and boil down to approximately 3/4 to 1 cup. Strain off the liquid and discard the residue. Add the Chinese Wolfberry (Gou Qi Zi), rice (Geng Mi), millet (Su Ya) and Chinese dates (Da Zao/Hong Zao) to the strained decoction, top off with another 3/4 to 1 cup of water, bring to a boil and simmer for 30 minutes until congee resembles a porridge. Mix the water caltrop starch (or cornstarch) and bring back to a boil. Serve warm. Eat once every three days. Properties: Sweet and warm. Channels entered: Spleen, Lung, Liver, and Kidney. Functions: Supplements the Middle Jiao and augments Qi, supports the Vital Qi (Zheng Qi) and has anti-caner properties. Astragalus root (Huang Qi), Chinese dates (Da Zao/Hong Zao) are supplementing ingredients that inhibit cancer; Chinese dates relieve Toxicity and supplement the Blood to inhibit cancer. Indications: Weakness and emaciation in patients with malignant tumors. Helps alleviate sideeffects of radiation and chemotherapy (Li, 2003, pp. 385-391).

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Lifestyle, Qigong, Meditation, and Nutrition for Advanced-Stage Oncology Patients Undergoing Metronomic-Dosed Chemotherapy Lifestyle encompasses a vast range of topics in Western society. We all tend to lead a busy lifestyle in various ways. For each person this can be different, so integrating a balanced approach may be of benefit. Generally speaking, for those unfortunately diagnosed with cancer and undergoing metronomic-dosed chemotherapy, it is important to rest after allopathic treatments. Trying to get 8 hours of sleep each evening or more in some cases it beneficial in allowing the body to recuperate from chemotherapeutic agents. Additionally, it is important to try and get some exercise even if this means walking to the mailbox or around the block and gradually increasing the distance each day (Mayo Clinic Staff, n.d.). Often advanced-stage oncology patients report that they initially awake with fatigue following their western treatments however, once they get up and out of bed or off the couch and get outdoors for a walk or other forms of exercise, they almost always feel better—less fatigued. It is important to stress that they should not push themselves to the point of exhaustion because this can be taxing and further delay their recovery. Finding their individual balance is subjective as each person is unique and not entirely like another. Furthermore, with today’s busy work environment it is important to stress that if a person must maintain their job which is frequent in the United States, they try and find the balance in not working themselves to complete physical and mental exhaustion. This will inevitably be detrimental towards their recovery. Traditional Chinese medicine theorizes that tumors are formed due to insufficient of the Zheng Qi, which leads to impairment and injures the functions of the Zang-Fu organs. This inevitably will lead to Qi stagnation initially, followed by Blood stasis. Fluids will congeal to

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form Phlegm, and accumulation and binding of toxic pathogenic factors will ensue giving rise to cancer and malignancy with metastasis in the late stages. Mechanisms that contribute to an individual’s decline are improper diet, inability to adapt to changes in climate or temperatures, overexertion, and emotional instabilities (Li, 2003, pp. 19-27). Learning and practicing qigong, meditation, or taijiquan can help one to regain structure and balance and assist in trying to regain balance in that it helps to regulate respiration, regulate Qi and Blood, provides balance in harmonizing emotions and reduces inflammation thus, increasing an individual’s quality of life (Oh et al., 2009). There are many national support groups such as Gilda’s Club that provide these services at no charge and reportedly by patients, most beneficial. Nutrition is important as cancer consumes the body’s resources. It is important to get a balance of nutrients with easily digestible foods which are readily absorbed and assimilated (Pitchford, 1996). I have already listed congees as an invaluable way to get nutrients. It is important that oncology patients abstain from an excessive amount of sugary foods as possible (Shigihara & Erickson, 2010, p. 102). We all utilize sugar metabolically speaking, however, an excess of sugary foods found in desserts, pastries, cakes and candy however may not be what the doctor had intended so to speak. Cancer cells love sugar just as our noncancerous cells do. Cancerous tumors create a dominant and erratic blood supply. They are able to quickly utilize sugars converted to glucose in the body, essentially starving other vital organs and tissues of much needed nutrients. Some physicians uphold in their theoretical foundations that when we feed our body excessive amounts of sugar, this is like adding gasoline to a fire. Cancer cells quickly gain the upper hand and

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utilize it for energy and proliferate. By decreasing the amount of refined and processed sugars and all processed foods that have high fructose and other non-essential additives, we can help to assist our internal environment in not feeding cells glucose. For oncology patients in the West who typically eat a diet high in processed foods that are prepackaged or convenient, a diet rich in whole foods, grains, and plant-based diets are suggested. Furthermore, many naturopathic physicians I have worked alongside recommend that fatty and processed meats should be avoided while a moderate amount of good protein found in cold water fish such as salmon and free-range hormone free chicken should be substituted in small amounts. In general, lean meats are recommended (Murray, 2002, pp. 150-164). Almond butter and tree nuts contains no aflatoxin and is safer for an oncology patient to consume due to them being immune compromised—it is recommended that they avoid peanut butter because of the aflatoxin that so easily grows on the legume (Campbell, 2006). There is much research on green tea (Camellia sinensis) and has been consumed in Asia for thousands of years. It is less oxidized than oolong or black tea which also come from the leaves of the same plant. Green tea is known for its anti-oxidative properties an contains polyphenols and flavonoids which are a group of phytochemicals present in many plant products responsible for health benefits such as anti-oxidative and anti-carcinogenic functions. Green tea is commonly recommended for advanced-stage oncology patients undergoing metronomic-dosed chemotherapy as it can help reduce inflammation and potentially assist in reducing neoplastic cell proliferation ("Tea and Cancer Prevention," 2010). Our environment has changed and we too must adapt. No longer are our foods commonly as rich in nutrients as they were in the last century. With the introduction of

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agricultural foods and chemicals such as pesticides, it is best (if possible) to consume trusted sources of organic foods found at various supermarkets or farmer’s markets locally in our demographic.

! Support Networks, Patient’s Mental Attitude and Conclusion Through the years, I have always observed one element that seems to be an important factor and not entirely understood is a patient’s mental state—in having a positive attitude towards being an active participant towards a journey of healing. This does not mean with the diagnoses of advanced-stage cancer that healing necessarily constitutes survival. It can mean many different things depending on the individual and their own personal journey. For some, it can be coming to terms with the fact that we are impermanent beings and we all inevitably will face mortality. For others, faith in whatever they believe and acceptance that they soon will pass —relinquishing control may be their own personal journey. Others, it simply may be embracing themselves and their family—having patience and understanding. Nonetheless, it is interesting to note that when patients diagnosed with advanced-stage cancer have a positive outlook, their outcome will be better no matter whether they survive for a greater period of time or whether they pass in serenity in my own clinical observation. There are some publications on this subject but often they are difficult to conduct stringent research methods ("Emotional Well-Being," 2013). In conclusion, having compassion for the people we are so fortunate to treat should remain in our conscious. For myself, having over a decade of experience in helping to manage individuals diagnosed with advanced-stage cancer receiving metronomic-dosed chemotherapy

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with Master Tung style acupuncture and applying Fu Zheng Gu Ben treatment strategies in an integrated clinical setting has been an honored privilege. With continued understanding and as my knowledge and application of Master Tung style acupuncture grows, so does the therapeutic efficacies of the treatments I am able to provide. There is an endless combination of Tung-style points that always enable the practitioner to refine their treatment strategies in order to have profound treatments results. With advanced practitioners and scholarly mentors such as Dr. WeiChieh Young, the late Dr. Miriam Lee, Dr. Chuan-Min Wang, Susan Johnson, and Dr. Henry McCann we are able to deepen our understanding of Master Tung style acupuncture and theory. I am grateful for their contributions in rich texts and lectures. As a practitioner, I am always aware that there is a dialogue amongst myself and the patients I am able to have a professional relationship with. At times, I am the teacher, communicating to them Chinese medicine and its intricacies. Most of the time, I am the student—learning from them. 


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