A Comparison Between Western Medicine and Traditional Chinese Medicine in the Etiology and Treatment

By

David Kim

Abstract

The number of cases of breast cancer is rising on every continent and it has touched the lives of millions of women every year. In the United states, breast cancer is one of the leading cause of death from malignant tumors for women. Ultraviolet rays cause most skin cancers and most lung cancers are caused by smoking but no single cause has been established for breast cancer. However, according to recent western research, genetic, environmental, and hormonal factors may play a role in breast cancer. On the other hand, emotional problems, diet, disharmony of directing and penetrating vessels and overwork are the treatment principles and prescriptions for breast cancer in Traditional Chinese Medicine. Women who are exposed to these factors may be at increased risk.

Both Western and Traditional Chinese Medicine treatment modalities have the strengths and limitations for breast cancer. This paper attempts to compare the etiology and treatment of breast cancer from both a Western and Traditional Chinese Medicine point of view.

Overall research indicate that Western Medicine and Traditional Chinese Medicine should combine together to dealing with breast cancer because a combination of both fields re-enforce each other to bring a therapy with a potentially high success rate.

History of breast cancer in Western Medicine

An Internet search of the PubMed database(1) of National Library of Medicine produced 119,162 articles using the key word breast cancer and the key word history breast cancer produced 4,208 articles. A search combining the key words written history breast cancer resulted in 2 related articles. These 2 articles were concerned with background material on history for western medical view of the breast cancer.

From this internet search, Dr. Baum M. in England, in his paper(2) he traced the history of the development of the treatment of breast cancer over a 4000-year period and he was focused last twenty years of treatment. Another Dr. Buchanan EB. From Pennsylvania, USA presented(3) three consecutive breast cancer series totaling 1,912 women treated by three generations of surgeons. All operations were done in one institution over the last 100 years. He found out that the most of the early patients under went radical mastectomy. The 673 patients in the last series were treated by an assortment of different modalities, reflecting the changing therapeutic concepts of the past 25 years. These internet search shows the improvement in operating conditions in western medicine to treat breast cancer is less then a couple hundred years.

History of breast cancer in Traditional Chinese Medicine

The old name for breast cancer was Ru Yan, the character Yan being composed of a mountain and rock which denote the hardness of the lump.(4) Ancient Chinese medicine did not have a concept of cancer or malignancy and could not differentiate lumps according to whether they were benign or malignant. However, the doctors were well aware of the seriousness and poor prognosis of certain types of lump, and Ru Yan indicated a lump which was difficult to treat and often led to death.

The complete Manual of Ulcers(Chuang Yang Jing Yan Quan Shu) of the Song dynasty(AD.960-1277) gave correct indication on prognosis: If it is not broken it can be treated, if it is broken it is difficult to treat. The earlier it is treated, the better. If it bursts inside it burns the flesh, it spreads to the internal organs and causes death(5). This description clearly shows that although the ancient Chinese did not have a conception of malignancy, they did conceive the idea of the disease spreading from the breast to the internal organs and leading to death.

Chen Bai Ming in the Beneficial Formulae of the Great Compendium of Gynecology(Fu Ren Da Quan Liang Fang, 1273) differentiates between breast carbuncle(yong) and lump(yan) saying that the former is characterized by redness, swelling and heat, the latter by its process of development: In the beginning there is a small accumulation like a turtle egg which is not red nor painful, after several month it gets bigger, then the lump breaks up like a ripe pomegranate, it bursts through, as though in a deep hole, this is due to Liver and Spleen being affected by anger, Qi and Blood are exhausted and it is called Ru Yan.(6)

Western Medicine view of etiology

Family History: A women having a family member with breast cancer, such as a mother, a sister, or even a maternal aunt or grandmother, has an increased likelihood of developing it. If several of them had this disease, her risk is greater. Dr. Patricia Kelly, a geneticist in the United States, tells that while hereditary factors are involved, they may account for only 5 to 10 percent of all breast cancer. We think, she explains, that a block of others are due to not-quite-as-strong hereditary factors working in combination with the environment. Family members having the same genes tend to share the same environment as well.(7)

Environmental Factors: Clearly there are environmental factors, broadly conceived, that are involved in triggering the disease, said Devra Davis, a scholar commenting in the journal Science. Since the female breast is one of the most radiosensitive parts of the body, women exposed to ionizing radiation have an increased risk of breast cancer. So do those exposed to toxic chemicals. Another environmental factor is diet. Some suggest that breast cancer may be a vitamin-deficiency disease and point to lack of vitamin D. This vitamin helps the body absorb calcium, which may in turn help prevent uncontrolled cell growth. Other studies link the fat diet, not as a cause, but as a promoter of breast cancer. The magazine FDA Consumer stated that the death rate from breast cancer was the highest in countries like the United States, where the intake of fat and animal protein is high. It commented: Japanese women historically have a low risk for breast cancer, but that risk has been rising dramatically, concurrent with a Westernization of eating habits; that is, from a low-fat to high-fat diet. A recent study suggested that the largr number of calories consumed in a high-fat diet may represent the real risk. Science News stated: Every excess calorie raises breast cancer risk, with each excess fat-derived calorie posing about 67 percent more risk than calories from other sources. Excess calories can put excess pounds, and women who are severely overweight are thought to have about a threefold higher risk of breast cancer, especially women past menopause. Body fat produces estrogen, a female hormone that can act adversely on breast tissue, leading to cancer.(8)

Hormones: Within a womans breast is a rich hormonal milieu that produces changes in the breast all throughout her life. Dr. Paul Crea, a surgical oncologist, writes in the Australian Dr Weekly: In some women, however, the exposure of breast tissue to prolonged hormone stimulation®|will set off a series of cytological changes that eventually result in malignant conversion. For this reason it is thought that women who have had an early menarche, by age 12, or have a delayed menopause, in the mid-50s have a higher risk. The additional estrogens received from ERT(estrogen replacement therapy) as a possible link to breast cancer has been the subject of much controversy. While some studies indicate that ERT creates no increased risk, other studies show a significant risk for long-term recipients. Considering the studies reviewed that the possibility exists that non-contraceptive oestrogen increases the risk of breast cancer by 30-50% after long-term use.(9) Report on the relationship between oral contraceptives and breast cancer suggest little risk from use. However, there emerges a subgroup of women who are at higher risk. Younger women, women who have never had children, and women who have used birth control pills for a long time may have as much as a 20-percent higher risk of breast cancer.

Examining the make up of the female breast explains why it is so vulnerable to cancer. Within it are ducts, tiny passageways, that channel milk from milk-producing sacs to the nipple. Lining the ducts are cells that divide and change continually in response to a womans monthly cycle, preparing her for pregnancy, lactation, and nursing her young. It is in these ducts where most breast cancers develop.(10)

The presenting complaint in about 70% of patients with breast cancer is a lump (usually painless) in the breast. About 90% of breast masses are discovered by the patient herself. Less frequent symptoms are breast pain; nipple discharge; erosion, retraction, enlargement, or itching of the nipple; and redness, generalized hardness, enlargement, or swelling of the arm may be the result of systemic metastases, but these symptoms are rarely seen on initial presentation.(11) Eighty percent of all breast cancer is infiltrating ductal carcinoma. Ductal carcinomas infiltrate the surrounding breast tissue. They are discovered when a lump is found, or in a mammogram. Another common forms of breast cancer are Pagets disease, which affects the nipple, cannot be detected by an examination. This form of cancer occurs when cancer cells migrate to the nipple The symptoms are itching, redness, and soreness. Paget,s disease always signals the presence of primary ductal carcinoma elsewhere in the breast tissue. Not all rashes and itching of the nipple are cancerous

Inflammatory carcinoma is another type of ductal cancer in which the lymphatic and blood vessels become plugged with a tumor. Inflammatory carcinoma is another type of ductal cancer in which the lymphatic and blood vessels become plugged with a tumor. The skin thickens and turns red. The breast becomes extremely tender and looks infected. This type of cancer spreads very quickly due to a rich blood and lymph vessel supply associated with the inflammatory reaction. Biopsy proof of malignancy is required because a benign breast condition may mimic an inflammatory carcinoma. Intraductal carcinoma is characterized by growth of cancer cells within the ducts. Sometimes this cancer does not invade other tissues. This disease is called intraductal carcinoma in-situ (meaning in place or localized). Lobular carcinoma occurs in about 9 percent of breast cancers. Lobular carcinomas occasionally occur in both breast simultaneously. Rare forms of breast cancer include: tubular carcinoma, malignant cystosarcoma phylliodes, medullary carcinoma, adenoid cystic carcinoma, and several others which are less common. These forms of cancer tend to be less aggressive. They are diagnosed and treated in a way that is similar to the more common forms of breast cancer.(12)

Traditional Chinese Medicine view of etiology

Emotional problems: Emotional problems are by far the most important cause in Chinese Medicine. Worry, pensiveness, sadness, anger, frustration, resentment, hatred, guilt can all cause stagnation of qi which in the long run may lead to blood stasis which forms masses. Stagnant qi, over a long period of time, may also implode to cause fire and toxic heat. It is important to understand that stagnation of qi comes not only from the liver but also from the heart and especially the lungs. In fact, even emotions that cause depletion of qi such as sadness and grief may cause stagnation of qi because when qi is depleted in the chest, it does not circulate well and therefore stagnates. In the particular case of breast lumps, the stagnation of the Lung qi and Heart qi are particularly relevant because these two organs and channels are situated in the chest. Ancient doctor Zhu Dan Xi says: When a women is worried and depressed, accumulation develops, Spleen-qi becomes weak, Liver-qi rebels horizontally, stagnant qi turns into nodules like turtle eggs, there is no pain or itching. After ten years ulcers develop and the disease is called Ru Yan. This statement clearly points out the emotional influence on the development of the disease and also its long-term development. Another Dr. Xia Shao Nong thinks that breast lumps and breast cancer are due to widowhood, breaking of relationships, divorce, death of ones children and bereavement at a young age from the death of ones spouse. These events, especially if they occur suddenly, upset the mind and lead to qi stagnation and qi depletion. It is interesting to note that all the events mentioned by Dr. Xia involve separation. One could form the hypothesis that the breast represents for a women the instinctive link with her loved ones(husband and breast-feeding children) and that it is therefore affected by separation.(13)

Overwork: Overwork in the sense of working long hours without adequate rest and with an irregular routine and diet, weakens Liver and Kidney Yin. Liver-Yin is the root of Liver-Qi, deficiency of Liver-Yin may often lead to stagnation of Liver-Qi.

Diet: Another cause of cancer from a TCM perspective includes an inappropriate diet. Three main categories exist in this area. First, it is believed that excessive intake of alcohol and hard, cold, hot, and roasted food can stimulate and damage the mucus membrane of the esophagus and stomach, leading to epithelial hyperplasia and eventually causing cancer. Second, the consumption of excessive dairy products and greasy foods may cause cancer of the colon, ovary, and breast. Third, injury to the Spleen and Stomach may result from intake. Stagnation which leads to lumps may occur due to circulatory disturbance of qi and blood caused by disturbance of meridian and visceral functions.

Disharmony of Directing and Penetrating Vessels: Disharmony of the Directing and Penetrating Vessels after the menopause results from the cessation of the periods, causing a relative imbalance between the top and bottom parts of the body. The Lower Burner is deficient in Blood and Essence so that the Qi of the Penetrating Vessel may rebel upwards and cause stagnation above. The Penetrating Vessel originates from the Uterus(in women) and connects with the breast and there is a connection between the uterus-Blood and breast-milk. In fact a saying states that the Uterus is the lower source of milk and the breast is the upper source of Blood.(14)Thus the drying up of Blood and Essence below may cause stagnation in the breast and lead to lumps. Because of the Penetrating Vessels influence on the Uterus and breast, some Chinese books also mention abortion, miscarriage, and lack of breast-feeding as contributory factors in breast lumps. The Directing and Penetrating Vessels also influence the formation of breast lumps in other ways, through the Gao and Huang structures. Gao literally means fat while Huang means Membranes, the Source points for these two structures are both on the Directing Vessel.(15) Chapter 40 of the Simple Questions mentions Huang: Some people are affected by swelling of the large joints and abdominal pain around the umbilicus: what is the cause of this disease?(The yellow emperor asks.) Chi po answers: This disease is called Hardness of the Viscera and is due to wind. When this overflows to the Large Intestine it reaches the Huang Membranes, the Source of the Huang Membranes is below the umbilicus and this causes pain around the umbilicus.(16) According to the Classic of Categories (1624): The gaps running up and down the abdomen in between the muscles of the abdominal cavity are where the Huang Membranes are situated.(17) This last passage clearly seems to indicate that the Huang Membranes are the connective tissues in the abdominal cavity that encapsulate and connect the viscera. Thus, Gao and H

A stagnation of Qi in the Directing and Penetrating Vessels, and especially in the latter, will therefore induce a state of tension and congestion in the Gao and Huang structures of the breast and obstruct the channels, vessels and Connecting channels of the breast; all these are related to the Penetrating Vessel because this vessel governs all Connecting channels (as it is the sea of the 12 Channels) and the blood vessels (as it is the sea of the blood). Long-term stagnation of Qi will eventually lead to accumulation of Phlegm and stasis of Blood, both important factors in the pathogenesis of breast lumps. The Huang structures (and therefore the Directing and Penetrating Vessels) are also involved in the pathogenesis of breast cancer, even though this is a carcinoma, i.e. cancer of the epithelial tissue. In fact, in recent years researchers have suggested that some of the non-glandular supporting cells within the breast (made of connective tissue and therefore Huang), may influence the growth of cancer cells. These cells form part of the supporting structure of the breast and produce some chemical messengers called growth factors which seem to communicate chemically with breast cancer cells to influence both their growth and their ability to spread.(18)

Western Medicine Treatment of breast cancer

At present, surgery, radiation, and drug therapy are the conventional treatments for breast cancer. Information about the type of tumor, its size, its invasive quality, whether it has spread to lymph nodes, and womens menopausal status can help the method of treatment.

Surgery: For decades radical mastectomy, the removal of the breast along with underlying muscles and lymph nodes, has been widely used. But in recent years breast-conserving treatment that include removal of only the tumor and lymph nodes, plus radiation, has been used with survival rates that equal those of mastectomy. This has given some women more peace of mind when deciding to have a small tumor removed, that being less disfiguring. But the British Journal of Surgery says that younger woman, those with cancer in several locations in the same breast or with tumors larger than one inch, have a higher risk of recurrence with conservation treatment.(19) An important factor in recurrence-free survival is noted by the Cleveland Clinic Journal of Medicine: Blood transfusion does have an adverse effect on the survival and recurrence rate ®| after modified radical mastectomy. The report showed that the five-year survival rate was 53 percent for one group who received blood transfusion, as opposed to 93 percent for the non-blood group.(20)

Radiation Therapy: Radiation therapy kills cancer cells. In the case of breast conservation treatment, tiny cancer seeds may escape a surgeons knife as he tries to preserve the breast. Radiation therapy can clean up lingering cells. But with radiation comes a slight risk of inducing secondary cancers in the opposite breast. Dr. Benedick Fraass recommends minimizing radiation exposure to the opposite breast. He states: with a few simple maneuver it is possible to reduce significantly the dose received by the opposite breast during primary breast irradiation. He suggests that a one-inch-thick lead shield be placed over the opposite breast.(21)

Chemotherapy: Despite efforts to eradicate breast cancer by surgery, 25 to 30 percent of women with newly diagnosed breast cancer will have hidden metastases too small to produce symptoms at first. Chemotherapy is a treatment that uses chemical agents to attempt to kill those cells that invade other parts of the body. It is limited in its effect because cancerous tumors are made up of different types of cells that each have their own sensitivities to drugs. Those cells that survive treatment may spawn a new generation of drug-resistant tumors. But the Lancet gave evidence that chemotherapy increased by 5 to 10 percent a womans chance of surviving an extra decade, depending on her age.(22) Side effects of chemotherapy may include nausea, vomiting, hair loss, bleeding, heart damage, immune suppression, sterility, and leukemia. Hormone Therapy: Antiestrogen therapy cuts off the growth-stimulating effects of estrogen. This is achieved by reducing estrogen levels in premenopausal women either by surgical removal of the ovaries or by drugs. The Lancet reported a ten-year survival rate for every 8 to 12 women out of 100 treated with either measure.

Traditional Chinese Medicine treatment of breast cancer

In TCM term, breast lumps are always characterized by excess and deficiency and the treatment should therefore aim to expel pathogenic factors and tonify the bodys qi. In the initial stage, the emphasis should be on tonifying the bodys qi, and middle to late stages on expelling pathogenic factors. In any case, resolving stagnation is always important. To expel pathogenic factors means to move qi, eliminate stagnation, eliminate blood stasis, resolve phlegm, drain fire resolve toxin and soften hardness, as required. Therefore ,to tonifying the spleen, liver, kidneys, regulates the directing and penetrating vessels, clear heat, clear toxin and nourishing the blood and essence are main principles for treatment of breast cancer with TCM.(23) It is essential to make an accurate TCM diagnosis to properly treat breast cancer. This diagnosis should be based on differentiation of syndromes, including signs and symptoms during the disease, general and local symptoms, as well as tongue and pulse diagnosis. The main TCM diagnosis in the case of breast cancer include the following:

Disharmony of Liver and Stomach: The stomach channel goes over the breast and many of its points are important for the breast, e.g. St12, St36, St4. It affects the breast as a whole, and also via the Penetrating Vessel which connects to the stomach at St-30(Qichong) The Liver channel goes over the side of the breast and specifically influences the nipple. Liver points which affect the breast are Liv3 and Liv14. In the initial stage, breast distention before periods, pain in the breast and nipple, dislike of having them covered, small nodules are noticed. Ru He Nei Xiao Tang, Jia Wei Xiao Yao San, Qing Gan Jie Yu Tang, Chai Hu Shu Gan Tang, Shen Xiao Gua Lou San, Xiao Yao San, Shu Gan Wan, Mu Xiang Shun Qi Wan are mostly used for the cases.(24)

Spleen yang deficiency with phlegm: Breast lumps are relatively soft, but in severe cases the breast may feel tender to the touch, feeling of heaviness, feeling of oppression of the chest, tiredness, feeling cold, loose stools, pale and swollen and wet tongue, deep week slippery pulse are noticed. Shi Wei Liu Qi Yin, Ren Shen Yang Rong Wan are mostly used for the cases along with acupuncture points,- Bl20, Bl21, Bl22, Ren12, St36, Sp3, St40.

Disharmony of Directing and Penetrating Vessels: Swollen breast, distention and pain of breasts before or during period, infertility, small-hard lump which is difficult to move, something discharge from the nipple, a feeling of tightness of the chest, anxiety, cold limbs, pale tongue, wiry pulse, this pattern is due to a Kidney deficiency affecting the Directing and Penetrating Vessels and resulting in rebellious Qi in the Penetrating Vessel, with a deficiency of the kidneys below and a stagnation above. Sp4, Kid,14,, Liv3, Sp6, Kid3, Sj6, Sp76, Ren4, and Moxa can be used. Jia Wei Yang He Tang, Lu Pu Tang, Er Xian Tang pluse Xiao Yao San are mostly used for the cases.

Stagnant Liver-Qi turned into Fire: Large breast lump like a heap, adhering to skin, inverted nipple, orange-skin effect, irritability, dry mouth, bitter taste, headache, red face, red, dry-yellow coating, wiry and rapid pulse, treatment principle should be clear the liver, drain fire, eliminate stagnation, resolve phlegm and toxic heat in this case. Liv3,Sj6, Sp4, Pe6, Liv14, Liv2, LI11, Sp6, St18, Gb41 can be used. Qing Gan Jie Yu Tang, is used for herbal treatment.

Toxic Heat: Long-standing illness, fluid inside breast, lump inside it, discharge of yellow or bloody fluid. Foul-smelling, painful, dry mouth, thirst, dark urine, bitter taste, red eyes, insomnia, red ,thick, sticky, dry, yellow coating tongue, rapid, wiry, overflowing pulse. Liv2, LI11, Sp10, Ren12, LI4, Pe5, Gb41, St18, SI1 are used. Wu Wei Xiao Du Yin and Xue Fu Zhu Yu Tang, Lou Ju Ci Gu Tang are used.

Cancer thrapy: One of study shows Huanglian extract inhibits cell growth by suppressing the expression of cyclin B1 and inhibiting CDC2 kinase activity in human cancer cells. A group of scientists found out that Huanglian inhibited tumor growth and colony formation of gastric, colon, and breast cancer cell lines in a time-and dose-dependent manner. Cell growth was completely inhibited after 3 days of continuous drug exposure to 10 microg/ml of herb. Huanglian represents a class of agents that can inhibit tumor cell growth by directly suppressing the expression of a cyclin subunit that is critical for cell cycle progression. These results indicate that traditional Chinese herbs may represent a new source of agents designed for selective inhibition of cyclin dependent kinases in cancer therapy.(25)

Prognosis: Chinese medicine can help to dissolve breast lump if they are small; if they are numerous or rather large, it may be difficult to dissolve them. However, Chinese medicine can make a positive contribution to a womens breast condition in practically every case even if the lumps are not dissolved: it can reduce the size of the lumps make the breast less swollen and tender, eliminate any discharges that there might be from the nipple, treat pre-menstrual tension, regulate the periods and prevent complications. Thus, it is always worthwhile treating a women with a benign breast pathology.(26)

Conclusion

TCM treatment could be beneficial for the patients who are in the advanced stages of breast cancer to help manage some side effects of the progressing disease while receiving chemotherapy or radiation therapy from western treatment. Advanced breast cancer patients usually suffer from fever, pain, insomnia, thirst, dysphoria, vomiting, anorexia, diarrhea, constipation, and electrolyte difficulties. Later stage breast cancer patients usually suffer from a deficiency of both yin and yang. TCM treatment can help eliminate some or all of these side effects. A women presenting with a breast lump should never be treated with TCM without referral to a gynecologist, because it is practically impossible to distinguish a benign from a malignant breast lump simply from palpation; benign and malignant breast conditions may coexist.

Advantage of the Western Medicine treatment is to using surgery, radiation, and chemotherapy which are to treat advanced stages of breast cancer patients and Traditional Chinese Medicine treatments are very successful for the benign conditions such as discharged nipple, breast pain, breast lump during menopause or emotional related conditions. Western Medicine or Traditional Chinese Medicine alone could not claim a 100% cure rate for breast cancer. A combination of both fields must be utilized to re-enforce each other to bring a therapy with a high success rate.

1.Pubmed

2.Baum M

3.Buchanan

4.Obstetrics

5.Obsterics

6.Obsterics

7.Awake

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9.E Barrett

10.Current

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12.Obstetrics

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16.Huang Di

17.Zhang Jing Yue

18.Baum

19.British

20.Awake

21.Awake

22.Lancet

23.Obstetrics

24.Obstetrics

25.Pubmed 11093765

26.Don thompson

*A Century of breast cancer surgery Buchanan EB- Department of Surgery, The Mercy Hospital of Pittsburgh, Pennsylvania

*Awake 1994 Apr. 8th p.3-10

*Baum M. Saunders C. Meredith S. 1994 Breast Cancer-Oxford University Press Oxford p.128

*Breast cancer 2000BC to 2000AD-time for a paradigm shift? Baum M. Department of Surgery Royal Marsden Hospital London, England

*British Journal of Surgery June 1998 Volume 85 Supplement 1 Breast p.10-24

*British Medical Bulletin of 1992 issue 48 p.345-355 E Barrett-Connor Hormone replacement and cancer

*Classic of Categories(Lei Jing) 1982 Zhang Jin Yue p.561

*Current Medical Diagnosis & Treatment 39th Edition p.705

*Don Thompson MITCM graduated 1997 A Comparison Between western Medicine and Traditional Chinese Medicine in the Etiology and Treatment.

*http://www.ncbi.nlm.nih.gov/PubMed

*Huang Di Nei Jing Su Wen 1979 The Yellow Emperors Class of Internal Medicine-Simple Question Press Peoples Health Publishing House Beijing p.225

*Lancet Voulume 353 Issue 9159 p.1132 Richard Sainsbury, Colin Johnston, Bob Haward

*Obstetrics & Gynecology in Chinese Medicinep.763-790 Giovanni Maciocia

*Prescription for Nutritional Healing p.109 James F. Balch, Phyllis A. Balch

*Pubmed 11093765 Lixk, Motwani M, Tong W, Bornmann W, Schwartz GK.