Introduction

Cancer is a common disease in small animal practice; it has been estimated that 1 in 4 dogs and 1 in 6 cats will develop a form of neoplasia at some point during their life.^1,2 It has been reported that almost 50% of dogs over 10 years old die of cancer-related problems, and cancer is the most common cause of natural death in dogs and cats in the United States.¹ However, treatment of cancer remains a challenge for both veterinarians and caretakers.

Conventional medicine understands neoplasia to arise due to a decrease in anti-tumor defenses, increased mutations and silencing of tumor suppressor genes such as p53 through methylation and deacetylation, along with exposure to carcinogens and a decrease in immune defenses and therefore DNA repair mechanisms. While we are beginning to unravel the complex biochemistry of cancer development and have begun to understand how DNA is damaged and repaired, we still have a long way to go before the cure for cancer will be found.

Traditional Chinese Medicine (TCM) has been used successfully in the treatment of cancer for thousands of years, long before we understood the basic pathobiology of tumors in Western medicine. Traditional Chinese Veterinary Medicine (TCVM) shares the similar philosophy and treatment of cancer in TCM. TCVM is not a replacement for Western diagnosis and therapy, but may be used with Western approaches to help heal patients. When the option for Western therapy is lacking, there are TCVM therapies which can be employed to help the patient live a quality life, reducing the rate to cancer expansion or, in some cases, leading to remission of the cancer. TCVM may be best suited to prevention of the development of cancer through healthy living. On the other hand, Chinese herbal medications have been shown to lead to spontaneous remissions of cancer. In some cases, these herbal products can be used in conjunction with traditional Western therapies, improving the outcome and reducing the side-effects from Western therapy alone. An integrative approach combining the best of both Western medicine and TCVM seems to be the only sensible course of action, providing the best overall care for the patient.

TCVM Etiology and Pathology

From a TCVM perspective, cancer is the result of Stagnation and lack of free movement of Qi and/or Blood. Tumors are the end result of a prolonged process of accumulation and densification of tissue due to the Stagnation and eventual Stasis of Qi and Blood. Many factors can cause this blockage in Qi or Blood flow and therefore lead to development of cancer. The common underlying (root) factors are: Zheng Qi (vital Qi) deficiency, Qi & Blood deficiency and Qi & Yin deficiency. Zheng Qi composed of Ying Qi (Nutritive Qi) and Wei Qi (Defensive Qi); When Qi is deficient, there will be Deficiency of the Wei Qi. If the Wei Qi is deficient, external pathogenic factors (Cold, Wind, Heat, Summer Heat, Dry and Damp) cannot be expelled from the body, blocking flow of Qi and Blood and allowing cancer to develop. It can therefore be appreciated that Qi deficiency is the root of cancer, and Phlegm accumulation, Qi/Blood Stagnation and Blood Stasis are the branches.

1.  Qi and Blood deficiency: Patients with the pattern of Qi & Blood deficiency have a lower cell immunity response than normal. Symptoms include: hair loss; dizziness; fatigue; a thin or obese body; shortness of breath; poor appetite; insomnia; abdominal pain; chronic digestive issues; a pale tongue with a white tongue coating; and a deep, thin, and weak pulse.

2.  Qi and Yin deficiency: Patients with Lung Qi deficiency may have a lower lymphocyte transformation rate and lower levels of serum immunoglobulins such as IgM and IgG. Symptoms include: panting; shortness of breath; insomnia; chronic respiratory or skin issues; cough without phlegm; lassitude; dry mouth; a thin tongue coating; and a thin pulse.

Treatment Strategy

Acupoints

• LI-4, LI-11, ST-36, SP-6, SP-10, HT-7, BL- 17, BL-20, BL-21, BL-24, BL-26, TH-5, CV-6, Shen-shu
• LI-4 is the Yuan-Source point that clears all Channels and calms the mind (especially when used with LIV-3), moves masses, tonifies and moves Qi and Blood, clears Heat and is a general immune stimulant.
• LI-11 tonifies Qi and clears Heat.
• ST-36 is a major tonification point; it tonifies the Spleen, Stomach, Qi and Blood and stimulates the appetite.
• SP-6 (the crossing point of the three Yin Channels of the pelvic limb) tonifies the Spleen, Yin, Qi and Blood.
• SP-10, the Sea of Blood point, tonifies, moves and cools the Blood.
• HT-7 is a Shu-Stream point and relieves pain, calms Shen and tonifies Heart Blood and Qi.
• BL-17 is the Influential point for Blood, which invigorates and nourishes Blood.
• BL-20 is the Back-Shu Association point of the Spleen, which is used for Deficient Spleen Qi and Deficient Blood.
• BL-21 is the Back-Shu Association point of the Stomach, and tonifies Spleen and Stomach Qi, Yuan (Source) Qi and Kidney Jing.
• BL-24 is the Sea of Qi point, which tonifies Qi.
• BL-26 is the Gate of Yuan (Source) Qi, which tonifies Qi.
• TH-5 tonifies Wei Qi.
• CV-6 is the Sea of Qi point; it tonifies Yang, Qi and Blood, and moves Stagnant Qi in the abdomen.
• Shen-shu is a classical point that tonifies Yuan (Source) Qi.

Chinese Herbal Formulas

• Qi Blood deficiency
• Shi Quan Da Bu Tang: Tonifies Qi, nourishes Blood and tonifies Yang; indicated for Qi deficiency accompanied by Blood and Yang deficiencies.
• Gui Pi Tang (Restore the Spleen Decoction): Nourishes Blood and tonifies Spleen Qi; indicated for combined Qi and Blood Deficiency
• Xiang Sha Liu Jun Zi Tang (Eight Gentlemen): Tonifies Qi, strengthens the Spleen, moves Qi and eliminates Damp; indicated for Qi deficiency with Dampness and anorexia.
• Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction): Tonifies Qi and raises sunken Yang; indicated for severe Spleen Qi deficiency causing low fever, chronic diarrhea and organ prolapse.
• Wei Qi Booster (JT): Tonifies Qi and Blood, boosts Wei Qi and inhibits mutation.
• Anticancer formulas
• Max’s Formula (JT): Softens hardness, transforms Phlegm and clears enlargement. The classical antecedent of this formula is Nei Xiao Luo Li San.
• Stasis Breaker (JT): Breaks down Stasis, softens hardness and clears enlargement. The classical antecedent of this formula is Nei Xiao Wan.
• Xue Fu Zhu Yu Tang (Drive out Stasis in the Mansion of Blood Decoction): Invigorates Qi/Blood, breaks down Blood Stasis and relieves pain; indicated for Blood Stasis with concurrent Blood Deficiency.
• Stasis in the Mansion of the Mind (JT): Breaks down Blood Stasis, transforms Phlegm, resolves nodules and relieves pain; used for tumors in the brain, particularly when Phlegm is accompanied by Blood Stasis and pain.
• Transporter formulas:
• Bone: Bone Stasis Formula (JT)
• Nose and sinuses: Xin Yi San
• Neck: Cervical Formula (JT), or Ge Gen Tang
• Thyroid: Hai Zao Yu Hu Tang (Sargassum Decoction for the Jade Flask)
• Spine: Da Huo Luo Dan
• Thorax: Ge Xia Zhu Yu Tang
• Lung: Qing Fei San
• Abdomen: shao Fu Zhu Yu Tang
• Vessels or heart: Xue Fu Zhu Yu Tang
• Mammary glands: Breast Stasis Formula (JT), or Chai Hu Shu Gan Wan
• Prostate: Prostate Invigorator (JT), or Qian Lie Xian Fang
• Bladder: Wu Ling San
• Herbal Formulas for treating clinical signs in the cancer patient
• Anemia: Si Wu Tong or Gui Pi Tang
• Anorexia: Xiang Sha Liu Jun Zi Tang (Eight Gentlemen)
• Anxiety or depression: Shen Calmer or Tian Wang Bu Xin Dan
• Bleeding/hemorrhage: Yunnan Baiyao
• Bowel incontinence: Bu Zhong Ti Qi Tang
• Constipation: Ma Zi Ren
• < >: Xiang Lian San or Shen Ling Bai Zhu
• Coughing: Zhi Sou San
• Cystitis: Ba Zheng San
• Edema: Shi Pi Yin
• Fatigue: Bu Zhong Ti Qi Tang, Si Jun Zi Wan
• Immunosupression: Gui Pi Tang
• Indigestion: Bao He Wan, Si Jun Zi Wan
• Nausea/vomiting: Happy Earth (JT) or Ping Wei San

Diet Therapy

Although eating healthy is the best tool in the fight against cancer, once cancer takes hold certain dietary changes may be help the patient fight against the effects of the cancer. Tumor cells rely heavily upon carbohydrates for their energy and rob the body of amino acids. On the other hand, tumor cells cannot utilize lipids (fats) for energy while the rest of the body can. As such, diets with increased fat content may slow tumor growth, allowing the patient to fight against the tumor. Protein content must be maintained a level sufficient for tissue repair, but carbohydrates should be held to a minimum. For those who cannot cook for their dog, a commercial food should be of good quality, moderate protein, moderate fat, and low carbohydrate (<10%) content.

Dietary Supplements

The rationale for each of these products is sound, but more than I wish to explain at the moment. Antioxidants (such as vitamin E, vitamin C, selenium, betacarotene, Ginkgo biloba, green tea and grape seed extract) do protect and help stabilize the immune system. Collagen support may help inhibit angiogenesis by the tumor. Mushrooms and astragalus help boost the immune system (activate NK Killer cells which attack tumor cells and to prevent destruction of T-elper cells). n-3 polyunsaturated fatty acids (PUFAs, or omega 3 fatty acids), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), can exert anti-neoplastic activity by inducing apoptotic cell death in cancer cells, either alone or in combination with conventional therapies. COX-2 inhibitor drugs double life expectancy with carcinomas while melatonin appears to improve survival times in all solid tissue tumors including gliomas. None of these measures will necessarily treat or cure cancer, but they will not do any harm and may provide quality of life. That is probably what is important in cancer which cannot be surgically removed.

Summary

Combining integrative medicine with mainstream oncology care can reduce clinical signs burden and improve the quality of cancer care and quality of life, and the well-being of patients and their owners.

References

1.  Xie H, Ma A. TCVM for cancer. 2013 Proceedings Annual Conference of the American Holistic Vet erinary Medical Association. American Holistic Veterinary Medical Association. Kansas City, MO, August 24–27 2013: 359-363

2.  Xie H. How to select Chinese herbal medicine for cancer patients. Am J Trad Chin Vet Med 2006; 1 (1): 49–52

3.  Cheng YY, Hsieh CH, Tsai TH. Concurrent administration of anticancer chemotherapy drug and herbal medicine on the perspective of pharmacokinetics. J Food Drug Anal. 2018 Apr;26(2S):S88–S95.

4.  Wu X, Cheng J, Wang X. Dietary Antioxidants. Potential Anticancer Agents. Nutr Cancer. 2017 May–Jun;69(4):521–533.

5.  Fang M, Yuan J, Peng C, Li Y. Collagen as a double-edged sword in tumor progression. Tu- mour Biology. 2014;35(4):2871–2882. doi:10.1007/ s13277-013-1511-7.

6.  Brown DC, Reetz J. Single Agent Polysaccharopeptide Delays Metastases and Improves Survival in Naturally Occurring Hemangiosarcoma. Evidence-based Complementary and Alternative Medicine: eCAM. 2012;2012:384301. doi:10.1155/2012/384301.

7.  D’Eliseo D, Velotti F. Omega-3 Fatty Acids and Cancer Cell Cytotoxicity: Implications for Multi-Targeted Cancer Therapy. Brown L, Rauch B, Poudyal H, eds. Journal of Clinical Medicine. 2016;5(2):15. doi:10.3390/jcm5020015.