This article is dedicated to the discussion of the remedy Chemo-Support which is intended to minimize the side effects of chemotherapy. This remedy was formulated 15 years ago and it has been used by many patients undergoing chemotherapy.

CHEMOTHERAPY SIDE-EFFECTS FROM THE POINT OF VIEW  OF CHINESE MEDICINE

If we analyze the side-effects or chemotherapy, there are important differences between various cytotoxic drugs and one could conceivably formulate an individual Chinese herbal formula for each.  However, one can identify common characteristics among the above side-effects.  We can attempt to group the side-effects according to the Chinese pathological pattern induced by the various cytotoxic drugs.  Looking at the side-effects of each drug, four patterns in particular stand out:

1.    DEFICIENCY OF QI, BLOOD AND YIN
Hair loss, diarrhoea, nail ridging, bone-marrow suppression, malaise, fatigue, depression, loss of appetite, neurological damage, dizziness, constipation, numbness, tingling, paraesthesia of hands and feet.

2.    ST-QI REBELLING UPWARDS
Nausea, vomiting.

3.    STOMACH HEAT
Mouth ulcers, stomatitis, stomach ulcers.

4.    BLOOD HEAT
Haematuria, fever, skin reactions, cystitis.

Thus, we can deduce from the analysis of the above patterns that cytotoxic drugs cause the following:

1.    Qi, Blood and Yin deficiency (of Stomach, Lungs, Liver and Kidneys)
2.    Stomach-Qi rebelling upwards
3.    Stomach Heat
4.    Blood Heat.

The treatment principles to adopt are therefore (the herbs used are indicated in brackets):

Tonify Qi, Blood and Yin (Huang Qi Radix Astragali, Ren Shen Radix Ginseng, Ling Zhi Ganodermae, Mai Men Dong Radix Ophiopogonis, Dang Gui Radix Angelicae  sinensis, Nu Zhen Zi Fructus Ligustri lucidi, Huang Jing Rhizoma Polygonati)

Subdue rebellious Stomach-Qi (Lu Gen Rhizoma Phragmitis, Ban Xia Rhizoma Pinelliae preparatum, Sha Ren Fructus Amomi)

Clear Stomach Heat (Lu Gen Rhizoma Phragmitis, Zhi Mu Radix Anemarrhenae)

Cool Blood (Mu Dan Pi Cortex Moutan)

ANALYSIS OF INDIVIDUAL HERBS  IN CHEMO-SUPPORT
-      Huang Qi Radix Astragali: tonify Qi and raise immune response.
-      Ren Shen Radix Ginseng: tonify Qi.
-      Ling Zhi Ganodermae: tonify Qi and Blood and raise the immune response.
-      Mu Dan Pi Cortex Moutan: cool Blood.
-      Zhi Mu Radix Anemarrhenae: clear Heat.
-      Fu Ling Poria: resolve Dampness.
-      Chen Pi Pericarpium Citri reticulatae: resolve Dampness, stop nausea.
-      Mai Men Dong Radix Ophiopogonis : nourish Yin.
-      Dang Gui Radix Angelicae sinensis: nourish Blood
-      Ban Xia Rhizoma Pinelliae preparatum: resolve Phlegm, subdue rebellious Stomach-Qi, stop nausea and vomiting.
-      Lu Gen Rhizoma Phragmitis: clear Stomach-Heat, stop vomiting.
-      Nu Zhen Zi Fructus Ligustri lucidi
-      Sha Ren Fructus Amomi: move Qi, resolve Dampness, stop nausea.
-      Huang Jing Rhizoma Polygonati: tonify Qi, nourish Yin and Jing.
-      Gan Cao Radix Glycyrrhizae uralensis: harmonize.



DOSAGE AND PROTOCOL
Chemo-Support works better if it is started some time before the beginning of chemotherapy and continued for about two weeks after the end. It is important to note that “during the treatment” means during the course of treatment, i.e. also in the days of break from the treatment.  The dosage is as follows:

-       Two weeks before start of treatment: 2 tablets a day
-       Four days before the start of treatment: 2 tablets twice a day
-       During the treatment: 3  tablets three times a day
-       After the end of the treatment for about 4 weeks: 2 tablets twice a day

It is best to take the tablets away from meals, i.e. about 1 hour before or after a meal, swallowed with hot water.  The tablets should also be taken separately from other medication, at least 1 hour away.  If the patient feels very nauseous and finds it difficult to swallow the tablets, these could be crushed and powdered, immersed in a small amount of hot water with three slices of fresh ginger and the water sipped slowly.

The dosage during treatment indicated above should be adjusted according to the severity of the side-effects and the above dosage could be reduced or increased.

If the patient is receiving both chemo- and radio-therapy and is taking both Chemo-Support and Radio-Support, the dosage of each should be reduced.  Adjustments can be made according to the patient’s side-effects and timing of therapies in this situation by using a higher ratio of Chemo-Support during the days surrounding chemotherapy or when its side-effects are heightened.  Similarly, the dosage of Radio-Support can be increased if the side-effects experienced from radiotherapy are more severe, or during the days surrounding the administration of radiotherapy.

Chemo-Support should be discontinued approximately four weeks after the end of the treatment when the condition should be reassessed and a different formula given.  By contrast, Radio-Support should be continued for at least 6 weeks after the end of radiotherapy.

ACUPUNCTURE TREATMENT OF CHEMOTHERAPY SIDE EFFECTS

Acupuncture can be used to great effect, in conjunction with Chemo-Support  to reduce the side-effects of chemotherapy.  Indeed, acupuncture can complement the use of Chemo-Support by tailoring the treatment to the specific side-effects suffered by the patient. The following are suggested point combinations for specific symptoms and signs.

Fatigue
Ren-12 Zhongwan, ST-36 Zusanli, SP-6 Sanyinjiao, BL-20 Pishu, BL-21 Weishu.

Nausea, vomiting
Ren-13 Shangwan, P-6 Neiguan, ST-34 Liangqiu, ST-36 Zusanli.  In addition to acupuncture, the following massage technique is very effective to combat nausea and vomiting: apply a massage oil liberally to the lower legs, make a loose fist with your hands, starting from ST-36, massage downwards along the Stomach channel using the knuckles of the index fingers all the way down to the ankle and then massage upwards along the Spleen channel using your thumbs.  This technique harmonizes the ascending and descending of Stomach- and Spleen-Qi, stimulating Stomach-Qi to descend and Spleen-Qi to ascend.

Alopecia
BL-17 Geshu (with direct moxa cones), ST-36 Zusanli, SP-6 Sanyinjiao, LIV-8 Ququan, BL-20 Pishu, BL-23 Shenshu.  Add Shou Wu Pian or Glorious Sea to Chemo-Support.

Myelo-suppression
BL-17 Geshu (with direct moxa cones), BL-11 Dashu (with direct moxa cones), BL-20 Pishu, BL-23 Shenshu.

Stomatitis, mouth ulcers
ST-44 Neiting, L.I.-4 Hegu, L.I.-11 Quchi.

Cystitis
Ren-3 Zhongji, BL-63 Jinmen, BL-28 Pangguangshu, BL-32 Ciliao, SP-9 Yinlingquan.

Fever
L.I.-11 Quchi, KI-2 Rangu, Du-14 Dazhui.

Skin rash
L.I.-11 Quchi, SP-10 Xuehai.

Diarrhoea
ST-25 Tianshu, ST-37 Shangjuxu.

BIBLIOGRAPHY
1)    Perry M, Anderson C, Dorr V, Wilkes J, The Chemotherapy Sourcebook, Williams & Wilkins, Baltimore, Maryland, 1999.
2)    Skeel R, Handbook of Cancer Chemotherapy, Williams & Wilkins, Baltimore, Maryland, 1999.
3)    Zhu YP, Chinese Materia Medica, Harwood Academic Publishers, Amsterdam, 1998.
4)    Bensky D and Gamble A, Chinese Herbal Medicine Materia Medica, Eastland Press, Seattle, 1993.
5)    Chang H.M. and But P.P.Hay, Pharmacology and Applications of Chinese Materia Medica, World Scientific, Hong Kong, Vol. I, 1986.
6)    Chen J K, Chen T T, Chinese Medical Herbology, Art of Medicine Press, City of Industry,         CA, USA 2004.

By Giovanni Maciocia