[Perspectives of Traditional Chinese and Western Medicine]Targeted immunotherapy stimulates fiery traditional Chinese medicine to nourish qi, clear heat and relieve side effects

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Text◆ Su Ziqian (Honorary Clinical Assistant Professor, Department of Clinical Oncology, University of Hong Kong, Traditional Chinese Medicine Physician)

(Hong Kong News) Many people mistakenly believe that Chinese medicine is static. In fact, TCM has continued to develop over its more than 2,000-year history. For example, the first traditional Chinese medicine book “Shen Nong’s Materia Medica” only recorded 365 kinds of traditional Chinese medicines. By the Ming Dynasty, Li Shizhen’s “Compendium of Materia Medica” had recorded 1,892 kinds. The number of traditional Chinese medicines in the modern “Chinese Pharmacopoeia” is even greater. The 2015 edition of the Pharmacopoeia contains 5,608 types of medicines, and the 2020 edition has expanded to 5,911 types.

The treatment methods of Chinese medicine in different eras have also continued to improve, which shows that Chinese medicine is actually a subject that is constantly expanding and developing. Faced with cancer, a relatively difficult disease, Chinese medicine will not rest on its laurels and will not reject the various current cancer treatment methods of Western medicine. The current trend in China is to combine Chinese and Western medicine to treat cancer.

Hepatitis caused by overactive immune system

In the past 10 years, Western anti-cancer drugs have developed rapidly, traditional chemotherapy has become a secondary role, and various targeted drugs and immunotherapy have become the backbone drugs, with great improvements in terms of radical cure rate, survival period and side effects.

For example, in recent years, a new type of drug commonly known as the “smart bomb”—antibody-drug conjugate (ADC)—has emerged. This drug combines targeted drugs and chemotherapy into one, and can achieve better results than chemotherapy drugs. It has strong anti-cancer effects and relatively mild side effects. Electrotherapy technology is also improving day by day, with improved accuracy and reduced side effects.

The changes caused by these new drugs to the body can be understood and dealt with accordingly using the theory of traditional Chinese medicine. For example, some patients who received immunotherapy and were injected with PD-1 inhibitors experienced physical fatigue, hypothyroidism, or inflammatory reactions in various parts of the body, such as skin inflammation and rash; or overexertion of the immune system caused hepatitis, pneumonia, etc.

Switch to traditional Chinese medicine to treat tumors under control

There is a saying in traditional Chinese medicine that “strengthens fire and nourishes qi.” From the perspective of traditional Chinese medicine, immunotherapy is a drug that stimulates fire. The body produces a large amount of “heat” that causes symptoms (similar to the inflammatory response in modern medicine), which in turn depletes healthy qi. , forming symptoms of heat on the one hand and deficiency of qi on the other.

Therefore, when combining traditional Chinese medicine with immunotherapy, heat-clearing and qi-tonifying drugs are often used together.

Give two cases. A patient in his 70s was diagnosed with lung cancer and had spread. After using immunotherapy, the effect was very good and the tumor was under control. However, after taking the medicine for more than a year, severe skin side effects occurred, and blisters similar to pemphigus appeared all over the body. The immunotherapy needed to be stopped. The skin gradually improved, but the cancer cells spread and recurred in the lymph nodes in the neck and armpits.

The patient was afraid of the side effects, so he refused to receive chemotherapy and switched to traditional Chinese medicine anti-cancer treatment. Half a year later, he found that the lymphatic tumor was under control again. The therapeutic effect of this patient is most likely due to the immunotherapy first stimulating the immune system, and the Chinese medicine complementing each other.

Hedyotis diffusa is often seen in prescriptions

Another patient with stage III lung cancer could not undergo surgical resection due to the large size of the primary tumor and insufficient lung function due to emphysema. The treatment method is to first use chemotherapy and immunotherapy to shrink the cancer cells, and then receive 30 times of electrotherapy. After completion, a year of immunotherapy injections will be required as consolidation treatment.

The biggest risk of this course of treatment is that when electrotherapy and immunotherapy are used together in a short period of time, although electrotherapy can stimulate the immunotherapy to produce a synergistic effect, the worst risk is that the immune system will be overstimulated and cause pneumonia, which can be serious or even fatal. Because the patient would be asthmatic when walking, he used traditional Chinese medicine to replenish qi and nourish the lungs during the treatment. In addition, Hedyotis diffusa was often seen in his prescription. The patient asked if it was used to fight cancer.

Hedyotis diffusa is mainly used to clear away heat and detoxify, and reduce lung fire.

The hope is to reduce the risk of severe pneumonia, not to fight cancer.

Since this Western medicine treatment plan is highly effective, the most worrying thing is only serious side effects. Therefore, during the immunotherapy period, the Chinese medicine prescription does not need to use too many anti-cancer drugs, but only focuses on replenishing qi and clearing away heat, which complement each other.

As can be seen from the above examples, learning about new Western medicine anti-cancer treatments can in turn guide the use of traditional Chinese medicine.

Lack of clinical trials hinders the development of traditional Chinese medicine

The biggest difficulty in the development of traditional Chinese medicine is that many prescriptions and treatments have not undergone very rigorous clinical trials.

Many studies on traditional Chinese medicine are only laboratory studies or some clinical case studies. Compared with most Western medicines, which have strict phase III clinical studies, traditional Chinese medicine requires more clinical trials. One of the biggest difficulties is that rigorous clinical trials require a large amount of funds and the coordination of large pharmaceutical companies. However, traditional Chinese herbal medicine is different from Western medicine and it is difficult to apply for patents. Therefore, the development of trials is lagging behind due to lack of investment.

Dosage and raw material quality are key

The Hong Kong government has begun to invest resources in the research and development of traditional Chinese medicine in recent years, hoping that there will be greater breakthroughs in the near future. At the same time, one of the keys to using Chinese herbal medicines for cancer treatment or research is the dosage and quality of the raw materials. Efforts are also needed to set quality standards in this regard.

Be sure to consult the attending doctor about Chinese medicine

Whether we use Chinese medicine alone or a combination of Chinese and Western medicine to treat cancer, a lot of research and practical work is still needed. Since each patient’s condition is different, if a patient wishes to add Chinese medicine to the treatment of cancer, he or she must first consult his/her attending physician and Chinese medicine practitioner.

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