Bridging the Gap. James Eugene Munson
the “Father of Medicine,” is largely responsible for naming the disease. He noted that the structure of a tumor with its swellings, blood vessels and suppurations resembled a crab in the sand with legs spread in a circular fashion. This imagery influenced physicians, patients, and others affected by the disease who described the pain of cancer as being similar to the pain of being caught in a crab’s pincers; or the physical quality of a hard, matted tumor, resembling the shell of the crab body; and how the movement of a crab reflected the fluidity of a tumor’s growth under the skin.
Hippocrates’ initial analysis of the disease is remarkable given the lack of technology, microscopes, scientific method, or knowledge of basic cellular division. His awareness of karkinos was quite limited and specific to visible cancerous formations, such as breast tumors or skin cancers. Further, there was no way to differentiate malignant from benign, and many physical maladies fell under the umbrella of karkinos: general swellings, polyps, pustules, nodes and glands. Despite this limited scientific evidence and understanding of the disease, Hippocrates noted the aggressive nature of the disease, stating cancer was “best left untreated, since patients live longer that way.”33
Hippocrates theorized the cause of disease as a result of an imbalance among four humors, or body fluids: blood, phlegm, yellow and black bile.34 This is referred to as humoral theory, the first of many theories on the biology of cancer. When in excess, black bile was deemed to be the culprit of cancer, and this theory was accepted as the cause for over 1,300 years. Black bile was associated with melancholia, the medieval word for depression, and it was thought that this particular fluid congealed in the area where tumors formed. This theory is remarkably similar to those of the ancient Chinese physicians regarding stagnation of phlegm pathologies.
Five centuries later, a famous Greek physician, Claudius Galen, furthered Hippocrates’ humoral theory through his medical observations. Galen also differentiated disease by excess of body fluids, some of which are realistic metaphors of modern day medicine, such as his understanding of inflammation as red, hot, with distending pain as a result of excess blood.35 Jaundice was perceived as a result of excess yellow bile and is now commonly associated with production and function of the liver; and pustules, tubercles and nodules of lymph that were often white and cool in temperature, reflected excess of phlegm. These conjectures maintain threads of similarity and truth in current medical diagnosis for liver disease or infections and viruses.
Hippocrates and Galen both determined of the four humors, black bile was most dangerous. It was believed one’s emotional health was inextricably linked with physical wellness within the scope of cancer pathology. Galen proposed that black bile was “trapped” cancer stating, “Of blacke cholor [bile], without boyling cometh cancer.”36 Galenic theory identified cancer as a systemic problem due to an excess of black bile, which created outcroppings of tumors throughout the body. Galen surmised removing tumors surgically was impossible because of black bile being deeply internal and throughout the body. Surgeons could attempt to excise a tumor, but the body would put forth more black bile immediately, so surgery was not advised.
Galen primarily attempted treatment of cancer by systemic means to eradicate the black bile. Remedies for cancer included lead tinctures, arsenic extracts, fox lungs, boar’s tooth, ipecac and senna to name a few.37 Pain was controlled with alcohol and opium tinctures. Rarely did Galen perform surgery, but some evidence suggests he did for palliative or cosmetic reasons. If the internal medical treatment was not effective, the most common method for treating cancer was a series of bleeding and purging techniques to literally extract the humors out of the body. This particular approach is an interesting comparison to an acupuncture technique used to resolve excess blood stagnation or heat referred to as bloodletting. Galen and Hippocrates’ early theorizing and attempt to understand the nature of cancer play an inherent role in the biology of cancer setting a foundation for the medical advances that followed.
Similar to Western physicians, Chinese doctors were making early attempts to identify tumors and treat them effectively. The Huang Di Nei Jing [The Yellow Emperor’s Internal Classic] is a core text of Chinese medicine; TCM would not exist without this comprehensive manuscript. In this classical literature, there are numerous descriptions of cancer-like formations, one may ascertain that the described masses, superficial sores or swollen areas of tissue could have been identified as early cancers. For example, early references to tumors include chang liu, identified as intestinal tumor and, xie ge, masses below the diaphragm due to blood stasis, and ge sai, an obstruction within the diaphragm.38 The translations elucidate the type of mass, location and quality. Shi jia, is described as stone-like masses in the uterus. In modern medicine this could be diagnosed as ovarian cysts, fibroids, or gynecological tumor.
The Nei Jing created a foundation for developing theories related to etiology of tumors. The fundamental basis of Chinese medicine diagnosis is rooted in aspects of excess and deficiency, and the factors that play a role in this delicate dynamic are pertinent to good health. This is specifically discussed in the Nei Jing where emotions such as joy or anger may result in the accumulation of pathology, which may linger and cause imbalance.39 It also states that environmental influences such as seasons that are excessively warm or cold, may perpetuate illness. Interestingly, in modern medicine there is recognition of environmental toxins and external influences that are linked to cancer formation. Also, significant to this assessment is the proper movement of ying qi (nutritive qi) and wei qi (defensive qi), both integral to upholding a strong immune system.
Tumor pathology is referenced throughout Qin and Han dynasties (221 B.C.–220 A.D.) and within classical texts such as the Nei Jing. Not only are the symptoms of the condition depicted, but also more importantly, they formulate TCM theory in order to understand the pathogenesis of the disease. For example, in the Nei Jing, in reference to intestinal tan, the famous physician Qi Bo states, “Pathogenic Cold settles outside the Intestines and struggles with Wei Qi (Defensive Qi). Qi cannot be nourished and will stagnate so that masses will form in the interior, pathogenic Qi will be aroused and polyps produced.”40 This answer by Qi Bo suggests a pathogenic factor (like one of the six excesses) will lodge interiorly and effect proper movement of qi and blood. As a result, there is an accumulation of these substances that provide opportunity for disease to manifest, such as cancer. Further, if the person’s constitution is already deficient, the capacity of the pathogen to overtake what remains of the individual’s health becomes even more harmful.
The Chinese classics note that pathogens can invade deeply when there is a constitutional deficiency. This concept is reflected in the Ling Shu, Chapter 75, which is essentially saying that pathogens or “evils” in TCM, particularly cold and heat, but also wind and fire, will invade into the interior when there is deficiency. A constitutional deficiency allows for a deeper and perhaps more tenacious penetration of an evil. The evil struggles with the defensive qi and the qi and/or fluids around it eventually trapping them and forming knots. These knots become tumors. At first soft, they grow as they linger and become more dense and more recalcitrant. If the evil strikes into or at the level of the sinews, then a sinew tumor is formed, and if into the intestines, then an intestinal tumor is formed, and so on.41 These diagnostic elements to TCM theory are extremely important in clinical medicine. The practitioner must identify the constitutional deficiency and assess the strength of pathogenic factor with respect to the subject’s constitution in order to effectively treat with acupuncture and herbal therapy.
A more detailed analysis of the theories presented in the Nei Jing takes place in the Nan Jing (Classic on Medical Problems). This is where pattern differentiation evolves specifically pertaining to oncological theory and development in Chinese medicine. The description of benign versus malignant tumors is discussed in the 55th Problem stating, “Accumulations consist of yin influences...stay in the depth and are hidden…emerge in the five depots… Their upper and lower extensions are clearly marked by end and beginning; to the left and to the right are clearly defined locations where they subside.”42 The Nan Jing also states that illness that arises in the depots (zang organs) are difficult to cure. That is a patient is likely to die. In contrast, an illness that arises