Bridging the Gap. James Eugene Munson
Chinese scientists and physicians were divided as to how to reconcile the new knowledge with the traditional, or with the question whether they should all together abandon Chinese medicine.
In the early 20th century Chinese medicine was banned in China. Chinese medicine survived by a stroke of luck, when communist China faced the fulfilment of the promise to provide medicine to all, without a sufficient number of physicians or availability of medicines and facilities. Although the communists embraced the slogan of ‘out with the old’ and promised to follow only ‘science and technology’, they had no choice to at least temporarily keep and even promote Chinese medicine. In the Chinese experiment communism and nationalism merged, and Chinese medicine was now a source of national pride, and a subject for development. Scientific and clinical attempts to better describe the function, utility and modern basis of Chinese medicine were attempted with vigor. Again, an exuberant discussion developed between the traditionalists, who claimed Chinese medicine should be practiced as existed, with personalized tailoring of treatment and multiple component medicines, the modernizers, who wanted Chinese medicine to transform into modern medicine by examining the functionality and utility of the medical concepts and therapies under biomedical terms and the modernists who wanted to abandon Chinese medicine all together, attempting to show the superiority of biomedicine.
For three decades I tried to educate practitioners of Chinese medicine about the known, the imaginary, the wrong and mainly the unknown in cancer care, both Chinese and biomedical. I also tried to take the treasure ‘buried in broad daylight’ in the Chinese pharmacopeia to develop a new form of medicine based on traditional uses and functions and modern biomedical molecular functions. Merging my appreciation of science, with the belief, developed through clinical observation, that addressing multiple pathophysiological systems simultaneously is more akin to how the body works, and how we might get to the ‘cause of the future’ was an important attempt for the future of cancer care. I got frustrated with both. I never felt that I was a good teacher, and I was not able to secure funding for any of the new drugs, despite scientific success.
The current work is an attempt by two American practitioners of Chinese medicine, in the relatively narrow field of oncology, to describe their work and the utility found in the combined or exclusive use of Chinese medicine in cancer care. It is hard to shy away completely from the debates of superiority, or the attempts to find theoretical equivalence between tenets. Yet, it is clear that their experience and humanity in the approach to cancer care, including attempts to fulfill the multiple needs of our patients, beyond this or that specific indication, shines through. I remember the evolution of Chinese medicine in cancer care starting from a view that it is quackery, to not effective, to not scientific, to unknown potential side effects, to unknown interactions, to where it is today; no debate, just do what is accepted by the cancer establishment. I’m so happy to see that Dr. Di Giulio and Dr. Munson describe this current state in integrative oncology, and yet, take the clinical utility and application of the modalities employed in Chinese medicine to educate practitioners and patients of their usefulness. Hopefully this work will re-ignite a useful debate and provide the necessary funding, that is not just lip-service, or a method to anchor careers, to study various modalities with methodologies akin to them and the patience to follow the slowness of progress afforded to any biological science. More so, I hope this work will provide benefits to patients in need.
Isaac Cohen, DOM, Ph.D.
Oakland, CA
November 2019
Introduction
“It does not matter how slowly you go as long as you do not stop.”
Confucius
The first question we are asked by cancer patients is, “What can Chinese medicine do for cancer?” As traditional Chinese medicine (TCM) doctors treating patients in various stages of this disease, we are familiar with this query but learning how to respond came carefully with time. Those who seek complementary therapy, like Chinese medicine, during their cancer experience, whether it is early diagnosis or in the midst of cyclical chemotherapy, are well-informed as to how conventional medicine will treat their cancer. What they are less familiar with is the breadth and scope of TCM oncology. Therefore, the question above is a pivotal moment for trained Oriental medicine practitioners to introduce this system of medicine that optimizes the body’s ability to heal. Current statistics indicate that 1:2 men and 1:3 women will be diagnosed with cancer and over half will receive some form of complementary therapy.1 This book aims to introduce the patient, caregiver, medical doctor or complementary healthcare provider to the valuable, rich therapy of TCM oncology. In addition, we hope to better prepare the Chinese medicine practitioner for the complexity of cancer management because it is likely that at some point every Chinese medicine practitioner will be sitting across from a cancer patient.
This clinical preparation is an integral component to the Chinese medical profession and particularly crucial as the practice of IO gains momentum. It’s philosophy is rooted in patient-centered care, with goals to reduce side effects of conventional treatment, improve quality of life and support emotional wellbeing. These outcomes are achieved through complementary therapies including acupuncture, bodywork, naturopathic medicine, and meditation to name a few. While patient empowerment is central to this subject, the spectrum of care is structured around evidence-based medicine as an adjunct to Western oncology protocols. As such, modalities such as moxibustion that do not meet the rigid scientific standards set forth by the medical community are often discouraged or dismissed as not having therapeutic value. Acupuncture, however, has been researched endlessly and with enough scrutiny that it is an accepted form of supportive therapy.
An extremely thorough systematic review of integrative oncology programs worldwide found that an increasing number of multifaceted facilities exist. Out of the 29 sites reviewed, acupuncture is offered at 41% of these locations.2 There is reference to “Traditional Chinese Medicine” as an offered service, but it falls in less than 2% of program centers.3 We can conclude that moxibustion, Chinese dietary therapy and herbal medicine are subsequently not available, indicating the limited degree to which the full-spectrum of what TCM offers is presented. Despite the breadth and longevity of the medicine, harnessed by a vast range of therapeutic abilities, the reality is that TCM practitioners limit their scope when it comes to integrative cancer care. The cause for this trend can be linked to several identifiable factors.
The barriers to seamless collaboration among holistic and conventional medical doctors are extensive. In cancer management, these challenges are acutely present and frequently frustrating. Communication among oncologists and natural medicine doctors is influenced by several factors. For example, it becomes difficult to dialogue as a collaborative unit when there is not a shared facility. The same systematic review noted above found that only 41% of the IO centers offer conventional treatments and complementary therapies in the same location. In private practice, patients are either self-referred based on a personal recommendation or another healthcare provider suggested acupuncture to alleviate side effects. It is rare to receive a note, email, or call from an oncologist to discuss patient care. A survey of Chinese medicine practices in Northern California demonstrated these findings by reporting that only 2% of TCM providers were consulted by a biomedical physician.4 In contrast, of the same respondents only 8% reported they always initiate communication. Thus, illustrating a lack of dialogue among all providers involved in the patient’s care and an opportunity to improve this collaborative dynamic.
The disconnect between doctors, as well as with patients, diminishes the therapeutic value of Chinese medicine before it can even begin, causing practitioners to limit their practice approaches and submit to basic, palliative protocols. This is not to say that focusing on improving the quality of life before, during or after cancer treatment is without importance or purpose. However, this resignation to solely mitigate side-effects of allopathic treatment compromises the integrity of the profession and stunts the advancement of Chinese medicine in a modern medical world. This became the turning point in our clinical focus, choosing to explore beyond the safe nest of private practice to search for collaborative relationships among cancer management providers. We cautiously hoped to discover integrative philosophies that respectfully valued our medicine