Bridging the Gap. James Eugene Munson
derives from experiences as doctoral interns in IO facilities, mentorships with licensed medical doctors, oncology dieticians and complimentary cancer providers. These professional opportunities were significant to the development of this material, enabling a bird’s eye view of integrative medicine. We do not intend to outline numerous discrepancies of IO programs, as we are equally indebted to modern medicine capabilities. At this point in biomedicine, we must rely upon conventional therapies as they provide the possibility of curing aggressive diseases like cancer. Our scope of practice is greatly limited in the West, and while measures toward integration are happening, they are dictated by science and sadly, Chinese medicine is not recognized as such at this time. Fortunately, however, we hold the tools to mitigate the harsh cytotoxic effects of chemotherapeutic agents, radiation, pharmaceutical side-effects, as well as addressing the emotional terrain of cancer diagnosis. Chinese medicine practitioners who commit to this endeavor, with skill, focus and determination can facilitate innate healing of the individual, optimizing the body’s capacity to fight the cancer and essentially, treat it.
For licensed practitioners, this serves as a jumping off point into clinical guidelines. We chose not to divide the content of this book by cancer type. Our goal is to highlight each modality that comprises Chinese medicine, building upon each pillar to create a foundation of clinical understanding and therapeutic purpose for refined cancer management. This enables the clinician to reference specific modalities as appropriate, and in that way become more comfortable integrating the medicine. We begin with the core elements of diagnosis in TCM oncology. From this vantage point a pathway into acupuncture therapy, Chinese herbal medicine, diet, exercise and manual therapy is illuminated. As with everything in Chinese medicine we also must reflect on the shen, or spirit. Its relationship to disease is deeply rooted in the constitution and, we feel, cannot be ignored in cancer care. Consequently, we are committed to the system of the eight-extraordinary meridians (EEM) to address emotional complexities of the cancer experience. As the famous Chinese physician, Li Shi-Zhen once stated, “If physicians are not aware of such theories of the extraordinary channels, they will remain in the dark as to the cause of disease.”10
Additionally, as students of Chinese medicine and novice practitioners who knew very little about oncology, we struggled extensively in learning how best to begin an intake with a cancer patient. There were no guidelines that integrated our knowledge of Chinese medicine with Western oncology. We aim to rectify that situation by presenting a framework for a basic TCM oncology intake that the licensed practitioner can modify. This enables seamless coordination with the patient’s conventional cancer treatment plan in order to treat the physical and emotional side-effects, concurrent health issues and encourage collaboration among providers. All of these components to integrative cancer care will be presented in case studies from our clinical experience to demonstrate the capacity of Chinese medicine, the value of using it as a system with multiple modalities at play and emphasizing its merit in integrative oncology. It is in this spirit of sharing, challenging concepts and methods while contributing to the evolution of health and wellness that we write this book.
References
Abrams, D. I., & Weil, A. (2009). Integrative Oncology. New York, NY: Oxford University Press.
Chace, C., & Shima, M. (2010). An Exposition on the Eight Extraordinary Vessels. Seattle, Washington: Eastland press.
Seely, D., & Young, S. (2012). A Systematic Review of Integrative Oncology Programs. Retrieved September 10, 2018, from http://www.current-oncology.com/index.php/oncology/article/view/1182/1078
Unschuld, P. U. (2003). Huang Di Nei Jing Su Wen: Nature, knowledge, imagery in an ancient Chinese medical text: With an appendix, the doctrine of the five periods and six qi in the Huang Di Nei Jing Su Wen. Berkeley, CA: University of California Press.
1 Seely, 2012
2 Seely, 2012
3 ibid
4 Abrams et al., 2009
5 Abrams et al., 2009
6 Abrams et al., 2009
7 ibid
8 Unschuld, 2003
9 ibid
10 Chase et al., 2010
1 What is Integrative Oncology?
“A doctor, like anyone else who has to deal with human beings, each of them unique, cannot be a scientist; he is either, like the surgeon, a craftsman, or, like the physician and the psychologist, an artist.”
W.H. Auden
Cancer is a complex condition encompassing hundreds of diseases within its presentation. Its characteristics are extensive, ranging from slow cellular division to fast, aggressive proliferation. The potency of this ever-evolving disease necessitates innovative and integrative therapies. The philosophy of IO was born from this awareness, a commitment to science and evidence-based medicine, while also recognizing therapeutic value in complementary modalities like traditional Chinese medicine. IO advocates conceptualize a framework of collaboration among medical paradigms to achieve a curable outcome that empowers the patient as well as the body’s ability to heal. The symbiotic energy of both the cause (cancer) and the effect (IO) harness the focus of Western and complementary medical systems due to its complex nature. This investigation is ideally done alongside patients and their loved ones to explore the capacity of healing through integrative approaches. As a result, IO practices are further empowered by the disease it seeks to manage and because of this, therapies outside the scope of conventional medicine are becoming implemented in the clinical environment.
For practitioners of Chinese medicine this is good news. At the forefront of the evolution of integrative medicine in the West, we are participants in early waves of collaborative treatment approaches that implement a range of complementary modalities alongside biomedicine. This is occurring at small public health clinics and also at large private hospitals where a range of services are valued and accepted more than ever before. Consequently, there is a momentous opportunity to bridge the gap between medicine of the West and the East. But building this bridge does not come seamlessly and without its challenges. Add in the complexity of a disease like cancer and the guidelines of integration become even more convoluted. As doctors of TCM, we honed our skills in Chinese medical oncology. It appeared only natural to lean into IO and explore its parameters, curious about the role of Chinese medicine within it.
We posed two simple questions as we embarked on this exploration. First, where does IO originate? In Chinese medicine diagnosis, the root must be examined to understand the branch. Its history would impart perspective on its evolutionary process as a prominent figure in the multitude of cancer management techniques. Secondly, what is the agreed upon definition of IO? Ideally, this clearly elucidates IO’s core mission and with equal importance, to inform complementary providers, like us, the degree to which Chinese medicine may or may not be an equal part to a greater whole. The simplicity of these queries unveiled the incredible complexity of this specialty. In a relatively brief period of time, as a result of on-site internships and doctoral research that analyzed IO programs, it became clear that the ideology of collaborative cancer care is inherently different from clinical applications at the ground level.
The Origins: Integrative Medicine
Every modality of medicine can be traced back to its historical origins, a link to the natural evolutionary processes that occur through experience, time, and sharing of information that led to its maturation. Integrative medicine is an example of this. It is an illustration of scientific advancement combined with perspectives that acknowledge the whole body, relating physical and emotional elements with disease presentation. This movement has gained significant momentum within the last few decades in the West as individuals grow increasingly frustrated with healthcare systems that appear depersonalized by doctors who have limited interaction time with patients and seem to follow medical flow-charts