Bridging the Gap. James Eugene Munson

      2 History of Oncology through Western and Chinese Medicine

      “All things change, and we change with them.”

      Chinese Proverb

      Despite cancer’s persistent and dominant presence in medicine today, its roots extend back thousands of years. This long history exemplifies the disease’s complex and resilient nature. Cancer has not been discriminatory through its course of medical evolution; just as the early societies of the West endured cancer’s pervasive character for thousands of years, so did the East. While the title of oncologist did not emerge until the late 1900s, the mention of benign and malignant tumors appears across ancient medical texts. Early physicians across the world were discovering the intricacies of this pervasive disease, many with similar theories to its roots. Although now the biomedical dynamics of cancer in modern medicine are well understood, it is important to explore the historical evolution of this aggressive illness to understand the power behind it.

      The timeline of cancer begins quite early with evidence of cancerous cells existing in fossilized dinosaur bones approximately 80 million years ago.²⁶ In 3000 B.C., Egyptian mummies were found to have cancer in fossilized bone as well, suggestive of osteosarcoma or bone metastasis.²⁷ The first written record of cancer is from 1550 B.C. where descriptions of surgical procedures on tumors were illustrated on Ebers Papyrus, one of the oldest preserved Egyptian medical documents.²⁸ Within the 110 pages of the scroll, there are 700 remedies and formulas to address numerous health conditions. Specifically related to cancer, the scroll cites eight references to tumors on the breast. It was believed cancer was an illness caused by the gods. It’s described as a virulent disease, recounting “a tumor against the god Xenus” it recommends, “do thou nothing there against.”²⁹ Essentially stating that there was no remedy for cancer. It may be assumed that even in 1600 B.C. cancer was a powerful entity of unknown origin treated with uncertainty and poor outcome.

      The Ebers Papyrus describes treatment of these tumors with a heated instrument called “the fire drill,” which was a form of cauterization to excise the cancer; the inscriptions suggest that treatment of this disease was only palliative. Other references to surgical procedures for ulcers and tumors are noted by “cutting out with a knife or burning with red-hot irons,” which also describes the excision of tumors through surgical means.³⁰ From 500–1500 A.D. similar procedures were employed mainly surgery and cautery for smaller tumors; pastes containing arsenic were applied to the skin as well for more severe cancers; phlebotomy (blood-letting), and references to powder of crab as well as magical/symbolic charms were used. Herbal and nutritional remedy was also an integral component to ancient medicine with certain recommendations for cancer. Medical manuscripts describe stomach cancer treated with boiled barley mixed with dates; uterine cancer was treated with a blend of pig’s brain mixed with fresh dates and inserted into the vagina.

      In ancient China, the word, cancer (ai), itself was not referenced specifically until 1171, where it was stated in a text written by Dongxuan Jushi, entitled Wei Ji Bao Shu [A Treasury of Relief and Treatment]. Preceding this reference, there exists a long history of observation and treatment of tumors noted in classic medical texts. As early as the Shang Dynasty (16th–11th century B.C.), there is evidence found on bones and tortoise shells from where the word for tumor, liu, is identified.³¹ In the Qin Dynasty (221–207 B.C.), physicians documented their observations of tumors, sores, suppurations, as well as theories on the disease. There was, of course, no specialty for oncology during the early dynasties of the East. However, in the Qin Dynasty, doctors were classified with specialties such as internal disease, dietitians, and specialists of sores or wounds. Doctors of the latter condition treated sores with and without ulceration, termed “swollen sores.” Traditionally, tumors were not divided as benign or malignant, but rather, according to visual and palpable characteristics.

      A remarkable observation discussed in ancient dictionaries from the early 2nd century of the Han Dynasty (206 B.C.–220 A.D.), Shuo Wen Jie Zi (Discussing Characters and Explaining Words) and Zheng Zi Tong (A Comprehensive Discussion on the Correct Use of Characters) also delineates the difference between zhong (swelling) and liu (tumor). An abscess that is swollen and ulcerating is described as zhong, and liu equates to its homophone meaning, “to flow.” Thus, the stagnation of qi and blood causes a swelling, or tumor: zhong liu. It is further explained that liu does not grow with the tissue but is rather the result of extended, chronic disease. It is remarkable that this concept is still applicable today and well understood in TCM diagnosis in two ways. First, the accumulation of qi and blood causes stagnation; and second, this accumulation may lead to acute or chronic disease, including cancer. In total, the diagnosis of qi and blood stagnation results from proliferation of tissue, inflammation and essentially, lack of flow.

      In the West, a word for cancer, karkinos was first noted in medical literature during the time of Hippocrates.³²