Chinese herbal medicine for advanced pancreatic cancer

TCM is a 3,000-year-old holistic system of medicine combining medicinal herbs, acupuncture, food therapy, massage, and therapeutic exercise for both treatment and prevention of diseases 1. It has its unique theories around concepts of aetiology, systems of diagnosis, and treatment, which are vital to its practice. The theories of TCM include Yin-Yang (e.g. positive and negative), the five elements (fire, earth, metal, water, and wood), Qi (vital energy) and blood, Zhang-Fu (five viscerae and six bowels), as well as channels and collaterals (Meridian doctrine) 2 3. Diseases are considered to result from internal causes as well as external causes, which are defined as disturbances e.g., the imbalance between Yin and Yang. Chinese medicines consist typically of complex prescriptions combining between four and 12 different herbal ingredients, including minerals or animal components. The combinations are based on special Chinese diagnostic patterns that involve inspection, listening, smelling, inquiry, and palpation. Herbs are used for correcting the imbalance of Yin and Yang in the body and maintaining kinetic balance under the movement of five elements. “Bianzheng Lunzhi” (the differentiation of symptom patterns and the prescription of formula of herbs) is the application of these theories.

Herbal therapy is the most commonly used part of TCM, and includes around 3,200 herbs. Herbs often used in cancer patients include Ginkgo biloba, Panax ginseng, Astragalus membranaceus. About 300 mineral and animal extracts and over 400 formulas are used 2. TCM herbal therapy is applied in three different ways, including individualised treatment (prescription of herbs on the basis of a TCM differentiation of the symptoms), use of fixed herbal formula (such as Chinese patented medicines), or the combined use of herbal medicine with conventional therapy. The composition of herbal preparations, dosage, and treatment duration vary.

Prevalence of use

Traditional Chinese herbal medicine has been used in China to manage the symptoms of patients with pancreatic cancer, such as jaundice, pain, and low appetite. There is no available data for the prevalence of herbal medicine use in pancreatic cancer patients. However, in China, it is not uncommon for patients with advanced pancreatic cancer to use herbal preparations and other TCM therapies.

Theory

In TCM, there is no equivalent diagnosis for pancreatic cancer, but the treatment intends to relieve the symptoms related to pancreatic cancer. Herbal treatment is designed to inhibit tumour growth and metastasis, stop pain and improve symptoms, reduce the adverse effects of chemotherapy and/or radiotherapy, enhance immunity, prevent relapse, increase survival, and improve quality of life.

According to TCM theory, practitioners prescribe herbal formulae according to the differentiation of symptoms of patients with pancreatic cancer 4. Therefore, the treatment varies from patient to patient and even at different stages of the disease.

Providers

TCM practitioners can either prescribe herbal formulae as decoctions, or prescribe commercially marketed herbal products such as Chinese patented medicines. Chinese patented medicines are manufactured mainly in China, while other neighbouring countries such as Japan, Korea, also produce herbal products.

Legal issues

In most European countries, herbal medicines are strictly regulated as dietary supplements. The European Directive on Traditional Herbal Medicinal Products allows herbal medicines to be registered as drugs if they have been used for 30 years (at least 15 years in EU countries and 15 years in non-EU countries). 5