The Treatment of the Gastrointestinal Tract Side Effects of Chemotherapy

abstracted & translated by

Bob Flaws, Dipl. Ac. & C.H., Lic. Ac., FNAAOM, FRCHM

Keywords: Chinese medicine, Chinese herbal medicine, chemotherapy, gastrointestinal side effects, Er Chen Tang (Two Aged [Ingredients] Decoction)

Many patients who are treated with chemotherapy experience the side effects of vomiting and nausea. Nausea and vomiting may occur within the first hour of chemotherapy and last up to a week. The percentage of patients vomiting in the first 24 hours of chemotherapy varies between 22-54% depending on chemotherapeutic agent. In some cases, this nausea and vomiting are so severe as to cause patients to stop therapy prematurely. However, Chinese medicine can often alleviate the side effects of chemotherapy as the following study suggests. The original article appeared in issue #2, 2003 of the Zhe Jiang Zhong Yi Za Zhi (Zhejiang Journal of Chinese Medicine) on page 58 under the title, “A Comparison of the Treatment of 193 Cases of Gastrointestinal Reactions to Chemotherapy with Er Chen Tang Jia Jian (Two Aged [Ingredients] Decoction with Additions & Subtractions) to 189 Cases Treated Solely with Chemotherapy.” It was written by Duan Dou-hua.

Cohort description:

The patients in this study were divided into two groups, a so-called Chinese medicine groups and a Western medicine groups. All the patients in both groups were seen as in-patients at the Hai Ning Municipal Tumor Hospital in Zhejiang province beginning in 1993. In the Chinese medicine group, there were 49 cases of lung cancer, 31 cases of stomach cancer, 33 cases of colon cancer, 19 cases of esophageal cancer, 22 cases of breast cancer, nine cases of nasopharyngeal cancer, three cases of kidney cancer, 16 cases of ovarian cancer, nine cases of cervical cancer, and two cases of other cancers. Among these patients, there were 129 males and 64 females aged 19-78 years with an average age of 58.5 years. In the Western medicine group, there were 53 cases of lung cancer, 28 cases of stomach cancer, 32 cases of colon cancer, 16 cases of esophageal cancer, 30 cases of breast cancer, 10 cases of nasopharyngeal cancer, one case of prostate cancer, 10 cases of ovarian cancer, six cases of cervical cancer, and three cases of other cancers. There were 126 males in this group and 63 females aged 23-72 years, with an average age of 62.2 years.

Treatment method:

Beginning 2-3 days after chemotherapy, the members of the Chinese medicine group received the following medicinals: Rhizoma Pinelliae Ternatae (Ban Xia), 10g, Fructus Amomi (Sha Ren) and Pericarpium Citri Reticulatae (Chen Pi), 6g each, Sclerotium Poriae Cocos (Fu Ling) and Radix Astragali Membranacei (Huang Qi), 15g each, and Radix Codonopsitis Pilosulae (Dang Shen), 20g. If dampness was heavy, six grams of Rhizoma Atractylodis (Cang Zhu) were added. If there was ductal glomus, 10 grams of Cortex Magnoliae Officinalis (Hou Po) were added. Those in the Western medicine group received their chemotherapy and did not take these or any other Chinese medicinals.

Treatment outcomes:

Marked effect was defined as elimination of vomiting and nausea after four days of taking the Chinese medicinals with increase in food intake. Some effect was defined as decrease in vomiting after taking the Chinese medicinals for four days and increase in food intake. However, even though the patient was not able to return to normal parameters, when they stopped taking these medicinals, their condition remained stable. No effect meant that, after four days of taking these Chinese medicinals, the vomiting and nausea had not been eliminated. It also could mean that, while taking these medicinals, there was some effect, but, when the patient stopped taking these medicinals, their condition reverted to as before. Based on these criteria, 131 patients out of 193 in the Chinese medicine group were judged to have gotten a marked effect and another 62 got some effect. Therefore, the total amelioration rate in this group was 100%. In the Western medicine group, 87 cases got some effect and 102 got no effect. Thus, the total amelioration rate in that group was only 46%.

Discussion:

According to Dr. Duan, chemotherapy damages the righteous qi at the same time as attempting to kill the cancer cells. Clinically, most patients present detriment to the spleen and stomach with loss of command over movement and transformation. Therefore, dampness obstructs the middle burner and qi and blood are both depleted. Based on this view of the disease mechanisms of post-chemo nausea and vomiting, Dr. Duan believes that the appropriate treatment principles are to mainly fortify the spleen and transform dampness, harmonize the center and downbear counterflow, and to boost the qi and nourish the blood. Within the above formula, Ban Xia and Chen Pi rectify the qi and downbear counterflow. Sha Ren is added to strengthen these effects of Ban Xia and Chen Pi. Fu Ling fortifies the spleen and percolates dampness. Dang Shen and Huang Qi fortify the spleen and boost the qi. As this study shows, other additions and subtractions can be made to this formula in order to increase its effect of harmonizing and downbearing. Er Chen Tang is one of the standard famous formulas of Chinese medicine with which all students and practitioners of Chinese medicine are expected to be familiar. The ingredients in this formula are readily available and are not particularly expensive. Therefore, this protocol could relatively easily be adopted as a standard one for the prevention and treatment of post-chemotherapy nausea and vomiting.