In China, traditional Chinese medicine is an accepted and integral part of clinical cancer management alongside Western medicine. Fuzheng, 扶正 therapy is utilized to support the patients’ healthy qi (zhengqi, 正气) or the immune system, while dispelling xieqi, 泄气 or pathogenic influences. However, the study and description of cancer within Chinese medicine and literature can be traced as far back as the Shang Dynasty, where it was described as liu, 瘤 tumor or lump. Herein we will examine the terminology and understanding of cancer from Chinese medical literature, tracing the evolution of knowledge and language used in cancer diagnosis.
The study and description of cancer within Chinese medicine and literature can be traced as far back as the Shang Dynasty (1300-1046 BCE) where it was described as liu, 瘤 tumor or lump.1,2 Further mention is made in The Rites of the Zhou Dynasty (1100 – 400 BC), also known as the Li Ji, 礼记as Chinese physicians began to treat swelling and ulcerations or necrosis.1 Throughout history, many other terms are used in the Chinese medicine classics to describe tumors, lumps and disease states that may be comparable to cancer. Terms include yan, 嚴 (cancer), ju, 疽 (ulcers), yong, 癰 (carbuncles), hen rou, 痕肉 (polyps), ji ju, 積聚 (accumulations), wu ming zhong du, 無名腫毒 (toxic swellings), fa bei 發背 (malignant tumors), jin shou, 筋瘦 (tumor on the muscles), and e he, 惡核 (malignant tumors). These terms are summarized in table 1 below.
Chinese Terminology – Tumor and Type
|Tumor Terminology||Simplified Chinese Terminology and Pinyin||Traditional Chinese Terminology|
|Chronic Tumor||昔瘤, xi liu||昔瘤|
|Sinew Tumor||筋瘤, jin liu||筋瘤|
|Intestinal Tumor||肠瘤, chang liu||腸瘤|
|Rock Tumor||石瘕, shi xia||石瘕|
|Accumulation||积聚, ji ju||積聚|
|Breast Tumor||乳岩, ru yan||乳岩|
|Cardiac Mass||伏梁, fu liang||伏梁|
|Cervical Cancer||石瘕, shi jia||石瘕|
|Liver Abscess||肝痈, gan yong||肝痈|
|Kidney Tumor||肾岩, shen yan||腎岩|
|External Kidney Tumor||外肾岩,wei shen yan||外腎岩|
|Penile Cancer||翻花下疳, fan hua xia gan||翻花下疳|
|Callous Lips Mass||茧唇, jian chun||繭唇|
|Tongue Cancer||舌菌, she jun||舌菌|
|Tongue Cancer||舌疳, she gan||舌疳|
|Malignant or Benign Tumor||肉瘤, rou liu||肉瘤|
|Malignant Skin Tumor||石疽, shi ju||石疽|
|Stony Malignant Boil||石疔, shi ding||石疔|
|Skin Tumor, Green-blue||青疔, qing ding||青疔|
|Skin Tumor, Flower Blossom||繁华疮, fan hua chuang||繁华瘡|
|Bone Tumor||骨瘤, gu liu||骨瘤|
|Bone Gangrene||骨疽, gu ju||骨疽|
|Tendon Tumor||筋瘤, jin liu||筋瘤|
|Phlegm Package||痰包, tan bao||痰包|
|Phlegm Kernel||痰核, tan he||痰核|
|Fatty Tumor||脂瘤, zhi liu||脂瘤|
|Blood Tumor||血瘤, xue liu||血瘤|
|Fetal Tumor||胎瘤, tai liu||胎瘤|
|Fetal Tumor||红丝瘤,hong si liu||紅絲瘤|
|Qi Tumor||气瘤, qi liu||氣瘤|
|Ear Fungus||耳菌, er jun||耳菌|
Table 1: Chinese Tumor Terminology
Yu and Hong describe the cause of cancer as an imbalance of yin and yang, the struggle between zheng qi (upright or healthy qi) and xie qi (pathogenic qi), which can emerge as either excess or deficiency syndromes.3 The vast majority of Chinese medicine literature regarding cancer has focused on the idea of obstruction and accumulation with contributing factors such as qi, blood, and phlegm.4 But within these etiologies, significant factors throughout the canon include emotional disturbance, damage to the viscera (zangfu), disharmony of qi and blood, exogenous pathogens, and inappropriate diet. It is these physical and emotional stimuli as well as invasion of liu yin, 六淫 or liu xie, 六邪 six exogenous pathogens (wind, cold, damp, heat, fire and dryness) that are the primary disruptors of cellular metabolism and the leading causes of these obstructions.
Chinese medicine’s most important text, the Huang Di Nei Jing, 黃帝內經 (HDNJ) or Yellow Emperor’s Inner Classic, presents not just concepts of disease and treatment, but also the ideal that the human body maintains a harmonious balance based on our environment, diet, emotion, and appropriate levels of physical activity.3 When this balance is disturbed, there is potential for dysfunction and disease. As mentioned above, the idea of obstruction and accumulation is one such potential.
The full clinical picture of tumors, ulcerations and potentially cancer is presented in the HDNJ, chapter 81 of the Ling Shu:
“The Defensive qi and Nutritive qi travel with the blood all around the body incessantly. Their itineraries correspond to the constellations in Heaven and principal waterways on Earth. When the Cold Evil qi resides in the conduits, blood flow becomes stagnant. Stagnant blood will cause obstruction, sequestering the Defensive qi, preventing it from circulating; boils ensue. Eventually, the sequestered Cold Evil qi provokes a febrile response. When the fever persists ulceration begins, and the suppuration follows. If the pus cannot be drained, the sinews become necrotic. With necrosis in the sinews, the bones are eroded. With bone erosion, the bone marrow will dissipate. If the marrow is not filling up the bone cavities [and thus blood circulation by-passes the rotten bone], [the pus] cannot be drained away. Consequently, blood supply dwindles and debility prevails, the sinews, bones and muscles become malnourished because blood circulation fails. When the febrile state spreads to the five Zang-organs, their functions are compromised and death is to be expected.”5
The HDNJ then continues to describe various ulcerations and tumors including xi liu, 昔瘤 (chronic tumor), jin liu, 筋瘤 (sinew tumor), chang liu, 肠瘤 (intestinal tumor), shi jia, 石瘕 (rock tumor), ji ju, 积聚 (accumulation), and ye ge, 噎嗝 (esophageal cancer).5, 6
The HDNJ recognized that “cancer” can arise from exogenous pathogens or the environment, emotional factors, and improper diet.2 “With discomfort, improper diet, periodic cold temperatures, pathogens prevail and accumulation occurs.”7 And the HDNJ tells us that these tumors are formed internally due to a specific movement of qi or lack thereof: 陷脈為瘻, 留連肉腠. “When the sunken vessels develop tumors, [this is because the qi] stays for long in the flesh and the interstice [structures].”8
Perhaps the closest description we have to the description of cancer in the HDNJ is in the description of ju, 疽, deep seated carbuncles.
“When heat is overbearing, it penetrates deep into the muscles, so that the bone marrow and sinews are wilting. In this case, the five Zang-organs are affected, blood and qi are exhausted [claudication of the blood vessels]. Below the carbuncle surface, there are no healthy tissue left. That is why it is called ju [deep seated carbuncle]. The surface of the deep-seated carbuncle is hard [induration] and darkish, like the hide from the nape of a cow. The surface of a carbuncle is thin and lustrous.”5
Further, the HDNJ describes many forms of therapy including spiritual, acupuncture, herbal and nutrition. Most notably, the HDNJ ensures us that if we follow the treatment methods derived through differential diagnosis there will be a “cure.” “It is possible to break up accumulations; and it is possible to destruct what is firm. It is possible to harmonize the qi; and it is possible to achieve a definite cure.”8
Wang Bing’s commentary on the HDNJ also suggests that “examples of [illnesses] that have formed internally because of a qi movement are the following: accumulations, concretions and conglomerations, goiters and tumors, peak illness and convulsion”8 And in The Central Treasury Canon (Zhong cang jing, 中藏經) the idea of cancer forming endogenously is reinforced: “The form of ulcer is sore, swollen, all because of the cumulative toxicity of the five viscera and six bowels […] and that the tumor is a partial consequence of systemic disease.”2
The Nanjing (黃帝八十一難經), or Classic of Difficulties, further discusses accumulation (ji, 积), and gathering (ju, 聚), in relation to the bowels and viscera, disease states, symptomology and pathogenesis. The fifty-fifth difficulty (chapter) suggests that accumulations are yin qi, substantive accumulations that do not move, and that they lump or create masses. “They stop and do not move,” and have clear borders, “their upper and lower [extensions area clearly marked by an] end and beginning; to the left and to the right are [clearly defined] locations where they subside.”9 Commentator Zhang Shixian, 張世贤 (circa 1510 CE) agrees that accumulations are yin qi, and that they also represent earth within the wuxing, (五行, 5 elements or 5 phases) framework. Gatherings (ju, 聚), may also be called “collections” by translators such as Unschuld, as discussed in the fifty-fifth difficulty and further illuminated in the fifty-sixth difficulty. The Nanjing suggests that these gatherings or collections are yang qi, they are not rooted, and may move throughout the body, and pain is not specific.9 They are the result of a disruption in circulation, but here Ming dynasty physician Zhang Shixian suggests that they reflect heaven and will generally resolve on their own.
One of the earliest illustrated Chinese texts on surgery and traumatology is Wei Ji’s Precious Text (Wei ji bao shu, 衛濟寶書), from the Song Dynasty (960-1279), compiled by Dong Xuan, 東軒. The text contains illustrations of various skin diseases including cancer (ai, 癌), viral infections of the hands known as whitlows (biao 瘭); carbuncles and abscesses (ju, 疽); chronic conditions (gu, 痼); and other abscesses (yong, 癰). These illustrations seek to correlate symptoms and therapeutic approaches and techniques. This is the earliest use of the term cancer (ai, 癌) according to Dosher and Peng. In the Song Dynasty (960-1278 CE), the text titled Treatise on Formulas of Straight Direction of Benevolent Aid of Diseases (Ren zhai zhi zhi fang lun) describes cancer as hard, uneven lumps – like a rock with concave or convex surface and a deep root. The text states these tumors are very hard to cure.11
Later in the Song Dynasty the San Yin Fang, 三因方 describes a tumor in the neck not dissimilar to a goiter called ying liu, 瘿瘤. And in the Medical Compendium of Zhu Dan Xi (Zhu dan xi yi xue quan shu, 朱丹溪醫學全書) there is mention of breast cancer. Zhu Dan Xi, 朱丹溪 (1281-1358) stated that lumps in the body were related to tangible phlegm.12 Along with the HDNJ, Zhu Dan Xi states that cancer can be the result of the accumulation of worry, anger and depression resulting in spleen qi deficiency and obstruction, and rebellious liver qi that are deep and hidden on the interior with perhaps very few symptoms. Xi further states that after years of suppression, a tumor may emerge on the breast with soreness (ru yan, 乳岩) and cannot be cured.12 In the Imperially-Commissioned Golden Mirror of Medical Learning (Yu zuan yi zong jin jian, 御纂醫宗金鑑), compiled in 1742, the authors present a vision of breast cancer also described as ru yan, 乳岩, (translated as breast mountain) perhaps derived from Chen Shi Gong’s 陳實功, Correct Teachings on External Ailments (Wai ke zheng zong, 外科正宗, 1617).
Other important texts that describe cancer include the General Treatise on Causes and Manifestations of All Diseases (Zhu bing yuan hou lun, 諸病源候論), which describes a tumor-like obstruction of the bowels called zheng jia, 癥瘕. The text also states that breast channels may be “attacked by wind and cold, the blood becomes astringent and carbuncles develop, cold increases heat disperses, and there are nodules like stone,” suggesting that breast lumps or tumors are the product of blood stasis and phlegm accumulation. In Yu Tuan’s Yi xue zheng zhuan, a picture of breast cancer emerges, described as predominantly occurring in women with anger and melancholy of middle age. This idea corresponds with modern research which suggests that the prevalence of depression in women increases the risk of breast cancer.13 Here, we see an imbalance of yin and yang obstructing the channels causing qi stagnation, blood stasis and the accumulation of phlegm. From these descriptions, we can conclude that in TCM diagnosis, blood dysfunction plays an important role in the development of cancer. A summary of Chinese medicine texts and their descriptions of cancer can be found in table 2 below.
Cancer Differentiation and Terminology, Sources in Historical Chinese Text
|12th century BCE||The Rites of the Zhou (Dynasty),|
|Unknown||Yang yi 瘍醫 (ulceration doctors), zhong yang, 腫瘍 (swelling & ulceration), kui yang, 潰瘍 (necrosis & ulceration), chuang yang, 疮疡 (lesion & ulceration), ying, 瘿 (glandular enlargement), liu, 瘤 (tumor), yan, 岩 (rock)|
|206 BCE – 220 CE||Yellow Emperor’s Inner Classic,|
|Unknown||Xi liu, 昔瘤 (chronic tumor), jin liu, 筋瘤 (sinew tumor), chang liu, 肠瘤 (intestinal tumor), shi xia, 石瘕 (rock tumor), ji ju, 积聚 (accumulation), ye ge, 噎嗝 (hiccup or belch), ye shi, 噎食 (dysphagia), fan wei, 反胃 (food regurgitation), ji ju zheng jia, 積聚㿂瘕 (immovable & moveable abdominal masses), fu liang, 伏梁 (cardiac mass), shi jia, 石瘕 (stoney movable mass, cervical cancer), gan yong, 肝痈 (liver congestion or abscess)|
|168 BCE||Recipes for Fifty-Two Ailments,|
|Unknown||Gu ju, 骨疽 (bone gangrene)|
|Tang Dynasty||A Thousand Golden Prescriptions,|
|Sun Si-miao||Ru yan 乳岩 (breast rock), rou liu, 肉瘤 (sarcoma), shi ju, 石疽 (stony flat-abscess), shi ding, 石疔 (stony malignant boil), qing ding, 青疔 (green-blue stony boil), fan hua chuang, 繁花瘡 (flower blossom lesion), gu liu 骨瘤 (bone vegetation)|
|Tang Dynasty||Medical Secrets of an Official,|
|610||Discussion on the Origins of the Symptoms of Illness,|
|Chao Yuan-fang||Gan ji 肝積 (liver accumulation), gan zhang, 肝漲 (liver distention), yong ji shan, 積疝 (accumulation hernia), bing lin, 病痳 (dribbling condition)|
|992||Holy Peaceful Benevolent Prescriptions, 太平聖惠方||Huang Xi-yin||Fei ji, 肺積 (lung accumulation)|
|1151||Prescriptions of the Peaceful Benevolent Dispensary,|
|Chen Shi-wen||Gan ji, 肝積 (liver accumulation), gan zhang, 肝漲 (liver distention), yong ji shan, 積疝 (accumulation hernia), pi huang, 痞黃 (obstinate jaundice)|
|1117||The Complete Record of Holy Benevolence, 聖濟總錄||Compilation||Fei ji, 肺積 (lung accumulation)|
|1263||The Golden Mirror of External Medicine, 金鑑外科||Chen Zhi-ming||Ru yan, 乳岩 (breast rock)|
|1571||Surgical Pivot, 外科樞要||Xue Ji||Qi liu, 氣瘤 (qi tumor)|
|1575||The Orthodox Medical Record,|
|Yu Tuan||Ru yan, 乳岩 (breast rock)|
|1602||The Criterion of Evidence and Governance, 證治準繩||Wang Ken-tang||Er jun, 耳菌 (ear fungus)|
|1760||A Compendium of Ulceration Doctors, 疡医大全||Chen Gu-shi||She jun, 舌菌 (tongue fungus), she gan, 舌疳 (tongue gangrene)|
|1665||The Orthodox Manual of External Prescriptions, 外科證治全生集||Chen Shi-gong||Rou liu, 肉瘤 (benign tumor, such as lipomas), jin liu, 筋瘤 (tendon tumors), tan bao, 痰包 (phlegm package), tan he, 痰核 (phlegm kernel), tai liu, 胎瘤 (fetal tumor), hong si liu, 紅絲瘤 (red silk tumor, or fetal tumor), fen liu, 粉瘤 (powder tumor)|
|1805||A collection of Experiences in Ulceration, 疡科心得集||Gao Ging-jun||Shi yong, (or rong) 失容 (loss of lustre), shen yan, 肾岩 (kidney rock), wai shen yan, 外腎岩 (external kidney rock), fan hua xia gan, 翻花下疳 (penile cancer), jian chun, 繭唇 (callous lips)|
|1838||True Surgical Interpretations,|
|Zou Yue||Zhi liu, 脂瘤 (fatty tumor)|
|1839||Categorized Evidence-like Differentiation, 類證治裁||Lin Pei-qin||Xue liu, 血瘤 (blood tumor)|
|1742||The Golden Mirror of Medicine,|
|Wu Qian||She jun, 舌菌 (tongue rock fungus), she gan, 舌疳 (tongue gangrene)|
Table 2: Cancer Terminology in Historical Chinese Text14
Of course, not every mention of abscess, lesion, or lump in Chinese medicine texts can be described as cancer, and we should be cautious when we overlay our understanding of western disease states on these pathologies. However, by examining these pathologies and etiologies, we may open the door to potential treatment methods, including points and formulas, and paths of inquiry for future research.
Robert Hoffman and Jian Li Gao conceived of and wrote the manuscript, Fei Fei Chen aided in translation and editing.
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