September 2005: Traditional Chinese Medicine

Standard for Chinese medicine for breast cancer?

Question from Tweet: What is the standard for treating breast cancer in Traditional Chinese Medicine? Is the cure rate the same or different from in the west?

Answers —Raymond Chang, M.D.: This is assuming that Chinese medicine has the same protocols as Western medicine. It does not. There is no standard regimen. It's not like conventional Western medicine, with a limited number of standards.

Chinese medicine depends highly on the individual practitioner and the patient. In a way there is no standard of treatment in traditional Chinese medicine for breast cancer. Therefore I think it's difficult to talk about cure rates for breast cancer in general. Maybe a response rate, but again I think the person raising the question may expect too much from medicine. I don't think we can quote a particular rate for Chinese medicine because it's so individualized. A lot of things we assume in the West like clinical trials and standardization of care do not yet exist in Chinese medicine.

Traditional Chinese Medicine goes back a few thousand years and breast cancer was rare, even a hundred years ago. Cancer was rare. If you look at traditional Chinese medicine textbooks, it hardly appears. It is sometimes called, "a hardness," a "firmness," a "lump." There are whole textbooks devoted to salmonella or typhoid, but nothing on breast cancer. So, there's no standard as you would expect. It's not a disease that affected hundreds of thousands of people.

Beth DuPree, M.D., F.A.C.S.: One of the things that I think is important to point out is that when women of Asian descent relocate from Asia to the United States, their incidence of breast cancer becomes the same as women who are born and raised in the United States. This goes along with what Dr. Chang is speaking about: in the Asian culture, breast cancer does not have the same history that it has had in the United States. Once women move into this country, adopt our diet and our stressful lives, and they live in this environment, the incidence begins to equalize that of women who have lived here forever.

Raymond Chang, M.D.: That is true. Thanks to globalization, breast cancer rates are globalizing as well.

Coenzyme Q10 with chemotherapy?

Question from Solo: My mother was diagnosed with breast cancer with liver metastases. She is currently on chemotherapy with Herceptin. I wanted her to start on Coenzyme Q10, however I was told that it would not be a good idea. What's your take on this and any other alternative treatments being used with chemotherapy?

Answer —Raymond Chang, M.D.: Coenzyme Q10 is not a traditional Chinese medicine although it has some Asian connections. I do not advocate its use with chemotherapy; but again, this is not Chinese medicine so I cannot comment further.

Strengthening the body for chemo?

Question from JTLEML: I was diagnosed at Stage IV and have been receiving chemotherapy non-stop for almost 20 months. Although I am tolerating treatment well, I worry about the toll that the chemotherapy itself will eventually take. What suggestions do you have for strengthening my body and enhancing the therapeutic effects of the chemotherapy?

Answer —Raymond Chang, M.D.: There may be some traditional Chinese herbs that can help with these. There are a lot of different Chinese herbal formulas used in China and Japan called Kampo remedies. Doctors use these concurrently with chemotherapy in their patients in order to reduce the side effects and perhaps enhance the treatment. It depends on the particular chemotherapeutic agent.

Adriamycin, for example, can be enhanced by certain ingredients from tea such as theanine. Japanese researchers have looked at combining theanine from tea (green tea or regular tea) with certain chemotherapies and found that its therapeutic efficacy is increased.

Again it depends what the patient is receiving. The regimen should be tailored to the actual agent because the side effects are different. If the patient is getting Taxol over a long period of time and is suffering from neuropathy, or has hand-foot syndrome (a skin condition that effects hands and feet from prolonged Xeloda treatment), it could be a different regimen or items used for that. One needs to see what therapy the patient is on and what complications we are worried about over time in order to design appropriate protective regimens.

Stop taking supplements?

Question from lmarshall: My surgeon has told me to stop all supplements because "they" don't know the effects on the body. I haven't started chemo yet but have heard that some Chinese herbs help relieve some of the symptoms. Should I take the supplements and ignore my surgeon?

Answers —Raymond Chang, M.D.: Surgeons usually do not advise on supplements. Most doctors would caution you—it's the common conventional approach. If you don't know anything, it's probably safer to tell people not to do anything. If you're not sure, liability-wise, you're safer telling people not to do it. If you tell people to go ahead and do it, you're liable. It's a common logic of physicians to say don't take it, don't do anything.

Of course, there are Chinese herbs that can be used, as I said in the previous question, depending on what symptoms we are referring to. If it's nausea for example, which is common from chemotherapy, then something like ginger is very helpful—ginger tea, ginger candy, even ginger pills. There is nothing that indicates ginger cannot be taken with chemotherapy. Ginger is very well established, and one of the respected herbs for nausea.

So in answer to your question, I would say yes. Maybe I shouldn't, but one can ignore that particular advice of the surgeon and take certain supplements.

Beth DuPree, M.D., F.A.C.S.: My best advice as a surgeon is to be open with your physician (whether it's your oncologist, surgeon, or radiation oncologist) about the supplements you would like to take. As Dr. Chang says, many times physicians will err on the side of caution and say not to use a supplement, but if the issue is raised in a non-threatening way, you may be able to help your physician understand the benefits that a supplement can have for their patients. Many of the holistic therapies and herbal supplements that I use with my patients were introduced to me by my patients and other colleagues.

Raymond Chang, M.D.: If you're unsure and your doctor is unsure, I do say that it's perhaps better not to do it. If you're not sure, don't proceed.

Herbs to avoid with Herceptin?

Question from Mwhite: I am on Herceptin. Are there any herbs I should not be taking?

Answer —Raymond Chang, M.D.: I don't know of any herbs that are contraindicated because of Herceptin. But I think there are herbs which certain breast cancer patients should not be taking. I do not have a specific compound that is contraindicated based on Herceptin as a drug. However, every patient is different. Each individual breast cancer patient has herbs that she should not take. Only her Chinese medical doctor could tell her what those were.

Is Dong Quai safe and helpful?

Question from Riverpal: I was specifically instructed by my surgeon NOT to take Chinese herbs. I have been taking and enjoying Dong Quai, [pronounced "dong kwaiy"] although I have not told him. Are there in fact some herbs that are safe and helpful (Stage III breast cancer, both ductile and lobular)?

Answer —Raymond Chang, M.D.: Dong Quai (Angelica) and such herbs are thought to be estrogenic. I would recommend if the patient is ER positive or PR positive that they should not take herbs such as Dong Quai.

Qi Gong to help immune system?

Question from RachalG: I have heard that Qi Gong [pronounced "chee kung"] can have very positive effects on the immune system. Can you explain this?

Answer —Raymond Chang, M.D.: Qi Gong is an ancient breathing exercise for internal strengthening. It has just recently in the past decade come to the West in a massive way. There are studies showing that it can enhance one's immune system. Having said that, it is very tricky to assess the true effects of a lot of things on the immune system.

For example, even humor, as in a joke, can enhance the immune system. If you use NK [natural killer] cells as an input parameter and study the effects of a joke, you can demonstrate the results after we hear a joke. This aspect of the immune system seems to improve. Sometimes it's hard to measure this kind of strength and it may not be as definitive as some researchers claim.

There are a lot of claims around things like Qi Gong, so one has to be careful when evaluating. There are many forms of Qi Gong. It's almost like dancing. Does dancing help improve one's posture? There are many forms of dancing. It depends on which form you're practicing. Qi is the Chinese word for energy and somebody, a so-called master, [a very experienced teacher] can give the energy to you. You can cultivate your own energy by practicing yourself. Sometimes a master gives or imparts it to you. That is an external Qi Gong.

There are studies that show a master or practitioner can deliver Qi to a laboratory animal. That's one kind of study. It would be helpful to have a study to check the immune system after someone had practiced regularly for 4 to 6 weeks, and see if the immune function had improved. I don't think the claims for Qi Gong are fully substantiated, and there are a lot of variations because of differences in methodology.

In general, it is a healthy practice, and that's the best one can claim since there are so many different styles, schools, methods, and so forth.

Summary of Chinese medicine?

Question from Eadie: Could you please summarize Chinese medicine for us?

Answers —Raymond Chang, M.D.: Chinese medicine is actually an entirely different system of understanding health, physical function, and disease and its causes in human beings. It has its own paradigm for treatments that is radically different from Western medicine. I won't get into too much of the diagnostic aspect (there are many theories of Yin and Yang), but let's talk about the practical treatment end.

There are traditional Chinese herbs, acupuncture, diet, and there are such minor treatments as massage and physical therapy. It is much more complicated than it seems because even with herbs, the traditional Chinese formula of so-called "herbs" contains only about 80% herbs. The rest includes such things as marine life (sea horses), reptiles, insects, or minerals from stones (pearls).

It's really natural medicine, if you will, not just herbal medicine; it's the use of all things natural to treat disease. This is what is called the Materia Medica. Materia Medica is the formal Latin name for the whole universe of things that are used to treat disease. Chinese medicine, based on different diagnostic paradigms, treats diseases or conditions using such things as the treatments I've just mentioned. That would be it in a nutshell.

Beth DuPree, M.D., F.A.C.S.: Chinese medicine, like many Eastern modalities, is focused more on the person as a whole as opposed to a disease alone. It doesn't forget the human being in the process of treating a disease.

Effect of tai chi?

Question from Fa: What can be the effect of tai chi chuan (taijiquan) for a breast cancer survivor?

Answer —Raymond Chang, M.D.: Tai chi, again, is a healthy exercise. The long story: it really is a martial art, but it is now used for health reasons, not for self defense. I think it's very healthy for both mind and body, especially for a cancer survivor (it doesn't have to be breast cancer). If you do it regularly, it's fine. I'm not sure that there's a study of survival or that sort of thing, but tai chi can help people with Parkinson's, it reduces stiffness, and in general, it can have a healthy effect.

Chinese massage for breast cancer?

Question from Sandys: How is Chinese massage used for a breast cancer patient?

Answer —Raymond Chang, M.D.: Traditionally, it is not. The Chinese massage is really tui na, [pronounced "twee nah"] Chinese physical therapy, a physical medicine. It is usually used for physical injury or martial arts—sort of the orthopedic branch. People do massage for relaxation and things. You can apply it that way. I don't see any difference, but I see that you can use it that way. There is no specific application of Chinese massage for breast cancer. One can use it, but non-specifically.

Classical forms of acupuncture?

Question from Fherdrich: Is there evidence-based support for classical forms of acupuncture treatment for people living with cancer?

Answers —Raymond Chang, M.D.: Interesting question because it specifies classical forms. There are many forms of acupuncture, true—there are classical forms and deviations. We can consider acupuncture as a whole acupuncture. I generally don't tell my patients to do acupuncture unless for specific reasons: they have a symptom, pain or nausea, or if they might feel better with it. The Chinese don't use it that way either.

There is no evidence that acupuncture can improve survival in cancer. It is not used to treat cancer; it is used to feel better from certain complications from the disease or the treatment. For someone living with cancer but who otherwise has no symptoms from cancer or from cancer treatment, I don't necessarily see the need for acupuncture. Some people just do it because they like it.

Beth DuPree, M.D., F.A.C.S.: Many patients seek acupuncture to help alleviate the side effects of cancer and as a part of overall wellness. Although the acupuncture is not intended as a cure or an alternative to treatments they are receiving, it can have a very positive effect on their overall well-being.

Raymond Chang, M.D.: It is useful. I tell my cancer patients that there are so-called quality of life or feel better treatments, and there are "live-longer" treatments. They are not necessarily mutually inclusive. Chemo may extend life but certainly does not make people feel better. Likewise, things that make people feel better may not improve their survival. So patients sometimes get mixed up. It depends on why you're using something. I absolutely agree that acupuncture, whether you're sick or not, will make you feel better. It's very relaxing.

Acupuncture OK if no signs of lymphedema?

Question from CorinnaL: Is it ok to get acupuncture needles in the arm of someone whose lymph nodes have been removed if there are no symptoms of lymphedema?

Answer —Raymond Chang, M.D.: I do not advise that. Even very small nicks sometimes can cause dramatic infections in the limb that has no lymph node. The infection can move very quickly. Although infections due to acupuncture overall are rare, we've all seen patients who have done nothing but maybe go to the nail salon and had a cut in the cuticle. They didn't even know there was any injury, but next thing they know, the whole thing is infected. This is especially bad when on chemo.

We do not advocate needles in the arm of lymph node dissection.

Massage spreads breast cancer cells?

Question from DenverMom: Does massage contribute to the spread of breast cancer cells to the lymph nodes?

Answers —Raymond Chang, M.D.: I think that is an ongoing concern. I don't mind my patients doing that.

Beth DuPree, M.D., F.A.C.S.: It's a big debate.

Raymond Chang, M.D.: I don't have a final answer. Certain locations no. On the torso, or a foot massage, I don't feel would be a problem. It's location related.

Beth DuPree, M.D., F.A.C.S.: The jury's still out.

Chinese diet for breast cancer patients?

Question from Elayne: What type of diet should a breast cancer patient follow, according to Chinese medicine?

Answer —Raymond Chang, M.D.: Chinese medicine may not always be scientific. It has its own idiosyncrasies based on culture that dictates what is an appropriate diet. The diet needs to be individualized, so it's not the same menu for everybody because in Chinese medicine people are divided into various types.

For example, let's take hot and cold. The idea is the "hot" person [someone whose personality is assertive or angry] should not eat hot food. The Chinese concept of temperature in food has nothing to do with how hot or cold the food is but what the quality of the food is. Certain foods are considered warm, certain foods are cold, certain foods are hot. For example, lamb is "warm" and it doesn't have anything to do with how it's cooked.

It depends on that patient's constitution. Treatments can be hot and cold, too. If the patient is undergoing a "hot" treatment like radiation, you don't add hot food to a hot treatment for someone who has a basic hot constitution on top of that. It can get fairly complicated, depending on what that individual is doing treatment-wise.

It can even relate to the season—during a colder season you can have warmer food to counteract the weather. I would not advise somebody living in the tropics who's undergoing radiation who has a hot constitution to eat too much food that is considered very hot. They should be on more of a cooling diet. But it would be different for someone living in Alberta in the winter time. There are individualized recommendations, depending on the situation.

There are certain things in the diet that are considered "inflammatory" that should be avoided by cancer patients because they promote swelling or growth. If you have an infection, abscess, or tumor you should not take things or eat things that promote growth or further inflammation. Again, this is based on culture; it's not scientific.

For example, shellfish. Recently, they found that crab, lobster, and shrimp blood contain a lot of copper. Copper promotes inflammation or growth—and there has been a long-standing belief in the Chinese dietary system that shellfish promotes inflammation.

We now know that copper is a very powerful angiogenic, and that antiangiogenesis is a cancer therapy. There's actually now a copper chelating drug that is in clinical trials in Michigan for cancer as an antiangiogenic. Shellfish use copper to carry oxygen like we mammals use oxygen in our blood. It is fascinating that some of these old cultural Chinese beliefs are finding scientific basis after such a long time.

Chinese medicine for depression, anxiety?

Question from CADorothy: How can Chinese medicine help with the depression and anxiety I feel about being diagnosed with breast cancer?

Answer —Raymond Chang, M.D.: There are Chinese herbs for treating depression and anxiety as defined in the West. Of course acupuncture also releases anxiety, and partially, Chinese medicine may help.

There is no Chinese psychotherapy. The root cause is in the mind, and the solution needs to come from self-transformation and not from something external like drugs or therapy. Somehow one needs to make a turn inside oneself and achieve a balance in the mind that way. Of course, this is not Chinese medicine but is an Asian tradition, the spiritual belief.

Meditation is very helpful relief for depression. I think the Asian traditions including India and Tibet (although not Chinese necessarily) include cultural beliefs of Buddhism, karma, and fatalistic beliefs. All these belief systems help patients cope with their diagnosis. Asians believe that anything that happens is not random. There's a reason something happens.

Patients are wondering where they get their breast cancer, and it makes them anxious not knowing where it came from. There's some reassurance from Chinese philosophy that things don't come from nowhere. People don't suffer from frustration from questions like that based on philosophical beliefs.

Chinese medicine without a practitioner?

Question from Farmerbeth: I live in a small town in the Midwest United States. I'm assuming I can't find a Chinese medicine practitioner anywhere nearby. Is there a way that I can use the healing benefits of this type of medicine on my own as I continue my regular breast cancer treatments?

Answer —Raymond Chang, M.D.: I'm not sure. Certainly you cannot do acupuncture on your own, but you can apply the theory of acupuncture. Let's say you're undergoing chemotherapy, you're nauseated, and you'd like to do something but can't find an acupuncturist. You can find Acubands in the pharmacy. They use the same principle, although I don't think they are as effective. You can apply the bands to the points that will relieve nausea when applied by traditional Chinese acupuncture. These bands can be found almost anywhere, including ordering from the Internet. You can try—it certainly won't hurt you to try.

There are also certain compounds, medicinal herbs, especially medicinal mushrooms (of Asian origin—common Western mushrooms do not have medicinal benefits) that are available in healthfood stores, so you do not need a Chinese practitioner. Or you can eat shiitake mushrooms, available in your supermarket.

Healthy body during chemo?

Question from Heyjude: I would like to know how you keep your body healthy during chemo. I am going to begin Taxotere for a breast cancer recurrence.

Answer —Raymond Chang, M.D.: There are many things one can do. A lot of it doesn't have to be Chinese medicine. There are so-called tonic herbs that can be taken to help with one's energy. There are many other elements in complementary medicine like supplements, including glutamine which is an amino acid that you can get in the pharmacy. It is increasingly prescribed by mainstream oncologists. It's not a drug and is proven to help in reducing side effects with Taxotere.

Resources on Chinese herbal treatments?

Question from Peter: Can you recommend printed or online resources to learn more of Chinese herbal treatments and breast cancer?

Answer —Raymond Chang, M.D.: You have to be careful because there's a lot of marketing online. I don't know what is hype versus what is real. I don't know if there is anything that can be applied just to breast cancer. My institution, the Institute of East-West Medicine, does hold grants, including some from the Gray Charitable Trust. We have an online site, www.asiancancerherb.info. It is the most comprehensive collection of over 500 Asian cancer herbal material that you can click by name to get pictures, chemistry, application, research, studies, and references. There are articles and news releases. It's entirely unbiased, no sales. It's purely for research or to learn about them.

Herbs for hot flashes from tamoxifen?

Question from Mollie: I am taking tamoxifen. Are there any herbs to relieve the hot flashes?

Answer —Raymond Chang, M.D.: Yes, but we don't recommend it. The herbs that are effective in reducing the hot flashes are likely to be estrogenic. They would dilute your tamoxifen and cancel out the purpose of taking it, so we don't recommend it.

There are Western herbs thought to be helpful and not detrimental, but I'm generally very careful not to mention Chinese herbs. Dong Quai may help, but again it dilutes the tamoxifen. Acupuncture may help but I think there are simpler, easier treatments for hot flashes.

Complementary therapy for all stages?

Question from Annalisa: Can complementary therapies be used for all types and stages of breast cancer?

Answer —Raymond Chang, M.D.: Yes. You can apply different things at different times for all stages. Complementary remedies are applicable in all aspects of cancer.

Liver cleansing while on chemo?

Question from Heyjude: Would you recommend a Chinese medicine for someone on chemo to cleanse the liver?

Answer —Raymond Chang, M.D.: No. Cleaning the liver, assuming the liver is dirty, is not a traditional Chinese function. It's a modern superstition I think: the idea that there's a dirty liver that needs to be cleaned.

Cost of complementary treatments?

Question from Hetty: How much do treatments cost? Will my insurance cover any of them?

Answer —Raymond Chang, M.D.: It's highly variable depending on what you're talking about. Acupuncture, depending on the part of the country, can run from $30 to $150 a session, depending on who's doing it. The cost of herbs depends on the ingredients. Americans may not be used to the fact that there are expensive herbs, but there are.

Asians are accustomed to expensive herbs. With ginseng, for example, there's $10,000 an ounce ginseng, and there's $1 an ounce ginseng, just like there are different vintages and varieties of wines, and pricing is very different. Generally, it should not be too expensive.

Insurance does not cover herbs. Insurance sometimes covers acupuncture, depending on the insurance company and the policy you have with them. It may be subject to indications and qualifications of the practitioner. There are regional differences also on that.

Regular, Chinese medicine doctors to talk?

Question from AmberG: Should my regular doctor talk with my Chinese medicine doctor about my treatments? How can I get them to connect?

Answer —Raymond Chang, M.D.: We generally believe it's a good idea to connect, but sometimes it may not be such a good idea. It depends on how well versed your Chinese practitioner is in Western medicine. I don't necessarily believe that making everybody connect is the best thing—sometimes they operate on different planes and it's disastrous.

I have had experience in dealing with Chinese practitioners who discuss the balance of Yin and Yang energy in a patient, versus the oncologists talking about whether someone is hormone-receptor positive or negative. They couldn't understand what one another was talking about. The Chinese practitioner wanted to put the patient on herbs to balance Yin and Yang so the patient feels better. But the Chinese practitioner doesn't know anything about estrogen receptors, and that the goal of the treatment may be to leave the patient a little unbalanced. That's the whole idea. The two find it impossible to communicate because they're talking totally different languages.

Licenses for Chinese medicine practitioners?

Question from MaggieP: What kind of license do Chinese medical practitioners have?

Answer —Raymond Chang, M.D.: It depends. For herbal medicine, there's no licensing in this country. Licensing usually goes state by state. Most states have licensing for acupuncture but no licensing for herbs. Herbs you can get without a prescription and they're over the counter to begin with, so it does not have a licensing requirement, Chinese herbs notwithstanding. There's license for massage and acupuncture.

Standard Chinese medicine as primary?

Question from Christine: My associate is using TCM (Traditional Chinese Medicine) as her primary therapy for breast cancer. Is there any kind of "standard" for use of TCM either before or after surgery?

Answer —Raymond Chang, M.D.: There is no standard. It's highly individualized. It depends on the practitioner and the patient.

Testing Chinese medicine therapies?

Question from Sheila: The NIH is now testing a lot of new therapies that might be helpful in breast cancer. What is NCCAM (the National Center for Complementary and Alternative Medicine) testing vis-a-vis Chinese Medicine?

Answer —Raymond Chang, M.D.: I think you can log on to the NCCAM website and see. They do fund some projects. I don't know if there's anything in the herbal or Chinese medicine areas that they're funding right now. I'm not familiar with their current funding, but you should be able to easily log on to their Web site and find out all the projects that are federally funded.

Therapies for metastatic cancer?

Question from Myrn11: Dr. Chang, given your extensive research and knowledge, what kind of hope can you offer to Stage IV metastatic breast cancer patients for the immediate future? Many of us are just living from scan to scan; chemo to chemo.

Answer —Raymond Chang, M.D.: Again, we don't claim or pretend to be able to treat or cure cancer any better than conventional medicines. I don't want anyone to have false hope. There are anecdotal cases of people who do very well with Stage IV disease using alternative approaches, so that is heartening.

It remains very difficult. It's not any easier for alternative practitioners to deal with than conventional practitioners. Ultimately, it's my personal belief that the true cure (because ultimately we as humans overcome) is at the level of the spirit and the mind. There's so much in the Eastern philosophy that gives hope and guidance at that level. Unfortunately, very few of my patients talk to me at a spiritual level—it's more a scan to scan, chemo to chemo, herb to herb level—whereas I feel that the ultimate resolution is really at the spiritual level. There's a lot I can offer from the East in that area and very little is explored in that area.

Chinese massage and surgical incisions?

Question from Sierra: If I have Chinese massage, what should I tell the massage therapist about my surgical incisions?

Answer —Raymond Chang, M.D.: Just tell them you had surgery. There's nothing special you need to tell them.

Quality of Chinese herbs?

Question from EmmLo: How do I know the quality of the Chinese herbs I get is safe?

Answer —Raymond Chang, M.D.: There is no oversight necessarily. The FDA only responds if there are complaints or actual cases where something bad has already happened. Then they will go and ban the substance, such as Kava-kava.

You're not going to know ahead of time that there may be a potential problem, so you're going to have to rely on a good practitioner. There's not necessarily any standardization of the ingredients, and you don't know the source of the material.

Take ginseng, for example—you don't know as a consumer or patient where it came from or how it was processed so it's hard to know if a batch was tainted. There was an herbal treatment for prostate cancer called PC-Spes which was effective until the California Department of Health Services discovered the herbs were tainted with Western drugs, DES [diethylstilbestrol] and tranquilizers. So issues like standardization and quality control may be a problem with herbs as it's not a highly regulated market. You have to go by your practitioner, the source from where you're getting it. Unfortunately the oversight is not completed yet.

Chinese treatment to prevent recurrence?

Question from Chat: I had my chemo and radiation therapies 3 months back. Is there Chinese treatment for prevention of recurrence?

Answer —Raymond Chang, M.D.: Potentially there are herbs one can take either for bolstering the immune system or that have direct anti-cancer properties. Again the herbal formulas will depend on the individual, the characteristics of the particular tumor, how invasive or aggressive it may be, the stage, etc. But in a nutshell there certainly can be treatments appropriate for secondary prevention.

Herbs for boosting white blood cells?

Question from Lila: What type of herbs would be most helpful for boosting one's white blood cells during chemo?

Answers —Raymond Chang, M.D.: Many similar tonic herbs and medicinal mushrooms can be useful. Mushrooms that are particular helpful can include Coriolis mushroom (PSK), Cordyceps, Ganoderma, etc.

Beth DuPree, M.D., F.A.C.S.: Herbs that enhance so-called Qi may help with the counts. There are so-called tonic herbs. Be careful—some of them may be estrogenic.

Chinese medicine and surgery?

Question from FionaMay: Have you had patients who are going through surgery for breast cancer and also want to use Chinese or another complementary medicine? What do you tell them?

Answer —Raymond Chang, M.D.: Surgery is not a modality of treatment in Chinese medicine. It's thought to be bad to open one up—the gas, the vital Qi, the vital air would escape if you cut a hole. Again, this may not be scientific but it's traditional Chinese medicine.

So we use the same Qi-enhancing tonics that we refer to above. I mentioned the herbs that boost white-blood-cell counts. It's the same kind of thing that's used during or after surgery. There are foods to eat that enhance healing; some types of fish, for example, to repair the leakage of vital energy due to surgery.