News Letter, Vol. 4 (6), June , 2012, © Copyright
Jun Xu, M.D. Lic. Acup., Hong Su, C.M.D., Lic. Acup.
Robert Blizzard III, DPT
Rehabilitation Medicine and Acupuncture Center
1171 East Putnam Avenue, Building 1, 2nd Floor
Greenwich, CT 06878
Tel: (203) 637-7720
Fax: (203)637-2693
Postchemotherapy Syndrome Treatment
Alleviating Amanda’s Chemotherapy Symptoms
Amanda W. is a forty-five-year-old woman who was diagnosed two years ago with stage 3A cancer symptoms in her left breast. She was screened by a mammogram and an ultrasound, which found a tumor about one inch across on her on her left breast, with five positive lymph nodes under her left arm. She had a mastectomy on the left side, with clearance of the lymph nodes under the left arm. She also was given chemotherapy for about three months. After chemotherapy, Amanda complained of nausea, vomiting, diarrhea, and a change of taste in her mouth; she also felt very weak and fatigued. She experienced hair loss and poor concentration, with occasional numbness and tingling on the tips of her finger and toes, and came to me for help in relieving or decreasing these multiple side effects of her chemotherapy.
Breast Cancer Statistics
In the United States, breast cancer is the second most common type of cancer among women. And among women worldwide, after non-melanoma skin cancer, breast cancer is the most common form of cancer. It is the number-one cause of cancer death in Hispanic women, and is the second most common cause of cancer death in white, black, Asian/Pacific Islander, and American Indian/Alaska Native women.
In 2005 (the most recent year numbers are available):
- 186,467 women and 1,764 men were diagnosed with breast cancer;1,2
- 41,116 women and 375 men died from breast cancer.1,2
Risk Factors for Breast Cancer
The key to preventing breast cancer is knowing the risk factors and practicing self-screening. The following risk factors might increase your chances of developing breast cancer:
- Age. The older you are, the higher the chance that you can develop breast cancer. In women over sixty, there is usually a higher chance of breast cancer than in women under sixty.
- A previous history of breast cancer.
- Family history. If a mother, sister, or daughter had breast cancer, or if breast cancer runs anywhere in your family, the risk is higher than for the average woman.
- Gene changes. If you have the BRCA1or BRCA2 genes, you will probably have a higher chance of developing breast cancer.
- Reproductive history. The older a woman is when she had her first child, the greater her chances of developing breast cancer will be.
- Women without children are at increased risk of breast cancer.
- If you got your first menstrual period before age twelve, there is an increased risk for breast cancer.
- If you became menopausal after age fifty-five, there is an increased risk of breast cancer.
- Menopausal women using hormone therapy with estrogen plus and progestin after menopause are at increased risk of breast cancer.
- Race. White women have a higher chance of developing breast cancer than darker-skinned women.
- Breast density. The higher the density of breast tissue, the higher the chance of breast cancer.
- Overweight or obese women have a higher chance of breast cancer.
- Lack of physical activity leads to a higher chance of breast cancer.
- Alcohol consumption in immoderate amounts leads to a higher chance of breast cancer.
Screening Mammograms
A mammogram is a picture of the breast made with x-rays. The National Cancer Institute recommends the following:
- Women in their forties and older should have a mammogram every one to two years.
- Women who are younger than forty and who have risk factors for breast cancer should ask their healthcare provider whether to have mammograms and how often to have them.
If a mammogram is positive, the following procedures might be recommended.
- Ultrasound. This will identify if the lump is a fluid-filled cyst or a solid mass.
- An MRI. This will give a detailed picture of the breast tissue.
- Needle biopsy, core biopsy, and surgical biopsy.
Stages of Breast Cancer
Here are the stages of breast cancer.
- Stage 0 is carcinoma in situ. Abnormal cells are in the lining of a lobule or in the lining of a duct.
- Stage 1 is 2 cm or smaller and has not spread outside the breast.
- Stage 2 is one of the following: The tumor is no more than 5 cm, with or without it spreading to the lymph nodes under the arm.
- Stage 3 is locally advanced cancer. It is divided into stages 3A, 3B, and 3C.
According to the United States Cancer Statistics 2005 from the Centers For Disease Control and Prevention, the following statistical data showed the chances of cancer for American men and women. (The numbers in parentheses are the age-adjusted—U.S. standard—rates per 100,000 people.) http://www.cdc.gov/Features/CancerStatistics/
Cancer Among Men
The three most common cancers among men include:
- Prostate cancer (142.4): First among men of all races.
- Lung cancer (84.6): Second among men of all races.
- Colorectal cancer (58.2): Third among men of all races.
The leading causes of cancer death among men are:
- Lung cancer (69.4): First among men of all races.
- Prostate cancer (25.4): Second among white (22.7), black (54.1), American Indian/Alaska Native (18.0), and Hispanic (18.7) men.
- Liver cancer: Second among Asian/Pacific Islander men (14.5).
- Colorectal cancer (21.0): Third among men of all races.
Cancer Among Women
The three most common cancers among women include:
- Breast cancer (117.7): First among women of all races.
- Lung cancer (55.2): Second among white (56.6), black (50.9), and American Indian/Alaska Native (37.6) women, and third among Asian/Pacific Islander (26.9) and Hispanic (25.2) women.
- Colorectal cancer (41.9): Second among Asian/Pacific Islander (32.2) and Hispanic (33.9) women, and third among white (40.8), black (49.4), and American Indian/Alaska Native women (24.5).
The leading causes of cancer death among women are:
- Lung cancer (40.6): First among white (41.6), black (40.2), Asian/Pacific Islander (18.2), and American Indian/Alaska Native (29.2) women, and second among Hispanic women (14.4).
- Breast cancer (24.0): First among Hispanic women (15.1), and second among white (23.3), black (32.9), Asian/Pacific Islander (12.3), and American Indian/Alaska Native (15.3) women.
- Colorectal cancer (14.6): Third among women of all races.
Racial or Ethnic Variations
- American Indian/Alaska Native men have the lowest incidence rates of cancer; however, Asian/Pacific Islander men have the lowest death rates from cancer.
- White women have the highest incidence rates of cancer; however, black women have the highest death rates from cancer.
- American Indian/Alaska Native women have the lowest incidence rates of cancer and the third-highest death rates from cancer.
Treatment in Western Medicine—Chemotherapy
Many cancers are treated with chemotherapy IV in their various stages. Therefore, different side effects will accompany the chemotherapy. The main organ or tissues of the human body that may be affected by chemotherapy doses are where normal cells rapidly divide and grow, such as the lining of the mouth, the digestive system, skin, hair, and bone marrow. After a treatment period longer than six months, your nervous system will be affected as well, and the symptoms of this, including poor concentration, decreased memory, peripheral polyneuropathy, and tinnitus, might appear. Long-term side effects can also include weight gain, loss of fertility, menopause, and secondary cancer, such as leukemia.
Short-Term Side Effects of Chemotherapy
- In the digestive system, some chemotherapy drugs can cause nausea and vomiting, even diarrhea, sometimes a sore mouth or mouth ulcers, changes in taste in the mouth and tongue, and changes in smell.
- Chemotherapy can affect the blood stem cells in the bone marrow. The bone marrow stem cells will divide into three different types of blood cells.
- Red blood cells, which carry oxygen to all parts of the body. If the red blood cell numbers are decreased, then the transportation of oxygen around the body will slow down and the person will develop anemia and feel very tired and lethargic. Sometimes she/he may feel shortness of breath, or feel dizzy and lightheaded because there is less oxygen being carried around the body.
- White blood cells, which are essential to the immune function for fighting infection and monitoring mutation, among other things. If your white blood cells counts are decreasing, the immune function will decrease and there will be an increased chance of infection.
- Platelets, which help the blood clot and control bleeding. If your platelet counts are decreasing, you have a high chance of bruising and you may have a nosebleed or may bleed more than usual from minor cuts or bruises.
- Hair loss: Some chemotherapy can damage the hair and make it brittle or thin, and some chemotherapy can make all of the hair fall out, usually a few weeks into treatment. The body, pubic, and underarm, hair may be lost as well. However, if your hair does fall out due to chemotherapy, it will grow back over a few months once your chemotherapy is finished.
- Skin and nail changes. Skin may become very dry and discolored and more sensitive to sunlight. Nails may grow very slowly or become brittle or flaky.
Long-Term Side Effects of Chemotherapy
- Chemotherapy’s effects on peripheral nerves: Some drugs can cause peripheral polyneuropathy, which is a sensation of tingling, numbness, and pins and needles in your hands or feet. This neuropathy will affect your ability to detect hot or cold objects, which could lead to burns or frostbite, and it can also decrease your sensitivity to the steps you take, which could lead to a fall.
- Chemotherapy’s effects on the central nervous system: Long-term use of chemotherapy may cause poor concentration, decreased memory, tinnitus, anxiety, restlessness, dizziness, sleepiness, or headaches.
- Chemotherapy’s effects on the kidneys: It can change the kidney function and lead to water retention, loose protein in the urine, or increased BUN and creatinine levels. In order to prevent kidney deterioration, intravenous fluid must be given for several hours before the treatment, and the kidney’s functions must be checked before and after each chemotherapy treatment.
- Secondary cancer is another long-term side effect of chemotherapy: Many different types of secondary cancer, such as leukemia, can occur.
- Chemotherapy’s effects on fertility: Some chemotherapy treatments may cause infertility. For women, it can sometimes bring on symptoms of menopause and temporarily or permanently stop the ovaries from producing eggs. For men, some chemotherapy drugs may reduce the number of sperm, or affect the sperm’s ability to reach and fertilize a woman’s egg during intercourse. Some drugs may also, temporarily or permanently, affect the sex life.
Treatment for Chemotherapy in Traditional Chinese Medicine—Acupuncture
Traditional Chinese medicine can help with many, but not all, of chemotherapy’s side effects. The acupuncture treatments listed below can be helpful with some side effects of chemotherapy.
Gastrointestinal (GI) symptoms
Gastrointestinal symptoms include nausea, vomiting, gastric regurgitation, tenderness or fullness of the stomach, abdominal pain with very bad breath, also hiccups, diarrhea, and constipation.
- For nausea and vomiting, Zhong Wan, Zu San Li, Nei Guan, He Gu, and Feng Chi are used.
- If a person feels hot and thirsty, it is good to add Da Zhui, Jin Jing, and Yu Ye.
- If the person has bad breath, Xia Wan and Nei Ting are added.
- If there is vomiting of clean water and the person experiences dizziness, Feng Long, Tan Zhong, and Gong Sun are added.
- For hiccups, Ge Shu, and Ju Que are used. If they are accompanied by diarrhea, Ta Chang Shu, Shen Shu, and San Ying Jiao are added.
- For constipation, Feng Long, left Shui Diao, and the left Gui Lai are used.
Table 6.1
| Points | Meridian Number | Conditions Helped | |
| 1 | Zhong Wan | Ren 12 |
See Table 13.32Nei GuanPC 6
See Table 16.13Zu San LiSt 36
See Table 13.34Feng ChiGB 20
See Table 12.15He GuLI 4
See Table 12.16Da ZhuiDu 14
See Table 12.17Jin JingExtra HN 12
See Table 26.48Yu YeExtra HN 13
See Table 26.49Xia WanRen 10
Abdominal pain, diarrhea, indigestion, vomiting10Nei TingST 44
See Table 29.111Feng LongSt 40
See Table 13.312Tan ZhongRen 17
See Table 14.413Gong SunSp 4
See Table 21.114Ge ShuUB 17
Vomiting, hiccups, belching, difficulty swallowing, asthma, coughing, spitting up blood, afternoon fever, night sweats, measles15Ju QueRen 14
See Table 16.116Da Chang ShuUB 25
See FigureSee Table 19.217San Yin JiaoSp 6
See Table 16.118Shui DaoSt 28
See Table 26.1119Gui LaiSt 29
See Table 26.11
Please refer to the accompanying Figures (illustrations) for the
locations of the points. And please note that these illustrations are
for information only and may not show all the exact locations of
the acupuncture points.
Figure 6.1
Fatigue
Chemotherapy can lead the person to feel fatigue, and have shortness of breath, weakness, difficulty walking or standing, heart palpitations, or insomnia.
- The acupuncture points will be Pi Shu, Wei Shu, Zhong Wan,and Zu San Li.
- For heart palpitations and insomnia (poor sleep), Xin Shu, Sheng Men, Ju Que, and San Yin Jiao are added.
- If the person feels cold, has weakness of the lower back and legs, Bui Hui, Da Zhui, Sheng Shu, and Guan Yuan are added.
- If the person feels hot or annoyed, has trouble sleeping, then Fei Shu, Tai Xi, San Yin Jiao are added.
Table 6.2
| Points | Meridian Number | Conditions Helped | |
| 1 | Pi Shu | UB 20 |
See Table 15.22Wei ShuUB 21
See Table 31.13Zhong WanRen 12
See Table 13.34Zu San LiSt 36
See Table 13.45Xin ShuUB 15
See Table 16.16Sheng MenHeart 7
See Table 29.17Ju QueRen 14
See Table 16.18San Yin JiaoSp 6
See Table 16.19Bai HuiDu 20
See Table 22.410Da ZhuiDu 14
See Table 12.111Shen ShuUB 23
See Table 14.412Guan YuanRen 4
See Table 30.113Fei ShuUB 13
See Table 13.114Tai XiKid 3
See Table 16.2
Please refer to the accompanying Figures (illustrations) for the
locations of the points. And please note that these illustrations are
for information only and may not show all the exact locations of
the acupuncture points.
Menopause and Loss of Fertility
Many people undergoing chemotherapy have impotence, decreased menstruation or menopause, and low libido, accompanied by dizziness, tinnitus, weakness in the low back and knees, and they always feel cold and have insomnia. The treatment is Sheng Shu, Guan Yuan, Qi Men, Zhi Gong, San Yin Jiao, and Zu San Li.
Table 6.3
| Points | Meridian Number | Conditions Helped | |
| 1 | Shen Shu | UB 23 |
See Table 14.42Guan YuanRen 4
See Table 30.13Qi MenLiver 14
See Table 19.34Zi GongExtraordinary Point
Prolapse of the uterus, irregular menstruation5San Yin JiaoSp 6
See Table 16.16Zu San LiSt 36
See Table 13.3
Please refer to the accompanying Figures (illustrations) for the
locations of the points. And please note that these illustrations are
for information only and may not show all the exact locations of
the acupuncture points.
Hair Loss
After chemotherapy, many people will have hair loss. Acupuncture can be used to help with this, mainly body acupuncture.
- Tai Xi and Xue Hai, Sheng Men, Feng Chi, Qu Qi, and He Gu.
- Plum Blossom needle, a cluster of 7–9 needles grouped together with a long handle, can be can be used for the hair loss, gently tapping on the scalp until the skin shows slightly redness or mild bleeding. The plum blossom should be used on alternative days, tapping on the scalp for about twenty minutes. After three or four weeks of treatment, the hair will start to grow gradually, especially in those areas that have lost a patch of hair.
Table 6-4
| Points | Meridian Number | Conditions Helped | |
| 1 | Tai Xi | Kid 3 |
See Table 16.22Xue HaiSp 10
See Table 30.13Shen MenHeart 7
See Table 29.14Feng ChiGB 20
See Table 12.15Qu QiLI 11
See Table 12.26He GuLI 4
See Table 13.1
Please refer to the accompanying Figures (illustrations) for the
locations of the points. And please note that these illustrations are
for information only and may not show all the exact locations of
the acupuncture points.
Effects on the Central Nervous System (CNS)
After chemotherapy, some people may feel such CNS symptoms as poor concentration, loss of memory, tinnitus, insomnia, nightmares, headaches, or fatigue.
- Acupuncture points for these symptoms will be Zu San Li, Nei Guan, He Gu, Sheng Men, San Ying Jiao, Feng Chi, as well as Bai Hui, Tang Yang, and Tou Wei.
- Another important treatment uses Plum Blossom needles around the cervical, thoracic, and lumbar spine, along the urinary bladder meridians. This is done by tapping from the top and going down three lines following the urinary bladder meridians. Normally, these treatments will greatly improve a person’s concentration, memory, and mental function.
Table 6.5
| Points | Meridian Number | Conditions Helped | |
| 1 | Zu San Li | St 36 |
See Table 13.42Nei GuanPC 6
See Table 16.13He GuLI 4
See Table 12.14Shen MenHeart 7
See Table 29.15San Yin JiaoSp 6
See Table 16.16Feng ChiGB 20
See Table 12.17Bai HuiDu 20
See Table 22.48Tai YangExtra Point
See Table 22.29Tou WeiSt 8
See Table 22.3
Please refer to the accompanying Figures (illustrations) for the locations
of the points. And please note that these illustrations are for information
only and may not show all the exact locations of the acupuncture points.
Peripheral Polyneuropathy
The long-term side effects of chemotherapy can gradually damage the peripheral nerves. The person may symptomatically feel numbness and a tingling sensation on both the hands and the feet, and may also experience burning, sharp pins and needles along them. The treatments will depend on the location of the condition.
- For the upper extremities, Jian Yu, Jian Liao, Qu Chi, He Gu, Tian Jing, Chi Zhe, and Da Ling, Yang Xi, Wan Gu, Yang Chi, and Wai Guan are used.
Table 6.6
| Points | Meridian Number | Conditions Helped | |
| 1 | Jian Yu | LI 15 |
See Table 26.12Jian LiaoSJ 14
Pain and motor impairment of the shoulder and upper arm3Qu ChiLI 11
See Table 12.24He GuLI 4
See Table 12.15Tian JingLJ 10
Migraine, pain in the neck, shoulder, and arm, epilepsy6Chi ZheLu 5
See Table 13.27Da LingPC 7
Cardiac pain, convulsions, epilepsy, foul breath, insomnia, irritability, mental disorders, palpitations, stomach ache, stuffy chest, vomiting8Yang XiLI 5
Headaches, redness, pain and swelling of the eye, toothache, sore throat, pain of the wrist9Wan GuSI 4
Headaches, rigidity of the neck, pain in the wrist, jaundice10Yang ChiSJ 4
Pain in the arm, shoulder and wrist, malaria, deafness, thirst11Wai GuanSJ 5
See Table 12.2
Please refer to the accompanying Figures (illustrations) for the
locations of the points. And please note that these illustrations are
for information only and may not show all the exact locations of
the acupuncture points.
Figure 6.2
- For the lower extremities, Huan Tiao, Chi Bian, Cheng Fu, Yang Ling Quan, Du Bi, Liang Qiu, Zu San Li, Kun Lun, Tai Xi, Jie Xi, Qiu Xu, Sheng Mai, and Zao Hai are used.
Table 6.7
| Points | Meridian Number | Conditions Helped | |
| 1 | Huan Tiao | GB 30 |
See Table 26.72Chi BianUB 54
See Table 26.23Cheng FuUB 36
Bloody stools, diarrhea, dysentery, hemorrhoids, impotence4Yang Ling QuanGB 34
See Table 15.35Du BiSt 35
Pain, numbness, and motor impairment of the knee6Liang QiuSt 34
Pain and numbness of the knee, gastric pain, motor impairment of the lower extremities7Zu San LiSt 36
See Table 13.38Kun LunUB 30
See Table 22.19Tai XiKid 3
See Table 16.210Jie XiSt 41
Pain of the ankle joint, muscular atrophy, motor impairment, pain and paralysis of the lower extremities, epilepsy, headaches, dizziness, and vertigo, abdominal distension, constipation11Qiu XuGB 40
See Table 32.212Sheng MaiUB 62
See Table 29.213Zhao HaiKid 6
Irregular menstruation, prolapse of uterus, urinary retention, constipation, epilepsy, insomnia, sore throat, asthma
Please refer to the accompanying Figures (illustrations) for the
locations of the points. And please note that these illustrations are
for information only and may not show all the exact locations of
the acupuncture points.
Figure 6.3
Figure 6.4
Treatment for the Side Effects of Amanda’s Chemotherapy
As you read from the above, Amanda had one of the common side effects of chemotherapy. I first treated her symptoms of pain, depression, and anxiety, with the above-mentioned methods and they are getting better. Then I tried to treat her GI symptoms and fatigue. Although her treatment with me was on, off, and regular, because she was busy going for chemotherapy a few times a week, after my treatments, she feels her appetite is better and her fatigue is much improved. I also treated the numbness and tingling sensation in her hands and toes for about three months, but it proved the most difficult problem to solve as she still felt numbness and tingling after the three months, so she was advised to come to my office once a week to maintain her treatment. The treatments were successful and she finally feels the numbness and tingling has been reduced. Additionally, her energy has been restored enough that she has been able to return to a regular schedule for her work and family life.
Tips to Use at Home or Office
- Acupuncture cannot cure cancer. Please be aware of the limitations of acupuncture in this respect.
- However, acupuncture can help a good deal with the side effects of chemotherapy. It is therefore worthwhile to try if you have gastrointestinal symptoms, fatigue, hair loss, infertility, CNS-related problems, or polyneuropathy after chemotherapy.