In 2011 I started working at St Luke’s Hospice in Winsford, Cheshire helping patients who had been diagnosed with cancer. Some were in the early stages of treatment, some post operation and it is the latter group on whom the following is based.
The case study below is about a single post operation patient who was prescribed Tamoxifen, a common post operative drug with breast cancer patients. The treatment protocol and results shown are illustrative but consistent with the treatment and results obtained across a number of patients in similar circumstances.
As such The Guy Protocol © has been developed, tested and has been shown to be effective on patients using Tamoxifen to help reduce the side effects of hot flushes.
Please note that some of the personal data has been redacted to protect patient confidentiality.
Case Study – Syndrome Differentiation
A XX year old female noticed a lump in her breast whilst on holiday and has been diagnosed with breast cancer. She has two children and is generally in good health and exercises regularly. There is no family history of cancer. This type of breast cancer is called oestrogen receptor – positive or ER positive breast cancer.
After she had her breast lump removed she underwent chemotherapy and was subsequently prescribed Tomoxifen. Tomoxifen is the standard treatment in premenopausal women with hormone positive breast cancer and is also routinely used in women who have been through the menopause. Tomoxifen is usually given after surgery for up to five years to prevent the recurrence of Cancer although some women take it for two to three years before switching to an aromatase inhibitor.
Hormones are substances produced naturally in the body, which act as chemical messengers and help control the activity of cells and organs. Hormonal therapies interfere with the way hormones are made or how they work in the body. Many breast cancers rely on the hormone oestrogen to grow. This type of breast cancer is called oestrogen receptor – positive or positive breast cancer. Tomoxifen blocks oestrogen from reaching the cancer cells. This means the cancer either grows very slowly or stops growing altogether. These symptoms can mimic menopause causing hot flushes/ night sweats, depression, palpations/ mood swings, and mental restlessness.
Within the first week of chemotherapy, nausea/vomiting, loss of appetite and bleeding gums can be common side effects. In TCM this is known as toxic heat consuming yin. These symptoms tend to happen around ten days after the initial chemotherapy injection. Chemotherapy damages the spleen and stomach and some cancer patients can sometimes suffer with constipation. Also experiencing sleep disturbance due to hot sweats.
Research on the therapeutic effects of acupuncture in enhancing anticancer immune functions, suggests that clinicians may use acupuncture to promote the induction and secretion of NK (natural killer)-cell activating cytokines that engage specific NK cell receptors that endogenously enhance anticancer immune function.
Within the hospice environment this lady was given six treatments. Each session she was treated using The Guy Protocol ©.
The protocol was based around the common symptoms presenting in most breast cancer patients and designed to alleviate the symptoms of hot flushes.
Needling was done bilaterally on both legs and special consideration was given to any contraindications in case of any lymphedema. Lymphedema is a swelling of the arm that sometimes happens after surgery or radiotherapy to the lymph nodes in the armpit. Lymphedema framework guidelines recommend avoiding puncturing the skin as this reduces the risk of infection.
In TCM, Breast Cancer and tumours are described as stagnation and as the stomach and kidney channels run through this area, and spleen around the side it can often be attributed to stagnation in these channels. The cancer could be genetic however considering the patient has no family history there could be another factor involved.
Symptoms and Signs Analysis
Antiestrogen therapy can cause vasomotor symptoms similar to those during menopause, including hot flushes, in patients with breast cancer receiving Tomoxifen.
Tomoxifen reduces the amount of phlegm in the breast but also blocks yin, leaving patients prone to yin deficiency.
The treatment principle in this case is to nourish yin but to also boost the immune system.
Typical symptoms of patients suffering from breast cancer can include;
- A lump or thickening in an area of the breast
- A change in the size, shape or feel of a breast
- Dimpling of the skin
- A change in the shape of your nipple, particularly if it turns in, sinks into the breast, or has an irregular shape
- A blood stained discharge from the nipple
- A rash on a nipple or surrounding area
- A swelling or lump in your armpit
Some Classic questions
- Sleep – Disturbed due to hot flushes and when awake starts to over think things.
- Bowels Urination – ok but a little constipated sometimes and then loose other times.
- Emotions – Worries about cancer coming back. Has two young children and wants to be around to see them grow up.
- Energy – Exhausted most of the time but keeps going.
- Pain – Breast pain around area
- Sweating – Yes hot flushes day and night times
Kidney Yin Xu / Ki Yang /Empty heat – Empty heat because of the chemotherapy which destroys kidney qi and wei qi. Can also compromise spleen too and dry up fluids.
In this case the patient’s tongue was Dry/Cracks indicating Thirsty
The patient’ s pulse: Empty pulse, weak
According to Chinese medicine, Tomoxifen tends to deplete the kidney yin ( the cooling function ). Acupuncture attempts to restore the yin., thereby controlling the hot flushes. Chinese medicine generally holds that acupuncture is not strong enough to get rid of the cancer by itself. Acupuncture is effective in promoting the flow of qi and aims to help the body recover, and to minimise the chance of recurrence.
Differentiated and Reflective Diagnosis
Cancer generally presents as a lump in the body although not all lumps may be cancerous. When normal cell division is interrupted and cells become abnormal this creates the conditions for a cancerous lump to grow. Abnormal cell division creates a cancerous lump, which presents as a tumour.
Non-cancerous or benign lumps cannot spread to anywhere else in the body however malignant lumps which are cancer can and often do grow into surrounding tissue.
Breast Cancer comes in many different forms and types however generally it presents as a lump in the breast. The shape and size of the breast may change and the nipple may become inverted. Sometimes you may get discharge from the nipple and may experience swelling or a lump in the armpit.
In the theory of TCM, breast cancer is seen as stagnation in the stomach and spleen or liver and kidney stagnation. Diagnosis depends on which symptoms the patient is presenting with. In this case my diagnosis is Kidney Yin Deficient that leads to Kidney Yang and empty heat.
It is recommended that patients have three regular meals and one or two snacks a day and to try to stay away from alcohol, caffeine and spicy foods as these can make flushes worse.
Patients may also need to experiment a little with foods that they don’t normally eat such as tofu, soya milk and nuts and seeds. Drink plenty of still/tap water; aim to drink 6-8 glasses a day. This may give more energy and helps to flush out any urinary infections, such as cystitis, which can be a common side effect of menopause.
Women who exercise and follow a healthy diet cope better with these symptoms and also help protect themselves against other diseases such as heart disease and osteoporosis.
Treatment Principle and Prescription
The main focus of this treatment is to address the hot flushes however consideration is also given to addressing the issue of sleep disturbances which can be due to the hot flushes at night time.
Table 1.0 – Treatment, timing, points and observations
Treatment throughout was by using The Guy Protocol © (see Appendix 1.4)
|Treatment||Timing||Points and Observations|
|1||Guy Protocol ©Spleen 6, 9 liv2, reduced, st36,ki3 tonified Although a little needle phobic once a few needles were placed she was more relaxed. Needles stayed in for twenty five minutes.|
|2||7 days later||Spleen 6, 9 liv2, reduced, st36,ki3 tonified Patient still experiencing hot flushes not particular change / still sleep disturbances. Needles stayed in for twenty five minutes|
|3||7 days later||Spleen 6, 9 liv2, reduced, st36,ki3 tonified Patient experiencing hot flushes but comments they are about 20-30% less frequent and not as severe. Sleeping much better. Needles stayed in for twenty five minutes|
|4||7 days later||Spleen 6, 9 liv2, reduced, st36,ki3 tonified Patient experiencing hot flushes but comments they are about 50-60 % less frequent and not as severe. Sleeping much better. Needles stayed in for twenty five minutes|
|5||7 days later||Spleen 6, 9 liv2, reduced, st36,ki3 tonified No flushes other than feeling a little warm , sleeping well. Needles stayed in for twenty five minutes.|
|6||7 days later||Spleen 6, 9 liv2, reduced, st36,ki3 tonified No flushes Needles stayed in for twenty five minutes.|
Table 2.0 – Acupuncture Point Prescription
|St36Tonify||Below the knee, 3 cun inferior to the lower border of the patella, one fingerbreadth lateral to the anterior crest of the tibia||Harmonises the Stomach,Fortifies the Spleen and resolves dampness,Supports the correct qi and fosters the original qi,Tonifies qi and nourishes blood and yin,
Activates the channel and alleviates pain,
Revives the yang and restores consciousness.
|Liv2Reduce||On the dorsal aspect of the foot, on the web between the first and second toes. 0.5 cun proximal to the web.||powerful point to soothe the liver and is primarily employed to clear heat and drain fire from the liver. It effectively cools blood, descends rising yang and subdues internal wind|
|Ki3Tonify||Appears on the medial border of the foot, posterior to the medial malleolus, in the dip between the end of the medial malleolus and Achilles tendon.||Tonifies the Kidneys and fortifies yangBenefits essenceNourishes Kidney yinFirms Kidney qi
Regulates the water passages and benefits urination
Benefits the ears and eyes
|Sp6Reduce||On the medial side of the lower leg, 3 cun superior to the prominence of the medial malleolus, in a depression close to the medial crest of the tibia.||Resolves dampness,|
|Sp9Reduce||In the depression between the medial malleolus and the Achilles tendon, level with the prominence of the medial Malleolus.||Harmonises the Liver and tonifies the Kidneys,|
To summarise, the patient experienced a reduction in the number and duration of hot flushes each week during the first three weeks of treatment. After her forth treatment her hot flushes stopped. As a consequence of this she started to sleep better and her general wellbeing improved.
Appendix 1.1 – Medication
The patient is on a variety of medication. Her prescription includes the following:
Tomoxifen Medication administered for breast cancer. It blocks oestrogen from reaching the cancer cells. This means the cancer either grows very slowly or stops growing altogether.
Appendix 1.2 – Glossary of terms
Chemotherapy: anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs are carried in the blood and can reach cancer cells anywhere in the body
Appendix 1.3 – Testimonial
“I started with hot flushes after having chemo therapy for breast cancer. My experience of acupuncture with Emma has been surprisingly 100% successful! I cannot recommend acupuncture and her services highly enough.
I will continue with acupuncture now for different health issues now experiencing the benefits as well as the overall well being I will get.”
Appendix 1.4 – The Guy Protocol ©
The Guy Protocol ©
The protocol was developed for use within the Hospice environment specifically for breast and prostate cancer care. Based entirely on TCM principles the protocol was developed to safely move the qi in patients who may not be able to undergo a standard acupuncture needling treatment.
The acupuncture treatments were carried out once a week in my local hospice, St Luke’s in Cheshire.
The points used were mainly because of the side effects of medications such as vomiting or hot flushes due to use of Tomoxifen in breast cancer.
Some of the patients are end of life patients but most require palliative care and living beyond cancer support. The hospice refers patients to an acupuncturist for pain, disturbed sleep, hot flushes and fatigue.
The protocol therefore needed to cover a wide range of presenting symptoms but was also safe in acupuncture terms for moving qi. I have been safely using this protocol for over two years with extremely encouraging results.
The protocol has been referred to the Clinical Director at the Hospice who is looking to design a clinical trial to assess the effectiveness of the treatment protocol in alleviating the side effects of Tomoxifen in Cancer patients.
The table overleaf (Table 3.0) outlines the points used and their functions.
Table 3.0 – The Guy Protocol ©
|ST 36||Tonify||Below the knee, 3 cun inferior to the lower border of the patella, one fingerbreadth lateral to the anterior crest of the tibia||Harmonises the Stomach Fortifies the Spleen and resolves dampness. Supports the correct qi and fosters the original qi, Tonifies qi and nourishes blood and yin
Activates the channel and alleviates pain
Revives the yang and restores consciousness
|KI3||Tonify||Appears on the medial border of the foot, posterior to the medial malleolus, in the dip between the end of the medial malleolus and Achilles tendon.||Tonifies the Kidneys and fortifies yang. Benefits essence – Nourishes Kidney yin Firms Kidney qi
Regulates the water passages and benefits urination
Benefits the ears and eyes
|SP6||Reduce||On the medial side of the lower leg, 3 cun superior to the prominence of the medial malleolus, in a depression close to the medial crest of the tibia.||Regulates qi and blood, hot flushes however works well with pain relief- Resolves dampness|
|SP9||Reduce||In the depression between the medial malleolus and the Achilles tendon, level with the prominence of the medial Malleolus.||Helps intestines due to medications – overall regulate lower jiao/swelling – quite often breast cancer patients will get thrush so this point also helps with this. Harmonises the Liver and tonifies the Kidneys|
|LIV2||Reduce||On the dorsal aspect of the foot, on the web between the first and second toes. 0.5 cun proximal to the web.||Powerful point to soothe the liver and is primarily employed to clear heat and drain fire from the liver. It effectively cools blood, descends rising yang and subdues internal wind|
© Emma Guy Dip.Ac AHPR MATCM 2015
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