1. ACUPUNCTURE & CANCER CARE Annekathryn Goodman MD, MPH Gynecologic Oncology -Massachusetts General Hospital

2. Things to do list…. Background Traditional Oriental Medicine
Acupuncture
Acupressure
Massage
Conclusions

3. Case Report 1 - Successful
38 year old woman with metastatic melanoma with brain mets
Intractable nausea/vomiting
5 sessions
Low dose magnets for home use

4. Case Report 2 - Successful
Total Rx time: 60 minutes
Infrared heat used over legs
2 steps to Rx
Step one
ST 36, LR 4, LU 5, LI 11, PC 6 ,HT 7 auricular shenmen
Step two
PC 6, LI 4 & 11, SP 3 & 9, KI 3, BAFENG
9 gauss magnets placed at PC 6 for home use at end of session
35 year old woman
Diagnosis: Stage IV gastric cancer
Indications for acupuncture:
Fatigue
Depression
Nausea

5. Case Report 3 - Unsuccessful
25 year old man
Medulloblastoma
Hiccups for 6 months
Nausea/ intermittent vomiting

6. Traditional Oriental Medicine (TOM)
“Traditional” medicine in such places such as: China, Japan, Cambodia, Korea, and Vietnam
Basic principles:
Five elements of wood, fire, earth, metal, and water.
Tao = “the way”, significance of change & process
Yin & Yang = 2 opposing forces that drive change
Qi = invisible universal energy force that is believed to flow through all living organisms.
Acupuncture = opens the meridians and/or directing the flow of ch’i to promote health
Combines diet, acupuncture, meditation, physical exercise, healing exercise, herbal medicine, and massage to promote health.

7. Philosophy & Theory of Chinese Medicine
Chinese medicine considers illness & cures in the human body as a combination of emotional, physical, psychological, environmental & cosmic factors
Chinese medicine deals with the mind, body, general health and disease totally when treating a person

8. Modalities of Chinese Medicine
Acupuncture
Acupressure
Moxibustion
Jiaofa (cupping)
Massage
Herbology
Chinese Nutrition
Qigong
Diagnosis-Observation of patient
Therapy & Therapeutic Techniques
Tuina (manipulation)
Yangsheng
Mantras

9. Diagnosis The four basic methods of examination (sizhen):
looking at the patient(wangzhen)
examination by listening, smelling, & tasting (wenzhen)
examination by interrogation (wenzhen)
examination by touching (qiezhen)

10. Observing the Patient Observes body as a whole
Some diseases show in the way a person moves & looks
Observes shape of the body-large, small, thin, fat
Observes posture of patient-may indicate deviation of backbone
Observes color of face & parts of body
Observes how patient behaves-quiet, aggressive, disturbed, does he think clearly, does he make sense
Observes parts of body-head, hair, hands, tongue,

11. ACUPUNCTURE ZHENFA (needle technique)
is a way of influencing bodily functions by inserting needles in the Xue (acupuncture points)

12. Understanding Acupuncture Traditional Chinese Principles
Body consists of 12 systems or channels through which Qi circulates.
Solid systems and hollow systems.
Lung, large intestine, stomach, spleen, heart, small intestine, bladder, kidney, pericardium, gall bladder, liver and san jiao.
Health is determined by the balance of the
Yin and Yang.
A block or stagnation of flow creates illness.
Stimulation of key points can restore qi flow.

13. Qi
Qi flows through each of us like a river, energizing, nourishing and supporting every cell, tissue, muscle, organ and gland.
Qi is the vital force, the presence of which separates the living from the dead. Its balanced, unimpeded flow is critical to sound health.

14. Qi
Any misdirection, blockage, or other derangement of the amount, flow or balance of Qi may result in pain, dysfunction and ill health.
Stress
Trauma
Accidents
Improper Diet
Strain
Surgery

15. Acupuncture Points

16. ACUPUNCTURE FIRST AID POINTS
365 MAIN POINTS
2000 ADDITIONAL POINTS
ACUPUNCTURIST USES 150 POINTS
5-15 NEEDLES COMPRISE A TREATMENT

17. ACUPUNCTURE FIRST AID MERIDIANS
12 SYMMETRIC MERIDIANS
6 UPPER EXTREMITY LUNG, HEART, PERICARDIUM, LARGE INT, SMALL INT, TRIPLE WARMER
6 LOWER EXTREMITY BLADDER, GALLBLADDER, STOMACH, KIDNEY, SPLEEN, LIVER

18. ACUPUNCTURE AID MERIDIANS
8 EXTRAORDINARY VESSELS (MERIDIANS)
CONCEPTION VESSEL
GOVERNING VESSEL
6 OTHER VESSELS THAT CONNECT DEEPLY

19. Set of Acupuncture Needles

20. ACUPUNCTURE TOOLS Fingers Needles (disposable) Magnets
Laser (infrared)

21. ACUPUNCTURE FIRST AID MEASUREMENTS

22. ACUPUNCTURE FIRST AID PREPARING THE PATIENT
Patients need to eat
Start very light
Few points
Careful explanation
Makes sure patient in a comfortable position
Darkened room
Patient call button, bell, etc

23. Acupuncture CONTRAINDICATIONS
Caution should be exercised in patients with:
A compromised immune system
Affected limb of someone who has a lymph node dissection (impaired lymphatic drainage)
Avoid insertion of needles in patients who are:
Thrombocytopenic (low platelet counts)
Using anticoagulant therapy (warfarin, aspirin, etc)

24. ACUPUNCTURE FIRST AID RISKS AND COMPLICATIONS
Vasovagal
Fatigue
Headache
Bruising
Cellulitis
Pneumothorax
Retained or broken needle
Minor adverse events
14 per 10,000 sessions (Acupunct Med 2001)
Serious adverse events
0.05 per 10,000 treatments or 0.55 per 10,000 patients (Acupunct Med 2004)

25. Acupuncture in Cancer Care
Pain
Fatigue
Breathlessness

26. Acupuncture in Cancer Pain Management COMMON TYPES OF CANCER PAIN
Visceral pain
Bone pain
Nerve pain

27. Acupuncture in Cancer Pain Management Eight Influential Points of the Eight Tissues
Zang Organs - Zhangmen LV13,
Fu Organs - Zhongwan CV12
Bone- Dazhu BL11, Marrow – Xuangzhong GB39
Blood –Geshu BL17, Qi- Tanzhong CV17
Tendons- Yanglingquan GB34,
Blood Vessels- Taiyuan LU9

28. Acupuncture in Cancer Fatigue Acupoints of Bu Zhong Yi Qi Tang
GV20-Baihui
CV12-Zhongwan
CV6-Qihai
ST36-Zusanli
SP6-Sanyinjiao
LU9- Taiyuan

29. Acupuncture in Cancer Fatigue Five Zang-organ Shu+ Ge Shu
BL13-Feishu
BL15-Xinshu
BL17-Geshu
BL18-Ganshu
BL20-Pishu
BL23-Shenshu

30. Acupuncture for Breathlessness
LU1 –Zhongfu
LU5- Chize
CV17-Tanzhong
BL13-Feishu

31. ACUPUNCTURE AID SPECIFIC CONDITIONS
Anxiety / Depression
Nausea
Constipation
Neuropathy
Hot Flashes

32. ACUPUNCTURE FIRST AID Anxiety
Auricular acupuncture
Sedating and calming body points
GV 20 Baihui (hundred meetings)
On midline of head, on midpoint of line connecting the ears
Yintang (hall of impression)
Midway between the eyebrows
HT 7 Shenmen (spirit gate)
Ulnar end of wrist crease, in depression on radial side of flexor carpi ulnaris tendon

33. ACUPUNCTURE FIRST AID Anxiety

34. Acupuncture for Depression in Cancer Survivors
HT7 –Shenmen
BL18-Ganshu
PC6-Neiguan
LV3-Taichong
LV14-Qimen
CV17-Tanzhong
SP6-Sanyinjiao
Yintang

35. ACUPUNCTURE FIRST AID Nausea
Acupuncture-point stimulation for chemotherapy-induced nausea or vomiting
Cochrane update from 2010
11 trials, 1247 patients
Acupuncture-point stimulation + anti-emetics showed significant reduction in acute vomiting (RR 0.82, 95% CI Acup0.69 to 0.99, p = 0.04)
Noninvasive stimulation techniques have minimal impact
Pericardium 6 Neiguan
(inner gate)
2 cun above transverse crease of wrist, between tendons of palmaris longus 7 flexor radialis
Spleen 9 Yinlingquan
(yin- mound spring)
Lower border of medial condyle of tibia, in depression posterior & inferior to medial condyle

37. Spleen 9

38. Acupuncture in Cancer Care NAUSEA & VOMITING
ST36-Zusanli, ST41-Jiexi
PC6-Neiguan, CV6-Qihai,
CV12-Zhongwan
Coldness-BL21-Weishu
Heat-EX-HN12Jinjin ,EX-HN13-Yuye
Phlegm retention-ST40,
Food retention-ST21-Liangmen, ST25-Tianshu
Liver Qi Stagnation-LV3
Deficiency Coldness of Spleen and Stomach
-BL21-Weishu & BL20-Pishu

39. ACUPUNCTURE FIRST AID Constipation
ST 37 Shangjuxu (upper great emptyness)
6 cun below lat patella, one finger breadth lat anterior border of tibia
CV 6 Qihai (sea of Qi)
Midline, 1.5 cun below umbilicus
SJ 6 Zhigou (branching ditch)
3 cun proximal to dorsal crease of wrist, between radius and ulna, on radial side of extensor digitorum

40. ACUPUNCTURE FIRST AID Constipation
ST 37 Shangjuxu (upper great emptyness)
6 cun below lat patella, one finger breadth lat anterior border of tibia
CV 6 Qihai (sea of Qi) (meridian also known as Ren)
Midline, 1.5 cun below umbilicus
SJ 6 Zhigou (branching ditch)
3 cun proximal to dorsal crease of wrist, between radius and ulna, on radial side of extensor digitorum

41. ACUPUNCTURE FIRST AID Constipation
ST 37 Shangjuxu (upper great emptyness)
6 cun below lat patella, one finger breadth lat anterior border of tibia
CV 6 Qihai (sea of Qi)
Midline, 1.5 cun below umbilicus
SJ 6 Zhigou (branching ditch) (meridian known as san jiao or triple warmer/heater/burner)
3 cun proximal to dorsal crease of wrist, between radius and ulna, on radial side of extensor digitorum

42. ACUPUNCTURE FIRST AID Neuropathy
SP 3 Taibai (greater white)
Medial side of foot in depression prox and inf to head of 1st metatarsal
SP 6 Sanyinjiao (3 yin meeting)
3 cun sup to prominence of medial malleolus, post border of medial aspect of tibia
LR 3 Taichong (great surge)
Dorsum of foot, in depression distal to junction of 1st and 2nd metatarsals
GB 34 Yanglingquan (yang hill spring)
In depression anterior and inferior to head of fibula, lateral knee joint

43. ACUPUNCTURE FIRST AID Neuropathy
SP 3 Taibai (greater white)
Medial side of foot in depression prox and inf to head of 1st metatarsal
SP 6 Sanyinjiao (3 yin meeting)
3 cun sup to prominence of medial malleolus, post border of medial aspect of tibia
LR 3 Taichong (great surge)
Dorsum of foot, in depression distal to junction of 1st and 2nd metatarsals
GB 34 Yanglingquan (yang hill spring)
In depression anterior and inferior to head of fibula, lateral knee joint

44. ACUPUNCTURE Neuropathy
Franconi et al. 2013
Rockstock et al.
Evid Based Compl Med 2013
Literature Review
8 papers
3 case series
1RCT auricular
1 rat experiment
2 RCT somatic acupx
1 RCT trial showed benefit

45. ACUPUNCTURE FIRST AID Hot Flashes
Bl 23 Shenshu (kidney’s hollow)
1.5 cun lateral to back midline (GV or Du meridian) , at lower border of spinous process of 2nd lumbar vertebra
Ki 3 Taixi (Great stream)
In depression between medial malleolus & tendocalcaneus, at level of tip of medial malleolus
SP 6 Sanyinjiao (3 yin meeting)
3 cun sup to prominence of medial malleolus, post border of medial aspect of tibia

46. ACUPUNCTURE FIRST AID Hot Flashes
Fifty patients randomized to 12 weeks acupuncture versus venlafaxine
History of ER positive breast cancer
Acupuncture equivalent to venlafaxine
JCO 2010 

47. Acupuncture and Joy R Abramson, MD . Medical Acu 2010 22:3
“strengthen their spirit and uncover their basic joyful nature”
“we relegate joy as something we will do when all of our work is completed”
Numerous acupuncture points with connection to spirit
Listen, observe, question, and determine where your patient is
“Law of Least Action”
The practitioner is equally effected: “How do I know this because it could all begin in me” Lao Tzu

48. Acupressure
Similar to Acupuncture in use of points but uses pressure instead of needles
Pressure on different points can relieve or cure many different ailments (including pain in bones, joints, muscles & nerves to blockages like carpal tunnel)
Continued use will relieve many conditions that normally require surgery in Western countries

49. Moxibustion
Application of very powerful & pungent essence to strategic points
Mainly used in combination with Acupuncture
Moxibustion is the burning of the Moxa herb
Moxa particularly effective when patient is suffering from cold or dampness

50. Moxibustion
Herb (dried mugwort : Artemesia argyi) pure Yang in nature therefore suitable for warming:
One method of treatment is burn herb rolled in paper a short distance from the skin along the track of the jing (meridians)
also burn over holes to allow to enter body (as ears, mouth, nose)

51. Jiaofa (horn-method)
Glass cups or bamboo segments, heated on the inside by fire, and stuck to parts of the patients body
Cup sticks tightly because of the vacuum created by the heat and dispels cold & dampness from the body. Warms the Qi and reduces swelling

52. Massage Involves manipulation of soft tissues Benefits may include:
 stress aches & pain
Improved circulation
Lymph movement & motility
Enhanced digestion & intestinal function
General relaxation 

53. Chinese Massage Consists of internal & external aspects
Influence conditions of the skin & muscles
May be directed at the bones, joints, blood, fluid, or other internal parts or functions
Uses techniques like chiropractic in the West
All parts of the body can be treated
Self-massage is form of this therapy

54. Eight Fundamental Techniques of Massage
TUI (pushing)
NA (grasping)
AN (pressing or pushing downward)
QIAN (pulling)
DA (beating)
DONG (moving)
MO (rubbing)
Gun (rolling like waves)

55. Massage Studies Results …
Inconclusive for relief from cancer-related pain
Evidence does not indicate promotion of tumor metastasis at this time
1 trial showed that massage reduced nausea in patients undergoing autologous (self) BMT
2 trials found manual lymph drainage to be effective with compression bandaging or sleeves in patients with arm lymphedema after surgery for breast cancer
BMT = Bone Marrow Transplant

56. Massage
Studies have shown that massage can be helpful in treating pain, anxiety, depression, and lethargy
Concerns:
Patients who are prone to bleed, thrombocytopenic or receiving anticoagulation therapy
Deep abdominal massage has been associated with internal bleeding
Avoid over stents or other prosthetic devices
Multiple Myeloma patients have greater fracture risk

57. Qigong The skill of directing & controlling Qi
Rapid development of Qigong is based on clinical results & supported by scientific research
Includes methods similar to hypnosis, psychotherapy, trance, laying of hands and magnetism
Is used for many things including the treatment of cancer
IS also the practice of exercise (Physician must undergo a long period of body & mind training before they are allowed to practice or teach)

58. Qigong
Practitioner uses concentration & relaxation in his/her body to make own qi flow (can transmit it into the patients body directly or by touching the person)
When this is done, magnetic, bio-electrical reactions, hormonal & molecular changes occur
Greatest changes within body cells
Qigong physician can teach patients health exercises both for rehabilitation or to prevent development of disease

59. Yangsheng Nourishment or cultivation of life
By taking care of one’s life & daily influences or activities,
Uses diet & exercise
Uses martial arts & even Yoga
Know your body
Stresses the importance of uniting the Qi

60. Mantras Mantras are powerful therapeutic means to the Chinese
Are pronounced silently or aloud
Promotes health & inner comfort
Mantras can have the opposite effect
Fu are talismans (secret writing in red ink or blood on yellow paper & given to the person) were used to expel evil influences or as a spiritual means to make a person more in harmony with their surroundings

61. Thank you