An Interview with TCM Oncology Specialist Dr. Erlene Chiang:
For years, cancer patients have sought out traditional Chinese medicine (TCM) to help counteract the harsh side effects of chemotherapy, radiation, and aggressive surgery. Research supports the use of acupuncture as a complementary therapy to address the nausea, pain, and emotional toll caused by allopathic treatments. Now, a growing number of US practitioners are starting to use TCM to address the underlying cancer – reflecting a more integrative style of care that can be seen in Chinese hospitals.
To learn more, we connected with Dr. Erlene Chiang, a Doctor of Acupuncture and Oriental Medicine and TCM oncology specialist with 30 years of experience utilizing acupuncture, herbal medicine, and lifestyle modification to provide both primary and complementary care for cancer patients.
What inspired you to specialize in oncology work within TCM?
My father practiced TCM for 60 years, and I knew all my life that I wanted to be a TCM practitioner too. After 10 years of practice, I became interested in the life force of things like tumors and cancer cells that are growing abnormally. Why is the lifespan and vitality of a tumor so much stronger than our own? How does a tumor grow from 2cm to 8cm in one month? We don’t ordinarily see that kind of growth when we’re 18 or 20 years old. I started reading about how tumors grow – does it grow downward, horizontally or vertically? That made me very interested in TCM oncology research.
Can you talk about the TCM theory of cancer?
All the TCM literature that talks about cancer, even back to the Yuan dynasty and the Nei Jing, starts with Liver qi stagnation. The Liver controls our emotions and qi distribution throughout the whole body, and stores the blood – so every cancer starts with Liver qi stagnation, with stress. Then it moves into qi and blood stasis, damp, damp-heat, the heat becomes toxin, and the toxin becomes cancer.
TCM can reverse the toxin back to neutral, back into dampness, then dissolving the dampness. In my practice, I work on the root cause, treating Liver qi stagnation, dampness, inflammation, toxins. And it’s very important, even when treating the toxin, to still support the Yuan qi. New practitioners are afraid of tonifying, because you are nurturing the tumor, but you’re also strengthening the patient.
How do the TCM and Western views and treatment of cancer differ from each other? What are the limitations of each?
Western medicine (WM) is strong in diagnosis by using lab tests and CT scans. But Western MDs are limited in that they look at the tumor without deep understanding of the root cause of the tumor from a holistic perspective. They see the changes to the cell or DNA, but there’s still no root cause of that change.
In TCM, we look at the body holistically and so we are able to see how each system is out of balance. Although we don’t have the same diagnostic technology, we use our own tools of observation. As an experienced TCM practitioner, you will be able to tell from the pulse whether there is cancer in the body – whether it’s on the verge (stage 0 or stage I pulse) or if it has already gone into stage III or IV. Whereas in Western medicine, patients often don’t get diagnosed until stage IV because they wait until there are red flags. In TCM, we are able to see the patient’s problem ahead of time. We see the body how Mother Nature made it, so when something goes against Mother Nature, something is going to happen for sure.
Can you talk about the integration of TCM and WM in oncology treatment in China? What can the US learn from the Chinese approach to cancer treatment?
I’ve visited many oncology hospitals in China and had the opportunity to compare cancer treatments there versus here in the US. First of all, the patients in China have universal healthcare, so they have easier access to TCM oncology. On top of that, all practitioners have a better understanding of the other side of the puzzle: the Western doctors have had six years of training in WM and one year of training in TCM; the TCM doctors have had six years of TCM training and one year of WM training. So there is greater support for patients to receive well integrated care.
So far, cancer research and treatment are still more advanced in the US than in China. When I was working with the American Cancer Society, I would get calls from patients in China asking for help with receiving treatment in the US after treatment in China had failed. The US has published so much research, it’s no wonder everyone wants to come here for cancer treatment. However, Chinese oncology research is catching up. In the next 10 years, I expect that Chinese research about cancer will be equivalent to or advanced beyond that of the US.
Currently in the US, treating cancer with TCM directly is discouraged, and instead we are expected to simply support patients receiving allopathic cancer treatments. How do you handle this in your practice?
I have lots of patients using TCM as an alternative treatment – that is, as their primary treatment, with no allopathic medicine at all – as opposed to a complementary treatment, where I am supporting them through chemotherapy, radiation or surgery. When a patient denies conventional WM treatment, often because they consider it too harsh, then I collaborate with an integrative oncologist at a local hospital. UCSF, Stanford, and SF General, for example, all have integrative oncologists.
It’s crucial to be open and honest with the patients about the risks and the costs when providing alternative care. I usually set up an initial treatment plan of one to three months. I make it clear that, during that period, the patient has to come every week, and has to follow my instructions closely. In those three months, maybe the tumor has already shrunk significantly, or maintained (did not grow). In order to gauge that progress, I work closely with the oncologists to gain access to regular scans and blood work. It’s important to build a positive initial connection with the oncologist: “Hello, I’m Erlene Chiang, I’m a specialist in TCM oncology, I’d like to speak to you about this patient,” and then I explain my treatment plan in 30 seconds.
Providing alternative care comes with a lot of responsibility – the tumor can change quickly. The oncologist will be the first one to alert the patient if something goes wrong, but as an alternative doctor, you must be sharp and intuitive in using your diagnostic skills to catch the patient before he or she “falls down.”
What do you see as the future of integrative cancer treatment in the US?
The top clinics – UCSF, Stanford, Mayo Clinic – already have integrative systems that include acupuncture. Acupuncture was fully legalized in California in 1975, and I think it takes 50 years after that time – so around 2025 – to see even more acceptance, not just in consumers but also in the Western practitioners. Western MDs and TCM doctors need to work on communication and trust in each other. Many of my acupuncture students think no Western doctor will want to talk to them, but if you don’t call them, you don’t know.
I also think Chinese research will contribute to integration here in the US. I do expect to see Chinese oncological research surpassing that from the US. If the research from the US stays within a narrow scope of what is acceptable and leaves out integrative medicine, it will fail to progress.
Tell me about your involvement in the American Cancer Society (ACS).
The Chinese unit of the ACS was introduced about 20 years ago. I had the honor of being the first TCM doctor that served as the president of the Chinese unit – prior to that, there were only MDs. When I was in my 2009-2010 ACS term, I brought all the TCM practitioners that I’d worked with into ACS. We had lots of deep discussions with oncologists about how TCM can help with WM; how WM can help the TCM doctors; how to communicate. I learned so much during my involvement with ACS, I really consider it the starting point in my career for greater exposure to more WM.
What tips can you offer to TCM students or practitioners just beginning to work with cancer patients?
Set expectations by communicate openly with patients about the costs and risks of treatment. Be clear about the treatment plan and the price, but also be flexible in changing both of those things to support the patient. We care about the patient’s wellbeing as a whole, not just about the tumor, and often their illness is related to the stress of their life and their finances. Take the time to talk to them, call them back, email them to see if they need anything else. Your job is to figure out how to help.
Also, remember to always treat the mind-body-spirit connection. Unlike WM, we must keep all three aspects of our patient balanced to see the full power of recovery and healing. In order to do this, I encourage my students to focus on their own mind-body-spirit health, so that they can share their learnings and experiences with their patients – and so they avoid burnout or loss of interest in practicing medicine.
Finally, never stop learning. Look at the research, ask experienced practitioners for support, and never be afraid to tell a patient, “I don’t know, let me do some research.”
Do you have any general recommendations that you make to all of your oncology patients?
I always tell patients that my role is only 30% of their treatment, and the other 70% is their responsibility. Their role, which isn’t easy, is to stay calm, healthy and positive. When they’re depressed about bad news about their cancer, they have to be proactive and do more than usual to take care of themselves – put down the chocolate and get more exercise. I reinforce the importance of maintaining their mind-body-spirit connection, and how positive thinking can positively impact their cells.
Patients come in and say, “I have six months to live.” But I avoid the deadline that the oncologist gives them, and instead I say, “Why don’t we put the numbers aside and focus on getting well today, tomorrow, next week, and next month. Let’s go month by month.” That builds the patient’s confidence, which can really help support their constitution.
Featuring Dr. Erlene Chiang
Erlene Chiang, DAOM, LAc has been practicing Traditional Chinese Medicine since 1985 and is a current instructor for the DAOM program at ACTCM. Her service and experience in the field of oncology includes the following: President, American Cancer Society, California Chinese Unit; Vice President, American Cancer Society; California Chinese Unit, Senior Administrative Director. She grew up in a family of famous physicians of Chinese medicine and is a third generation TCM doctor. Mentored by her father, she possesses a deeply refined talent for TCM diagnosis, oncology focused treatment strategies, with specific emphasis on Chinese herbal formulas.
Interviewed by Dr. Stephanie Albert
Dr. Stephanie Albert holds a Doctorate of Acupuncture and Chinese Medicine from the American College of Traditional Chinese Medicine in San Francisco, CA. She runs a private practice out of the Lotus Center in the Mission district of San Francisco, where she works with patients to address stress, insomnia, pain, women’s health issues, and other health complaints through acupuncture, herbal medicine and lifestyle modification. www.stephalbert.com
AKAN for The Shack of Mirdad