Cancer Answers: with guest Dr. Dehua Zheng, April 19, 2009

Dr. Dehua Zheng, Cancer Care in China
 April 19, 2009Welcome to Yale Cancer Center Answers with Drs. Ed Chu and
Francine Foss, I am Bruce Barber.  Dr. Chu is Deputy Director
and Chief of Medical Oncology at Yale Cancer Center and he is an
internationally recognized expert on colorectal cancer.  Dr.
Foss is a Professor of Medical Oncology and Dermatology and she is
an expert in the treatment of lymphomas.  If you would like to
join the discussion, you can contact the doctors directly at canceranswers@yale.edu and
the phone number is 1888-234-4YCC.  This evening we welcome
Dr. Dehua Zheng.  Dr. Zheng is a surgical oncologist from
China and a visiting fellow at Yale Cancer Center.Chu
Dehua, welcome to the show and thank you for being with us this
evening. Let's start off by having you tell us a little bit about
your background.Zheng
          
 Thank you.  I grew up in Fuzhou City in southern east China
and finished medical school at the First Military Medical
University in Guangzhou City in south of China.  At the
university there is a good school of traditional Chinese
medicine.  Although my major was modern medicine, I also
learned something of principal philosophy and treatment techniques
with traditional Chinese medicine.  After graduation, I did my
surgical training and got my PhD at the Chinese PLA General
Hospital in Beijing. I then became an attending surgeon in the
transplant center of the same hospital.Foss
Dehua, could you tell us what brought you halfway around the world
to visit us here at Yale Cancer Center?Zhen
This is a good question.  I am very interested in immune
regulation for transplant patients.  As you know,
immunoregulation is an optimal way for us to treat allograft
rejection and graft-versus-host disease.  Over the last three
years I have read papers about photopheresis, immunotherapy,
devised by Dr. Edelson's research team at Yale.  Quite
remarkably, photopheresis proved to be effective in both turning on
the immune reaction against at least one cancer, CTCL, and turning
off undesirable autoimmune reaction without significant side
effects in autoimmune disorders and rejection of a transplant
organ.  But up until now, the exact scientific mechanism of
photopheresis has not been fully understood.  So, I visited
here to establish cooperation with Dr. Edelson and Dr. Foss for
further study.  Maybe we can use some theory of a traditional
Chinese medicine to explain the clinical efficacy of
photopheresis.Foss
And photopheresis, as you know, involves methoxypsoralen which
comes from a lime, which is a natural substance, and so in some
ways there are a lot of connections between the photopheresis
process and some of the traditional medicine that you are probably
familiar with.3:49 into mp3 file 
http://www.yalecancercenter.org/podcast/Answers_Apr-19-09.mp3Chu
 Maybe just to let our listeners know and perhaps appreciate a
little bit better, Dr. Foss, who is my co-host for the show, was
one of the pioneers in trying to develop photopheresis as an
approach strategy to reduce the incidence of graft-versus-host
disease, which unfortunately, is common in patients who undergo
stem cell transplantation.Foss
That is right. It is very exciting for us having taken
photopheresis from cutaneous T-cell lymphoma, which is essentially
a cancer, a lymphoma, into the arena of graft rejection,
graft-versus-host disease, for bone marrow transplant. It is
particularly exciting for me to have Dehua here representing the
whole field of transplant and solid organ transplantation, in China
and around the world, now looking at applying photopheresis as a
process to prevent organ rejection.  This has been a very
exciting collaboration for us.Chu
That is great.  In fact Dehua, I was going to ask you, back in
China you said you were focused on transplantation, can you tell us
what specifically you were involved with; transplantation for
hematologic malignancies, leukemia, lymphoma, or the
transplantation of solid tumors?  Tell us a little bit more
about that.Zhen
Our hospital is the biggest hospital in Beijing and our transplant
program is the biggest one in the army/military service.  Our
transplant center is also a comprehensive transplant center. 
We perform kidney transplantation, liver transplantation, heart
transplantation, and bone marrow transplantation for hematologic
malignancies.  A very serious problem for transplantation is
rejection and GVHD.  We are very happy to have the opportunity
to establish collaboration with Yale Cancer Center and Yale
Dermatology to develop a new immunoregulation therapy.Foss
Dehua, a lot of our listeners are probably not familiar with how
medicine is practiced in China. You have had the opportunity while
you are here to make rounds with me and to see how the cancer
center works and how we approach the clinical care of cancer
patients here in the United States. I wonder if you could let our
audience know how you would compare that to the way things are done
in China?Zhen
Modern western medicine here is very different from the Chinese
traditional one.  I would say that western medicine is a
quantitative constructive science, whereas traditional Chinese
medicine is an organismic quantitative schema, better described in
the videos as a resilient, dynamic ecosystem. The focus of medical
science is upon the pathologic entity here, and Chinese traditional
medicine draws upon a natural, centered cosmology that emphasizes
the relationship between the seed and the soil.  What is it
about the terrain that permits a cancer or any disease to take
root?  Our ancestors believed that the human body is a small
universe,8:16 into mp3 file 
http://www.yalecancercenter.org/podcast/Answers_Apr-19-09.mp3that is connected with the big universe around us by some
special energy channels.Chu
I get the sense that you are feeling that here in the United States
and in the western countries, we focus so much on laboratory
results, what the x-rays show, and we look at the number, so to
speak, whereas perhaps in China and the more traditional Chinese
eastern approach, you look at the patient and look at the whole
body as it is and maybe don't focus so much on the numbers, is that
accurate you think?Zhen
In China we also use modern medicine, but at the same time we use
traditional Chinese thinking. When we use traditional Chinese
thinking, we pay attention to the patient's overall feelings and
their symptoms because sometimes people have bad feelings or
symptoms, but if you use machines, images, or laboratory tests, you
find nothing.Chu
I know a lot of people in Taiwan and in China, where I have visited
quite frequently, talk about a patient being 'hot' or patient being
'cold' and the Chinese physician can tell sometimes just based on
feeling the pulse, looking at the tongue, or just feeling the
temperature of the skin.  What has your experience been in
that regard?Zhen
Usually we look at the tongue's color and also we feel the pulse,
because we have Yin and Yang theory and Yin and Yang cannot live
without each other.Chu
So there needs to be a balance within a system, within an
individual's body.Zhen
This is not a simple balance, just like a harmonious balance, Yin
and Yang can mix together and then become vital energy that in
Chinese means "chi."  This vital energy can flow through the
way of the meridian system.  This is the system which connects
our small universe to the outside universe.Foss
When you see a patient with cancer, you are thinking about that
patient on a number of different levels. You are obviously thinking
about the disease itself, what you can measure on the x-rays, and
what the pathology tells you about the cancer cells, but you are
also looking at the patient from a different perspective as you
just mentioned, with respect to the whole person and sensing
perhaps differences in energy and disruptions in these meridians
that you are describing.  When you treat a patient with cancer
then, are you using multiple modalities for treatment or are you
sticking pretty much to the way we approach the patient, which is
chemotherapy and supportive care?Zhen
We combine the western medicine as you mentioned as a standard
treatment, then we12:22 into mp3 file 
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 combine these standard treatments with our alternative treatment,
like acupuncture, to relieve the pain after surgery and to help the
patient recover from chemotherapy and radiation.Foss
Is it common in China that all physicians treating cancer patients
would utilize all of these different modalities of treatment?Zhen
Nearly 70% do with the patients with cancer.  When they are
performing surgery, radiation, and chemotherapy, they will
simultaneously have some traditional Chinese medicine like herbals,
acupuncture, or meditation or something.Chu
Dehua, I am curious, you are obviously a surgeon trained in modern
western style medicine, but in your own clinical practice do you
prescribe what we call complementary alternative approaches?Zhen
Yes, sometimes.  When I find the patient's pain is very
severe, and if they are using pain medication they will have some
more side effects, and some pain medication can suppress the
breathing, so at this time we use acupuncture or acumassage.
Sometimes we inject some drugs, very little drugs, into an
acupuncture spot.  If you inject drugs into these special
spots you can enhance the efficiency of the drug.Foss
We are going to return in a few minutes to talk a little bit more
about traditional Chinese medicine.  You are listening to Yale
Cancer Center Answers and we are here discussing cancer care in
China with Dr. Dehua Zheng.Foss
Welcome back to Yale Cancer Center Answers, this is Dr. Francine
Foss and I am joined by my co-host Dr. Ed Chu and Dr. Dehua Zheng,
a visiting fellow from China. We talked a little15:57 into mp3 file 
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 bit about Chinese medicine and how it is very different from
traditional western medicine. Dehua, can you go through more about
the differences in your mind between what you have seen here, your
experiences at Yale Cancer Center, and how you practice medicine in
China?Zhen
At Yale Cancer Center I find all of you only use modern medicine
for patients.  Very few physicians know about Chinese
medicine.  So, when the patient has some problems with chronic
pain, or when they have sub-health problems, you have no drugs to
alleviate them.  At this time, the objective of Chinese
traditional medicine is to help the people live healthier lives and
help people recover from their damaging therapies.  I think if
we can combine these two, you will get a more powerful therapeutic
effect for the patient.Chu
One thing that I found very fascinating when I had a chance to
visit the Chinese traditional herbalists in China, Taiwan, Hong
Kong, and throughout Asia, is that the doctor's offices are
embedded within the food markets. I should say, they are next to
the fruits and vegetables, the fish market, the meat market, and it
is amazing to me that individuals will go everyday, they will get
their fruits, veggies, meat and fish, and then at some point they
will then go to the herbalist's office to get their tea, or an
extract of various herbs, and take that to help with whatever
medical condition they might have. What has been your experience
been?Zhen
I would like to say that in Chinese traditional medicine, food and
drug are connected very closely.  Sometimes food is a drug,
and drug is food; there is no isolation from each other.  Our
Chinese traditional medicine is more than herbal and acupuncture,
we also have dietary therapy.Foss
Ed and I have both been at the National Cancer Institute, where for
a large number of years now there has been a natural products
division that has screened a lot of different foods and natural
substances and identified not only new cancer drugs, but also
antioxidants and other things that are beneficial for health.Chu
What is interesting is that there are warehouses full of extracts
from all around the world, it is really quite remarkable, but I
guess the typical approach that I know the NCI has taken and here
in the United States and other western countries, is to try to take
these barks and trees and whatever extracts and try to isolate the
most active ingredient. Whereas my sense is that in traditional
Chinese herbal medicine, it is not just a single active agent but
all of the different agents in a particular herbal extract working
together, a kind of complete balance of that extract.Zhen
Yes.  If you would like to understand why Chinese herbal
medicine has so many compounds, this is our ancient tradition of
Confuscism.  In Confuscism theory, they said that in a
country21:03 into mp3 file 
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 we should have a king, a minister, and some messengers or other
officials that work together.  Then, under the rule of the
king, this country will be in harmony.  This country, just
like a human body, if you use a drug, it is just like a hierarchy
of the society.  Some compounds are king compounds, some
compounds are ministers, some compounds are messengers, and
everyone is important.  Without the messenger the king cannot
deliver the message to the minister. So, if you only take one
compound, maybe this compound will lose the efficacy for the
disease treatment.Foss
To what degree are these compounds and these mixtures standardized
in China? If you go from one herbalist to another and get
essentially the same mixture, will it really be the same
composition?Zhen
Maybe, it depends on the herbalist's experience or their fluency of
preparing these drugs. Also, in China, herbals are not the same;
when it is spring, when it is autumn, and in winter, the same
herbal does not have the same function.  Just like the human
body we are an ecosystem.  If the outer environment is
changing, the inner ecosystem is changing, and so you should use
your diagnosis of symptoms and disease individualized to this
patient to make the preparation of the drug that is a mixture of
compounds that is right for the patient.Chu
Dehua, Chinese traditional herbal medicine has been practiced for
up to 3000 years, going back to historical times, just in your
lifetime, as a practicing physician, have you seen much in the way
of changes to the overall approach to the use of traditional
Chinese medicine?Zhen
Yes.  Nowadays in China traditional Chinese herbalists also
learn western medicine and Chinese people do not see western
medicine and eastern medicine as controversial things, they see
them as united together.  Western medicine also has some
impact on traditional Chinese medicine, just as you said, sometimes
we can add compounds into some traditional mixtures to make the
treatment efficacy more than before.Foss
Ed, you have been working with Dr. Chang at Yale to develop herbal
medicines in the treatment of cancer and the side effects
associated with cancer.  Can you tell us a little bit about
that?Chu
I am glad you asked that Francine because it really has been a
fascinating story. About 5 or 6 years ago, as you know, our good
friend and colleague Professor Chang in pharmacology who has had a
longstanding interest in Chinese herbal medicine, identified a very
interesting herbal made up of four main herbs. Within those main
herbs we have now been able to identify up to 64/65 individual
components and this herb has been used in everyday practice in
China, Taiwan, and around the orient for the treatment of diarrhea,
nausea, vomiting, and26:16 into mp3 file 
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 fatigue, so we have actually been studying it in combination with
western chemotherapy in the hopes of trying to reduce side effects.
Many side effects, in particular for drugs that are used for
colorectal cancer, pancreatic cancer, and liver cancer, are in fact
diarrhea, belly cramps, nausea, vomiting, weight loss, and fatigue
and already in some of the studies that we have done here at Yale
Cancer Center and also at the VA Hospital, we found that this herb,
which is called PHY906, can indeed reduce the GI side effects.
Right now our good friend and colleague Dr. Wasif Saif is the
Principal Investigator, and myself and Dr. Leichter are also part
of that study, as well as Dr. Chang, looking at this herb in
combination with a drug called irinotecan for patients who have
metastatic colorectal cancer. It is still early, called the phase I
part, but we are planning a larger phase II study. So far it looks
like this herb helps patients tolerate the chemotherapy drug much
better.Foss
That is a really interesting story Ed, and it reminds me of one of
my patients that I saw back when I was in Boston a number of years
ago who was an elderly Chinese gentleman who had end-stage
metastatic pancreatic cancer. We really could not offer him
anything more, but his family took him home and he was on an herbal
therapy and I actually saw him a year later and the gentleman's
cancer had stabilized or stopped growing and he was feeling very
well. He was in his 80s and he really looked very well and very
fit.  So of course, we physicians were all wondering what was
in that herbal preparation, but I think the story just goes to show
you that there really are a lot of things that we physicians do not
know, and perhaps physicians in China, now going back about 2000
years, have been using this kind of medicine. Dehua, can you offer
any suggestions or insight for our listeners in terms of if
patients here wanted to think about alternative therapies or herbal
medicines, how they might go about doing that?Zhen
If they can visit China to find the very experienced herbalist or
traditional Chinese practitioner that will be perfect. 
Because here in the United States some practitioners only use the
preparation of the drugs, but they do not differentiate the
symptoms, the disease, and they cannot grasp this ability.  If
they cannot grasp this ability, it will be dangerous for them to
give the preparation of a Chinese traditional herbal.Chu
On that note, we unfortunately have to end the program this
evening.  You have been listening to Yale Cancer Center
Answers and I would like to thank our special guest for this
evening's show, Dr. Dehua Zheng from Beijing, China, for joining us
and we look forward to having you on a future show when you come
back to visit us here at Yale Cancer Center.  Until next time,
I am Ed Chu from the Yale Cancer Center wishing you a safe and
healthy week.If you have questions or would like to share your comments, go
to yalecancercenter.org where you can also subscribe to our podcast
and find written transcripts of past programs.  I am Bruce
Barber and you are listening to the WNPR Health Forum from
Connecticut Public Radio.