1. Insufficient vital essence

Insufficient vital essence causes deficiency syndromes. Since various deficiency syndromes may occur in cancer patients, insufficient vital essence is considered the basic pathogenesis of cancers. Insufficient vital essence results from congenital defects, senility, protracted illness, overexertion, improper diet, over indulgence in sexual activity or invasion by exogenous pathogenic factors.

2. Blood stasis and phlegm accumulation

Traditional Chinese medicine holds that cancerous tumors are the result of blood stasis or phlegm accumulation or both. Qi activates and governs blood circulation. Deficiency of qi may cause blood stasis. Stagnation of qi, which is usually due to an emotional upset or affection by exopathogens, is another common factor that impedes the normal flow of blood and results in blood stasis and eventually tumor formation. Accumulation of phlegm is related to the various deficiency sates described above, particularly deficiency of spleen qi characterized by failure in transporting and transforming the refined substances from food and water which leads to the formation of phlegm.

3. Invasion of exogenous pathogenic factors

Exogenous pathogenic heat or cold can invade the body, disturb the smooth flow of qi and blood and, as a result, cause the retention of qi and blood and the formation of tumors.

Differential Diagnosis of Syndromes

1. Qi deficiency

Primary manifestations: general lassitude, shortness of breath, weak breathing and speaking, spontaneous sweating that worsens on exertion, pale tongue with thin, white coating and weak pulse.

Conditions associate with cough and expectation of copious thin sputum indicate a deficiency of lung qi; poor appetite, fullness in the abdomen after meals, loose stool or edema indicate a deficiency of spleen qi; palpitations or arrhythmia may appear in cases with deficiency of heart qi.

2. Yang deficiency

Primary manifestations: intolerance of cold, cold limbs, slow pulse with the manifestations of qi deficiency.

Deficiency of kidney yang is manifested as weakness of the loins and knees, impotence, frequent urination at night, incontinence of urine, diarrhea before dawn or edema complicated by the general manifestations of yang deficiency.

3. Blood deficiency

Primary manifestations: Pallor or sallow complexion, pale tongue with thin, white coating and thready pulse. Additional manifestations may include palpitations, insomnia, amnesia and dream-disturbed sleep, suggesting deficiency of heart blood; blurred vision, dizziness, ringing in the ears, numbness of the hands and feet or scanty menstrual flow, indicate deficiency of liver blood.

4. Yin deficiency

Primary manifestations: Dry mouth with preference for beverages, absence of tongue coating, constipation and concentrated urine, indicating consumption of body fluids; feverish sensation in the palms, sole, and chest, afternoon fever, night sweating, deep red tongue without coating and fine rapid pulse, suggesting interior heat due to yin deficiency. Patients with yin deficiency, suffering from restlessness, dizziness, dryness of the eyes, nocturnal emissions, soreness and weakness of the loins and knees, can be diagnosed as having yin deficiency of the liver and kidneys. Those with yin deficiency, suffering from dry cough or cough with expectation of scanty, sticky sputum, can be diagnosed as having yin deficiency of the lungs.

5. Stagnation of liver qi

Primary manifestations: Fullness and distending pain in the hypochondriac regions, irritability, belching, loss of appetite, distending sensations in the breast, thin, white tongue coating and taut pulse.

6. Blood stasis

Primary manifestations: Fixed pain or mass in a given region of the body, petechiae or bleeding, dark complexion, dry scaly skin, dysmenorrhea with discharge of dark-red blood or clots, purple or dark-red tongue and fine and hesitant pulse.

7. Phlegm-dampness

Primary manifestations: Cough, expectations of mucoid white sputum, loss of appetite, abdominal distension, white, greasy tongue coating and slippery pulse.

Treatment 

1. Qi deficiency

Principle of treatment: Invigorate qi.

Formula of choice:  Four Gentlemen Decoction; the most commonly used herbs to tonify qi: Ginseng, codonopsis root, and astragalus root. For deficiency of lung qi, use Lung-Tonifying Decoction, in which ginseng, astragalus root, replenish lung qi, tangerine peel and aster root descend lung qi and prepared rehmannia root and schisandra berry invigorate the kidneys, the root of qi.

For deficiency of spleen qi, Ginseng, Poria, Ovate Atractylodes Powder is an effective formula. It includes the ingredients of the decoction of Four Gentleman Decoction, as well as lablab bean, dioscorea root, coix seed, and lotus seed which invigorate spleen qi; amomum fruit which enlivens the spleen and strengthens the action of principal drugs; and platycodon root which acts as guiding drug. For the cases with deficiency of heart qi, use Heart-Nourishing Decoction, in which ginseng, astragalus root, licorice root, and schisandra berry replenish heart qi; cinnamom bark invigorates heart yang; tangkuei and ligusticum root nourish the heart blood; and jujube, poria, polygala root and biota seed ease the mind.

2. Yang deficiency

Principle of treatment: Replenish yang with herbs warm in nature.

Formula of choice: Aconite Center-Rectifying Decoction for deficiency of spleen yang; in this formula, prepared lateral root of aconite and blast-fried ginger, both of which are pungent in flavor and hot in property, restore yang of the spleen and stomach by warming the middle-warmer to dispel cold; add ginseng, ovate atractylodes root and licorice root to replenish qi and strength the spleen.

Right-Restoring is an effective recipe for treating deficiency of kidney yang.

3. Blood deficiency

Principle of treatment: Nourish blood.

Formula of choice: Four Ingredients Decoction to replenish liver blood; the treatment of blood deficiency is usually combined with herbs that invigorate qi and nourish the kidneys, for example, Tangkuei Blood-Supplementing Decoction, which includes a large dosage of astragalus root; Spleen-Returning Decoction is frequently prescribed for deficiency of heart blood.

4. Yin deficiency

Principle of treatment: Nourish yin and increase body fluids.

Formula of choice: Since yin deficiency frequently causes heat, methods for nourishing yin are often used with those for expelling heat; use Major Origin-Supplementing Decoction to treat yin deficiency of the liver and kidneys, in which ginseng, dioscorea root and licorice root replenish the spleen, prepared rehmannia root and tangkuei  nourish liver yin and cornus fruit and lycium berry invigorate kidney yin.

Deficiency of lung yin can be treated with Lily Bulb Metal-Securing Decoction, in which rehmannia root nourishes yin and clears away heat from the blood; ophiopogon root, scrophularia root and lily bulb nourish yin, ,moisten the lungs, remove phlegm and arrest cough; tangkuei and white peony root invigorate blood and nourish yin; and licorice root and platycodon root eliminate phlegm and coordinate the effects of the other ingredients in the formula.

5. Stagnation of liver qi

Principle of treatment: Regulate liver qi.

Formula of choice: Bupleurum Liver-Soothing Powder.

6. Blood stasis

Principle of treatment: Promote blood circulation to remove blood stasis.

Formula of choice: Infradiaphragmatic Stasis-Expelling Decoction, in which tangkuei, ligusticum root, peony root, peach kernel, carthamus flower, flying squirrel's droppings, moutan bark promote blood circulation to remove blood stasis, and cyperus root, bitter orange, lindera root and corydalis tuber regulate qi to alleviate pain.

7. Phlegm-dampness

Principle of treatment: Remove dampness and phlegm.