In modern medicine, tumors are generally named based on their origin in human organ tissues and biological behavior.According to the biological characteristics of tumors and their harmfulness to the body, they are generally divided into benign and malignant tumors.Based on the way tumors exist, they are further classified into solid tumors and non-solid tumors.Solid tumors often form obvious masses and are primarily treated with a comprehensive surgical approach.Non-solid tumors are mostly malignant tumors of the blood system, which often do not present obvious masses in clinical practice, with treatment primarily focused on chemotherapy.Traditional Chinese Medicine (TCM) summarizes five major causes of tumors:Qi Stagnation, Blood Stasis, Phlegm-Dampness, Heat-Toxin, and Deficiency of Zheng Qi.Qi Stagnation refers to a pathological state where the flow of Qi is obstructed and stagnant.For example:In lung cancer patients, the diagnosis may indicate that the lung has lost its ability to descend and disperse, leading to Qi stagnation in the upper jiao, presenting symptoms such as chest tightness, cough, and shortness of breath;In early-stage liver cancer patients, the diagnosis may indicate that the liver has lost its ability to regulate and disperse, leading to stagnation in the liver meridian, resulting in rib-side distension and discomfort;In gastrointestinal tumor patients, the diagnosis may indicate gastrointestinal Qi stagnation, leading to abdominal distension and pain that comes and goes, varying in intensity.Blood Stasis occurs due to local blood stagnation, where blood flow is slow and obstructed, which also hinders the movement of Qi, creating a vicious cycle where Qi stagnation exacerbates blood stasis, and blood stasis further aggravates Qi stagnation, leading to pain due to obstruction of Qi and blood.When blood stasis is severe, local blood gradually forms clots and masses.Phlegm-Dampness arises from dysfunction in the Qi transformation of organs such as the lungs, spleen, and kidneys, leading to metabolic disorders of fluids, resulting in stagnation and accumulation of phlegm and dampness.Over time, this affects the movement of Qi and blood, causing Qi and blood stagnation, leading to dysfunction in the spleen and stomach, which further promotes the accumulation of dampness, creating a pathological cycle.Heat-Toxin includes toxins from viral infections, tobacco, pollutants from cooking fumes, chemical toxins in occupational environments, and various toxins from air, water, and soil pollution, as well as toxins from food. These can also arise from pathological products such as phlegm, dampness, and blood stasis accumulating in the body, obstructing the meridians and organs, leading to the generation of toxins.Heat arises from toxins; if heat and toxins are severely obstructed, the body’s Zheng Qi becomes weak and cannot expel the toxins, leading to the accumulation of heat and toxins, which over time can develop into tumors.Deficiency of Zheng Qi refers to the weakness of the body’s Zheng Qi, where pathogenic factors become excessive, and the body lacks the strength to resist these pathogenic factors, resulting in continuous pathological damage and the occurrence and development of cancer.At the same time, when the body’s Zheng Qi is weak, the physiological functions of the organs become disordered, leading to the potential for pathological products such as blood stasis and phlegm to arise.For further reading:
Understanding Tumor Etiology and Pathogenesis in Traditional Chinese Medicine
1. Etiology
Since tumors are local manifestations of systemic diseases, resulting from the interplay of external and internal factors, the pathogenic factors are quite complex. The “Three Causes Theory” proposed by Chen Wuze in the Song Dynasty still holds certain guiding significance for analyzing tumor etiology.Thus, according to Chen’s theory of “internal causes,” “external causes,” and “non-internal and external causes,” the etiology of tumors can be summarized into four aspects: deficiency of Zheng Qi, invasion of external pathogens, emotional disturbances, and dietary injuries.(1) Internal Causes1. Deficiency of Zheng Qi: The deficiency of Zheng Qi and dysfunction of the organs is one of the main causes of tumors.The Huangdi Neijing states:“When Zheng Qi is present, pathogens cannot invade.” The Huo Fa Ji Yao states:“Healthy individuals do not accumulate, but those who are weak do.” The Jingyue Quanshu points out:“Individuals with insufficient spleen and kidney function and those who are weak and disordered often have accumulations.” The Wai Ke Yi An succinctly states, “Deficiency of Zheng Qi leads to accumulation.”If the body’s essence and Qi are abundant, yin and yang are balanced, and the functions of the organs are coordinated, tumors are rare; conversely, they can induce tumor formation.This sufficiently illustrates that “deficiency of Zheng Qi” is the fundamental cause of tumor occurrence and development.Shen Douyuan in the Ming Dynasty noted in the Wai Ke Qi Xuan that:“Cancer occurs after the age of forty, with blood deficiency and Qi decline, often due to excessive consumption of rich foods.”This indicates that as age increases, organ function declines, leading to deficiency of Zheng Qi and internal accumulation of toxins, resulting in tumor formation.2. Emotional Disturbances: TCM believes that emotional disturbances play a significant role in the occurrence and development of tumors.For example, the Suwen: Tongping Xushi Lun states that esophageal cancer is a “disease of violent grief”; the Yixue Jinliang clearly states that “due to unresolved grief, excessive thinking, sudden anger, and fear, blood and Qi become stagnant in the upper jiao… Grief leads to Qi stagnation, which accumulates in the chest, causing phlegm to form, and over time, phlegm masses obstruct the upper jiao, making it difficult for food to enter and leading to illness.”Regarding breast cancer, the Danxi Xinfang attributes it to “grief and anger accumulating day by day, obstructing spleen Qi and reversing liver Qi”; the Wai Ke Zheng Zong states:“Grief injures the liver, excessive thinking injures the spleen, and unfulfilled desires lead to fatigue of the meridians, resulting in masses.”The Yixue Zhengzhuan further states:“This condition often occurs in middle-aged women who are troubled by grief and anger.”This indicates that emotional disturbances can directly affect the body’s normal physiological functions, causing disordered Qi and blood, Qi stagnation, blood stasis, and phlegm accumulation, leading to tumor formation.This aligns with modern medicine’s view that psychological factors can lead to cancer.(2) External Causes and Invasion of Pathogens: TCM believes that the occurrence of tumors is related to the invasion of external pathogens, and modern medicine has also proven that 80% of tumor patients have their illness related to carcinogenic factors in the external environment.Due to historical limitations, ancient people could not propose these more precise causes, so they summarized external carcinogenic substances as the six excesses [wind, cold, heat, dampness, dryness, fire (heat), and pestilence].However, there is considerable understanding that the invasion of external pathogens can lead to dysfunction of the organs, Qi stagnation, blood stasis, and internal phlegm accumulation, which can eventually lead to cancer.The Lingshu: Baibing Shisheng states:“Accumulation arises from the cold, leading to accumulation.”The Lingshu: Jiu Zhen Lun states:“The guests of the four seasons and eight winds in the meridians are the causes of tumor diseases.”Here, the “eight winds” refer to the six excesses of external pathogens.The Lingshu: Cijie Zhenxie further states:“The entry of external pathogens into the body is deep; cold and heat clash, lingering and causing internal damage… The pathogenic Qi resides within and does not disperse, leading to muscle and tendon tumors… leading to intestinal tumors… leading to past tumors.”This indicates that external pathogens, cold, and heat can all lead to the occurrence of tumors.The Zhu Bing Yuan Hou Lun provides more specific descriptions of how the six excesses can cause tumors, such as “brain dampness, which causes sudden growth of flesh like horns on the head,” “black moles, which are caused by wind evil clashing with blood Qi, leading to transformation,” and “malignant masses, which are caused by the clash of wind-heat toxins with blood Qi, growing on the neck, and encountering wind and cold, leading to non-dissipation and non-ulceration.”These records from over fifteen hundred years ago show that TCM had already documented the relationship between different tumors and various evils in detail, providing a basis for how to prevent different tumors.(3) Non-Internal and External Causes1. Dietary Imbalance(1) Improper or excessive dietary habits:Can affect the dysfunction of the organs and the disorder of Qi, blood, and fluids, leading to internal generation of evils, causing damage to fluids, Qi stagnation, and phlegm accumulation, resulting in cancer.Ancient TCM texts have long recorded the carcinogenic effects of diet. The Song Dynasty’s Jisheng Fang states:“Overindulgence in five flavors, consuming fishy and dairy products, and excessively eating raw and cold fruits and vegetables can lead to accumulation in the stomach… which can eventually lead to masses.”The Yuan Dynasty’s Weisheng Baojian also states:“Individuals with weak spleen and stomach or those who overeat or consume excessive cold foods… can lead to accumulations and masses.”The Ming Dynasty’s Wai Ke Zheng Zong discusses the causes of lip cancer, stating:“Due to consuming fried and roasted foods excessively, combined with excessive worry, phlegm follows the fire and accumulates in the lips.”The Qing Dynasty’s Yixue emphasizes: “Wine drinkers often suffer from esophageal obstruction, and those who prefer hot wine are particularly affected.”(2) Unclean Diet:Such as neglecting food hygiene and consuming spoiled or moldy food.(3) Overconsumption of sticky, hard-to-digest, or excessively fatty foods can lead to food stagnation, phlegm and stasis formation, and cancer due to mutual accumulation of deficiency and phlegm.2. Imbalance of Work and Rest: Refers to excessive fatigue or excessive leisure, which can lead to illness.Excessive labor includes physical labor, mental labor, and sexual labor.Excessive physical labor depletes Qi, excessive mental labor depletes yin and blood, and excessive sexual labor damages kidney essence, all leading to deficiency and the onset of disease.Chen Shigong noted in his discussion of bone tumors:“Excessive sexual desire can harm the kidneys, leading to weak kidney Qi and lack of nourishment for the bones, resulting in bone tumors.”As for the causes of breast tumors, it emphasizes that “men’s breast masses differ slightly from women’s; women damage the liver and stomach, while men damage the liver and kidneys, often due to excessive anger and sexual desire… leading to kidney deficiency and weak essence… and the liver meridian cannot nourish, resulting in tumor formation.”Excessive leisure refers to excessive idleness, not participating in labor and exercise, leading to poor circulation of Qi and blood, decreased resistance, and illness.The Huangdi Neijing states, “Prolonged sitting injures flesh, prolonged lying injures Qi,” which illustrates this principle.Analysis of Tumor Diagnosis and Treatment: Understanding Tumor Pathogenesis in TCMPathogenesis refers to the mechanisms of disease occurrence, development, change, and outcome.Due to the complexity of tumor etiology, the variety of tumor types, and the diversity of clinical manifestations, the changes in pathogenesis are also very complex.However, they can generally be summarized into four aspects: dysfunction of the organs, Qi stagnation and blood stasis, phlegm accumulation and dampness, and internal toxins.1. Dysfunction of the Organs: If the functions of the organs are disordered, Qi movement may become chaotic or weak, which can become an internal cause of tumor occurrence.The Nanjing: Difficulty 55 states:“Accumulation arises from the five organs; masses are formed by the six bowels.”This affirms that the formation of accumulations is due to dysfunction of the organs.The Zhu Bing Yuan Hou Lun emphasizes that “accumulations arise from disharmony of yin and yang, weakness of the organs, and invasion by wind evil, clashing with the Qi of the organs.”TCM also believes that the occurrence and development of tumors are closely related to the lungs, spleen, and kidneys, as patients with malignant tumors often exhibit deficiency of lung and spleen Qi, lung and kidney yin deficiency, or spleen and kidney yang deficiency.These patients often have lower cellular immune function than normal individuals. By using herbal medicine to invigorate Qi, nourish the lungs and kidneys, or tonify the spleen and kidneys, one can enhance the body’s cellular immune function, restore the balance of endocrine disorders, and strengthen the anti-cancer ability, which is beneficial for recovery.2. Qi Stagnation and Blood Stasis: Qi and blood are the material basis for the physiological activities of the organs and meridians.Thus, the Nanjing: Eight Difficulties states:“Qi is the root of human existence.”When Qi flows smoothly throughout the body, entering and exiting freely, it promotes, warms, defends, and maintains the normal physiological functions of the body; while “blood is the mother of Qi,” blood circulates through the five organs and six bowels, nourishing and moistening all tissues and organs.Qi and blood mutually influence each other; Qi disorders can affect blood, and blood disorders can affect Qi, leading to pathological changes such as Qi stagnation and blood stasis, and in severe cases, Qi and blood deficiency.As stated in the Suwen: Regulation of Menstruation:“When blood and Qi are not harmonious, all diseases arise and transform.”Blood follows Qi; when Qi flows, blood flows; when Qi stagnates, blood coagulates; prolonged stasis leads to the formation of masses, thus Wang Qingren states:“If there is a mass in the abdomen, there must be a physical blood component.”All tumors that form masses and are accompanied by pain are often due to Qi stagnation and blood stasis, thus regulating Qi and invigorating blood is an indispensable method for treating tumors.3. Phlegm and Dampness Accumulation: Phlegm arises from the failure of internal water and dampness to transform, leading to stagnation of fluids; or it can be produced by heat burning fluids, causing coagulation.Both phlegm and dampness are considered yin evils, heavy and turbid, easily obstructing yang Qi and hindering Qi movement, leading to obstruction of the meridians.If not resolved over time, it can transform into heat, leading to phlegm-damp heat toxins that cause sores, discharge, and difficulty healing; or phlegm-damp can transform into cold, causing internal obstruction of the intestines and stomach, leading to abdominal distension, diarrhea, or even lower limb edema. Hence, the saying goes, “All diseases arise from phlegm.”The Danxi Xinfang was the first to point out:“Any mass in the body is often due to phlegm.”This became the formal introduction of the theory that phlegm can also lead to tumors.Once this theory emerged, many followed suit.For instance, the Ming Yi Zhi Zhang states regarding goiter:“It must be due to Qi stagnation and phlegm accumulation, leading to obstruction in the pathways.”Qing Dynasty’s Lin Peiqin in Leizheng Zhicai referred to malignant lymphoma as phlegm masses.He stated:“If the mass has been present for years, is not red or painful, is firm and difficult to move, and eventually becomes painful, it is a phlegm mass.”Thus, treating phlegm and stasis has become two major treasures in TCM for diagnosing and treating tumors.Modern pharmacological research has also confirmed that many phlegm-dissolving and mass-dispersing herbal medicines have excellent anti-cancer and tumor-inhibiting effects.4. Internal Toxins: In TCM, “toxins” have multiple meanings; they are a high-level summary of pathogenic factors, nature, mechanisms, and pathology.TCM believes that any substance harmful to the human body is referred to as toxins, including both external toxins and internally generated toxins.External toxins include what modern medicine refers to as chemical, physical, biological, and environmental factors; internal toxins are the pathological products formed by various pathogenic factors within the body, as stated in the Lingshu: Nine Needle Theory:“The guests of the four seasons and eight winds in the meridians are the causes of tumor diseases.”Hua Tuo’s Zhong Cang Jing also states:“The pain and sores caused by toxins arise from the accumulation of toxins in the five organs and six bowels.”Both texts point out that cancer can arise from both external toxins (i.e., “four seasons and eight winds”) and from internal “accumulation of toxins in the organs.”Toxins can also be divided into “yang heat toxins” and “yin cold toxins.”External heat toxins are often due to exposure to natural fire and heat evils, such as bacterial and viral infections, tobacco, chemical toxins, or spoiled food; internal heat toxins often arise from imbalances in the organs’ yin and yang, emotional disturbances, dietary indiscretions, excessive alcohol consumption, or overconsumption of rich foods leading to heat and inflammation.Yin cold toxins also play an important role in cancer development, as the Lingshu: Baibing Shisheng states, “Accumulation arises from cold, leading to cancer,” indicating that yin cold toxins can also lead to cancer.Internal toxins are significant factors in tumor occurrence; however, tumor cells themselves can also be viewed as a type of toxin, known as cancer toxins.Cancer toxins are considered yin toxins, deeply hidden and chronic; they are solid evils, but not external evils, rather a special type of internally generated toxin with strong invasiveness, rapid progression, significant fluid consumption, easy metastasis, and high lethality. Therefore, the treatment of this disease cannot be solely managed by general detoxifying medications.In summary, deficiency of Zheng Qi, Qi stagnation and blood stasis, phlegm and dampness accumulation, and internal toxins are the pathological mechanisms of cancer occurrence and development in TCM.Clinically, due to the different causes of various cancers, significant individual differences among patients, and the variability of conditions, the pathogenesis is often complex and intertwined. Even among patients with the same type of tumor, there can be significant differences in their conditions.Sometimes, the same patient may experience changes in their condition at different stages of the disease, so these pathological mechanisms are not isolated or simple; they are often interrelated.Some patients may exhibit both deficiency of Qi and blood along with excessive toxins, while others may have Qi deficiency combined with blood stasis, or Qi stagnation combined with phlegm accumulation. Most patients present with a mix of deficiency and excess, often with multiple conditions coexisting.Therefore, it is essential to treat cancer effectively by understanding each patient’s specific clinical manifestations, distinguishing the primary and secondary aspects of the pathogenesis, analyzing the causes, and tailoring treatment accordingly.