Convergent Points Volume 1 Issue 1

Five Element Acupuncture Treatment for a Patient with Stage IV Metastatic Cancer: A Case Report

Introduction

Colorectal cancer is the third-leading cause of death from cancer worldwide (Rawla et al., 2019). The five-year survival rate for colorectal cancer is 50% (Lahans, 2007). Synchronous liver metastases from colorectal cancer have been shown to occur at a rate of 14.5% (Manfredi et al., 2006). Biomedical treatment for colorectal cancer includes resection of the colon with ileostomy along with chemotherapy and radiation. Liver metastases from colorectal cancer are treated with hepatectomy and chemotherapy (Kato et al., 2003).

The search phrase "Worsely Five Element acupuncture AND cancer" yielded no search results in the PubMed database, leading the author to conclude that little research has been done on this subject. Eckman (2021) was a case study that used elements of Worsely theory to treat cancer patients using a novel style of acupuncture called Constitutional Conditional Acupuncture. Other than this one instance, there are no other case reports or studies that purely use Worsely Five Element acupuncture as an adjunctive treatment for cancer.

Worsley Five Element acupuncture is based on using the sheng (creation) and ke (control) cycles for moving qi. A person’s constitutional factor (CF) is the element that is their greatest strength and greatest weakness. When a person's qi cycles are disrupted, the CF is the aspect that is most impacted at the body, mind, and spirit levels. For example, in this case, the patient’s CF of metal—organs of Lung (LU) and Large Intestine (LI) in Eastern Asian medical systems—corresponds to the first area of cancer, colorectal. After the CF, the element next most impacted is called the “first within". For this patient, the first within was wood, related to the next biomedical diagnosis of metastasis to the liver.

Worsley Five Element acupuncture often uses spirit points to assist the patient’s integration of body, mind, and spirit for optimal functioning. According to Worsley Five Element theory, the three aspects of a person—jing, shen, and qi—need to be in alignment for the person to fulfill their destiny. Jing is the inherited endowment or ancestral essence of a person (yuan qi). Shen, the person’s spiritual, heavenly inheritance, is what makes each person unique. Qi is the motivating force that fuels all physical functions. This patient’s CF of metal and first within of wood correspond respectively to the spirits of the po (related to LU organ) and the hun (related to LR organ). The po consists of the physical spirit that descends back into the earth upon death. The po also houses the seven emotions associated with the zang (yin) organs, namely joy, fear, anger, grief, worry, melancholy, and fright. The hun consists of the ethereal soul that ascends upward upon death and comprises the jing, qi, and shen (Jarrett, 2009).

The metal element (LU and LI) is related to inspiration from heaven and letting go of what is no longer needed (Worsley, 1990). The acupuncture treatment supported the patient emotionally and physically in the last 14 months of his life. It consisted of treating his spirit level using upper Kidney (KI) points and outer Urinary Bladder (BL) points, as well as points to treat his CF.

This case indicates that the use of Five Element acupuncture may provide ongoing support for a patient diagnosed with terminal cancer.

Patient Information

The patient was a 48-year-old, postoperative Caucasian male with a history of colorectal cancer. He had undergone a high ileostomy that was then reversed after six months. Subsequently, he was diagnosed with metastatic liver cancer that was treated with a 75% hepatectomy. Carcinoembryonic antigen (CEA) findings following the hepatectomy indicated he was clear of tumors. He sought acupuncture treatment for quality-of-life support. He expressed fear about the return of his cancer and wanted assistance with his overall health and emotional well-being.

The patient had no family history of cancer. He was married with two teenage children and lived in a suburb with his wife and son; his daughter was at college. He owned his own business as a structural engineer. He expressed his concern that emotional issues led to the development of his colorectal cancer. The patient had feelings of guilt for past actions and thought his inability to let go and frustration with his behavior were major factors in his disease progression.

Before the cancer diagnosis, he followed a standard American diet with high carbohydrate intake and social alcohol use. Post diagnosis, he limited carbohydrates and alcohol and increased fruit and vegetable intake. In addition, he exercised four to six times per week. The patient reported that he slept eight hours per night with no dream disturbances. The patient denied any other significant history of illness.

The patient began acupuncture treatment in October 2015 with a chief concern for his quality of life and emotional well-being. In December 2015, his CEA count was elevated and new tumors were discovered. His oncologist informed him that his cancer was not responsive to chemotherapy and radiation would not be beneficial. A positron emission tomography (PET) scan showed increased size and number of tumors in both lungs and early stage necrosis of the liver.

Diagnostic Theory and Diagnosis

The Worsley Five Element acupuncture CF was diagnosed based on assessment of the patient’s color, sound, odor, and emotion (CSOE). Every element has multiple correspondences. For instance, the wood element correspondences are spring, green, shout, upward energetic movement, Liver, and Gallbladder (Hicks, 2011). This patient’s colors were white and green; his sounds were weep and shout; his odor was rotten; his emotions were grief and anger. Palpation during his initial examination yielded evidence of accumulation along the Gallbladder channel. There was no tenderness on alarm points or with hara diagnosis, a Japanese abdominal palpation technique Worsley included in the physical assessment portion of a patient intake. Palpation of his three jiaos (the upper, middle, and lower parts of the abdomen) showed normal temperature in the upper jiao and cold temperature in the middle and lower jiaos.

The pulse was rapid (6-7 beats per breath), with significant deficiency in LR and GB (Gallbladder), LU and LI, and KI yin and yang positions. The tongue had a slippery white coat, and a purple body pinched and narrowed on both sides with distended sublingual veins.

From a Worsley Five Element perspective, the patient's CF was metal with wood within (Worsley,1990). As mentioned previously, his CF and first within correlated to the areas of cancer diagnosis and metastasis, namely the large intestine and liver. The final area of metastatic invasion, to the lungs, corresponds again to the metal element. The biomedical diagnosis was Stage IV metastatic colorectal cancer.

Treatment

All acupuncture for this patient used 0.18x30 filiform DBC brand needles inserted to a depth of 5 to 8 fen (15 to 24 mm). Treatment focused on the spirit level with support on the body level. It began with clearing energetic blocks to qi movement from Worsley Five Element theory. This was done using specific treatment protocols called Internal Dragons (IDs), External Dragons (EDs), and Aggressive Energy (AE) (Worsley, 1990). The acupuncture points of IDs and EDs (see Table 1) assist the patient in controlling difficult emotions, which may include obsessions or addictions. Both ID and ED treatments are needled with a dispersing action. AE is used to release xie qi (unhealthy or polluted qi) and is needled shallowly with no needle stimulation. Xie qi travels along the ke cycle in a destructive manner. The AE treatment re-establishes the correct sheng cycle movement of qi through the zang organs (Hicks, 2011).

Treatment continued by supporting the CF of metal and wood within, as well as spirit level points (see Table 1). The patient received weekly acupuncture for 29 treatments, then transitioned to biweekly treatments until August 2016. He received a total of 39 treatments. Acupuncture ended in October 2016 after the patient entered hospice care.

Table 1: Acupuncture points used most frequently in this case

After the patient's Stage IV cancer diagnosis in January 2016, the acupuncturist reexamined him. His pulses were deficient in LU/LI, LR/GB, PC (Pericardium), HT (Heart), and KI yin and yang. His face had attained a gray cast, and he expressed his emotional response to the diagnosis as depression. The patient’s sound was weep, his odor was rotten, and his emotion was grief. His voice was hoarse and had a quiet tone. He breathed with a shallow, rapid rhythm. His tongue was pale, scalloped, and showed a divot in the LU area.

Treatment focused on his spirit with the use of LU9 (Tai Yuan), PC7 (Dai Ling), KI26 (Yu Zhong), and Conception Vessel (CV)15 (Jie Wei). Subsequent treatments focused on calming the mind with Buddha’s triangle (LU9, HT7, and PC6; Tai Yuan, Shen Men, and Nei Guan, respectively), Gates of Buddha (LI4 and LR3; He Gu and Tai Chong), and Yin Tang. After three treatments, the patient’s voice became stronger, his color returned to his normal white, and the divot in the LU area of his tongue was no longer present. His pulses in PC and HT returned to a normal level of qi based on the Worsley pulse system. By February 2016, the sound of his voice was shout, and his color was green. This indicated that the wood element, the patient’s first within, had emerged as the most prominent element. Based on assessment of his CSOE, his odor remained rotten, and his emotion consisted of anger and grief. This was attributed to the stage of grief he had reached. Treatment focused on calming the mind with Gates of Buddha, Yin Tang, and Urinary Bladder (BL)23 (Shen Shu). Subsequent treatment on the metal and wood elements combined with upper KI spirit points, KI20 (Fu Tong Gu), KI21 (You Men), and KI22 (Bu Lang), brought the patient’s appearance back to white and green. His pulses also came up to the normal level in LU/LI and KI, even though LR remained deficient. This finding indicated that his normative elemental constitution had been re-established.

Further treatments included Buddha’s triangle to treat his CF and benefit his shen. HT7 and PC6 were used to connect him with his shen and assist him in appropriately opening and closing the Pericardium gate to his Heart (the official of Supreme Controller) (Hicks, 2011) and the outside world. This allowed him to connect with himself profoundly. HT7 is the yuan source point for Heart and works on a deep energetic level. The name of PC6 in the Worsley tradition is Inner Frontier Gate and, when functioning appropriately, this gate protects the shen from spirit level damage.

Outcomes

By April 2016, the patient was able to assess his situation realistically with calmness. His breathing rate was normal, and he was able to breathe deeply. His voice was no longer hoarse. His pulse rate was three to four beats per breath. His color, sound, odor, and emotion all reflected his CF of metal with a hint of wood within. He reported that his anger had abated, and that he was handling grief well. He was able to function in his community and business with enthusiasm.

The patient reported increased calmness, less agitation of spirit, and felt he was moving toward acceptance of his condition and the potential outcome. In addition, he was able to let go of any guilt he felt from earlier life experiences and strengthen his relationships with his family. He remained asymptomatic from October 2015 until August 2016. In early August 2016, he developed a cough and difficulty breathing with exertion. In September 2016, he went hiking and climbing on a trip to Africa with a group of other professionals. Upon his return, his cough became constant and his fatigue excessive. At that time, he entered hospice care. His last acupuncture treatment was in October 2016. He died on December 3, 2016.

Discussion

The patient’s need for perfection within himself, a trait often found in people whose CF is metal—may have been a catalyst for the qi deficiency that allowed cancer to take root in his colon. He expressed regret for not meeting his family's and his own expectations. He had a sense that he had failed and was unable to forgive himself. This inability to let go is a function of the Large Intestine and may have contributed to the emotional stasis and subsequent physical stasis of his tumors.

Treatment of the CF and first within was able to bring greater harmony to these elements. This included the ability to let go of his regrets, gain greater self-acceptance, and release the frustration of his situation. Over the course of acupuncture treatment, the patient gained the ability to maintain a healthy lifestyle, build closer relationships with his family, and accept the inevitability of his death. Five Element treatment strategies supported the patient’s spirit, which may have led to being symptom-free for a longer period, even while his CEA level and tumors increased.

This case indicates that further work with terminal patients using Worsely Five Element acupuncture treatment as palliative care should be explored.

Patient Perspective

During the period of care described in this report, the patient stated, “Acupuncture treatment allowed me to have the energy to continue with my work and be with my family for a longer time than I thought I would be. I felt more vibrant and calmer and more able to accept my life and the future."

Informed Consent

The patient provided informed consent to the publication of this case prior to his death. His widow has agreed to the publication.

Statement of Safety

No adverse events were reported by this patient during treatment. Acupuncture was adjunctive to biomedical cancer care and provided additional support to the patient as he navigated through diagnosis and treatment.

References