Acupuncture for Cancer Pain: Opening the Four Gates

Among patients with advanced cancer, approximately seventy percent are tormented by pain until the very last moment of life. Especially in those with systemic metastasis, cancer pain is the most common and predominant symptom. For a minority of patients, cancer pain remains difficult to alleviate even with multiple analgesics, and relying solely on willpower is utterly unbearable, severely compromising their quality of life and survival time.

Li Shucheng, Deputy Director of the Acupuncture and Moxibustion Department at Foshan Hospital of Traditional Chinese Medicine in Guangdong Province, explains that for certain intractable types of cancer pain, acupuncture treatment can stimulate the patient's brain to secrete a substance known as endorphins, thereby producing a sedative and analgesic effect. At the same time, it can markedly improve the patient's systemic symptoms, stabilize mood, increase appetite, boost confidence in treatment, and help the patient pass through the final period of life with a calm and positive attitude.

Chinese medicine holds that cancer patients typically exhibit a pattern of zheng qi deficiency with pathogenic excess — that is, the physical presence of the tumor entity coexists with a body whose various functions have been in a chronically weakened state under the assault of the cancer. Therefore, to achieve favorable therapeutic results in acupuncture treatment, emphasis must be placed on acupoint selection and the application of needling manipulation, combining attack and supplementation — both supporting zheng qi and expelling pathogens. For example, one of the most commonly used empirical acupoint formulas for cancer pain is "Opening the Four Gates" (kai si guan). The "Four" refers to the two paired points Hegu (LI4) and Taichong (LR3), together called the "Four Gates Points." These signify the critical junctures of human life. The two points — one governing qi and the other blood, one yin and the other yang, one on the hand and the other on the foot — can regulate yin and yang throughout the body. As a Ming dynasty acupuncturist stated: "For cold, heat, impediment, and pain, opening the Four Gates resolves them." The selection of the Four Gates Points focuses on regulating qi and promoting blood circulation, ensuring the meridians are unblocked — where there is free flow, there is no pain.

Beyond the empirical Four Gates formula, different acupoint combinations are selected based on pattern differentiation according to the location of the patient's tumor as well as the cold, heat, deficiency, or excess nature of the condition. In terms of manipulation technique, the approach is to first tonify qi and then drain excess. In acupuncture manipulation, heavy pressure with light lifting constitutes the tonifying method; conversely, light pressure with heavy lifting constitutes the draining method. For cancer pain patients, after inserting the needle with heavy pressure, gentle manipulation is generally applied first to tonify the patient's deficiency, and only finally are heavy manipulation techniques used to expel pathogens. "When needling cancer pain patients, the acupuncturist must be completely focused and concentrated, gathering essence, qi, and spirit upon the needle, and correctly applying tonifying and draining manipulations — only then can the patient be relieved of suffering."