Many readers have asked my opinion of Tian Xian (pronounced dee-an-see-an), an herbal supplement and purported cancer cure that originated in China.

There are various websites selling and promoting this product (for example, tianxian.com, tian-xian.com, cancer-central.com, etc.). On many of these you will find strong warnings about counterfeit versions of Tian Xian—so it is difficult if not impossible to tell if you are getting the authentic and original Tian Xian or some phony knock-off. To confuse things further, the product is now being manufactured and sold in the USA under the name Tien Hsien liquid (tienhsien.com). In addition there are distributors in at least 15 countries, many of whom maintain their own commercial presence on the Web.

You need a scorecard to keep track of all the players, and I don't claim to have one. For the purposes of this review, therefore, I will call the product "Tian Xian" and refer to the www.tian-xian.com website as my primary source of information on the product

The company's marketing strategy strongly hinges on testimonials. There are dozens of these. Some patients claim that by taking the liquid, they were able to shrink their tumors or make them go away entirely. Some of these cases, if genuine, are truly impressive. But it is impossible to tell from many of these stories whether it was the Tian Xian that made the tumors shrink or whether some other concurrent treatment, such as radiation or chemotherapy, brought about the improvement.

Readers can judge the credibility of these testimonials for themselves. I would only caution that there are several major problems in relying on anecdotes to assess the effectiveness of cancer treatments. For example:

• Patients may misinterpret their own medical condition or history. People do not always listen carefully when they are very sick, or fully absorb what they have been told. They may not fully understand, in a dispassionate and scientific way, the natural course of their illness and its treatment. Doctors themselves may make inaccurate statements, which are then taken as dogma by the patients and their families.
  
  
• Patients may mis-state the course of their disease. They may be eager to thank those who have treated them kindly and whom they perceive to be helping them. It's only human nature to do so. But that can lead to distortions in their accounts.
  
  
• The statements of patients may be deliberately changed or distorted by others, usually for commercial purposes.
  
  
• Some testimonials may be fictitious. In the most extreme cases, these "patients" may either not exist at all, or may be paid shills. While I believe this is rare, in my 30 years in this field I have witnessed this sort of deception.
  

Even so, testimonials can be both instructive and valuable. They form a good starting point for an investigation. But in and of themselves they are NOT an adequate demonstration of the effectiveness of a new treatment, orthodox or unconventional. Establishing the effectiveness of a potential new treatment requires a considerable amount of hard work and a formidable investment of time and money. We can complain all we want about the bureaucratic hassles put in the way of true innovators. But until we have the results of laboratory studies and rigorous clinical trials we do not have reliable information on any proposed treatment.

Publications

I looked forward eagerly to reading the "publications" section of the tian-xian.com website. I anticipated substantial research results. But instead of scientific studies what I found were a number of popular books, all with garish covers, in five or six languages. Books in English included "The Cancer Terminator: The Marvellous Effects of China No. 1 Tian Xian Liquid" and "Never Ever Give Up! Survival from Cancer." Both, not surprisingly, were written by Wang Zhen Guo, the inventor of Tian Xian.

Who is Wang Zhen Guo?

According to a spokesman, "Dr. Wang Zhen Guo, the formulator of Tien Hsien Liquid from China, is the guest professor of two universities in China since 2001 till now. One is called ‘Guang Zhou University of Traditional Chinese Medicine,' and the other is called ‘Guang Xi College of Traditional Chinese Medicine.'

At his website Wang gives a rather charming picture of his early life. He says that "at my age of 18…I was undergoing practical training at the Liu Dao Gou Health Clinic in Tong Hua City in the capacity as an intern in a medical institute." This will surprise most readers, since at age 18 a would-be Western doctor is only just beginning his or her pre-medical education. We do not have an equivalent category of "intern in a medical institute," who wears a white coat and gets to treat cancer patients. Wang, who began his working career as a pig tender, was already a village herbalist when he attended the "Western" medical school in his area, the Province Tong Hua City Health School). He then had two years of training.

He claims to have received many honors since he first introduced the product in 1989. For instance, he says he received an award for the "Best Individual Invention" at the 38th Brussels Eureka World Fair for Invention. At the tianxian.com website there are pictures of him receiving awards, as well as a picture of him posing with China State Chairman Mr. Jiang Zemin. This could indicate a certain degree of government sanction for his activities. Having never heard of the Eureka World Fair for Invention, I searched for it on the Internet but came up with only a few references, almost all of which originated from various Tian Xian websites themselves.

Similarly, Wang claims to have received the "Second Annual Technology Entrepreneurs Award" in China as well as the "National Distinguished Contribution Award for Outstanding Young Professional." Searching on these terms you are again brought back to Tian Xian websites. While these awards may be significant in China this fact fails to register on Western search engines. Certainly as far as Google's search of over four billion pages is concerned, these are not internationally recognized honors.

What is Tian Xian?

The company's website says that Tian Xian is manufactured from "rare selected herbs and is produced under the strictest guidelines ensuring a product that is pure and free of contaminants." There are in fact twelve listed ingredients:

• Cordyceps (caterpillar mushroom)
• Astragalus
• Ganoderma lucidum (or reishi mushroom)
• Panax ginseng root
• White Atractylodes Rhizome (Atractylodes macrocephalae rhizoma)
• Batatatis Rhizoma (Dloscorea batatas)
• Codonopsis Root (Codonopsis pilosula)
• Patchouli Leaves (Pogostemon cablin)
• Barbary Wolfberry Fruit (Lycium barbarum)
• Pearl Powder (Margarita)
• Glossy Privet Fruit (Ligustrum lucidum AIT)
• Licorice Root (Radix glycyrrhizae)

For the most part, these are well known and well regarded Chinese herbs. Indeed, some of them have been used for hundreds of years in the treatment of cancer and other serious diseases. With traditional treatments of this sort there are usually some publications to be found in PubMed, the National Library of Medicine's international medical journal database, and indeed PubMed does have citations for articles on some of the individual ingredients listed above. However—and this is the important thing—I can find only one scientific study on the topic of Tian Xian, a recent one that concerns kanker sores in the mouth, not cancer (Sun 2004). The inventors apparently went straight from formulating this mixture to selling it directly to the public without the intervention of a single scientific study.

If the promoters are to be believed, Tian Xian has now been used by "over one million people all over the world and has had tremendous success." Again, we are thrown back on the vagaries of testimonials for proof of this "success."

What might be the harm in taking Tian Xian?

The fact that Tian Xian's ingredients are mainly herbal in nature certainly does not preclude the possibility of toxicity. Singly, the ingredients themselves are probably harmless, although I can find no evidence from Tian Xian's manufacturers that any toxicity studies have been carried out, nor it is possible to establish whether acceptable standards of purity and potency have been adhered to in the manufacturing process.

There is always the risk that people will assume that because a product is ‘natural' it is therefore harmless, and that if a little is good, more is better. Because no toxicity studies have been published there is no way of knowing how much is safe, and whether there is a possibility of interaction with other medications. There is also the risk that people will choose to treat themselves with Tian Xian instead of some more effective treatment. While I think this risk is sometimes overstated, it happens occasionally and when it does is tragic. There is nothing at the Tian Xian website to warn people against relying on this scientifically unproven remedy for a disease in which time is usually of the essence.

Then there is the matter of price. In general terms, one can hardly fault an entrepreneur for wanting to make a profit from his invention. However, the charges for Tian Xian seem excessive and the proposed price is clearly related to the cure-mongering practiced at the various websites.

Twenty-eight days' worth of so-called Super Tian Xian Liquid sells for US $1,090. But that's not the end of the possible charges. The site cautions that "for all kinds of cancer, the curative effect will be better if matched with Tian Xian Capsule (Wan) and Tian Xian Suppository." These capsules run $150 (per box of 150) and the suppositories cost an additional $80 (for a box of 12). Extravagantly, the website claims that these are "mainly for curing of cancer of esophagus, cancer of stomach, intestinal cancer, cancer of lung, liver cancer, mammary cancer, cancer of uterus, malignant lymphoma, oophoroma [i.e.,ovarian cancer], prostatic cancer, cancer of testis, cancer of urinary bladder, cancer of vagina, haemorrhoid." That's a tall order! By talking loosely of cancer "cures" in this way, patients' expectations are raised to unreasonable heights. Patients and their families are then understandably primed to fork over US $1,200 or more per month, on the basis of only the flimsiest of documentation of effectiveness.

These are my main criticisms of the Tian Xian promotion. However, I need to qualify these remarks by stating again that at least some of these ingredients are truly promising in the treatment of cancer. They were hardly invented by Mr. Wang but are part of a very ancient tradition in China, supplemented by a considerable amount of scientific research. Let me give a few examples:

Cordyceps sinensis, also called the caterpillar mushroom, is found in the highlands of China, Tibet, and Nepal, growing above 10,000 feet. Its Chinese name is dong chong xia cao. According to standard sources, a dehydrated hot water extract contains 16 percent beta glucan, 7 percent cordycepic acid and 0.2 percent adenosine.

If we search this topic in PubMed, we find the following number of papers on the following topics:

• Cordyceps 211
• Cordyceps and cancer 25
• Cordyceps and cancer (limited to clinical trials) 1

This latter paper concerns a clinical study of 36 Chinese patients with advanced cancer. The study concluded that a cordyceps-containing formula "could restore cellular immunological function, improve quality of life, but had no significant effect on humoral immunological function. The results suggested that [it] could be used as adjuvant drug in advanced cancer" (Zhou 1995). This is promising, although a far cry from the claims of cure advertised at the Tian Xian websites.

Here is a similar survey of the scientific basis for ganoderma (reishi):

• Ganoderma 301
• Ganoderma and cancer 43
• Ganoderma and cancer (limited to clinical trials) 4

The most interesting of these clinical papers, in my opinion, originated at Massey University in New Zealand. It showed that an extract of ganoderma also had a significant effect on the immune function of cancer patients. Desirable cytokines (hormone-like substances), such as IL-2, IL-6 and interferon-gamma were enhanced, whereas the "bad" or pro-inflammatory cytokines such as IL-1 and TNF-alpha were significantly decreased.

Treatment also resulted in a significant increase (approximately 8 percent) in natural killer (NK) cell activity. The authors concluded that this product "enhanced the immune responses in patients with advanced-stage cancer." (Gao 2003).

Thus, in my opinion, there is a rational therapeutic basis for including certain of the listed ingredients in this product, although the product itself is undoubtedly being over-hyped and over-priced.

Make One's Own Formula

It would be possible to put together a formula out of the more promising of these components without too much difficulty, and at a much lower price. For example, if you bought cordyceps from an ethical supplier of mushrooms over the Internet it would cost you around $25 for 90 capsules (400 mg per capsule). A typical dose is 2 to 8 capsules per day, split between morning and evening doses. At a dosage of six of these per day the cost would be around $50 per month, i.e., less than two dollars per day. Reishi is similarly priced and astragalus is even less expensive.

This might have some benefit for cancer patients. Short of true clinical trials—which we emphatically do not have—it would be hard to say for sure. It is difficult to sort out the truthful from the wildly exaggerated when it comes to herbs and cancer. I would love to see the US government sympathetically investigating claims such as this. But little is being done in that direction.

Despite my critical overview, I suspect that there is a kernel of truth to Tian Xian and that it has tapped into the great (and largely unexplored) promise of traditional Chinese medicine (TCM). However, a number of different factors have made for a situation that is fraught with danger for patients. These include a burgeoning entrepreneurial spirit on the part of the Chinese and a willingness to market unsubstantiated cures to the West; a growing number of desperate or disillusioned cancer patients willing to try almost anything; and an oncology profession that feels no sense of urgency about finding effective treatments other than those promoted by the pharmaceutical industry.

It is not a good situation. Add the Internet into this volatile mix and you have the perfect medium for the growth and proliferation of untested treatments such as Tian Xian.

Ralph W. Moss, Ph.D.

References:

Gao Y, Zhou S, Jiang W, Huang M, Dai X. Effects of ganopoly (a Ganoderma lucidum polysaccharide extract) on the immune functions in advanced-stage cancer patients. Immunol Invest. 2003 Aug;32(3):201-15.

Sun A, Chia JS, Wang WB, Chiang CP. Immunomodulating effects of "tien-hsien liquid" on peripheral blood mononuclear cells and T-lymphocytes from patients with recurrent aphthous ulcerations. Am J Chin Med. 2004;32:201-15.


Zhou DH, Lin LZ. [Effect of Jinshuibao capsule on the immunological function of 36 patients with advanced cancer] Zhongguo Zhong Xi Yi Jie He Za Zhi. 1995 Aug;15(8):476-8. Chinese.
Version #2, revised August 31, 2004.