Supporting Cancer Management : Conceptual Framework TCM

Prof. Yunming •••
Nanjing Medical University Affiliated Hospital of Yangzhou (Yangzhou, China 225009)

Preface
§ Chinese medicine treatment of cancer has a long history § the ancient chinese Oracle already has a record of "tumor" the ancient Chinese Medical script "Huang Di Nei Jing" already have specialised doctors and tumor classification for 2000 years TCM has abundant experience in clinical cancer practice

§ A historic breakthrough in the past 60 years is the Integrate theory and method of conventional medicine with TCM § Modern experimental methods (from the system to the tissues and organs, cells, molecular level) § Evidence-based medicine approach Evidence§ Innovation in traditional Chinese medicine as the concentrated herbal granules

The characteristics of traditional Chinese medicine - Has their own theoretical system - Emphasis on human internal factors - Mainly Using natural medicines (herbal, animal drugs, mineral drugs, etc.) and combination with acupuncture theraphy, pshycotherapy, dietotheraphy, exercise therapy, etc.

1 .Classifications of Types of adjuvant therapy for tumors of Chinese medicine
§ Features: - Reducing surgery, radiotherapy, chemotherapy side effects - Enhanced the sensitivity of chemotherapy, and radiation - Many reasons for inoperable lesions, radiotheraphy, chemotheraphy, the patients administered with TCM can improve living quility, prolong survival rate

1 several categories of Chinese medicine treatment of cancer
§ 1.1 clearing away the heat-evil and toxic materials 1.1 heatex: herba taraxaci ( Pu Gong Ying• Ying• rhizoma smilacis glabrae (Tu Fu Ling)

1 Several categories of Chinese medicine treatment of cancer
§ 1. 2. dissipating a mass

1 Several categories of Chinese medicine treatment of cancer
1.3 supporting healthy energy and building up foundation

1 Several categories of Chinese medicine treatment of cancer
1.4. 1.4. Activating blood circulation to dissipate blood statis

1.1. Several categories of Chinese medicine treatment of cancer
§ Mechanism: -Anti-tumor activity Anti(directly terminate cancer cells) -Regulate the immune function -Regulate metabolism (autonomic, endocrine) -Promote tumor cell differentiation -Inhibit tumor thrombus formation

Several categories of Chinese medicine treatment of cancer
§ Cruciality of efficacy - Diagnosing the individual indications - Drug combinations Framework - Dose administration - Accumulated doctors experience and basic theories of TCM

2. Methodes of integrated TCM and conventional medicine on cancer treatment
2.1. Combination of surgery and TCM 2.1.1. Pre-operative : Objective: to improve Prethe physical condition and create better conditions for surgery

§ 2.1.2. post-operative recovery 2.1.2. postObjective: To promote tissue repair, adjust bodily functions to deal with complications -, to improve post-operative gastrointestinal postdysfunction -, regulate autonomic nerve function: postpostoperation sweating, sweating after movement. -, regulate water and electrolyte disorders: in gastrointestinal surgeries, especially those with fistula formation, a large number of digestive juice is lost.

2.1.3 Long-term post-operative treatment Longpost2.1.3.1. early stage, radical surgery, without radiotherapy or chemotherapy may be pure traditional Chinese medicine treatment, long-term follow-up. longfollow2.1.3.2. patients who need chemotherapy and radiotherapy , TCM herbal may reduce side effects, increased efficacy( ex: lung cancer IIB T2 N1M0) 2.1.3.3. after surgery for various reasons can not accept chemotherapy, radiotherapy , may have a long-term longmaintenance treatment of traditional Chinese medicine to improve the quality of life and prolong survival time

2.2. Chinese medicine combined with chemotherapy and radiotherapy 2.2.1. The clinical problems faced by chemotherapy and radiotherapy -Toxicity: skin and mucous membrane radiation damage and nerve injury, pneumonia and pulmonary fibrosis, colitis and digestive tract ulcers, cystitis; gastrointestinal response to chemotherapy, bone marrow suppression, immune suppression, neurological damage, organ damage and skin, hair damage and so on.

2.2.1. The clinical problems faced by chemotherapy and radiotherapy -Desensitization and drug resistance: radiationradiation-induced tumor blood supply shortage, hypoxic tumors cells on the radiation induced multi-drug resistivity multiresistance (MDR) and so on.

2.2.2. TCM reduces radiation toxicity - Prevention and control of radiation-induced radiationskin reactions and ulcers: - Treatment of radiation proctitis and - Radiation cystitis;

2.2.3. TCM reduces chemotherapy toxicity -Reduces Chemotherapy induced gastrointestinal reactions (nausea, vomiting, poor appetite, abdominal distension, etc.; -Improve the bone marrow suppression; -Reduce nerve injury

2.2.4 Mechanisme of TCM synergistic effect to chemotherapy and radiaotheraphy -Mechanisme :
- Reversal of multidrug resistance (MDR) - Affecting the cell cycle distribution - Improve the tumor surrounding tissue and tumor microcirculation:

2.2.4 2.2.4. Researches Result of Synergistic effect of TCM to chemotherapy and radiotherapy - Research results Over the years, in TCM to enhance tumor chemotherapy and radiotherapy effects, our clinical and experimental studies have conducted extremely broad, deep and intriguing results. Here are some of the introduction.

Experimental data (1) Beijing Chinese Medicine Hospital with building up healthy energy and activating blood circulation and dissipate blood statis, combined with chemotherapy, not only reduced chemotherapy side effects, but also improved the successful completion rate of chemotherapy (treatment group completed the rate of 79.59% in the control group 52.63, P <0.05, statistically significant differences), and also improved the cancer patient's blood hypercoagulability, improved cellular immune function in patients: compared to chemotherapy alone, there are obvious advantages;

§ Data (2) Liu Jiaxiang, etc. with the formula "anti"anti-tumor Yifei Yin" Treatment of 271 cases of non-small cell lung cancer, non§ group 1: "anti-tumor Yifei Yin“group: "anti§ group 2: "anti-tumor Yifei Yin" plus "antichemotherapy group, § group 3: chemotherapy group, randomized controlled.

the results showed : A. TCM group and TCM plus chemotherapy group was significantly superior to chemotherapy group. B. TCM group and TCM plus chemotherapy group significantly inhibit metastasis of lung cancer in stage III. C. TCM group 1,2,3,5-year survival rates were 73.21%, 33.06%, 1,2,3,513.96% and 11.17%, with a median survival time of 406 days; 11.17% D. TCM plus chemotherapy group 1,2,3,5-year survival rates were 1,2,3,573.24% and 40.54%, 52.04% and 18.43%, the median survival 52.04% 18.43% period 449 days E. Chemotherapy group 1,2,3,5-year survival rates 39.03% and 1,2,3,511.06%, 35.78% and 0%, the median survival period 267 days. Has 0% significant statistic diferences. F. The result Showed that anti-tumor Yifei can prolong survival and antiimprove life span, improving symptoms and quality of life, combined with chemotherapy for lung cancer significantly attenuated the synergistic effect.

§ Data (3) the author himself in Nanjing University of Traditional Chinese Medicine Hospital with Astragalus, Ganoderma lucidum etc in formula "Rectifying Xiaoliu" combined with chemotherapy for 69 cases diagnostically confirmed by pathology or CT examination as advanced cancer patients were randomly divided as treatment group and the chemotherapy control group, § treatment group, the effective (CR + PR) is 31.58% in the control group effective rate was 22.58%, statistically significant differences (P <0.05 ). Immune function before and after treatment is seen in the table below:

Comparison of immune function in both groups before and after treatment (X ± S)
group time T L c T R(%) 49.38±4.02 53.72±5.28•• N K c A(%) 9.39±4.38 12.71±4.71••

TCM before Plus after chem o chem Before o after

47.59 ±0.61 49.81±3.51•

9.34±4.66 10.21±5.57•

Compared with TCM plus chemotherapy group : before treatment, •P <0.01; compared with chemotherapy group after treatment ,compared to • P <0.01; Compared with chemotherapy group before treatment, € P> 0.05

§ Data (4) Beijing Guang An Men Hospital, observed 669 cases of advanced gastric cancer patients with "Jianpiyishenfang powder" (from Codonopsis, Atractylodes, Ligustrum lucidum, etc) into the attenuated toxicity effect of chemotherapy, suggesting that usage of the formula can elevate patients chemotherapy complition rate to 94.44 percent, while chemotherapy alone is only 73.73%. Gastrointestinal reactions, systemic reactions, blood and immune indicators shows that the former are better than the latter, followed up 303 cases, the 1,3,5,10-year survival 1,3,5,10rates were 99.01%, 77.31%, 53.40% and 47.37%.

2.3 TCM Research on anti-metastasis and antiantiantirecurrence
2.3.1. Known TCM ways to prevent recurrence and anti-metastasis antimechanisme -Antimutagenic -Direct cytotoxicity -Immunoenhancement -Inhibit tumor cell proliferation, induction differentiation of cells tumor -Induced apoptosis of tumor cells -Affecting telomerase activity - Inhibit tumor angiogenesis

2.3.2 Anti-recurrence and metastasis Antiof research results
Data (1) Yang Guo Wang using Chinese herbal compound, "Guben Xiaoliu Capsule" in research of Inhibition of mouse Lewis lung cancer growth and anti-angiogenesis antiresearch found that: there is significant resistance effect to mouse Lewis lung cancer, neovascularization generation

2.3.2 TCM anti-metastatis and recurrance antisuppression research results
Data (2) Xu Ling and friends, with "Yi Fei anti-tumor” anticompound ( astragalus, North Adenophora, winter days, Ligustrum lucidum, etc) in the treatment of 45 cases of lung cancer stage • , and TCM plus chemotherapy group 22 cases and chemotherapy group 27 cases as control group, 3 months later the metastatis rate is respectively 13 cases, 5 cases, and 17 cases. indicates that TCM, TCM plus chemotherapy group effect in stabilising lesion, suppression of distant metastasis was superior to chemotherapy group (P <0.05 and 0.01), while increasing natural killer cell activity in patients, OKT3, OKT4 value.

2.3 TCM Research on anti-metastasis and antiantianti-recurrence
Data (3) In experimental studies, it is observed that fermentation of natural Cordyceps sinensis and water extract fermentated Cordyceps sinensis has significantly inhibited subcutaneous transplanted Lewis lung cancer local growth and spontaneous lung metastasis. Probably caused by Chinese caterpillar fungus that regulates immune function; Rhizoma cnidi with the active ingredients TMP significantly inhibited melanoma cells C57/BL6 in the mice spontaneous lung cancer metastasis.

2.3 TCM Research on anti-metastasis antiand anti-recurrence antiData (4) Lin Hongsheng reported,with the Chinese herbal compound lung cancer inhibitor 2 , with high, medium and low-dose lowrespectively inhibited Lewis lung cancer metastasis rates as 39.7%, 54.6%, 64.1%, as compared with the control group were significantly different (P <0.05 and 0.01).

2.4. TCM Research of long term extending survival rate results
TCM goal to treat malignant tumors are not limited by reducing tumor size, In recent years, along with molecular targeted therapies in clinical application, the length of survival as the efficacy evaluation is more and more attentive.

2.4. TCM Research of long term extending survival rate results
§ Data (1) Guo-Rong Chen reported for non(1 Guononsmall cell lung cancer, TCM plus chemotheraphy treatment group, 60 cases , and chemotherapy control group, 60 cases, § Results of the treatment group: CR + PR 58%, with a median survival period of 19 months , while the control group was only 35 %, and 10 months.

§ Data (2) Yu Guiqing observed 669 cases of (2 advanced gastric cancer with "Jianpiyishenfang powder" (radix Codonopsis pilosulae, Atractylodes, Ligustrum lucidum, etc) combined with chemotherapy, 303 cases of long-term followlongfollowup , the 1,3 , 5,10-year survival rate reached 5,1099.01%, 77.31%, 53.4%, 47.37%.

§ Data (3) Zhou Jianhua with "Nourishing Yin and (3 Yang Wei Fang" compound (radix adenophorae herba Dendrobium, rhizoma dioscorea batatis,rhizoma curcumae, radix Ophiopogonosis, Polygonatum, etc) combined with radiotherapy in 85 patients with esophageal cancer patients . And 50 cases of radiotheraphy as control, the results showed of treatment group 1,3,5-year survival 1,3,5rates were 74.12%, 30.16%, 21.05% , while the control group 44%, 22.27%, 0%.

3. The strengths and limitations of Chinese medicine on cancer treatment
§ 3.1 The advantages of Chinese medicine to treat cancer A, emphasises on "the whole body concept", focusing on tumor with the patients body as part and the overall relationship, starting the antianti-cancer from the regulation of homeostatis environment B, Less toxicity effects, wide indications C, on the Western radiotherapy, chemotherapy, interventional therapy has attenuated synergistic effect; D, has abundant methodes for anti-metastasis and recurrence antiE, can improve symptoms, improve quality of life and prolong survival; F, right precancerous lesions have some preventive effect.

3.2 The limitations of Chinese medicine to treat cancer A, weak effect of partial debridement B, although according to specific diagnostic treatment is difficult to adjust the specific indicator, mainly rely on TCM theory and doctor’s experience effects between different individuals is various; C formula are complicated, the determination of active ingredients is relatively difficult.

Summary
TCM can assist the conventional treatment as complimentary means on oncology, in tumor prevention and treatment has very broad prospects, and we look forward to more Western medical experts and Chinese medicine experts to join hands. to do more international cooperation, in order to effectively control the malignancy of human cancer.

Thank you!
•••

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