Dissertation
Dissertation > Medicine, health > Chinese Medicine > Chinese medicine clinic > Medical records,medical words ( clinical experience )

Yu Ren- Cun Academic Thought and clinical experience in the clinical observation of combination chemotherapy in advanced gastric cancer with Yiqihuoxuejiedu side

Author HuFengShan
Tutor YuRenCun
School Beijing University of Traditional Chinese Medicine
Course Traditional Chinese Medicine
Keywords Yu Ren deposit Academic thinking Lessons Learned Internal virtual doctrine Equilibrium theory Blood doctrine Yiqihuoxue detoxification side Advanced gastric cancer Chemotherapy Clinical observation
CLC R249
Type Master's thesis
Year 2011
Downloads 29
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Professor Yu Rencun, who has been engaged in clinical research in Combination of Western Medicine and Traditional Chinese Medicine (TCM) for 40 years, is famous all over the world for profound knowledge, skillful treatment of TCM and Western Medicine, abundant experience and obvious efficacy. The unique academic thoughts and clinical experience of treatment in integrated TCM and Western Medicine have been gradually formed in practice, which made him become one of the founders and leaders in Integrated Medicine of Oncology in China.To make a comprehensive understanding of tumors, the etiology and pathogenesis is the first thing to know. According to his clinical observation of many years, based on the previous theory of exogenous pathogenic factor, diet and seven emotional factors, the theory of inner deficiency was proposed. Although exogenous pathogenic factor, diet and seven emotional factors were closely related with the ongoing and development of tumors, the inner deficiency was considered to be the key factor. Professor Yu pointed out that exogenous pathogenic factor could not invade the body to cause disease if vital energy is plenty. In contrast, deficient vital energy was unable to repel the evil, leading to its remain in the body, affecting the normal functions of viscera, channels, vital energy, blood and fluid, changing the internal environment, and causing the diseases in the end.Through many years of clinical treatment, Professor Yu has been continuously concluding and studying oncology, and he has paid a large amount of energy to study the theoretical research. He has held the view that the ongoing, development and metastasis of tumors were owing to many aspects of imbalance in the body, such as imbalances between oncogene and tumor suppressor gene, proliferation and differentiation, proliferation and apoptosis, immunity and aggression of tumor, as well as the imbalance of deficiency, phlegm, blood stasis and toxin. The theory of balance was raised and applied in clinical practice, and the intension, which meant the balance between Yin and Yang would make good spirit, was deepened. Guided by classical theory of TCM, reasonable comprehensive treatment mode has been gradually used in clinical.In modern treatment, operation, chemotherapy and radiation, as the main therapies in Western Medicine, have large influences on human bodies, especially the operation, which would cause the normal tissues and organs lost and affect more for subsequent treatment. The theory of inner deficiency guided us to pay more attention to adjusting the internal environment while eliminating the lesion was the main approach in Western Medicine. Only Chinese herbs were taken in the whole process during the perioperative period, around chemotherapy and radiotherapy period, could better therapeutic effects achieve. For clinical treatment, Professor Yu came up with four principles and four combinations. Four principles meant the combinations of syndrome differentiation and disease differentiation, vital energy strengthening and pathogens eliminating, systemic and local treatment as well as short-term therapy and long-term healthcare, while four combinations referred to Chinese herbs with operation, chemotherapy, radiotherapy and biological therapy.The states of vital energy and pathogens were paid attention to in clinical treatment. The states of vital energy were judged by the speed and level of changes, according to age, other diseases, assistant examination, treatment history, KPS and general state, while the states of pathogens were evaluated by the speed of tumor’s development and TNM, owing to the tumor’s growth, clinical symptoms, differentiation, tumor markers and related images. The theory of balance was used to guide the treatment, and the therapies were various in terms of different stages. Master the drug proportion of repelling tumor and strengthening vital energy in every stage, apply combinations of syndrome differentiation and disease different iat ion in the long run during consolidation stage, which would prolong life spans, develop life qualities and increase recovery rate in certain extent.For the diagnosis and treatment of tumors, Professor Yu applied the theory of Qi and blood, which could receive great efficacy. The applications were including the relationships between imbalance of Qi, blood, pathogenic products and clinical state. The imbalance of Qi and blood involved Qi stagnation, Qi deficiency, blood stasis and blood deficiency, while pathogenic products referred to dampness, phlegm, stasis and cancer-derived toxin. According to clinical observation, the symptoms of Qi and blood imbalance were quite common. The syndromes of Qi stagnation, Qi deficiency, blood stasis, and blood deficiency would appear after the imbalance of Qi and blood, while dampness, phlegm, stasis and cancer-derived toxin would be led to owing to this imbalance, giving rise to the growths of tumors. Different therapies would be applied according to the proportions of dampness, phlegm, stasis and cancer-derived toxin. The methods of removing dampness, dissolving phlegm, eliminating stasis and repelling toxins were utilized according to the syndromes, and strengthening treatment was performed due to the state of imbalance of Qi and blood.According to the long-term clinical observation, Professor Yu considered Qi deficiency and blood stasis to be the commonly existing syndrome for patients with tumors, especially for those in the advanced stage. A number of clinical practice followed confirmed the close relationship between Qi deficiency syndrome and dysfunctional immune system as well as endocrine disorders, while blood stasis syndrome was necessarily linked with blood coagulation abnormality, microcirculatory disturbance and blood hyper coagulabi lity. In terms of the views above, the Gu Ben Qu Yu formula (Strengthen the origins and repel the blood stasis) and Gu Ben Yi Liu formula (Strengthen the origins and repress the tumor) were developed, obtaining good clinical efficacy. Moreover, the views above were confirmed in further scientific research. Professor Yu has been the first specialist in the treatment of integrated TCM and Western Medicine, who proposed the application of strengthening vital energy and activating blood circulation to repel tumors. The view was demonstrated both in clinical and in experience, and relevant reports were gradually increased, which played a positive influence in the development of theories for the treatment in TCM.I have learned from Professor Yu for three years by participating in the fourth experience inheritance activity. During his careful training process, my work mainly focused on study, organization and heritage in order to sum up and inherit his clinical experience. A lot of cases in treating malignant tumors were collected and classified, especially the information about advanced non-small cell lung cancer, digestive cancer, including colon cancer and gastric cancer, breast cancer and gynecologic cancer. By data system of famous doctors in TCM, data code, composition and alteration of database structure, file generation, data entry and management were fulfilled. The information, including the patient’s general data, four diagnostic messages, syndrome differentiations, basic treatment, fundamental formulas, Chinese herbs, chosen index and orders of importance, were built by the system. By collecting, summing up and analyzing the information, the unique experience, academic thoughts and clinical understanding of Professor Yu’s were concluded.By the collection of large amounts of cases, the diseases, such as gastric cancer, breast cancer, lung cancer, colorectal carcinoma, liver cancer and two kinds of tumors were concluded in terms of historical evolution of the names, etiology, pathogenesis, syndrome differentiation and treatment, clinical cases and understandings. Moreover, relative diseases, such as mammary gland hyperplasia, hyperlipidemia and insomnia, were treated, which improved the quality of life. The etiology, pathogenesis, syndrome differentiation and treatment, clinical cases and understandings of these diseases were analyzed and summarized as well. The modified formula of Liu Wei Di Huang Pills was prescribed by Professor Yu to treat large quantities of patients, which acquired great efficacy. The clinical experience of the modified formula by Professor Yu was concluded by the analysis of syndrome differentiation and treatment combined modern pharmacology and clinical cases. According to the analyses for all kinds of diseases mentioned above, I strove for the conclusions of clinical experience for the treatment of tumors by Professor Yu.The innovation of my research was the add it ion of the herbs with the function of clearing away toxins for the treatment of tumors, based on the strengthening vital energy and activating blood circulation method in the past, which was particularly adaptable to the patients with tumors in advanced stage, the syndrome of which was Qi deficiency and blood stasis, with toxin accumulation. According to the clinical research, for patients suffering from gastric cancer in advanced stage, the Chinese herbs of strengthening vital energy, activating blood circulation and clearing away toxins could alleviate blood hypercoagulability, increase immunity and develop qualities of life. The formula could not only replenish vital energy and blood, but also activate blood circulation and repel stasis, as well as suppress tumors, without obvious adverse reaction, which were reasonable and essential to utilize for gastric cancer in advanced stage. The herbs should be prescribed according to types of the disease, related viscera, proportion of Qi deficiency and blood stasis. In lights of clinical research, the conclusions were that the dosage of strengthening vital energy should be more than that of activating blood circulation and the best proportion was from 7:3 to 6:4, and with the herbs of clearing away toxin, the formula could increase alleviating rate of clinical symptoms, receive quick effectiveness, attain great efficacy and develop life qualities of the patients. Objective:Observe the clinical efficacy for gastric cancer in advanced stage by the formula of replenishing vital energy, activating blood circulation and clearing away toxin plus chemotherapy.Methods:The 102 qualified cases of gastric cancer in stage IV were randomly divided into chemotherapy plus Chinese medicine group and simple chemotherapy group. The regimen of XELOX was adopted in simple chemotherapy group, while the formula of replenishing vital energy, activating blood circulation and clearing away toxin was taken a dose each day with chemotherapy in chemotherapy plus Chinese medicine group. The therapeutic effects were evaluated, including the size of the tumor, the adverse drug reactions involving WBC, Hgb, PLT, functions of liver and kidney, routines of blood and urine, ECG and neurotoxicity, the syndrome of Qi deficiency and blood stasis, the quality of life, the coagulation index and immunity index, when the trial was finished.Results:When the trial was finished, there were 51 effective cases for statistical analysis in chemotherapy plus Chinese medicine group,48 cases in simple chemotherapy group. The results were shown below.First, for the clinical curative effect, the effective rate and beneficial rate were 31.37% and 60.78% respectively in chemotherapy plus Chinese medicine group, whi le 25.00% and 41.67% were respectively revealed in simple chemotherapy group. The effective rate in chemotherapy plus Chinese medicine group was slightly higher than that in simple chemotherapy group, but the difference between the two groups was not obvious (P>0.05). But the beneficial rate in treatment group was obviously higher than that in control group, showing obvious difference (P<0.05). It showed that the effective rate was similar between the two groups, while the beneficial rate in the treatment group was improved significantly.Second, for the relative adverse drug reactions, in the aspects of Hgb, PLT, functions of liver and kidney, routines of urine and stool, ECG and neurotoxicity, there was no obvious difference between the two groups after treatment (P>0.05). The decrease of white blood cells in chemotherapy plus Chinese medicine group was obviously slighter than that in simple chemotherapy group, the difference between the two groups was obvious (P<0.05). It showed that the Chinese herbs in treatment group could relieve chemotherapy-induced toxicity.Third, concerning the change of symptoms of the Qi deficiency and blood stasis syndrome, the difference of symptom integrations before treatment in both groups was not obvious. After treatment, however, the symptom integration in chemotherapy plus Chinese medicine group was obviously lower than that before treatment, showing obvious difference (P<0.05), while the integration was slightly higher than that before treatment in simple chemotherapy group, showing no obvious difference (P>0.05). The syndrome score in chemotherapy plus Chinese medicine group was obviously higher than that in simple chemotherapy group, showing significant difference (P<0.01). It showed that the Chinese herbs in treatment group could alleviate the symptoms of Qi deficiency and blood stasis syndrome.Fourth, as far as the quality of life was concerned, the KPS was higher after treatment in treatment group, showing obvious difference (P<0.05), the score of which was slightly lower after treatment in simple chemotherapy group, showing no obvious difference (P>0.05). But the difference for the KPS between the two groups was obvious (P<0.05). It showed that the formula of replenishing vital energy, activating blood circulation and clearing away toxin plus chemotherapy could improve the quality of life.Fifth, in terms ofthe coagulation index, the results of FIB and FDP after treatment were improved in treatment group, showing obvious difference (P<0.05). And the results of TT, PT, FIB, APTT, D-D and FDP in control group after treatment showed no obvious difference. While after treatment, the results of FIB and FDP in treatment group were improved, showing obvious difference (P<0.05) between the two groups. It showed the adoption of the formula of replenishing vital energy, activating blood circulation and clearing away toxin could alleviate blood coagulation.Sixth, in lights of immune index, NK cell activity and CD4/CD8 were improved after treatment in treatment group, showing obvious difference (P<0.05), and the NK cell activity and CD4/CD8 after treatment in simple chemotherapy group showed no obvious difference (P>0.05). While after treatment, the results of NK cell activity and CD4/CD8 in treatment group were improved, showing obvious difference (P<0.05) between the two groups. It showed that the Chinese herbs in treatment group could improve the immune function. Conclusion:The formula of replenishing vital energy, activating blood circulation and clearing away toxin combined with chemotherapy for treatment of advanced gastric cancer, can enhance short-term efficacy and reduce some side effects, alleviate the symptoms of Qi deficiency and stasis syndrome, improve quality of life, immune function and coaulation index, which indicates that this formula combined with chemotherapy has the functions of improving effects and decreasing toxicities

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