Lung cancer is one of the most important malignant tumors that seriously endanger human life and health. It is the most important cancer in the world both in terms of incidence (1.2 million/year) and death (1.1 million/year), and the trend of lung cancer is increasing year by year, which brings a heavy burden to the society. How to improve the treatment effect of lung cancer has become a medical problem that needs to be solved urgently. Modern medical methods such as surgery, radiotherapy, chemotherapy and molecular targeted drugs have certain efficacy in treating lung cancer, but they all have their own shortcomings. Chinese medicine has its own characteristics and advantages in the treatment of lung cancer, and it is playing an increasingly important role in the treatment of lung cancer. The experience of Chinese medicine in the treatment of lung cancer is described as follows.
1. Detailed examination of etiology and disease mechanism
Lung cancer belongs to the category of “lung accumulation” and “ben” in Chinese medicine, and the name of lung cancer is not found in ancient Chinese medical literature, but there are records of similar lung tumors. For example, the earliest extant medical text in China, Su Wen? The Treatise on Strange Diseases” mentions that “the disease is full under the duress, and the qi is rebellious for two or three years. …… The name of the disease is rest and accumulation.” Before the Eastern Han Dynasty, the medical book “Difficult Classic? Fifty-six difficulties” said: “the lung of the accumulation of the name is called Xiben, in the right under the ribs, covering as large as the wai, long does not stop, people sprinkle cold and heat, wheezing and coughing, hair lung congestion.” Southern Song Dynasty medical book “Jisheng Fang” also clouded: “the shape of Xiben, in the right under the ribs, covering as large as the wai, panting and running overflow, is the lung accumulation: diagnose its pulse floating and hairy, its color white, its disease gas rebellion, back pain and less gas, happy to forget the eyes all night, skin cold, skin swelling when pain, or like the edge of the lice, or like needles.” All these descriptions are very similar to the clinical manifestations of lung cancer. The occurrence of lung cancer is more closely related to the deficiency of positive qi and the invasion of evil toxins. Internal deficiency of positive qi and imbalance of yin and yang in the internal organs are the main basis for the development of this disease, while smoke poisoning, mountain miasma, industrial waste gas and ore dust are the common causes of this disease. The lung is a delicate organ, which is easily attacked by evil and poison, resulting in a loss of lung qi purification and lowering; stagnation and failure to promote the blood vessels and veins, stagnation of qi and blood, and the interconnection of poison and stasis, resulting in lumps. “Phlegm”, “stasis” and “deficiency” are the basic pathological mechanisms of lung cancer, which run through the whole course of the disease. As stated in “Miscellaneous Diseases Source and Stream Rhinocandle”, “Evil accumulates in the chest, obstructs the airway, the air is not pronounced, it is phlegm …… for blood, all the evil is fighting with the positive, the evil is winning, the positive is not allowed to control it, so the mass is formed.” The author has observed the TCM evidence of 120 patients with advanced non-small cell lung cancer, and the results showed that 109 patients showed deficiency evidence of different degrees, accounting for 90, 83%; 73 patients showed phlegm evidence, accounting for 60, 83%; 72 patients showed blood stasis evidence, accounting for 60, 00%. It is confirmed that the occurrence and development of lung cancer can be highly summarized by the three words “phlegm”, “stasis” and “deficiency”.
2. Adhering to evidence-based treatment
Discriminatory treatment is the process of applying theory, method, prescription and medicine in clinical practice, which is the basic feature and essence of Chinese medicine. In the treatment of lung cancer, we should also strictly abide by the principle of treating with evidence. After years of research and exploration, we have divided lung cancer into four main types as follows.
(1) Lung heat and phlegm stasis
(1) Lung heat, phlegm and stagnation: cough, coughing, chest tightness, shortness of breath or back pain in the chest and ribs, blood in the phlegm, constipation. The tongue is dark red, with yellow or white greasy coating and a stringent pulse.
Treatment: Clearing the lung and removing phlegm, resolving blood stasis and dispersing knots.
Main recipe: Reed Stem Soup (Thousand Gold Essentials) combined with Peach and Red Four Things Soup (Medical Jinguan) plus and minus.
Drugs: 30g of reed stem, 30g of winter melon seed, 30g of coix seed, 9g of peach kernel, 6g of safflower, 12g of red peony, 9g of angelica, 15g of Chuanxiong rhizome, 30g of raw groundnut. In case of phlegm stagnation and heat, add Yinhua, forsythia and scutellaria; in case of chest and ribs distension and pain, add whole guavas, yanhuosuo and heliotrope.
(2) Spleen deficiency with phlegm and dampness
Main symptoms: cough with phlegm, chest tightness, dullness, fatigue, shortness of breath, abdominal distension, loose stools. The tongue is pale and fat, with tooth marks on the sides, white and greasy coating, and moist and slow pulse.
Treatment: Strengthening the spleen and dispelling dampness, resolving phlegm and dispersing knots.
Main recipe: Six Gentlemen’s Son Soup (“Good formula for women”) plus or minus.
Drugs: Radix Codonopsis pilosulae 15 g, Poria 15 g, Atractylodes macrocephala 15 g, Chen Pi 6 g, Fuxia 9 g, Platycodon grandiflorus 6 g, Zhe Bei 15 g, Shou Gong 6 g, Cat’s Claw 15 g, Quan Gua Zhu 15 g, Roasted Licorice 6 g. For Qi deficiency and asthma, add Radix et Rhizoma ginseng, Cordyceps sinensis, and Conchia sinensis; for phlegm-heat loving the lung, add Fishocephalus and Scutellaria.
(3) Yin deficiency and phlegm-heat
Main symptoms: cough with little phlegm, or dry cough without phlegm, blood in the phlegm, chest catarrh, shortness of breath, sleeplessness, dry mouth, constipation, hot flashes and night sweats. The tongue is red, with little or thin yellow coating and fine pulse.
Treatment: Nourishing the kidney and clearing the lung, expelling phlegm and dispersing nodules.
Main recipe: Baihe Gujin Tang (Collection of Medical Formulae) plus and minus.
Drugs: Lily 15g, Radix et Rhizoma 15g, Radix Rehmanniae 15g, Radix Medlar 15g, Radix et Rhizoma Ginseng 15g, Radix Angelicae Sinensis 9g, Radix Paeoniae Alba 15g, Radix et Rhizoma Zhejiang 15g, Radix Platycodon 6g, Radix et Rhizoma Glycyrrhizae 6g. If coughing up blood is very bad, add Phellodendron leaf, Cyperus rotundus and Bletilla; if the five hearts are troubled and hot, add Zhi Mu, Dan Pi and Huang Bai; if the mouth is dry and wants to drink, add Pollen and Tian Dong; if the stool is dry, add Fire Ma Ren and Cyperus seed.
(4) Qi and Yin deficiency
Main symptoms: cough with little sputum, low cough sound, blood in the sputum, fatigue, shortage of breath, dry mouth without drinking. The tongue is red, the coating is thin, and the pulse is weak or fine.
Treatment: Benefit Qi and nourish Yin, resolve phlegm and disperse knots.
Main recipe: Shengwen San (Discussing Confusion in Internal and External Injuries) plus and minus.
Drug: Prince’s ginseng 30g, Mai Dong 15g, Wu Wei Zi 9g, Huang Qi 30g, Tian Dong 15g, Lily 15g, Zhe Bei Mu 15g, Bei Almond 15g, Shan Ci Gu 9g, Xian He Cao 15g. For those with blood in the sputum, add Bletilla, Flos Daturae and Panax ginseng; for those with chest and back pain, add Yanhuosuo, Citrus aurantium and Yujin; for those with high fever that does not subside, add Buffy’s horn, Baiwei and Zixue Dan.
3. Identify the deficiency and the actuality to determine the attack and supplementation
According to the changes of body condition and cancer tumor, the process of fighting between evil and positive can be roughly divided into three stages, namely, early, middle and late stages. For example, in the “Essential Reading for Medical Practitioners? It is said in the chapter of “Gathering”: “The positive and the evil are not mutually exclusive, if they are low, one victory is one loss, the evil is growing day by day, the positive is being cut day by day, if they are not attacked, the death will come from and on! However, the attack is too fast, the righteousness of the injury, the end of the three methods of middle school must not be said. The beginning of the disease is still strong, the evil is still shallow, it is subject to attack; the middle of the disease for a long time, the evil is deeper, weaker, it is subject to attack and supplement; the end of the disease demon after a long time, the evil encroachment, the righteousness of the residual, it is subject to supplement. Cover the accumulation of the righteousness, day by day, month by month, not Yi dynasty, so to go, there should also be gradual, great urgency is wounded right qi, right qi injury can not be transported, and the evil anti-solid carry on.” From here we can find that the staging criteria of TNM in modern medicine and the staging in Chinese medicine are not exactly the same, they represent different meanings respectively. The reason for this is that the staging referred to by the former is decided according to the size of the tumor, the presence or absence of lymph node metastasis, and the presence or absence of distant metastasis, and is based on the tumor as the main object of observation, while the staging in Chinese medicine is decided according to the mutual condition of the body’s positive energy and evil energy in the process of disease development, and is based on the body as the main object of observation. The treatment should be based on supporting and cultivating the root of the disease, and the treatment should be based on both attack and supplement.
4. To support positive energy, we should pay attention to protecting the spleen and stomach, and to eliminate phlegm and blood stasis.
As mentioned above, deficiency of positive energy plays a very important role in the development of malignant tumors. As mentioned above, deficiency of positive qi plays a very important role in the development of malignant tumor. In the book of “The Essential Reading of Medicine”, it is said that “the cause of accumulation is the deficiency of positive qi and then the entrenchment of evil qi. Lung cancer is a disease caused by deficiency, which leads to actuality. It is a disease in which the whole body is deficient and the local area is actual, in which spleen deficiency plays a key role in the occurrence of tumor. Among the 120 patients with advanced non-small cell lung cancer observed by the author, 109 patients showed different degrees of deficiency, and 75 of them had spleen deficiency, accounting for 62.50% of all patients. According to Chinese medicine, the spleen is the source of phlegm production and the lung is the reservoir of phlegm. The function of the lung is to produce the main qi, and the respiration of the lung is mainly dependent on the inhalation of the lung and the combination of the water and grain essence of the spleen and stomach. The spleen is the source of the body’s qi and blood. The function of the lungs depends on the spleen to transport fluid and disperse essence in the lungs, which is not only a prerequisite for the lungs to regulate water channels, but also provides the necessary nutrients for the physiological activities of the lungs. If spleen qi is weak, spleen loses its health, fluid metabolism is impaired, and water is stagnant, phlegm will be produced and drink will be produced, which will affect the propagation and purification of lung, furthermore, blood will stop and become stasis, stasis of blood will become internal, phlegm and stasis of internal obstruction, which will accumulate in lung and develop into lung cancer. Therefore, Zhang Jinyue said, “People with deficiencies in the spleen and kidneys and those with weaknesses and disorders have accumulated diseases.” The Treatise on the Spleen and Stomach even suggests, “All diseases are born from the failure of the spleen and stomach.” Therefore, when treating lung cancer, special attention should be paid to regulating the spleen and stomach.
Chinese medicine has always believed that the occurrence of malignant tumors is closely related to phlegm and stasis. Phlegm travels with qi in the body and is nowhere to be found. Phlegm has the characteristics of retention and stagnation, and its pathogenic nature is characterized by stagnation, fluidity and diversity, so the ancients believed that “stubborn phlegm produces all diseases” and “all diseases are mostly caused by phlegm”. Zhu Danxi even clearly put forward “phlegm as a thing, with the Qi lift, nowhere to go”, “all people with lumps in the middle and lower body, mostly phlegm” thesis. In terms of blood stasis, Sli Shou’s “Difficult Classic Benyi” of the Yuan Dynasty says: “accumulation is also said to be a disease caused by the accumulation of blood vessels.” The “Ming Medical Guide” points out: “If the circulation of the human qi circulates around, the veins are clear and smooth circulation, how can there be tumor problems also ……” “Twelve kinds of medicine” says: “The disease of choking and diaphragm, there must be stasis.” In the Qing Dynasty, Wang Qingren’s “Medical Forest Correction” emphasizes, “The lump in the belly and abdomen must have a form of blood.” All these indicate that phlegm and blood stasis are important pathological mechanisms in the formation of cancer, and phlegm and stasis are pathological products of lung cancer on the one hand and pathogenic factors of lung cancer on the other. Therefore, the method of removing phlegm and stasis is one of the main methods to treat lung cancer. In my unit, 124 cases of advanced non-small cell lung cancer were treated with the method of removing phlegm and stasis. No change (NC) or stable (SD) was 84 cases (67, 7%) and progressive (PD) was 40 cases (32, 3%). The survival rates at 1, 2, 3, 4 and 5 years after treatment were 56%, 32%, 16%, 8% and 3%, respectively, which achieved good clinical efficacy. Commonly used drugs to dissolve phlegm and disperse knots include zhebeimu, guajia, raw semen, raw nanxing, mountain conch, cat’s claw grass, Xiaquocao, etc.; commonly used drugs to activate blood circulation and eliminate stasis include peach kernel, curcuma, trigon, panax notoginseng, etc.
5.Pay attention to the combination of disease identification and evidence identification
Discriminatory treatment is the basic feature of Chinese medicine and the essence of Chinese medicine in treating diseases. Like other diseases, Chinese medicine treatment of malignant tumor should also be based on the four diagnoses and eight principles of Chinese medicine, as well as the principles, methods, prescriptions and medicines. However, due to the special pathological and biological characteristics of lung cancer, TCM treatment of lung cancer should be based on the principles and principles of evidence-based treatment and combined with disease-based treatment to improve the clinical treatment effect. Combining evidence-based treatment with disease-based treatment, that is, identifying the disease while identifying the evidence, combining the traditional theories and experiences of Chinese medicine for many years, and selecting drugs with proven anti-cancer efficacy for treatment according to the nature, taste, efficacy and clinical application characteristics of drugs. A lot of clinical practice proves that the combination of evidence-based and disease-based treatment can often achieve better results in the treatment of malignant tumors, which is based on scientific evidence. Only with proper combination of disease identification and evidence-based treatment can we obtain better clinical effects. The commonly used herbal medicines for identifying disease in ovarian cancer include Shou Gong, Shan Ci Gu, Sheng Nan Xing, Sheng Han Xia, Cat’s Claw, Shan Hai Si, Coix Seed, Curcuma longa, August Zha, etc. The commonly used Chinese patent medicines for identifying disease include Heshan Tablets, Xi Huang Wan, Eleutherococcus lactis injection, Kang Leite injection, etc. However, it should be noted that there are many disease-specific drugs with certain toxicity, and the correct concoction method, dosage, contraindication and route of use should be noted in clinical use.
6.Case introduction
Tan Moumou, male, 67 years old. He was admitted to Singapore in November 1996 with recurrent cough and sputum, and his chest CT indicated an occupying lesion in the right upper lung, and bronchial fibrinoscopy biopsy showed a moderately differentiated squamous carcinoma. He was diagnosed as right upper lung squamous carcinoma (T4N0M0, stage IIIb). The patient requested TCM treatment and came to our hospital. At the first consultation, she had a cough, sputum, which was white in quantity and thick in quality, poor appetite, and no other special discomfort. He was diagnosed with lung accumulation and identified as spleen deficiency, phlegm and dampness. The treatment is to strengthen the spleen, benefit the qi and disperse the phlegm. After two weeks of treatment, the patient complained of cough, sputum and other symptoms were significantly reduced, and his appetite improved, so he continued the treatment with the above formula plus reduction, together with oral intake of Heshan tablets and regular intravenous injection of eleuthero milk injection.