Pancreatic cancer is a malignant tumor of the gastrointestinal tract that is highly malignant, difficult to diagnose and treat, and about 90% of them are ductal adenocarcinomas originating from the epithelium of the adenohypophysis. Its morbidity and mortality rates have increased significantly in recent years. 5-year survival rate is <1%, and it is one of the malignant tumors with the worst prognosis.
The diagnosis rate of pancreatic cancer in early stage is not high, the surgical mortality rate is high, and the cure rate is very low. Progressive pancreatic cancer is often accompanied by pain, jaundice, nausea, vomiting, cachexia and other symptoms, which bring great pain to patients. Therefore, improving patients’ quality of life and prolonging survival are still the primary objectives of pancreatic cancer treatment.
The comprehensive treatment of pancreatic cancer includes surgery, radiotherapy, chemotherapy, minimally invasive treatment, biological treatment, Chinese medicine treatment and other treatments. As one of the main treatments for pancreatic cancer, TCM therapy can not only significantly improve the symptoms, but also destroy and inhibit the tumor. My experience in treating pancreatic cancer with TCM is summarized below for the reference of my colleagues.
I. The main pathogenic mechanism of pancreatic cancer is the deficiency of liver and Yang, and the presence of heat in the cold and dampness.
Pancreatic cancer is called “Fuliang” in ancient times, and the etiology of Fuliang in classical Chinese medical literature is mostly considered to be poor qi flow and spleen-dampness. The cause of pancreatic cancer is mostly due to depression of the seven emotions, or dietary disorders, resulting in damage to the liver and spleen, loss of harmony between the internal organs, obstruction of spleen movement, internalization of damp-heat and internal stasis of toxins. If treatment from spleen and damp-heat can only improve some of the symptoms but not eliminate the tumor, the effect is not ideal.
The idea came from a 68-year-old male pancreatic cancer patient I treated, who had 1-2 bowel movements per day before chemotherapy, but had diarrhea nearly 20 times per day after chemotherapy with gemcitabine, often in his pants, which was unbearably painful, and ineffective with licorice diarrhea heart soup and Ge Gen scutellaria soup. The main symptoms of pancreatic cancer were found to be consistent with the syllabus of syncope, after which he was treated with Wu Mei Wan with good results.
In order to study the relationship between pancreatic cancer and syncope, we retrospectively investigated more than 100 cases of pancreatic cancer patients with definite diagnosis admitted to our hospital since six years, and explored whether there was any correlation between clinical symptoms and stage, clinical symptoms and site. The results suggest that the first symptoms and consultation symptoms of pancreatic cancer patients are more or less the same, which are epigastric fullness and discomfort, epigastric pain, poor appetite, emaciation, jaundice, back pain, shoulder and back pain, weakness, diarrhea, constipation, nausea and vomiting, abdominal mass, dry mouth, and fever.
Among these symptoms, only jaundice appeared more frequently in pancreatic head cancer than in pancreatic tail cancer, while epigastric fullness and discomfort, epigastric pain, poor appetite, emaciation, back pain, shoulder and back pain, weakness, diarrhea, constipation, nausea and vomiting, abdominal mass, dry mouth and fever did not correlate significantly with the stage and location of the tumor. The symptoms that appear more frequently are epigastric fullness and discomfort, epigastric pain, poor appetite, emaciation, low back pain, shoulder and back pain, and weakness. Patients with the first symptoms are mostly accompanied by diarrhea, nausea and vomiting, abdominal mass, and fever.
According to the syllabus of syncope, “Syncope is a disease of thirst, gas hitting the heart, pain and heat in the heart, hunger and not wanting to eat, food then vomiting post. If you eat, you will vomit. If you go down, you will not be able to stop the diarrhea”. The main symptoms of adenocarcinoma are in accordance with the syllabus of syncope, in which epigastric fullness, epigastric pain, decreased appetite and diarrhea are consistent with the clinical manifestations of syncope.
The essence of syncope is the deficiency of liver yang, resulting in a mixture of cold and heat. The liver is the main organ of spring, and the liver is the organ where yin and yang are born, and when the cold ends, yang begins to grow, just as the cold ends in spring, yang begins to sprout. The Yang in the liver is the Qi of the lesser Yang in spring, which is beginning to sprout and not yet flourishing, so it is easily killed and weakened by the Liver Yang, resulting in dirty cold. However, it is also internalized by the phase fire, which becomes heat due to depression, thus forming a mixture of cold and heat. The three symptoms of thirst, Qi hitting the heart and pain and heat in the heart are caused by the internal depression of the phase fire and upward rushing. If the liver Yang is deficient and discouraged to remove the earth, then there is hunger and lack of desire to eat, vomiting and posting when eating, and more than one can get down from the post, which is a sign of dirty cold. Accordingly, the main pathogenesis of pancreatic cancer is deficiency of liver yang.
In addition, pancreatic cancer is prone to liver metastasis, and “if the righteousness exists within, the evil cannot dry up”, which also supports that the main pathogenesis of pancreatic cancer is deficiency of liver energy. It is also found that pancreatic cancer is prone to peripheral infiltration and lymph node metastasis, which is consistent with the manifestation of phlegm and dampness in Chinese medicine.
Therefore, it can be said that pancreatic cancer with deficiency of liver yang is the root, while heat and dampness are the symptoms.
In fact, it is not enough to improve the symptoms and stabilize the tumor, but the tumor must disappear in order to be free of worries, and the disappearance of the tumor must be accompanied by warming the Yang and dispersing the cold to dispel the dampness and disperse the knots. The two complement each other.
As we all know, Wu Mei Wan is the main formula for syncretic yin disease, which is based on warming the liver and regulating its cold and heat, using both cold and heat. Similarly, Wu Mei Wan is also suitable for pancreatic cancer with deficiency of liver-yang and cold-dampness with heat. The liver collects blood, is the main drainage agent, and uses yang for the body yin. Yin refers to the fact that the liver collects yin blood, which nourishes the liver body, connotes liver yang and produces bile; Yang refers to the function of the liver, which is based on liver yin.
Wu plum is sour and warm in nature, enters the liver meridian, astringent to the liver and soft, and has the nature of hair, but can not produce blood, so with angelica to warm the liver blood, the two together to nourish the liver body, can help the liver Yang use. Ginseng is beneficial to liver qi, and the five pungent and hot herbs of Radix et Rhizoma Ginseng, Radix et Rhizoma Ginger, Radix et Rhizoma Cinnamomi, and Radix et Rhizoma Sichuan pepper are used with ginseng to warm yang and benefit the liver. Liver yang is easily depressed and turns into fire during the growth stage, so Huang Lian and Huang Bai are added to clear the evil of fire and heat. And Huang Lian with Radix et Rhizoma Polygonati, one clearing heat and drying dampness, one warming Yang and transforming dampness, dampness and heat can be eliminated. Dried ginger and Sichuan pepper warm the middle, can transform the cold dampness in the middle jiao. Hossein and Phellodendron are used together to sink cold and clear damp-heat. Gui Zhi warms Heart-Yang and pushes Yang Qi up.
Simple chronic pancreatitis can be solved with Wu Mei Wan, but pancreatic cancer is a disease of sinking cold and chronic cold, so the original formula of Wu Mei Wan is not capable of handling it. Compared with general syncope, pancreatic cancer has more deficiency of liver yang, heavier cold and dampness, as well as cancer toxicity, evil heat and blood stasis. The formula can be supplemented with raw astragalus to nourish the qi and blood of the body and is good at nourishing liver qi. Combined with the characteristics that pancreatic cancer is prone to liver and lymph node metastasis, Bai Shao, a medicine to nourish liver, is added in the treatment to nourish liver blood and regulate liver qi together with Angelica Sinensis to reduce the chance of liver metastasis; lymph nodes are classified as “phlegmatic nucleus” in Chinese medicine, and the cause of “phlegmatic nucleus” is mostly cold-dampness and phlegm condensation. In Wu Mei Wan, there are already a lot of warming Yang, dispersing cold and dampness, and we can add Cat’s Claw Herb, Sea Fushi and Centipede to treat lymph node metastasis by removing phlegm and dispelling wind.
Although the root cause of tumor formation lies in the lack of consolidation of positive qi, the formation of lumps must be embedded with toxic evil. In addition, for those who have no tumor after surgery and those who are weak, it is better to use less medicine, lighter dosage and shorter time.
If the tumor is developing rapidly, the physically strong person can choose 2-3 kinds of drugs and the amount can be large. It is indicated that blood stasis is one of the main causes of pancreatic cancer, so it is necessary to add frankincense and myrrh to invigorate blood circulation and remove blood stasis.
In the treatment of pancreatic cancer, it is necessary to add anti-tumor Chinese medicine, such as compound woodchuck combination, Jinlong capsule, Huachansu tablet, Delisheng injection, etc. Moreover, combined with the overall dialectical evidence, topical application of warming Yang, dissolving phlegm and softening hard and loose nodules, medicinal use of Chuan Wu, Cao Wu, seaweed, sea floating stone, Sichuan pepper, cat’s claw herb, bile south star, mountain cichlid mushroom, gecko, cinnamon each 90g, musk 1g, thick decoction for topical application for 4-8 hours daily, has good effect on eliminating tumor, relieving pain and treating ascites.
Basic herbal formula.
Wu Mei 30-60g, Radix Angelicae Sinensis 15g, Fructus Sinensis 3g, Chuan Pepper 6-10g, Cinnamomum Cassia 15g, Huang Lian 3-10g, Huang Bai 10-15g, Radix Codonopsis Pilosulae 15g, Radix Ginger 10-15g, Radix Aconite 10g (first decoction), Radix Paeoniae Alba 20g, Radix Astragali 30g, Radix Gecko 30g, Radix Cat’s Claw 30g, Fructus Hedei 50g, Boswellia 10g, Myrrh 10g, Radix Chrysanthemum 30g; water Decoction, one dose daily, divided into two doses.
Addition and subtraction of drugs and treatment ideas.
1, jaundice, add 15g of Inoceramus, with 1g of mannitol and 1g of alum to be taken by flushing.
2, epigastric pain and lumbago plus blood cupping at painful points.
3, constipation, plus 10g of wine rhubarb.
4, epigastric distension, plus 10g of thick park, large abdominal bark 15g.
5, dampness is very dry mouth, add Job’s Tears 30g, Su Stem 15g, dampness is relieved by dry mouth.
6, poor appetite, add blood cupping and moxibustion for Spleen Yu, Stomach Yu and Foot San Li.
7, diarrhea, add 15g of red stone resin, 15g of pomegranate peel, while increasing the amount of umeboshi to 60g.
8, for nausea and vomiting, add 15g of Fucus vesiculosus and 15g of Ochre.
9, in case of Qi deficiency and weakness, add moxibustion of Qi Hai and Guan Yuan.
10, in case of Yin deficiency, add Zhi Mu 15g.
11, in case of Blood stasis, add Curcuma longa 10g, leech 6g.
12, in cases of combined ascites, add 15g of Dagastrodia bark, 10g of Lungwort, 10g of Sichuan pepper, and 10g of Sichuan pepper, together with 3g of Hosin, 10g of Sichuan pepper, 10g of Lungwort, 10g of Gui Zhi, 10g of Astragalus, finely powdered and applied to the umbilicus, with external moxibustion once a day for 2 hours each time.