Primary bronchopulmonary cancer, referred to as lung cancer, refers to malignant tumors of the primary bronchial mucosa and alveoli, and is one of the most common malignant tumors. This disease is equivalent to lung cancer in the national standard of Chinese medicine disease name, and also belongs to the category of cough, hemoptysis, chest pain, phlegm drink, lung accumulation and rest ben in Chinese medicine.
I. Diagnosis
Refer to the 2005 Chinese Medical Association Clinical Diagnostic and Treatment Guidelines/Tumor Book/Lung Cancer Diagnostic Criteria.
II. TCM treatment plan
(I) Treatment principles
1.Non-small cell lung cancer Stage I and II: surgical resection, postoperative Chinese medicine treatment, postoperative chemotherapy as appropriate. Stage III: surgical treatment (preoperative chemoradiotherapy as appropriate), postoperative Chinese medicine treatment and adjuvant chemoradiotherapy for those who can be operated, and simple Chinese medicine treatment for those who cannot be operated and chemoradiotherapy. Stage III inoperable and Stage IV: Chinese medicine treatment is the main treatment, with chemotherapy, radiotherapy and biological treatment as appropriate.
2.Small cell lung cancer: Chinese medicine treatment and chemotherapy, surgery and radiotherapy as appropriate.
(2) Discriminatory treatment
Based on the identification of the disease, the treatment can be applied to patients at all stages.
1. Qi and Yin deficiency, internal stasis and toxicity evidence
Identification: cough with little sputum, or thin and sticky sputum, or blood in the sputum, low cough, shortness of breath and shortness of breath, spontaneous sweating or night sweating, fatigue, pale face, wind, dry mouth and little drinking, red or light red tongue with tooth marks, thin coating and weak pulse.
Treatment: Benefit Qi and nourish Yin, resolve blood stasis and detoxify.
Radix: Shengwen San combined with Sha Shen Mai Dong Tang plus or minus: Prince’s ginseng, Astragalus, Mai Dong, Wu Wei Zi, Sha Shen, Ganoderma lucidum, Lady’s mantle, Xian Ling Spleen, Almond, Mulberry Bark, Poria, Fa Xia, Da Qing Ye, Curcuma longa, Flea Huo, Half Branch Lotus, White Flowered Snake Tongue Plant, Licorice. Take with water decoction.
2.Yin deficiency and internal heat, internal stasis and toxicity
Identification: cough without or with little sputum, or with blood in the sputum, low fever and night sweating, disturbed sleep, dry mouth, dry stool, red tongue, thin yellow tongue coating, or flaking, or light vivid without coating, thin pulse.
Treatment: Nourish Yin and clear heat, resolve blood stasis and detoxify.
Radix Polygoni, Radix et Rhizoma, Radix et Rhizoma Macrocephala, Radix Angelicae Sinensis, Radix Paeoniae Alba
Radix Salviae Miltiorrhiza, Almond, Radix Scutellariae, Radix Scutellariae, Radix Paeoniae, Radix Glycyrrhiza Uralensis 5g Decoction.
Addition and subtraction: for shortage of breath and weakness, add Astragalus and Baishen; for chest pain, add Peach kernel and Panax notoginseng powder; for blood in sputum, add Pu Huang charcoal (cloth bag), Xian He Cao, Bai He or Yunnan Baiyao (punch); for low fever, add Yin Chai Hu and Fishy Herb.
3.Spleen deficiency, phlegm and dampness, and internal stasis and toxicity
Evidence: cough with phlegm, chest tightness and shortness of breath, dullness and loose stools, fatigue, yellowish complexion, pale and fat tongue or teeth marks, white and greasy tongue coating, moist and slow or smooth pulse.
Treatment: Strengthening the spleen and dispelling phlegm, resolving blood stasis and detoxicating.
Ginseng, Radix et Rhizoma Polygonatum, Almond, Dandelion
Astragalus membranaceus, spleen, peony, licorice
Take with water.
Add or subtract: for excessive sweating and shortness of breath, add white ginseng, maitong and wu wei zi; for phlegm with difficulty in coughing, add sea fushion and geranium; for internal stagnation of chest water, add scape seed, jujube, lobelia and mulberry bark; for phlegm-dampness and heat, add scutellaria and fishy grass; for high fever, add raw gypsum (broken and decocted first), Zhi Mu and water hyacinth (decocted first).
4. Qi stagnation, blood stasis and internal stasis of toxins
Evidence: Poor coughing, or dark red phlegm and blood, chest pain with a fixed location, such as cone and thorn, chest tightness and suffocation, purple lips, dry stools, purple tongue, or petechiae, thin coating, string or astringent pulse.
Treatment: Regulating Qi, promoting stagnation, resolving blood stasis and detoxicating.
Radix et Rhizoma Peach-Hong Si-Wang Tang with Addition: Peach kernel, safflower, angelica, red peony, raw earth, yujin, curcuma longa, hedgehog, beehive, melon basket, white flowered snake’s tongue, stone, and root
Glycyrrhiza glabra, taken with water.
Add and subtract: for phlegm and blood, add Panax notoginseng powder, Phellodendron charcoal, and Radix et Rhizoma cyperus; for swollen lymph nodes, add Cichlidium mushroom, raw oyster, and Xia Ku Cao.
5. Deficiency of kidney yang and internal stagnation of toxins
Identification: coughing and shortness of breath, shortness of breath when moving, lumbar soreness and knee weakness, tinnitus and dizziness, cold limbs and exhaustion, light red tongue, thin white fur, sinking pulse.
Treatment: Tonifying the kidney and nourishing the qi, resolving blood stasis and detoxifying the toxin.
Radix: Jin Kui Kidney Qi Pill with addition and subtraction: Radix Rehmanniae, Cornu Cervi Pantotrichum, Cinnamon, Yam, North Sage, Walnut
Schisandra chinensis, Achyranthes bark, Cistanches bark, Boneset, Chen Pi, Fleabane, Glycyrrhiza glabra, decoction in water.
Add or subtract: for coughing up blood, add 30g of Cynanchum spp.
(B) Medicine for identification of disease
1.Commonly used Chinese patent medicines.
(1) Ping cancer tablets: support and inhibit tumor; usage: 8-10 tablets per time, taken orally, 3 times a day.
(2) Cancer Fucang: strengthening the spleen, tonifying the kidney, regulating qi and harmonizing the stomach; usage: 8-10 tablets per time, taken orally, 3 times a day.
(3) Fuxiangfanfan capsule: benefiting Qi, nourishing Yin, resolving blood stasis and detoxification; usage: 2 tablets per time, orally, 3 times a day.
(4) Anti-cancer capsule: anti-cancer, anti-inflammatory, asthma; usage: 4-5 capsules per time, orally, 3 times a day.
(5) Crow’s bile oil soft capsule: soft and anti-cancer; usage: 4 capsules per time, orally, 3 times a day.
(6) Ophiopogon Oil Oral Milk: softens and disperses knots, anti-cancer; usage: 20ml per time, orally, 3 times a day.
(7) Xihuang capsule: detoxify and disperse nodules, relieve swelling and pain; usage: 4-8 capsules per time, orally, 2 times a day.
(8) Huey Hui Sheng Oral Liquid: Eliminate Y and remove blood stasis; usage: 10ml each time, orally, 2 times a day.
(9) Ginseng One Capsules: Benefit Qi and help fight cancer; usage: 2 capsules per time, orally, 3 times a day.
(10) Ubiamycin: support and anti-cancer; usage: 1 tablet or 1 capsule per time, orally, 3 times a day.
2. Commonly used herbal injections.
(1) Kangai Injection: It is suitable for the deficiency of Qi and Yin; usage: 20-40ml once, once a day, diluted with 5% glucose injection or physiological saline 250ml-500ml and injected intravenously for 15-30 days.
(2) Addi injection: It is effective in benefiting qi and nourishing yin, resolving stasis and detoxification; suitable for yin deficiency and internal heat, internal stasis and toxicity; usage: 50-100ml once, diluted with 5% glucose injection or physiological saline 250ml-500ml and injected intravenously once a day, 14-21 days as a course of treatment.
(3) Sodium zebrachoate vitamin B6 injection: the effect is to resolve blood stasis and detoxification; suitable for Qi stagnation and blood stasis, internal stasis and toxicity; usage: 10-20ml once a day, diluted with 5% glucose injection or physiological saline 250ml-500ml and injected intravenously, 14 days as a course of treatment.
(4) Crow’s gall bladder oil injection: the efficacy is to clear heat and detoxify, soften hardness and disperse nodules; suitable for the evidence of internal heat and toxicity; usage: 20-30ml once, diluted with 5% glucose injection or physiological saline 250ml-500ml and then injected intravenously once a day for 14-21 days.
(5) Cicatrizine Injection: Clearing heat and detoxifying, resolving phlegm and softening firmness; suitable for the evidence of phlegm-heat and poisonous knot; dilute with 5% or 10% glucose injection and then drip, 20-100ml once a day, 14 days as a course of treatment.
(6) Eleutherococcus injection: anti-cancer; usage: 400-600mg (4-6) at a time, diluted with 400-500ml of 5% glucose injection, intravenous, once a day, 14-21 days as a course of treatment.
(C) Chinese medicine interventional therapy
(1) Indications: mainly applicable to patients with locally advanced lung cancer who cannot tolerate surgery, radiotherapy, systemic chemotherapy, etc.
(2) Commonly used perfusion drugs: opium bile oil milk, eleuthero injection, etc.; can be combined with chemotherapy drug perfusion, such as gemcitabine, cisplatin, etc.
(D) Treatment of common complications
1.Treatment of malignant pleural fluid
(1) Characteristic Chinese herbal medicine and medicine treatment
Symptom characteristics: chest and hypochondrium fullness or pain, shortness of breath, coughing and spitting, difficulty in turning the side, white fur, sunken and string pulse.
Treatment: Attacking and expelling phlegm and drinks
Formula: Scape Drabble and Jujube Diarrhea Lung Soup combined with Five Peel Drink plus or minus: Scape Drabble (decoction) 30g, Jujube 10g, Atractylodes Macrocephala 15g, Mulberry Bark 15g, Zelenia 15g, Osmanthus 6g, Poria Bark 30g, Poria 10g, Almond 10g, Chen Pi 15g, Semen 10g, Lungwort 30g, Coix 30g, Curcuma 9g Licorice 5g.
(2) Special herbal thermal infusion therapy
A central venous catheter was placed in the chest cavity for drainage under routine operation after ultrasound localization, and the ascites was drained continuously, slowly and intermittently within 2 to 3 days. After the catheter is filled with saline at 45℃ for 800~1000mL each time and kept for 20 minutes, the thoracic lavage fluid is drained again, and so on for 3 times, the intra-thoracic thermal perfusion is repeatedly performed. The patient was instructed to change position within 2h after the injection to facilitate uniform contact between the drug and the pleura. Once a week, two times a course of treatment, a total of 1 course of treatment. In the event of toxic side effects, conventional anti-vomiting and symptomatic supportive treatment should be administered.
2.Specialized Chinese medicine for bone metastasis
Symptoms: bone pain, light day and heavy night, thin body, shortage of breath and fatigue, less color, even the limbs are not warm, or fear of cold, lumbago and knee weakness, light tongue with petechiae, white moist coating or white greasy coating, sunken tight pulse or string.
Treatment: Warming Yang, tonifying Blood, dispersing nodules and relieving pain.
Radix: Yang He Tang with addition and subtraction: Shu Di Huang, Deer Horns Gum (melted), Gui Zhi, White Mustard Seed, Boneset, Boneset, Whole Scorpion, Centipede, Astragalus, Fructus Lycii, Fructus Chasteberry, Radix Rehmanniae, Radix Achyranthes.
Add and subtract: for cough with clear sputum, add Radix Panax notoginseng, Radix ginger, Radix lycopodium; for asthma, add Roasted Ephedra, Almond, Su Zi; for internal stagnation of chest fluid, add Semen scabra, Jujube, Mulberry Bark, Plantago ovata.
3.Therapy of brain metastasis with special Chinese medicine and identification
Most of the cases are caused by deficiency of positive energy, low anti-cancer power of the body, evil toxins going to the brain and phlegm stasis blocking the ligaments.
Basic treatment: Benefit qi, tonify kidney, resolve stasis and disperse nodules.
Radix: Radix Angelicae Sinensis, Radix et Rhizoma, Radix et Rhizoma Paeoniae, Radix et Rhizoma Paeoniae.
Peach kernel, safflower, red peony, Chuanxiong, astragalus, lady’s mantle, dogwood, bone marrow, cow knee, whole scorpion powder (punch), centipede, stiff silkworm, curcuma longa, poria skin, Chen Pi, mulberry white peel, zedoary, lobelia, fleabane, licorice.
Add or subtract: for constipation, add rhubarb, xuanming powder (punch); for nausea and vomiting, add half asia, 15g of bamboo rhizome or clove, persimmon tip.
(E) Treatment after surgery, radiotherapy and chemotherapy
1.Post-surgery treatment
Treatment: Double tonification of Qi and Blood, benefit the lung and strengthen the spleen.
Formula: Bajhen Tang with reduction: Bai Shen Huang Qi
Fu Ling, Atractylodes Macrocephala, Angelica Sinensis, Salvia Miltiorrhiza, Fructus Schisandrae, Semen Coicis, Fritillariae, Fritillariae, Rhizoma, Chen Pi, Glycyrrhiza Glabra.
Proprietary Chinese medicine: Cancer Fucang: 8 to 10 tablets per time, orally, 3 times a day.
2.Treatment during radiotherapy
Treatment: Nourish Yin and clear heat, strengthen the spleen and stomach.
Radix: Radix Salviae Miltiorrhizae, plus or minus: Salviae Miltiorrhizae, Fritillariae, Pleurotusae, Morinda citrifoliae, Scutellariae, Poria, Radix Astragali, decoction.
3.Treatment during chemotherapy
Treatment: Strengthen the spleen, benefit the kidney, nourish the blood and harmonize the stomach.
Formula: Liu Jun Zi Tang with reduction: Radix Codonopsis pilosulae, Atractylodes macrocephala, Radix et Rhizoma Polygonati
Fu Ling, Yam, Coix Seed, Chen Pi, Astragalus, Fructus Lycii, Cuscuta, Radix et Rhizoma Polygonati, Glycyrrhiza glabra, decoction in water.
Proprietary Chinese medicine: Cancer Fucang: 8 to 10 tablets per time, orally, 3 times a day.
(VI) External treatment methods
1.Sanwang pain relief cream (composed of rhubarb, cypress, turmeric, toadstool, musk, ice chips, strychnine, safflower, frankincense, myrrh, peach kernel, angelica, blood exhaustion, foxglove, fleabane, mushroom, curcuma longa, whole scorpion, centipede, cinnamon branch, etc.), applied to the local tumor or painful area, changed once in 24 hours, 7 days as a course. It is suitable for lung cancer pain.
2.Gansui 9g, Sharen 10g, finely grinded together, take garlic head and mash it, mix it with the powdered medicine, make a medicine paste with water and put it on the umbilicus. It is suitable for those with lung cancer and pleural fluid.
(VII) Acupuncture treatment
1. Post-surgical rehabilitation treatment
Indications: Post-surgical lung and spleen deficiency, chest pain and weakness.
Operation method.
Acupuncture points: hegu, sesanli, lung yu, spleen yu, stomach yu, ankylosis, sanyinjiao.
Technique: acupuncture points once a day or every other day, tonic method, with each time after obtaining the qi to transport the needle for 5 minutes, retain the needle for 30 minutes, 10 times for a course of treatment.
Direction: Acupuncture the hand and foot Yangming meridian points to strengthen the spleen and stomach, regulate qi and relieve pain. Acupuncture the dorsal Yu point to regulate the qi and blood functions of the internal organs and promote postoperative recovery.
2.Bone marrow suppression
Indications: Bone marrow suppression after receiving radiotherapy or chemotherapy for lung cancer.
Operation method.
Acupuncture points: Feet San Li, San Yin Jiao, Da Zhi, Blood Sea, Lung Yu, Spleen Yu, Kidney Yu, Diaphragm Yu.
Technique: select 2 to 4 acupoints each time, and warm moxibustion with moxa for 15 to 30 minutes at each point. Acupuncture or moxibustion once a day or every other day. 10 times is a course of treatment.
Directions: Acupuncture the meridian points of the spleen and stomach to promote the transformation of qi and blood. Acupuncture and moxibustion of back points invigorate Yang energy and promote the transformation of Qi and blood.
(VII) Chinese medicine treatment of emotional and mental disorders
For lung cancer patients with emotional and mental disorders, a variety of TCM emotional and mental guidance therapies are applied, including “talking therapy” for individual patients, “meditation and tranquilization method”, “happy and cheerful method”, and “doubt and doubt relief method”. The “Explain Doubt with Doubt” method, “Transferring Attention” method, and
The method of “guiding and moving qi” and “overcoming emotion with emotion” are similar to individual psychotherapy, group mutual help emotional and spiritual guidance therapy and five elements music guidance therapy.
(H) Extracorporeal high-frequency tumor heat therapy machine treatment
Through the principle of “endogenous heat” generated by high-frequency electromagnetic field in human body, it can effectively kill cancer cells without damaging normal tissues, and can be used in combination with traditional Chinese medicine to increase the therapeutic effect. It is suitable for patients with solid tumors and combined cancer pain. Take the corresponding area and treat it for 60 minutes each time, once a week for four weeks, and it can be used for two consecutive courses of treatment.