Primary bronchopulmonary carcinoma (referred to as lung cancer), is one of the most common malignant tumors. In clinical practice, the histological classification of lung cancer is generally divided into four categories, squamous carcinoma, adenocarcinoma, large cell carcinoma, and small cell carcinoma, or fine bronchoalveolar carcinoma is separated from adenocarcinoma and treated as a separate type, for a total of five categories. According to relevant literature, the incidence and mortality rate of lung cancer is the highest among all cancers, and it is considered the most dangerous malignant tumor to human health and life today.
Chinese medicine has certain advantages in treating lung cancer in terms of improving clinical symptoms, improving survival quality, preventing metastasis and recurrence, and prolonging survival, and has also achieved certain clinical efficacy. As the etiology and pathogenesis of lung cancer are complex, there is no set of unified and recognized criteria for identification and typing.
It is generally believed that this disease occurs due to the deficiency of positive qi in human body, the imbalance of yin and yang qi and blood, the dysfunction of internal organs and meridians, and the lowering of the body’s resistance to disease, which causes the evil qi to take advantage of the deficiency and stay in the lungs, resulting in the interconnection of phlegm, qi, blood stasis and evil toxins, forming a lump over time and developing into lung cancer. This disease belongs to “lung accumulation”, “cough”, “breath spray”, “hemoptysis” and “chest pain” in Chinese medicine. “chest pain”, etc. The treatment of this disease in TCM mainly adopts a combination of evidence-based and disease-based treatment.
The following are some main treatment ideas about the current research results of relevant scholars combined with Zhang Shi’s clinical practice.
1.1 The experience of scholars in the treatment of lung cancer
1.1 Professor Liu Jiaxiang proposed that the treatment of lung cancer should be based on helping the righteousness and supplemented by eliminating the evil.
According to Chinese medicine, “the righteousness exists within and the evil cannot dry up”, and “where the evil comes together, its energy must be weak”. The treatment advocates that “to treat a disease, we must seek its root cause”. Prof. Liu Jiaxiang of Shanghai University of Traditional Chinese Medicine, through the research of many modern scientific methods such as clinical and experimental zoology, immunology, biochemistry, cellular molecular biology, etc. for 40 years, found that the occurrence of lung cancer is mostly related to the deficiency of positive qi and the body’s immune function, especially the low level of cellular immunity. Therefore, he proposed the treatment plan of “treating the root of the disease, supporting the positive and eliminating the evil”.
According to Liu, “Zheng deficiency” is the intrinsic basis for the formation of lung cancer and is also the key to its development and evolution. Cancer is only a local manifestation of the systemic disease, so it is necessary to emphasize on supporting and cultivating the root of the disease, taking care of the positive energy of the body at all times, and achieving the purpose of controlling or shrinking the lung tumor by strengthening the resistance of the body. The common method is to identify the evidence first, and according to the evidence type, it can be divided into yin deficiency, qi deficiency, qi-yin deficiency and yin-yang deficiency, and so on, to nourish yin, benefit qi and warm yang, and add soft and detoxifying drugs as appropriate. According to a report by Liu Jiaxiang et al. on the treatment of lung cancer in a large sample, the treatment of lung cancer with the Fu Zheng method indicated that several indexes were significantly improved compared with those before treatment, and the median survival was better than that of the control group.
However, the Fu Zheng method is not a simple accumulation of tonic drugs, nor is it a complete tonic without distinguishing yin and yang. Instead, it is based on the patient’s clinical manifestations, pulse, tongue, length of illness, and degree of disease, and identifies yin deficiency, yang deficiency, qi deficiency, and blood deficiency, and then treats them separately. On the basis of the treatment principle of helping the righteous primarily and dispelling the evil, Liu classified lung cancer into “spleen deficiency, phlegm-dampness type”, “internal heat of yin deficiency type”, “both qi and yin deficiency type” and “both yin and yang deficiency type”. The “Yin-Yang two deficiency type” and “Qi stagnation and blood stasis type”.
1.2 Professor Zhou Zhongying’s treatment of lung cancer is based on the elimination of evil and the generous use of the compound method.
Prof. Zhou Zhongying pays special attention to the importance of “cancer toxicity” in the pathogenesis of malignant tumors. He believes that the formation of cancer is related to diet, external sensation and emotion, all three of which can lead to the development of cancer; at the same time, these three can also act as a pathological product to further cause the disease evil to be deep and unresolved, and the blood cannot function normally and stagnate as stasis. When “cancer toxin” and “phlegm stasis” are combined, a lump is formed, which is soft, hard, or as hard as a rock, attached to one or several places and cannot be moved, forming a cancer body.
Toxic evil is full of the body, depleting the vital energy and weakening the body, which eventually leads to “toxicity and loss of vitality”. Therefore, Zhou proposed that “detoxification treatment should be carried out throughout the whole treatment process to eliminate the original cause of the disease and alleviate the extent of the disease”.
Zhou believes that the pathology of lung cancer is closely related to its physiological function. If the lung is affected by evil, the fluid cannot be distributed normally and will remain as phlegm; if the blood cannot be treated, it will remain as stasis. The accumulation of “phlegm” and “stasis”, which breeds toxicity and heat, causes depletion of qi and injury to yin, and eventually leads to a deficiency of both qi and yin, and the accumulation of phlegm and stasis. The treatment starts from benefiting qi and nourishing yin, resolving phlegm and removing stasis, clearing heat and detoxifying toxins, and commonly used drugs include southern ginseng, northern ginseng, asparagus, maidenhair, sizzling baijia, fenghuai, zeqi, chenpi, suzi, white mustard seed, mountain cichlid mushroom, cat’s claw grass, white flowered snake’s tongue herb, dabei mu, almond, fishy grass, etc.
At the same time, Zhou believes that tumors are characterized by multi-factor pathogenesis, multi-symptom integration, and co-existence of multiple symptoms, so he proposes that the effective way to treat this disease is to adopt “a generous combination of multiple treatments”.
According to Zhang, Zhou’s idea of treating tumors by “compounding multiple methods” is worthy of reference and has its theoretical basis and academic origin. In the Yellow Emperor’s Classic of Internal Medicine, there is an article in the Su Wen Zhi Zhen Da Lun, “If the odd does not go, then the even does, which is called the heavy formula. The even does not go, it is the counter-support to take it, the so-called cold, hot, warm and cool, from its disease also. The theory. The scriptures suggest that for complex illnesses, if the “odd” or “even” prescriptions alone cannot be effective, “heavy prescriptions” or “counter-adjuvant” methods should be used. This is the same as the “combination of multiple treatments”. This is in line with the “generosity of compounding multiple treatments”.
Especially for tumor diseases, because of the characteristics of multi-factor pathogenesis, multi-symptom integration and co-existence of multiple symptoms, it is worthwhile to study in depth the effective way of “the generosity of multiple treatment methods”.
1.3 Dr. Zhang Xiaochun proposed that the treatment of lung cancer should combine the identification of evidence and stage
Dr. Zhang Xiaochun believes that in tumor treatment, there is often no evidence to identify, or there are side effects after western medicine treatment, or there are multiple methods of Chinese and western medicine combined treatment, at this time, there are certain defects in discriminative treatment, which cannot solve many problems in tumor treatment. Therefore, it is proposed that in the treatment of tumor, in addition to the identification of disease and evidence, the method of identifying the stage of treatment should be adopted.
Zhang’s so-called stage differentiation treatment is to apply TCM treatment methods according to the pathological characteristics and changes of each treatment period and disease stage in which the tumor patient is in, in order to obtain the best treatment effect.
Specific to the characteristics of lung cancer, clinical treatment methods such as surgery, radiotherapy, chemotherapy and molecular targeting can be used. There is often no evidence to identify during the treatment process. Let’s say, after radical surgery for central type non-small cell lung cancer, the lesion no longer exists, but there is the possibility of recurrence and metastasis, and further treatment is still needed, how to treat? Where to start? How to treat the disease? A realistic and tricky proposition in front of our medical staff of TCM oncology.
According to Prof. Zhang, identification of disease, evidence and stage must be organically combined and selected at the right time.
2.Professor Zhang Bingxiu’s experience in treating lung cancer
In recent years, through the clinical observation of a large sample of lung cancer patients, based on the in-depth discussion of the etiology and pathogenesis of lung cancer, Dr. Zhang proposed that “the deficiency of positive energy, combined with external ‘fire-heat’, ‘phlegm-stasis’ and ‘cancer toxicity’, the pathogenesis of lung cancer is a combination of the two. The pathogenesis of lung cancer is based on the in-depth discussion of the etiology of lung cancer.
Now, we briefly introduce the pathogenesis and clinical treatment of lung cancer.
2.1 Etiology and pathogenesis of lung cancer
2.1.1 Deficiency of vital energy
According to Suwen’s Commentary on Heat Diseases, “Where evil comes together, its qi must be deficient”. In “The Source of Miscellaneous Diseases Rhinoceros Candle on Accumulation and Obstruction of the Qi Passage”, it is said that “Evil accumulates in the chest, blocking the Qi channel, and the Qi cannot be passed, and it is phlegm, food and blood, all of which are in the fight between evil and positive. From this, we can conclude that the basis of the pathogenesis of lung cancer is deficiency of positive qi.
2.1.2 Toxic triggers
”Evil flourishes and becomes poisonous”. Fire”, “heat”, “phlegm”, and “stasis” caused by various reasons are all eventually passed through “Poison” is the final form of development.
On the basis of the dysfunction of human internal organs, together with “fire”, “heat”, “phlegm” and “stasis”, the specific The invasion of disease-causing factors (i.e. cancer toxin).
In the “Direct Instruction Formula of Renzai? It is said in the “Supplementary Formula” that “cancer is high up and deep down, like a rock cave, with a cumulative pendant, and the heat toxin is deeply hidden”.
Regarding the poison of “phlegm” and “stasis”, they are also interrelated, either by the weakness of spleen and lung, which can easily help dampness to produce phlegm, or by the evil of fire and heat to refine liquid into phlegm, and the evil of phlegm can turn into stasis for a long time. The “Treatise on the Origin of Diseases” says that “blood stasis within the body, sometimes with heat and yellow face, and if the stasis does not subside for a long time, it becomes accumulation of Y obstruction.”
2.1.3 Emotional and moral related
The occurrence of lung cancer is related to emotions. The lung is the master of qi, in the will is worry, its mother is spleen, its son is kidney, and its system is liver. Emotional and mental disorders, deficiency of internal organs, loss of qi mechanism, phlegm and stagnation, which will turn into heat over time and become a lump, which will become a toxic cause and become lung accumulation.
Ming? Chen Shigong’s “Surgery” says: “depression hurts the liver, thought hurts the spleen, accumulation of thoughts in the heart, the wish can not be reached, resulting in the meridian gangrene, accumulation of phlegm nucleus.
2.2 Treatment rules
It is said in the “Treatise on Stabbing Methods” that “when the righteousness exists within, evil cannot be dried up”. Therefore, the cultivation of positive qi should not be neglected, and the role of positive qi in the regression and prognosis of the disease itself should be given full attention, which is also a major feature of the treatment method of Chinese medicine.
Specifically on how to master the relationship between eliminating evil and supporting the righteousness, “The Essential Readings of Medicine? The “accumulation” is very detailed, said: “the first, the beginning of the disease, the righteousness is still strong, the evil is still shallow, then any subject to attack; in the middle, subject to disease for a long time, the evil is deeper, the righteousness is weaker, any subject and attack and supplement; the last, the disease demon after a long time, the evil encroachment, the righteousness of the residual, then any subject to supplement.
Suwen Wu Chang Zheng Da Lun: “big poison cure, ten to its six, often poison cure, ten to its seven, small poison cure, ten to its eight, no poison cure, ten to its nine, grain and meat, fruit and vegetables, food and nourishment exhausted, no make over, hurt its positive also.”
On the premise of understanding the etiology of the disease, Master Zhang proposed the basic principle of treating lung cancer from “fire toxin”, “phlegm toxin” and “stasis toxin”.
Through clinical observation, it is often more difficult to treat those with Yin deficiency. According to “Miscellaneous Diseases Guangzhu Zongju”, “Yang deficiency is easy to treat, while Yin deficiency is difficult to finish the attack”. It is prescient.
In the treatment method, warm tonic should be used with caution. Lung cancer lesions are hard and difficult to decay and collapse, like “Yin gangrene” in Chinese medicine, which is a yin evidence.
However, the lung is a delicate organ, which likes to moisten and hate dryness, and it is smooth to proclaim and descend. The lung qi flourishes in autumn, and the lung qi is blocked, so it is easy to turn heat into heat and burn lung yin.
Cancer toxin blocking the lung, not dispersing, growing into lumps, and agglutinating with phlegm and stagnant blood, will definitely depress and turn into heat over time, thus injuring yin and consuming fluid, resulting in pathological changes of yin deficiency and internal heat.
Therefore, as the evidence of lung cancer has more heat and less cold, warm tonic should be used with caution to prevent burning of yin and fluid.
2.3 Basic formula for lung cancer
Zhang Shi’s treatment for lung cancer is based on the addition of Chuan Bai Mu, Bai Hua Shi Tong Cao and Bai Ying, which have definite anti-cancer efficacy, to Clear Lung and Eliminate Blood Stasis Tang, also known as Fu Zheng and Eliminate Blood Stasis and Break Y Tang. The basic formula consists of the following drugs: 15g of Astragalus membranaceus, 30g each of Coix Seed, Fructus Cacao, Fritillariae (later), 12g of Chinese Yam, 10g each of Radix Angelicae Sinensis, Curcuma longa, Semen Parviflora, Pericarpium Citri Reticulatae, Radix Platycodon grandis, Radix Platycodon grandis, and Radix Bupleurum, and 10g each of Cichlidium spp. (For the specific formula ideas and explanations, see the chapter of “Experimental formula”)
2.4 Treatment by type
Based on his clinical experience, he divided lung cancer into four types of symptoms, namely “phlegm-heat,” “phlegm-stasis,” “deficiency of both spleen and lung,” and “deficiency of lung and kidney yin. “The four types of symptoms were identified and treated.
2.4.1 Phlegm-heat internalized type This evidence is most often seen in patients with a previous plump body type, or with phlegm-dampness in abundance. The symptoms are coughing, coughing phlegm, yellowish and thick phlegm, coughing into lumps, or not easy to be coughing out; the pulse is slippery, or slippery, or both string-like; the tongue is thick and greasy, yellow or old yellow; the tongue is light red or red, mostly accompanied by bitterness and dryness of the mouth, chest tightness, shortness of breath, lack of appetite, and yellowish urination. It is caused by the internal phlegm and the internal and external heat, and the phlegm and heat are intertwined, obstructing the lung channels, and the airways are not smooth, resulting in asthma and stuffiness. The treatment is to increase the strength of clearing heat and resolving phlegm. The original formula is supplemented with 15g each of Bai Ying and Bai Hua Shi Tong Cao to increase the capital for clearing heat and detoxifying, and for relieving dampness and fighting cancer. If the congestion of lung heat is more prominent, with great heat, great asthma, great thirst, etc., Scutellaria baicalensis, Psidium guajava, and Pleurotus oleraceus can be used as equivalent according to the symptoms.
White Flower and Snake Tongue Herb, bitter and sweet in taste, cold in nature. It belongs to the heart, lung, liver and large intestine meridians. It has the function of clearing heat and detoxifying toxins, promoting dampness and fighting cancer. Guangdong Traditional Chinese Medicine: “Decongesting and detoxifying, expelling wind, relieving pain and anti-inflammatory. Mainly used for treating snakebite, cancer and appendicitis, dysentery and other diseases.” Guangxi Materia Medica Selecta: “Mainly treats cancer, type B encephalitis, hepatitis, dysentery, tracheitis, etc.”
Baiying is the rhizome of white hair vine. Its taste is sweet, bitter, and cold in nature. It has the effect of clearing heat and dampness, detoxifying and anti-cancer. Kai Bao Ben Cao: “The note of the other book: the stem and leaves cook porridge, extremely detoxification of heat.”
2.4.2 Phlegm and stasis blocking the ligaments This is most often seen in the middle and late stages of the disease process, because the refined liquid becomes phlegm, and the prolonged retention of drink becomes stasis, which leads to unfavorable breathing, poor qi flow, stagnation of qi and blood, and finally leads to phlegm and stasis blocking the ligaments. Patients are mostly seen with ashy complexion, cough, hemoptysis, chest tightness, chest pain, nail fault in the skin of the limbs, and obscure or blue-purple nail bed. The pulse is thin and astringent, or the pulse is not full, but small and short, the tongue is thin and lacking in fluid, the tongue is lined with purple or purple-dark, and the veins under the tongue are seen to be convoluted. The cause of the disease is due to stagnation of Qi and blood. Treatment is to activate blood circulation and stop bleeding. In case of hemoptysis, add 15-30g of Cyperus rotundus and 15-30g of Yimoucao.
2.4.3 Spleen and lung deficiency type This evidence is mostly seen in patients with obvious deficiency of positive energy. The spleen and lung are related to each other in the Five Elements theory. Earth is the mother of gold, and earth produces gold. The patient suffers from pulmonary disorders, the disease tosses and turns, and the lung qi is damaged; the son’s disease is tired of the mother. In addition, the patient is not well fed, and the spleen and stomach lack sources of Qi transformation. The combination of the two causes leads to deficiency of both spleen and lung. The patient mostly sees, weakness, poor nourishment, lack of Qi connection, even coughing and sputum weakness, and a dull complexion. On examination, the pulse is weak and the tongue is thin and white or white and greasy, or greasy and slightly yellow. The main treatment is to strengthen the spleen and stomach, benefit the qi and tonify the lung. The original formula plus Si Jun Zi Tang reuses Fu Ling and Bai Zhu (20-30g). At the same time, prunus ginseng and raw ginseng can be added. Cordyceps can be added if available.
2.4.4 Lung and kidney yin deficiency type This is usually seen in the late stage of the disease, or after radiotherapy due to “heat toxicity” attack, burning lung yin. Patients usually have a burning sensation behind the sternal stalk, or thick sputum with blood, or hemoptysis with bright red blood, red cheekbones, dry mouth and drinking, restless sleep at night, and confused dreams. On examination, the pulse is sunken or fine, the coating is thin and lacking in fluid, and the tongue is red. The cause of the disease is due to deficiency of lung and kidney yin. The original formula is supplemented with 10g each of North and South Saxifrage, Medicago sativa and Lily, 15-20g of Radix et Rhizoma Polygonati, and in case of yin deficiency, Erzhi Wan (10g each of Dried Liancao and Chasteberry). If there is also hemoptysis, or blood in the sputum, or damage to the lung collaterals, add 10g of Agaricus blazei and melt it into the mixture.