Today we introduce you to chemotherapy-induced peripheral neurotoxicity, which is a common adverse effect of chemotherapy, mainly manifested as abnormal peripheral sensation, including abnormal burning, itching and sharp pain, numbness and reduced balance. Because it is not fatal, it is easily overlooked by doctors, patients and their families. It is this abnormal sensation that causes many patients to fall like “stepping on cotton”, which seriously affects the quality of life of patients. What factors are likely to lead to peripheral neurotoxicity after chemotherapy? The main factors are related to chemotherapy drugs, including the type of chemotherapy drug, dose, frequency and route of administration. Which drugs are likely to cause peripheral neurotoxicity? A variety of chemotherapeutic drugs can cause peripheral neurotoxicity symptoms. Currently, the main chemotherapeutic drugs that cause peripheral neurotoxicity are vincristine, paclitaxel, oxaliplatin, fluorouracil and capecitabine. What are the characteristics of peripheral neurotoxicity caused by different chemotherapeutic agents? The characteristics of peripheral neurotoxicity due to different chemotherapeutic agents vary greatly depending on their pharmacological mechanisms and the patient’s constitution. Here we take paclitaxel and oxaliplatin, which are commonly used chemotherapeutic drugs in clinical practice, as examples, and introduce them to you separately. Paclitaxel is a broad-spectrum antitumor drug, and neurotoxicity is the main adverse effect of paclitaxel, including peripheral neurotoxicity, motor neurotoxicity, autonomic neurotoxicity and central nervous system toxicity. Among them, the incidence of peripheral neurotoxicity is high, about 62%. Peripheral neurotoxicity is manifested as numbness, abnormal sensation, tingling and burning sensation, first seen in fingers and toes, usually seen 24-72 hours after drug administration, with dose accumulation, which can occur 48h after infusion at 100-200mg/mL, and even more after 6 cycles, with an incidence of over 80%. Oxaliplatin neurotoxicity is of two common types: acute toxicity and chronic toxicity. About 82-92% of patients will experience transient acute neurotoxicity after drug administration, with rapid onset and manifested as numbness, pain, abnormal or absent sensation in the distal limbs or around the mouth during or within a few hours after the end of intravenous infusion. This toxicity is induced or exacerbated by cold and may resolve within hours or days, mostly related to the rate of infusion. Chronic neurotoxicity is dose dependent, with approximately 10-15% of patients experiencing neurological symptoms at cumulative doses of 780-850 mg/m2, mainly in the form of sensory nerve dysfunction, such as abnormal sensation in the extremities, progressing to ataxia or functional impairment. Chronic neurological damage due to oxaliplatin is reversible in about 80% of patients, but only about 40% of patients recover fully after 6-8 months of treatment interruption. What does Chinese medicine know about peripheral neurotoxicity after chemotherapy? This disease is considered to belong to the category of “numbness”, “insensitivity”, “paralysis” and “atrophy” in Chinese medicine. Many medical writers have recorded, such as “ten thousand diseases back to spring” said: “palsy, all body Qi deficiency; wood, damp phlegm dead blood also”, “all people all over the body paralysis, called unkind, are due to Qi deficiency by wind and dampness also”; Wang Ji “principles of medicine” said: ” There is a deficiency of blood can not guide the blood to glorify the tendons and veins and make numbness, there is a deficiency of blood to glorify the tendons and flesh, resulting in astringency of the tunnel and make numbness”; Shen Jinao “miscellaneous disease source rhinoceros candle” proposed “hemp, qi deficiency is the root, wind and phlegm is the standard; wood, dead blood stagnation in the internal, and external wind and cold, Yang Qi deficiency, can not move.” It can be seen that deficiency of qi and blood and invasion of external evil are the core pathogenesis of the disease, with the original deficiency and the actual symptoms. Tumor patients with deficiency of vital energy, chemotherapy drugs further damage the vital energy of the body, resulting in deficiency of qi and blood, yin and yang, blood deficiency can not fill the blood vessels, resulting in “blood does not glory tendons”, qi deficiency can not push the blood to run, yang deficiency, warmth deficiency, pushing weakness, cold extremities, blood stasis, and then it is not easy for qi and blood to reach the extremities, a vicious circle, so there will be The vicious cycle results in numbness, abnormal sensation, dullness, and even limb dysfunction. Therefore, the treatment should be based on the principle of benefiting Qi and nourishing Blood, warming Yang and activating Blood circulation. How can TCM methods quickly and effectively achieve the above treatment principles? Clinically, we use a combination of methods, including: 1) bloodletting by puncturing the toes/fingertips to expel evil and open the ligaments; 2) oral administration of Chinese herbal medicine and soaking, both internal and external regulation, to benefit qi and nourish blood and open the ligaments; 3) moxibustion of the Laogong and Yongquan points for half an hour each, once a day, to warm the yang and promote blood circulation. Chinese medicine believes that “the external treatment of the reason is the internal treatment of the reason, the external treatment of the medicine is the internal treatment of the medicine”, oral and external use can often share a miraculous effect, we often use Huangqi Gui Zhi Wuwu Tang plus or minus, “Jin Kou Essentials – blood paralysis deficiency labor disease pulse evidence and treatment of the sixteenth” said: “blood paralysis, yin and Yang are micro; inch mouth on the micro, ulnar The blood paralysis, both yin and yang are weak; the inch mouth on the micro, ruler small and medium tight, external evidence of the body is not benevolent, such as wind paralysis, Huangqi Gui Zhi Wuwuwu Tang is the main. The formula is designed for blood paralysis with deficiency of qi and blood and yingwei. Astragalus is sweet and warm to nourish qi, qi is the marshal of blood, qi moves blood; angelica, jujube, white peony, nourish blood and blood, blood is sufficient to move qi; cinnamon branch warms menstruation and disperses cold, warms blood vessels; poria strengthens the spleen; red peony, chicken blood vine, turtle worms, Datura, wei ling xian invigorate blood to dispel blood stasis and activate the channels. The whole formula works together to tonify the Qi, nourish the Blood, warm the Yang and open the channels. It should be emphasized that the above three methods need to be applied in order of priority. Generally, the best results are achieved by doing bloodletting by puncture first, 1-3 times a week, supplemented by oral and external Chinese medicine and moxibustion. So, how to prevent the occurrence of peripheral neurotoxicity due to chemotherapy? Good prevention requires adequate attention and avoidance of misconceptions. Specifically, pay extra attention to the care of living during chemotherapy, such as keeping warm, avoiding any cold water, cold objects and cold wind and other cold stimuli, etc. Cold objects include not only things in the refrigerator, but also bed rails, handrails and other metal products, which are easily ignored details of life, and it is difficult for doctors to give a comprehensive account. We strongly recommend that chemotherapy patients wear thin gloves to keep warm and prevent inadvertent contact with cool objects. In addition, there is another misconception that patients and their families take for granted, that is, since cold things are scary, is it okay to have hot things? We found that a lot of patients have the habit of soaking their feet, pursuing the higher the temperature, the better, which is also wrong! Too cold, too hot are external stimulation of the body, after chemotherapy nerve sensory abnormalities often lead to our inability to perceive such external changes in a timely manner. Therefore, hot and cold stimulation can induce the occurrence of peripheral neurotoxicity of chemotherapy, which should be paid extra attention.