Drug ideas for tumor refractory eruption

Gastrointestinal symptoms are common adverse reactions in the treatment of malignant tumor patients. Most of the patients suffer from gastrointestinal reactions such as erosion, nausea, vomiting, anorexia and abdominal distension to varying degrees when receiving radiotherapy, systemic chemotherapy or catheter interventional chemotherapy. With the prolongation of treatment time, the symptoms aggravate and obviously affect the quality of life of patients, and even some patients postpone or give up the treatment. Tumor patients often have persistent erratic reflux during radiotherapy, chemotherapy or after surgery, and conventional symptomatic treatment is ineffective. It is called “retching” in Nei Jing and later called erratic. Western medicine believes that erratic rebellion is due to spasm of the diaphragm. Chinese medicine believes that the erratic is different from the cold, heat and deficiency, the actual evidence, such as the accumulation of cold, dry heat, phlegm blockage, deficiency, including spleen and kidney Yang deficiency, gastric Yin deficiency, etc., but always from the loss of stomach and lowering, gastric rebellious diaphragm pathogenesis, the treatment to and lower the gastric Qi more commonly used. In my clinical work, I found that some of the tumors with persistent erratic rebellion are difficult to be treated by conventional methods, but with the “special medicine” to lower the rebellion and stop vomiting or transfer to other methods can often obtain satisfactory results, the experience is summarized below. Ochre is bitter in taste, cold in nature and heavy in quality, good for entering the liver and heart blood. It can be used for vomiting and eructation, and even regurgitation and choking in patients undergoing chemotherapy due to weak stomach qi, imbalance of qi in the middle jiao, and upward rebellion of stomach qi. Ochre is often used in combination with Radix et Rhizoma, from the treatise on typhoid fever. Radix et Rhizoma is warm, pungent and slightly bitter, specializing in lowering Qi and stopping vomiting, promoting the lung and eliminating phlegm. The amount of ocher commonly used in clinical practice is 15g-30g. Zhang Xichen, a famous doctor in modern times, discussed the functions of ocher in detail in his book “Zhong Zhong Ginseng Xilu” [1]. According to him, “raw ochre is the most powerful in pressure, it can calm the stomach, flush Qi upwards, open the chest and diaphragm, drop phlegm and saliva, stop vomiting, and pass dry knots”, and “although it is of stone quality, it is different from other stones, even if it is not calcined by fire and taken as a powder, it is not harmful to the stomach and intestines”. In case of severe eruption and vomiting, ochre is often used as a substitute for several taels. Zhang’s treatment of a woman vomiting repeatedly, the stool does not pass, the lower epigastric pain in the knot, five or six days spoon water does not exist, where the entrance to the drug is vomiting, ochre two two decoction drink, and again vomited, then changed to ochre four two, sieve out the fine powder two Xu, the remaining three two decoction soup mix the fine powder to take, the knot was opened, the stool also passed. This decoction method has been tried by the author many times in clinical practice with satisfactory results. It is important to note that ochre is bitter and cold in nature, and in excess it can easily injure stomach qi. Generally speaking, the dosage is not too much for real cases, but up to 60g or even 100g for heavy cases, while the dosage should be lighter for those with obvious weakness of stomach qi, 15g-20g is better to avoid bitter cold injury to the stomach, so that the erratic rebellion will not be removed and the middle jiao will be more deficient. In addition, those with prolonged illness or deficiency of stomach qi should be used together with dang ginseng and yam; those with loose stools can use calcined ochre, taking its astringent nature, with a slightly smaller dosage than raw. Second, clove with tulip, the opposite of the Chinese medicine has the opposite of the taboo, since ancient times. In the Jin Dynasty, Zhang Yuan in the “pearl capsule supplement medicinal fugue” will be “18 anti”, “19 fear” compiled into a song, since then widely circulated. The “nineteen fears” clearly put forward “cloves should not be seen with tulip”. The author found in the clinical process, the deficiency of cold erratic in clove persimmonti soup based on the addition of tulip, can often be good results, and no adverse reactions were found. Clove pungent warm, into the spleen, stomach and kidney meridian, warming the middle to disperse cold and subdue rebellion, warming the kidney to help Yang, is the treatment of deficiency cold erratic; tulip gold hard cold, to the heart, liver and gallbladder meridian, moving qi to relieve depression, cooling the blood to disperse stasis, bile to clear the heart, as the blood in the qi medicine. Clove and yujin are used together, one warm and one cold, one descending and one dispersing, together with the function of descending and moving qi to stop vomiting, which is very suitable for treating persistent erratic and vomiting in tumor patients. In ancient times, there are many precedents of the combination of clove and yujin, such as the ten incense rejuvenating elixir in the formula of “The Bureau of Harmony”; modern clinical reports on the combination of opposite and fearful drugs are common. Mr. Zhu Liangchun, a famous contemporary physician, believes that “when there is a disease of this kind, the medicine of this kind should be used”, and there is no need to be bound by the “eighteen anti” and “nineteen fears” [2]. The male clove is the flower bud, with sufficient aromatic power; the female clove is the fruit, with light odor and weak efficacy. General clinical often with male cloves and tulip according to 1:3 or 1:4 combination. Third, half asia raw, lowering the rebellious vomiting power is more half asia pungent warm, into the spleen, stomach two meridians, lowering the rebellious vomiting, dry dampness, phlegm, dissipate lumps and knots, for the lowering of Qi rebellion of the special drug. It is commonly used in clinical practice to lower Qi rebellion and stop vomiting, while Qingxia and Fuxianxia are good at harmonizing the stomach, drying dampness and resolving phlegm. The traditional method of concoction of Semen with water and alum, licorice, etc. soaked, antiemetic components have been removed most of the efficacy is greatly reduced. I do not know that the raw use of half ansia, the function of lowering the rebellious began to magnify. It is poisonous, so it is important to pay attention to the decoction method. Generally, it should be decocted alone for 40 minutes, to taste no spicy sensation, and then the remaining drugs with the decoction. If you pound the raw half ansia with fresh ginger and decoct it for 30 minutes, the toxicity will be removed and the antiemetic effect will be better. If the herbs are hot, add Scutellaria baicalensis, Huanglian and Zhuru; if they are cold, add ginger, Cornus officinalis and Chenpi. In addition, tumor patients often have symptoms of subcardiac fullness during chemotherapy in addition to eruption and vomiting, and the stomach and epigastric region is blocked by something, but there is no pain when pressed. It is especially suitable to lower the rebellion and stop vomiting, lower the Qi and disperse the knots. Tumor is a difficult disease with complex etiology and mixed pathogenesis of deficiency, cold and heat, which makes treatment difficult. Tumor stubborn erratic is often ineffective with multiple methods, at this time, it can be treated from the experience of previous sages that “long-standing disease must have stasis and strange disease must have stasis”. Stasis of blood blocking the gastric ligaments, loss of harmony and descent of the stomach, and upward rebellion of gas can lead to frequent erratic rebellion, vomiting, regurgitation or even choking. Wang Qingren in the “Medical Lin Correction” proposed that “erratic commonly known as playing croup, because of blood stasis in the blood ……. If the blood stasis is even, the trachea is occluded, the in and out of the gas does not work, suffocating and dying”, “erratic is blood stasis, once you see erratic, regardless of the severity, that is to resolve the blood stasis”, treatment with blood stasis soup. As mentioned before, although there are differences between cold and heat, the pathogenesis of erratic is always qi rebellion on the top, and qi is the handsome blood, qi rebellion is blood rebellion, Wang Qingren believes that the symptoms of “dry vomiting and choking on water, erratic” is “blood stasis” or “blood stasis Blood stasis”. Blood stasis and blood stasis soup has the characteristics of resolving blood stasis without harming blood and regulating qi without depleting qi, which can dispel blood stasis, smooth qi flow, lower rebellion and stop vomiting. According to the experience of Mr. Yan Dexin, a famous contemporary doctor, for those who have repeatedly failed to get rid of erratic vomiting and whose disease has been in the ligaments for a long time, they can use Tongkou and Blood-vitalizing Tang. It is worth mentioning that although some patients with tumor eruption do not have obvious signs of blood stasis, the method of invigorating blood and resolving blood stasis is also effective. On the basis of activating blood circulation and resolving blood stasis, the patient should be identified and classified according to clinical symptoms, and treated with the addition and subtraction of Blood Mansion and Blood Stasis Tang.