1.Discussion on Treatment of Gastric "Inflammation-cancer" Transformation based on the "Five-view Differentiation and Treatment" System
Yuansha GE ; Bowen XU ; Jie LI
Journal of Traditional Chinese Medicine 2024;65(19):1988-1993
Standardized gastroscopy screening makes the diagnosis of precancerous lesions of gastric cancer (PLGC) clearer. Correa evolution is the key to gastritis-cancer transformation, suggesting that PLGC is the core of the body's transformation from normal to cancer. Based on the "five-view differentiation and treatment" system for malignant tumors, we explored the establishment of a new system for preventing and treating malignant transformation of benign and inflammatory lesions from five dimensions, including pre-disease view, time-space view, core view, symptoms view and precision view. (a) pre-disease view: early intervention to intercept inflammation-cancer transformation; (b) time-space view: following the time-space framework as the disease progresses; (c) core view: focusing on the core pathogenesis of inflammation-cancer transformation. In terms of different stages, qi deficiency and stagnation are mainly manifested in the early stage, which can be treated by invigorating qi and resolving constraint; in the middle stage, yin turbidity is blocked internally, and it can be treated by warming yang and removing turbidity; in the cancerous stage, cancer toxin are blocked, for which the anti-cancer, toxins-resolving and stasis-dissolving method is suggested. In terms of the location of the disease, it is suggested to relieve disease in the upper body by rectifying qi and dissolving phlegm with emetic therapy (vomit induction); for the disease in the middle, it it suggested to nourish yin and clear heat by elimination method; pathogen in the lower requires dredging method by moving qi and dissipating cold; (d) symptoms view: using herbal pairs to deal with the main symptoms; (e) precision view: enriching targets to prevent and control cancer directionally.
2.Biological Basis for ''Five-phase Evolution'' of Malignant Tumors
Xiaoyu ZHU ; Yuansha GE ; Jie LI
Chinese Journal of Experimental Traditional Medical Formulae 2022;28(20):209-217
China ranks the first in the morbidity and mortality of malignant tumors in the world. Traditional Chinese medicine (TCM) has played a crucial part in preventing recurrence of malignant tumors after surgery, enhancing efficacy and reducing toxicity of radiotherapy and chemotherapy, and promoting the survival of patients with advanced tumors. According to the whole process of tumor occurrence and development and via the long-term clinical practice, we proposed the "deficiency-cold-toxin-blocking-failure evolution theory" of malignant tumors, with depression in the whole process and cancer toxin as the core. The theory is a summary of pathophysiological status at different stages of tumor development based on the disease and syndrome. This paper analyzes the biological basis of the theory. To be specific, we believe that the ''deficiency'' is mainly caused by the tumor immunoediting abnormality and thus the escape of clearance. In addition, the ''cold'' is in line with the metabolic reprogramming of the tumor microenvironment. ''Toxin'' is manifested as the stemness of cancer cells induced by the tumor microenvironment. ''Blocking'' is closely related to the enhanced permeability and retention (EPR) effect of tumor neovasculature. ''Failure'' is exactly the cachexia caused by change of dominant metabolism. ''Depression'' is essentially stress-the accelerated progress of the neuroendocrine system. In combination with clinical practice, we conclude that method of reinforcing healthy Qi and adjusting the balance can help recover tumor immunoediting and restore the immunity to regulate the "deficiency". Moreover, replenishing Qi and warming Yang can correct the tumor metabolic programming to avoid "cold". Removing toxin and reinforcing healthy Qi can reverse tumor cell stemness and thus suppress the ''toxin''. Eliminating the ''blocking'' source can suppress tumor angiogenesis and help regulate the EPR. Regulating Yin and Yang will help relieve the change of dominant metabolism and futile cycle to avoid ''failure''. The method of relieving depression and regulating Qi can relieve neuroendocrine stress and prevent tumor progression, thus alleviating the "depression". Moreover, effect of these methods was tested with effective formulas. This study is expected to lay a foundation for the establishment of a new system for the clinical prevention and treatment of malignant tumors.
3.Construction and Consideration of Comprehensive Evaluation System for Clinical Effectiveness of Traditional Chinese Medicine in Treating Malignant Tumors
Jingyuan WU ; Bowen XU ; Guanghui ZHU ; Yuansha GE ; Ying ZHANG ; Jie LI
Journal of Traditional Chinese Medicine 2023;64(19):1954-1960
With reference to the comprehensive evaluation system for the clinical effectiveness of Chinese patent medicine, this paper summarized the current status and problems of the comprehensive evaluation of the clinical effectiveness of traditional Chinese medicine (TCM) in the treatment of malignant tumors from seven aspects, including safety, effectiveness, cost-effectiveness, innovation, suitability, accessibility, and TCM features. On this basis, the characteristics of TCM and the disciplinary characteristics of oncology are considered, and multiple sources of evidence, focus on dominant groups of people, consideration of economic toxicity, paying attention to post-marketing research, targeting at patients' willingness of medication, anchoring the supply of TCM services, and introducing symptoms threshold events are further emphasized. Moreover, methods such as nested case-control studies, enrichment designs, real-world research, and intelligent TCM diagnosis and treatment platforms are used to obtain high-level clinical evidence, ultimately building a scientific, homogeneous, and standardized comprehensive evaluation system for the clinical effectiveness of TCM in the treatment of malignant tumors.
4.Analysis of Traditional Chinese Medicine Syndrome Characteristics and Related Factors of Yang Deficiency Syndrome in Postoperative Gastric Cancer Patients: A Multicenter Cross-Sectional Study
Yuansha GE ; Ruike GAO ; Jie LI ; Bowen XU ; Jingyuan WU ; Luchang CAO ; Ziyu KUANG
Journal of Traditional Chinese Medicine 2024;65(24):2565-2571
ObjectiveTo explore the distribution characteristics of traditional Chinese medicine (TCM) syndromes in postoperative gastric cancer patients, and to analyse the factors associated with yang deficiency syndrome and its severity. MethodsTotally, 173 patients who underwent postoperative gastric cancer surgery and were treated in four centers nationwide from February 22, 2022 to March 21, 2023, were enrolled. General information and TCM syndromes were collected, and Diagnostic Scale for Yang Deficiency Syndrome in Gastric Malignancies was filled in. The frequency of TCM syndromes after gastric cancer surgery was analyzed, and univariate analysis and multivariate logistic regression analysis were performed on the related factors of yang deficiency syndrome versus non-yang deficiency syndrome and between different severity of yang deficiency syndrome. ResultsThe most common syndrome after gastric cancer surgery was qi deficiency (95 cases, 54.91%), followed by yang deficiency (87 cases, 50.29%). Patients with yang deficiency syndrome were often suffered from qi deficiency, qi stagnation, and phlegm dampness syndrome. Comparing yang deficiency syndrome with non-yang deficiency syndrome, univariate analysis showed that history of alcohol consumption, pathological stage, degree of differentiation, Lauren grade, signet ring cell carcinoma, vascular cancer thrombus, and nerve invasion were statistically significant (P<0.05); and multivariate logistic regression analysis showed that history of alcohol consumption, signet ring cell carcinoma, pathological stage Ⅲ, Ⅳ, and vascular cancer thrombus may be correlated with yang deficiency syndrome in postoperative gastric cancer patients (P<0.05). The univariate analysis showed that age, pathological stage, precancerous lesions, and body mass index grade were significantly different when compared between mild and severe yang deficiency syndrome (P<0.05); multivariate logistic regression analysis showed that age, low body weight, and pathological stage Ⅲ and Ⅳ might be correlated with severe yang deficiency syndrome after gastric cancer surgery (P<0.05). ConclusionQi deficiency and yang deficiency are common TCM syndromes in postoperative patients with gastric cancer. Alcohol consumption history, pathological staging (stage Ⅲ and Ⅳ), signet ring cell carcinoma, and the presence of vascular cancer thrombus may be correlated with the occurrence of yang deficiency syndrome, and higher age, low body weight, and pathological staging (stage Ⅲ and Ⅳ) may be the correlates of severe yang deficiency syndrome.