| [Objective]:Under the guidance of traditional Chinese medical (TCM) theory combined with instructor's clinical experience, this article not only explores deeply TCM theory of cancerous pain, clarifies its etiology and pathogenesis, pathological nature and main therapeutic method, but also provides reliable TCM theoretical basis for development of Aitongping (ATP) Capsule. According to clinical observation of ATP capsule and experimental study of its anti-tumor mechanism, the advantages of Chinese medicine in treating cancerous pain will be explored.[Methods]:1.Theoretical Study:By retrieval of medical literature of past ages and collating and analyzing large data-sets, deeply understanding of cancerous pain in TCM and modern medicine will be illustrated in this article, and TCM theory of cancerous pain will also be explored according to TCM theory and mentor's clinical experience.2.Clinical Research:Eighty cancer patients were randomly divided into two groups,40patients in the treatedgroup took ATP capsule and40patients in the control group。The relevant clinical conditions of cancerous pain, tumor lesions,TTP, QOL,Daily morphine consumption and adverse reactions.3.The Experimental Study:The mechanism of analgesic effect of ATP capsule. the effect of ATP capsule on β-EP and NO in hypothalamus;Determine the weight of H22xenografted mice and also the tumor weight, observe tumor cell apoptosis, VEGF expression and the impact of CXCL12-of CXCR4biological axis by electron microscope, and explore the possible anti-tumor mechanism of ATP capsule.[Results]:1.Theoretical Study:The chief cause of cancerous pain included the six climate exopathogens, internal damage by excess of seven emotions, deficiency of vital Qi, turbid phlegm stagnation, inner blood stasis and spread of cancer toxin, the key point of etiology and pathogenesis is the blockage of Qi and blood and channels by dispersion of cancer toxin, pathological factors include cold, phlegm, blood stasis and cancer toxin, in which the cancer toxin is the key one, the pathological nature attributes to deficiency of Ben and repletion of Biao, and the excessiveness in Biao is more important. Indeterminate lesion location involves Fu organs like lung, liver and kidney, cancerous pain occurs early in lung and liver, and kidney in the late stage. The method of treatment of cancerous pain involves eliminating cancer toxin, removing phlegm and blood stasis, and dredging collaterals and relieving pain.2.Clinical Research:In the control of the primary tumor lesion, the stability ratio of treatment group was82.5%, but control group50%,which was lower than the treatment group, and the difference was significant (P<0.01). TTP of treatment group was55.80±21.38days (control group45.38±23.07days), which was longer than control group, the difference was statistically significant (P<0.05). The two groups of patients used morphine hydrochloride sustained release tablets meanwhile, the group used morphine combined with ATP capsule had less morphine dosage, fewer morphine-related side effects and higher quality of life than the group used morphine alone to control pain. Through appropriate treatment of cancerous pain, the quality of life of both treatment group and control group dramatically increased compared with before with significant statistically difference. But compared with control group, treatment group improved more significantly (P<0.01). simultaneously, patients with oral administration of weak opioid analgesics had higher incidence of constipation symptoms, but lower in the treatment group, the difference was also significant (P <0.01).3.Experimental Research:ATP capsule exerts central analgesic effect by inhibiting the release of NO in central nervous system and increasing the content of β-endorphin in central nervous system. ATP capsule at the dosage of18g/kg and36g/kg can significantly inhibit the growth of the tumor-bearing mice, the inhibition ratio were31.3%and55.3%respectively, which showed good anti-tumor effect. ATP capsule at the dosage of18g/kg and36g/kg could obviously induce the apoptosis of hepatocarcinoma H22tumor cells, the dosage of36g/kg can significantly inhibit the expression of VEGF, reduce tumor angiogenesis and the expression of CXCR4, and lessen the metastatic ability of tumor cells.[Conclusion]:ATP capsule was a new formulation of traditional Chinese medicine in treating cancerous pain developed with the guidance of TCM theory. Compared with control group, the treatment group could control cancerous pain, stabilize the tumor, and also prolong TTP of patients. ATP capsule in combination with morphine therapy can reduce the usage and the side effects of morphine, which insured the advanced stage patients better quality of life and longer survival period. The study shows that Ai Tong Ping capsule may treat cancerous pain by affecting the transmission of nociceptive stimulation and pain sensation in central nervous system. Anti-tumor mechanism of Aitongping capsule is a multi-channel, multi-target, the anti-tumor mechanism of ATP capsule was multi-way and multi-target, whose good pain control ability was associated with its anti-tumor mechanism. |
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