The Regularity And Relatively Empirical Study Of The TCM Treatments On Malignant Bone Tumor

The total incidence rate of malignant bone tumor is low,but it often results in extremity disability and even threats to life.In the past few years,five-year survival rate has been consumedly raised since combined therapy including operation and neoadjuvant chemotherapy etc,was applied. TCM,as a part of combined therapy,manifests characteristic therapeutic effect and potentiality on stabilizing the focus of infection,lowering the toxicity of chemoradiotherapy,prolonging live time and improving the quality of life.On account of various kinds of reasons,the research on malignant bone tumor by TCM is relatively lagging.The knowledge on the regular pattern of the development of its TCM syndromes and its pathogenesis is still insufficient.The curative effect and mechanism of TCM needs to be further authenticated by empirical study.To solve these problems,we tried to collect the related modern documents and sum up the regularity of the TCM treatments on malignant bone tumor.To treat malignant bone tumor,we made an experimental study on the mechanism of action with the method of invigorating vital energy and promoting blood flow and eliminating phlegm to treat malignant bone tumor.We also made a clinical retrospective study on patients with malignant bone tumor to explore its Traditional Chinese Medicine(TCM)syndromes and the characteristics of its TCM pathogenesis.PartⅠRecent developments in the treatment and the role of TCM in Management of malignant bone tumor:A Review and PerspectiveReview the Recent developments in malignant bone tumor(including tumorigenesis mechanism,clinic,tendency)and the recognition in traditional Chinese medicine about it(including name,pathogenesis, therapeutical principle,etc),and make the document basis on the next research relatively. 1.Pathogenesis and syndromes about Bone Tumor in the relatively modern documentsAim:To summarize the regularity of Pathogenesis and syndromes in the documents.Methods:Screen the pathogenesis and syndromes recorded in the documents which were published from 1989 to 2007,then establish the database,analyze the characters of treatment regularity with frequency analysis,factor analysis,and cluster analysis.Results:(1)Pathogenesis:①Frequency analysis:Stagnated blood and renal deficiency are the most common pathogenesis and the occurrence frequency of is over 50%in all the 55 documents.The frequency of occurrence of stagnated blood,renal deficiency,poison,deficiency of vital energy,blood deficiency and frigidity is 80.98%.②Cluster analysis:Category 1:sputum,stagnated blood,endohygrosis,blood deficiency,renal deficiency,deficiency of vital energy,splenic asthenia.Category 2:stagnated blood,qi-stagnancy.Category 3: stagnated blood,pathogenic heat,poison,frigidity,renal deficiency, deficiency of vital energy.③Factor analysis:F1:blood deficiency, deficiency of vital energy.F2:endogenous wetness-evil,endogenous wetness-evil,rigidity.F3:blood deficiency,qi-stagnancy.(2) Syndromes:①Frequency analysis:Accumulative frequency of occurrence of qi-stagnancy and blood stasis,asdthenic splenonephro-yang,pyretic toxicity,hemophthisis,YIN-cold,stagnation of QI due to depression of the liver is 81.47%.The frequency of occurrence of qi-stagnancy and blood stasis and asdthenic splenonephro-yang has significant deviation from the other syndromes.②Cluster analysis:Category 1:retention of phlegm-heat in the interior,deficiency of both vital energy and yin, weakness of the spleen and stomach,liver and renal debility,phlegmatic hygrosis,QI and blood deficiency,pyretic toxicity,retention f heat in the interior,deficiency of vital energy and blood stasis,YIN-deficiency of the lung and kidney,humid heat,sputum and blood stasis,stagnation of QI due to depression of the liver.Category 2:asdthenic splenonephro-yang,YIN-cold.Category 3:qi-stagnancy and blood stasis.Conclusions:Asthenia and sthenia inclusion is the major reason of bone tumor in TCM.Sputum,blood stasis,endogenous wetness-evil are the major sthenia pathogeny and renal deficiency,deficiency of vital energy, deficiency of vital energy and deficiency of vital energy are the major asthenia pathogeny.Qi-stagnancy and blood stasis,asdthenic splenonephro-yang,pyretic toxicity,pyretic toxicity,hemophthisis, YIN-cold,stagnation of QI due to depression of the liver are the major syndromes.2.Regularity of prescriptions in traditional Chinese medicine in patient with malignant bone tumorAim:To summarize the regularity of in traditional Chinese medicine in patient prescriptions with malignant bone tumor,and to make the basic study for the next clinic and empirical study.Methods:The prescriptions in traditional Chinese medicine of the chief physician in patient with final diagnosis of malignant bone tumor from Jan.2005 to Nov.2007 in Guangdong hospital of TCM were reviewed,then established the database,analyzed the characters of treatment regularity with frequency analysis,factor analysis,and cluster analysis.Results:(1)Frequency analysis:tonic.Accumulative frequency of occurrence of drug for invigorating blood circulation and eliminating stasis,heat-clearing drugs,drug for dissipating dampness and apophlegmatisant is 78.6%.And these drugs take the major role of prescriptions in TCM.Drugs of cold property and warm property of all are 70.3%,and there is no significant difference(P＞0.05).(2)Cluster analysis:all clusters obey the rules of strengthening healthy qi to eliminate pathogens,reflect the therapeutic principles of tonifying the spleen and kidney,invigorate vital energy and promote blood flow, heat-clearing,detoxicating and dehygrosis.(3)Factor analysis (frequency over 14 times):F1:PORIA from Yunnan of China,atractylodes macrocephala,heterophylly falsestarwort root.F2:Zedoary rhizome, centipede,scorpio,Hedyotic diffusa,scutellariae barbatae,herba.F3: Astragalus mongholicus,salvia miltiorrhiza,Codonopsis pilosula.Conclusions:The basic compatibility rules in endotherapy of TCM treating on malignant bone tumor are nourishing qi to invigorate spleen and promote blood flow,combining with invigorating the kidney, dissipating phlegm,dehygrosis or heat-clearing and detoxicating according clinic syndromes. PartⅢEmpirical study on herbs of invigorating vital energy and promoting blood flow of treating tumor-bearing miceAim:To investigate the effect and mechanism of modified Decoction of Four Drugs on the biological behavior of the in vivo infiltrating growth of malignant bone tumor.Methods:We established the mice orthotropic transplantation model of osteogenic sarcoma KHOS and observed the growth of the transplantation tumor after treating with the modified Decoction of Four Drugs by intragastric administration to interfere the biological behavior of the animal models;measure the expression of VEGF,MVD of the transplantation tumor by the way of immunohistochemistry.Results:High-dose modified Decoction of Four Drugs group has significant effect on restraining the proliferation of bone tumor cells (P＜0.01),while middle and low-dose groups have no significant effect on restraining the proliferation of bone tumor cells(P＞0.05),the tumor-inhibiting rate of high-dose group is higher than that of the middle and low-dose groups which are 3.98%and 9.24%separately.The high-dose modified Decoction of Four Drugs group has the significant effect of inhibiting positive objective density of expression of VEGF(P＜0.05),but has no significant effect of inhibiting positive objective rate of expression of VEGF(P＞0.05).The effect of inhibiting the expression of VEGF of the transplantation tumor tissue by the middle and low-dose groups is not significant(P＞0.05);There are no significant difference of the MVD expression of the transplantation tumor tissue between every two groups(P＞0.05).Conclusions:High-dose modified Decoction of Four Drugs group can restrain the growth of bone tumor in vivo in tumor-bearing mice.There is not enough evidence that the modified Decoction of Four Drugs can reduce the expression of VEGF and MVD to control the growth of new vessels of tumor which can interrupt the growth of malignant bone tumor in vivo.