Retrospective Study On Professor SHU Peng’s Treatment Of Gastric Cancer

Objective:Based on Professor Shu Peng’s clinical cases of treating Gastric Cancer(GC),her clinical experience and academic thought in the treatment of GC were studied and discussed,the study is composed of medical case data mining,case study,interviews etc.The purpose of study is to make her academic thought be summed up and be inherited comprehensively as well as to provide ideas and methods for the diagnosis and treatment of GC in Chinese medicine(TCM).Methods:(1)Studying the literature of TCM on GC in recent 30 years,analyzing and discussing the current status of TCM research on GC.(2)Based on the existed theory of Chinese medicine for GC,this paper summarizes the viewpoints of modern physicians on the etiology,pathogenesis,treatment principles,methods and prescriptions.(3)Professor Shu Peng’s medical records of clinical diagnosis and treatment of GC from February 2010 to March 2019 were registered by using Medcase Ver3.8 data recording and mining system,and a special database was established and screened strictly according to the inclusion and exclusion criteria.The frequency method,association rules and cluster analysis were applied to 339 cases which met the criteria.The pathogenesis type,TNM stage,treatment stages,symptoms,principle of treatment,prescriptions and medicines etc.were excavated from the medical records and the results were analyzed to summarize Professor Shu Peng’s clinical experience.(4)Four representative cases in different treatment stages with significant effect were sorted out and analyzed to summarized the treatment rules.(5)Professor Shu Peng’s views on the etiology,pathogenesis and treatment of GC were recorded and discussed in detail in a structured interview.Results:(1)167 TCM literatures on GC focused on theoretical research,experience summary and clinical observation were retrieved.(2)MTC believes that GC etiology passes through external causes such as six excess and pathogenic toxin etc.and internal causes such as dietary disorders,emotional injuries,correct qi deficiency etc.leading to spleen stomach and visceral functional disorders,qi stagnation,food accumulation,blood stasis,phlegm node,heat/fire toxin after a long delay and mutual influences will take tumor form.GC principle of treatment can be summed up as "strengthen the correct and expel pathogenic factor",strengthen the correct needs to pay attention to the spleen and stomach,Liujunzi decoction is accordingly the most used formula.(3)This study included 339 GC patients with 1046 consultations.Firstly the data mining of the general group mas conducted,then that of the other three sub-groups which are formed according to different treatment stages were carried out:adjuvant chemotherapy group included 27 patients with 37 consultations,rehabilitation group 202 patients with 793 consultations,palliative group 108 patients with 214 consultations.Results:① Basic situation:General group male female sex ratio is 1.7:1;Adjuvant chemotherapy group 1.25:1;Rehabilitation group 1.6:1;Palliative group 2:I.GC’s highest incidence age is between 60 and 69.②Pathogenesis distribution and TNM stage:adenocarcinoma represents 97%of histopathologic type distribution;G3 represents 79%of histological grade distribution;diffuse type represents 38.09%of Lauren classification distribution,stage IV represents 36.15%of TNM stage distribution.③Clinical manifestations:general group’s symptoms with a frequency above 10%are:poor food intake,sloppy stool,belching,lack of strength,acid reflux,aversion to cold;coated tongue with thin white tong fur,rose;less tong fur,red;greasy tongue fur,rose;rose with dental mark is often seen;thin pulse frequency is the highest.In adjuvant chemotherapy group belching frequency is particularly high;greasy tongue fur frequency is relatively high.In rehabilitation group paresthesia and epigastric dull pain frequency is relatively high.In palliative group poor food intake and lack of strength frequency is particularly high;less tong fur frequency is low,dark tongue relatively high.④Principle of treatment:strengthen the spleen and nourish the stomach,resolve the toxicity and expel the pathogenic factors is the basic principle.⑤Formulas and medicines:in general group,there are 45 drugs whose usage frequency are above 10%,representing overall 82.81%,among them,Jineijin,Zhigancao,Fuling,Dangshen,Chenpi,Banxia,Zhebeimu,Chaomaiya,Chaoguya,Chaoshanzha,Chaoshenqu,Ezhu,Sanleng,Chaobaizhu,Shenghuangqi,Sanqi’s usage frequency are above 50%.The basic formula is "Liujunzi decoction".According to K-means Clustering rules,three core prescriptions were obtained:the first is Shenghuangqi,Dangshen,Chaobaizhu,Fuling,Danggui,Chenpi,Fabanxia,Wumei,Ganjiang,Shijianchuan,Zhigancao.The second is Shenghuangqi,Dangshen.Chaobaizhu,Baishao,Danggui,Fabanxia,Chenpi,Sanleng,Ezhu,Shijianchuan,Zhigancao.The third is Shenghuangqi,Dangshen,Chaobaizhu,Fuling,Baishao,Danggui,Sanleng,Ezhu,Shijianchuan,Chenpi,Banxia,Zhigancao.In adjuvant chemotherapy group core prescription is Sanleng,Dangshen,Banxia,Danggui,Zhigancao,Shijianchuan,Fuling,Ezhu,Chenpi,Jineijin.In rehabilitation group drug’s frequency above 50%are Jineijin,Fuling,Zhigancao,Dangshen,Chenpi,Banxia,Zhebeimu,Chaomaiya,Chaoguya,Chaoshanzha,Chaoshenqu,Chaobaizhu,Ezhu,Sanleng,Shenghuangqi。In the palliative group,where Ezhu and Sanleng usage frequency is relatively high,one core prescription was obtained:Beishashen,Nanshashen,Tianmendong,Gancao,Maimendong,Shengshigao,Zhimu.There are many drag’s pairs and drugs groups that contain "anti-cancer" drugs like Tengligen,Banzhilian,Shancigu,Jixingzi,Dibiechong,Xuchangqin,Wugong,Bihu,Hongdoushan,Fengfang.(4)The four treatment stages are represented by neo-adjuvant chemotherapy stage,adjuvant chemotherapy stage,rehabilitation stage and palliative stage,their respective core principle of treatment are attack and tonify,regulate spleen and stomach;stimulate the strengthen of spleen and stomach transport function;benefit the qi,transform stasis,resolve toxicity;nourrish posterior heaven,resolve toxicity and attack pathogenic factor.(5)GC’s primary etiology is spleen and stomach deficiency,its pathogenesis is spleen and stomach deficiency,turbidity and toxin accumulation,principle of treatment is firstly to strengthen the spleen and nourish the stomach,secondely to resolve the toxicity and expel the pathogenic factors.We should tonify and promote transport to improve spleen and stomach function.Though each treatment stage has his own target,they all follow one unique principle which concerns the treatment according to syndrom differenciation.Conclusion:By means of these four research methods as theory study,data mining,case study and interviews,Professor Shu Peng’s clinical experience and academic thought in the treatment of GC is summed up.Her treating mode is based on the combination of TCM and western medicine system which includs pathological diagnosis,according to pathogenesis characteristic of each treatment stage and by differentiating of disease,syndrome and symptom she gives out the formulas and the drug prescriptions.