Therapy Of Resolving Phlegm And Regulating Stomach In Treatment Of Chemotherapy-induced Vomiting:experience And Academic Thought From Professor Wei Pin-kang

Objective:To explore experience and academic thought from Professor Wei Pin-kang about therapy of resolving phlegm and regulating stomach (RPRS) in treatment of chemotherapy-induced vomiting (CIV).Methods:4parts were included:theoretical source, analysis of herbal medication, clinical trial and experimental testing. Theoretical source:Theoretical foundation about therapy of RPRS was expounded gradually Analysis of herbal medication:TCM clinical literature in CNKI (1989-2010) involving CIV was retrieved and analyzed to explore the rule of Cliinese medicine in treating CIV Subsequently herbs and prescriptions of cases concerning CIV were collected from Wei Pin-kang case-database (keywords: chemotherapy and vomiting,2006.1-2010.10). The herbs, category nature, flavor, meridian distribution and couple herbs were summarized by frequency method or hierarchical cluster analysis. Clinical trial:A randomized, crossover trial of two periods was performed on48patients received chemotherapy first time. They were randomly divided into two groups who received administration of granisetron hydrochloride and dexamethasone injection combined or not combined with RPRS decoction according to adverse order. The frequencies of vomiting daily in each group were recorded. MDASI and KPS were used to evaluate status of patients. Experimental testing:Wistar rats were injected intraperitoneally with cisplatin to induce pica and conditioned taste avoidance. The RPRS decoction was administered with granisetron hydrochloride administered as control drug. Kaolin, saccharin solution intake and common feed consumption were recorded in the following24h and72h. The content of5-HT,5-HIAA and DA in brain stem, small intestine and senun were detemiiiied in ELISA.Results: Qi regulating, restorative, phlegm resolving decoctions and restorative, phlegm resolving, qi regulating herbs were used frequently in literature. Warm and flat were main medicinal properties. Sweet, pungent, bitter herbs and meridian tropisms to spleen, stomach and lung were given priority to others. However, qi regulating, resolving phlegm, invigorating qi, relieving food retention herbs and etc were used frequently in prescriptions from Professor Wei Pin-kang. The most frequently used herbs had31species including Radix Ghxyrrhizae, Rhizonui PiiieJh'ae*EndotheUum Corneum Gigeriae Galh\RhizomaArisaewatis, Radix Paeoniae Alba, Radix et Rhizoma Rhei and etc. Warm nature and pungent, bitter, sw:eet herbs were most frequently used. These herbs mostly attributed to spleen, stomach, liver and lung meridians. The couple-herbs used most frequently includedRhizor}m PineJIiae and R]}izoma Arisaematis, Fnictus Aurantii Inmiantnts and Stdmmtttre Bitter Orange, Flos Caiyophyfli and Calyx Kaki and etc. Clinical trial proved that vomiting frequency ond3CP=0.0172) and scales of multi-items in several days (P-0.05), including fatigue, nausea, sleep, distress, dyspnea, loss of appetite, drowsiness, dry mouth, sadness, vomiting, numbness, general activity and mood in MDASI, of patients combined with RPRS decoction had statistical differences. Experimental testing showed that RPRS decoction inhibited pica significantly, improved saccharin solution intake and anorexia induced by cisplatin in rats. RPRS decoction reduced higher content of5-HT,5-HIAA and DA in brain stem at24h and72h, DA in serum at24h,5-HT and DA in senun at72h and increased content of DA in small intestine at24h after cisplatin administration.Conclusion: Professor Wei emphasizes dissolving phlegm and descending stagnation because phlegm and stagnation are two important etiological factors of CIV. He suggests therapy of RPRS to treat CIV RPRS decoction can inlribit effectually CIV (acute and delay), relieve adverse reaction of chemotherapy and improve quality of life on the base of regulating content of5-HT,5-HIAA and DA in brain stem, small intestine and senun.