Research On Summarizing Traditional Chinese Medicine Academic And Clinical Experience On Primary Liver Carcinoma Based On Syndrome Differentiation By Professor Qian Ying

Primary liver cancer (primary liver cancer, PLC, also named hepatic carcinoma from the Greek hepar, meaning liver) is a common type of cancer which has high morbidity and mortality. The incidence of PLC is insidious. Patients usually show asymptomatic early but most of them are diagnosed until an advanced stage. The patients of PLC mainly have obvious symptoms of digestive tract and can survive 3-6months at advanced stage on average. PLC is one of the most severe health complications.Traditional Chinese Medicine (TCM) Therapy is an important part of comprehensive treatment for PLC. It’s significant to summarize TCM academic and clinical experience on primary liver cancer based on syndrome differentiation of the famous doctors of TCM. PLC patients can benefit from the TCM inheritance and development.Professor Qian Ying is a great capital TCM master. He has been engaging in liver disease with TCM for many years and accumulating rich experiences. He has unique insights in illuminating the etiology and pathogenesis of PLC with TCM theory and he has personalized TCM treatment which can make better efficacy for PLC. We studied his academic thought and clinical experiences for PLC based on syndrome differentiation. There are these parts as the following. They include a theoretical research on the formation of his academic thought for PLC and further generalizations of his original content for PLC treatment with TCM. Then we did a retrospective study on herbs and prescriptions for PLC in TCM treatment by Professor Qian Ying. Professor Qian Ying created a TCM prescription named Hu Qi San. So we did a prospective study on PLC treatment with Hu Qi San.Objective:To trace back to the theoretical origin for PLC by Professor Qian Ying, to summarize the TCM characteristics and clinical experiences for PLC treatment by him, to identify the features of him, to refine academic thought for PLC by Professor Qian Ying, to find the most frequent herbs and prescriptions for PLC by him with data mining, to verify the theoretical research conclusions, and furthermore, to do an observational study and to investigate the efficacy of HUQISAN for patients of late PLC.Methods:We did all the theoretical and experiences topics with combination of literature research and experts interviews. We did a retrospective study in 111 PLC cases who received TCM treatment by Professor Qian Ying. We mined Professor Qian Ying’s frequent herbs and prescriptions and We described the clinical signs of the cases and did a self-control study to explore the clinical efficacy. Then we did a prospective cohort study that 56 patients with advanced PLC was divided into two groups:Hu Qi San group and the usual treating control group. We collected all the patients’ clinical symptoms and quality of life as well as size of the tumor and we recorded results of liver function test and alpha-fetal protein (AFP) at the treatment stage of 4th and 12th weeks. We compared all the values between the Hu Qi San and the control group. Furthermore, we followed all these patients.Results:Professor Qian Ying’s TCM clinical thinking of PLC was based classic books. He inherited and carried forward the ancient physicians and we found out of his origin. We found that "adjusting both internal organs and function of the liver" is the most important and basic academic thought to treat PLC by Professor Qian Ying. We concluded that it is his major method for Professor Qian Ying to deal with PLC disease by "adjusting both internal organs and function of the liver". We discovered that he created Hu Qi San and he emphasized consideration of five internal organs however focus on liver, spleen and kidney organs. We also found that he treats PLC with mild TCM and his basis principle of treatment for PLC is to strengthen the body resistance, to detoxify and to eliminate the tumor.The retrospective study showed no significant difference (p>0.05) in sexuality, age and the choice of the treatment when PLC patients were divided into groups according to the Child-Pugh classification. Patients were divided into TCM group and combination therapy one following the methods of the treatment. It showed no significant difference in sexuality and age. A significant difference of the Child-Pugh classification and clinical staging of hepatic carcinoma in Barcelona (BCLC) showed with the two groups (p<0.05). The results also suggested that the main clinical manifestation for patients with liver cancer were bloating, fatigue, anorexia, abdominal pain, jaundice and other symptoms. These symptoms relieved after Qian Ying’s treatment. Data mining research results showed that mistletoe, astragalus, Salvia miltiorrhiza, radix curcumae and fructus polygoni orientalis are frequent herbs by Professor Qian Ying in treatment of primary liver cancer in accordance with Hu Qi San created by him. After 1 months of treatment, patients with total bilirubin (TBIL) were significantly decreased, there was significant difference between before and after treatment (p<0.05), There are no significant difference (p> 0.05) in walues of alpha fetoprotein (AFP),alanine aminotransferase(ALT), aspartate aminotransferase (AST) before and after treatment.The results of prospective study showed that the main symptoms of patients with advanced liver cancer is fatigue, bloating, anorexia, insomnia, irritability, nausea, anorexia, abdominal pain etc. We evaluated the efficacy at 4th weeks and 12th weeks. The symptoms was improved which had significant difference (p< 0.05) between the treatment group and the control group. Patients in the treatment group with abdominal distension, abdominal nausea, anorexia, insomnia and other symptoms improved significantly. the quality of life score had significant difference compared with the treatment group and the control group(p< 0.05). The life the quality score of patients in the treatment group is higher than the control group. Advanced liver function of liver cancer patients showed progressive deterioration, after 12th weeks of treatment, it decreased the total bilirubin (TBIL) in the treatment group than the control group. there was significant difference in the degree of reduction(p>0.05). But in the ALT, AST, albumin (ALB), prothrombin time (PT) and alpha fetoprotein (AFP) index, there was no significant difference between the treatment group and the control group. Survival analysis results of a prospective clinical data show that:in univariate analysis, tumor type, tumor size, Child-Pugh classification of liver function, TBIL is the main factor affecting the survival time of advanced liver carcinoma (p< 0.05).In multivariate analysis, tumor size, Child-Pugh classification of liver function, TBIL were the main factor affecting the survival time of advanced liver carcinoma (p< 0.05).The survival time in the treatment group were longer than those of in the control group. The survival time is longer in patients with TCM treatment, but compared with the control group, there was no significant difference (p> 0.05).Conclusion:"Adjusting both internal organs and function of the liver" is the basic TCM academic thought to treat PLC by Professor Qian Ying. The theory is unique and creative. He has deep identification with "Yidu" (epidemic toxin) factors and different pathogentic factors between stasis a depression. He adjusted both internal organs and function of the liver for PLC patients. He usual used these TCM methods just as follows:raising and invigorating Qi, relieving dyspepsia, nourishing liver and kidney, removing blood stasis and removing dampness, clearing heat and detoxicating, etc.All these TCM methods reflected the core points of his academic thought of "adjusting both internal organs and function of the liver". We confirmed that Hu Qi San is the most common TCM prescription for PLC. Patients of Advanced liver cancer often showed gastrointestinal symptoms and insomnia, mood disorders. It’s effective to improve syndrome of fatigue, anorexia, abdominal distension, abdominal pain, insomnia for those patients. In addition, Hu Qi San can improve the quality of life of patients with liver cancer and reduce the damage degree of liver function. One of prognostic factors on the patient of advanced liver cance is the level of total bilirubin. Hu Qi San is effective to reduce the damage degree of bilirubin. Hu Qi San may prolong survival in patients of advanced liver carcer.