| Objective:Triple-negative breast cancer(TNBC)is considered as a special type of breast cancer,which is difficult to treat.The differentiation and treatment of TNBC in clinical TCM depend on personal experience,lacking a standardized and unified system of syndrome differentiation and treatment.Differentiation of symptoms and signs is an important feature and essence of TCM.Differentiation of symptoms and signs is the premise of treatment.Accuracy of differentiation of symptoms and signs is the key to affect clinical efficacy.The inaccurate syndrome differentiation of TNBC will greatly affect the effect of traditional Chinese medicine in the treatment of TNBC Therefore,it is necessary to establish a standard system of TCM syndrome differentiation for TNBC,which is easy to learn,master and apply.This paper intends to apply the Zangxiang syndrome differentiation system created by Professor Wu to the diagnosis and treatment of TNBC,and explore its rule of differentiation and treatment.Methods:Firstly,by consulting a large number of relevant literature and periodicals of traditional Chinese medicine on breast cancer,the origin,syndrome manifestation,etiology,pathogenesis,treatment and prescription of TCM for breast cancer were summarized,and the latest progress of modern traditional Chinese medicine and Western medicine for TNBC was summarized.The nature and characteristics of disease was recognized.Secondly,retrospective study method was used to collect TNBC cases in hospital and periodical literature.The eligible cases were included in the study according to preoperative group,chemotherapy group and consolidation group.Basic situation statistics and disease location and disease identification were carried out,and SPSS20.0 data file was established.Cluster analysis and host analysis were applied.Statistical methods such as component analysis were used to analyze the distribution of disease location,disease nature and disease combination of three groups of TNBC On this basis,we constructed the "TNBC syndrome diagnosis information table",and summarized the basic syndrome,location and disease characteristics of TNBC.Then,the theory of Zangxiang syndrome differentiation is applied to the syndrome differentiation of TNBC,and the theory of Zangxiang syndrome differentiation is used to guide the treatment of TNBC and explore the rule of differentiation and treatment.Finally,the relationship between the TCM name of TNBC,the pathogenesis of TCM metastasis and the tumor environment(TME)was analyzed and discussed.Results:(1)The results of epidemiological investigation showed that group 1 included 119 patients in preoperative period,group 2 included 112 patients in chemotherapy period and group 3 included 42 patients in consolidation period.The average ages of three groups of TNBC patients were 51.58±12.1.50.87±11.16?56.36±12.17,and those with definite lymphatic metastasis accounted for 30.25%,36.61%and 33%respectively.0,6.25%and 23.81%had distant metastasis.(2)There were 74 symptoms in group 1,97 symptoms in group 2 and 106 symptoms in group 3.Group 1 included 7 location of Diseases:liver,breast,heart,spleen,kidney,bone and lung,and 8 nature of diseases:blood stasis,phlegm,Qi stagnation,heat(fire),Qi deficiency,blood deficiency,Yin deficiency and dampness;Group 2 included 9 diseases of liver,spleen,heart,kidney,lung,bone,chest wall,stomach and brain,and 8 nature of diseases:blood stasis,Qi deficiency,Qi stagnation,blood deficiency,phlegm,dampness,heat(fire),Yin deficiency,Yin deficiency,dampness and Yang deficiency;group 3 included 7 location of Diseases:liver,heart,spleen,lung,kidney,stomach and bone,and 10 nature of diseases such as Qi deficiency,blood stasis,Qi stagnation,Yin deficiency,phlegm,heat(fire),blood deficiency,water stopping,dampness and Yang deficiency.Distribution of original syndromes:Group 1 contains 8 syndromes,Group 2 contains 10 syndromes and Group 3 contains 16 syndromes.(3)Symptom clustering:Group 1 clustered into 8 categories,Group 2 clustered into 7 categories,Group 3 clustered into 8 categories;Disease location clustering:Group 1 clustered into 2 categories;Group 2 clustered into 3 categories,Group 3 clustered into 4 categories;Disease clustering:Group 1 clustered into 2 categories;Group 2 clustered into 4 categories,Group 3 clustered into 3 categories;Disease location-associated disease clustering:Group 1 clustered into 2 categories;Group 2 clustered into 4 categories,Group 3 clustered into 3 categories.(4)Principal Component Analysis:Group 1 has a cumulative contribution of 83%,a load coefficient of more than 0.3,a total of 29 principal components;Group 2 has a cumulative contribution of 85%,a load coefficient of more than 0.3,a total of 27 principal components;Group 3 has a cumulative contribution of 95%,a load coefficient of more than 0.3,a total of 27 principal components.(5)Based on the symptoms distribution of three groups of TNBC patients and the clinical experience of their tutors,95 TNBC symptoms and tongue and vein manifestations were screened out,and the location and disease of 95 syndromes were standardized.A "TNBC syndrome standardized diagnostic information table"with "location and disease" as the core was constructed.(6)The syndrome of stagnation of liver-qi and stagnation of phlegm and blood stasis is the basic syndrome of TNBC.Referring to the relevant dialectical criteria and the clinical experience of the tutor in diagnosing TNBC,the characteristics of liver,spleen,stomach,heart,kidney and lung of TNBC,as well as Qi stagnation,phlegm,blood stasis,blood deficiency,Yin deficiency and yang deficiency,heat(fire)and dampness are formulated.Conclusion:(1)Through the study of TCM literature,we found the important influence of emotional factors on TNBC,and the importance of liver,spleen and kidney position,Qi stagnation,phlegm and blood stasis in the differentiation of TNBC.Through the study of Western medicine literature,we realize that TNBC has high heterogeneity and high recurrence and metastasis rate.At present,surgery,radiotherapy and chemotherapy are still the main treatment,and more treatment methods are still being explored.(2)The results showed that the basic disease location of triple negative breast cancer was liver,the basic disease was qi stagnation,phlegm and blood stasis,and the basic syndrome was "liver stagnation,qi stagnation,phlegm and blood stasis".At the same time,the results of disease location clustering and disease nature clustering reflect the internal correlation between disease location and disease location,disease nature and disease nature,and reveal the pathogenesis of triple negative breast cancer to a certain extent.The results of disease location combined with disease clustering reflect the internal relationship and combination rule between disease location and disease nature of triple negative breast cancer.(3)The theory system of Zangxiang syndrome differentiation is applied to the treatment of TNBC,emphasizing the location and nature of disease differentiation,following the principles of syndrome differentiation,image detection,combination of principle and flexibility,and combination of disease and syndrome.The treatment of TNBC under the guidance of Zangxiang syndrome differentiation theory is based on the combination of disease and syndrome.The key points of syndrome differentiation and treatment are disease location and disease nature.(4)TNBC belongs to the category of "Ruyan" in traditional Chinese medicine.According to the characteristics of recurrence and metastasis of TNBC,the hypothesis of "persistent phlegm and deep stagnation" is put forward.Phlegm and blood stasis are the pathological basis of the disease and metastasis.The fundamental reason for its easy occurrence of metastasis is the flourishing of positive and deficient pathogens,which is an important condition for the occurrence of metastasis.Meridians a are an important way for the occurrence of metastasis.Phlegm,blood stasis and fire toxicity in TCM are very similar to inflammatory tumor microenvironment,and they have important influence in promoting metastasis of TNBC. |
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