| Discussion on TCM syndrome classification of 200 breast cancercases and the rules of application of Chinese herbal medicineBreast cancer is the first killer of woman health. Traditional Chinese medicine (TCM) takes some certain advantages in breast cancer therapy. Currently, TCM treatment is one of the main therapeutic medicines for postoperative patients. However, Chinese herbal medicine still lacks its standardization and instruction rules during clinical trial. TCM syndrome classification is also not unified. As individual practitioner reported different TCM syndrome classification, it is difficult to get a clear guide from their reports for our clinical research on unifying the TCM treatment of breast cancer. Purpose:The purpose of this research is to do a preliminary study on the distribution of TCM syndrome classification of our breast cancer patients at different therapeutic stage and also the rules of application of Chinese herbal medicine to them by several TCM oncologists of Guanganmen Hospital in order to lay the foundation for future preliminary research. Methods:We surveyed 200 breast cancer patients who seeked treatment at the clinic of Guanganmen Hospital by a standard questionnaire during June to Dec 2006．The patients were asked to self-assess the degree of their subjective symptoms (present and retrospective symptoms) listed in the questionnaire themselves or with the help of the co-investigators. Then, we based on the diagnosis and treatment criteria which was mainly drawn from the "Diagnosis and Treatment Directory of China Academy of Chinese Medical Sciences Guanganmen Hospital" to analyse their TCM syndrome classification at pre and postoperations, after tomoxifen treatment and during the clinical consultation. We also evaluated the patients' life quality and their main clinical manifestation after the tamoxifen treatment. During the research, we had also established a database for further studies and follow-ups in the future. Our research also collected 429 prescriptions for breast cancer patients prescribed by a few oncologists at the same clinic in Guanganmen Hospital between June and Dec 2006 to analyse their rules of application of Chinese herbal medicine. Results:For the distribution of TCM syndrome classification of breast cancer, the survey results showed as follows:(1) The outcome from high to low in frequency for preoperative patients was: syndrome of the stagnation of liver Qi (57．2%), syndrome of deficiency of liver and kidney Yin (18．7%) , syndrome of disharmony of both Chong channel and Ren channel (9．1 %) , syndrome of deficiency of both Qi and Blood (8．0%), syndrome of phlegm accumulation due to the deficiency of spleen (4．3%), syndrome of pathogen heat accumulation (3．2%), and syndrome of deficiency of both Qi and Yin (2．7%).(2) The pattern presented from high to low in frequency for postoperative patients was: syndrome of deficiency of both Qi and Blood (54．6%), syndrome of the stagnation of liver Qi (26．2%), syndrome of deficiency of liver and kidney Yin (13．1%), syndrome of disharmony of both Chong channel and Ren channel (3．8%), syndrome of phlegm accumulation due to the deficiency of spleen (2．2%), syndrome of deficiency of both Qi and Yin (1．1%), and syndrome of blood stasis (0．5%).(3) The descending order of the frequency after patients' tomoxifen treatment was: syndrome of deficiency of liver and kidney Yin (46．2%), syndrome of the stagnation of liver Qi (27．7%), syndrome of deficiency of both Qi and Blood (15．4%), syndrome of disharmony of both Chong channel and Ren channel (4．6%), syndrome of phlegm accumulation due to the deficiency of spleen (3．1%), or syndrome of deficiency of both Qi and Yin (3．1%) and syndrome of blood stasis (1．5%) .(4) The result from high to low in frequency during patients' clinical consultation was: syndrome of the stagnation of liver Qi (38．0%) , syndrome of deficiency of liver and kidney Yin (26．0% ) , syndrome of deficiency of both Qi and Yin (24．5%) , syndrome of deficiency of both Qi and Blood (12．0%) , syndrome of disharmony of both Chong channel and Ren channel (11．0%) , syndrome of phlegm accumulation due to the deficiency of spleen (3．0%), syndrome of blood stasis (1．5%), and syndrome of pathogen heat accumulation (0．5%) .(5) The TCM syndrome classification at preoperation and the patients' onset age as well as their menstrual status were analysed by chi-square tests respectively. The P values were 0．017 and 6．03E-05, respectively. Both P values were less than 0．05．These showed that the TCM syndrome classification was correlated with onset age as well as menstrual status.As for the study of main clinical manifestation after patients' tamoxifen treatment, the survey results revealed as follows:(1) In 114 patients who were at pre-menopause of onset, 70 (61．4%) had positive hormone receptor. However, within the 87 cases of those who ever took or were taking tomoxifen, 28 cases or 32．2% had stopped the drug due to its adverse reactions.(2) The total number of patients who were on tomoxifen or other types of endocrine drug was 106 cases. This was 53．8% of 197 cases.With regards to the research on the rules of application of Chinese herbal medicine, the results of the analysis were:(1) In 429 TCM formulas for curing breast cancer collected from several TCM oncologists, there were herbs of eliminating pathogen heat and toxin, herbs of tonifying the deficiency of the body, herbs of activating Qi, herbs of dispersing dampness and eliminating excessive water, herbs of resolving phlegm, herbs of softening hardness and dispersing accumulations, herbs of activating blood circulation and removing blood stasis, herbs of smoothing spirits,etc.(2) Herbs that were used at least 100 times in these 429 TCM formulas included 11 herbs of tonicfying the deficiency of the body (raw Huangqi, Gouqizi, raw Gancao, Baishao, Baizhu, Danggui, Maidong, Nuzhenzi, Taizishen, Buguzhi, Tiandong), 4 herbs of activating blood circulation and removing blood stasis (Yujin, Jixueteng, ezhu, Danshen), 4 herbs of activating Qi (Yuanhu, Bayuezha, Chenpi, Zhiqiao), 3 herbs of eliminating pathogen heat and toxin (Banzhilian, Gongying, Baiying), 3 herbs of dispersing dampness and eliminating excessive water (Filling, raw Yiyiren, Zhuling) and 6 other herbs such as fried Chaihu, Jiaosanxian, Jiaoshenqu, Fangfeng, Chantui and Zhebei. Among all, the top two most frequently used herbs were rawHuangqi and Gouqizi.Conclusion:The TCM syndrome classifications with distribution more than 20% in the various therapeutic stages of breast cancer were syndrome of deficiency of liver and kidney Yin, the stagnation of liver Qi, syndrome of deficiency of both Qi and Blood and syndrome of deficiency of both Qi and Yin. Syndrome of deficiency of liver and kidney Yin was observed after patients' tomoxifen treatment and during patients' clinical consultation. The percentages were 46．2% and 26．0%, respectively. The stagnation of liver Qi was found out in all the therapeutic stages. The distribution was: preoperation 57．2%, postoperation 26．2%, after tomoxifen treatment 27．7% and during clinical consultation 38．0%. Syndrome of deficiency of both Qi and Blood was noted at postoperation with a percentage of 54．6%. Syndrome of deficiency of both Qi and Yin was observed during patients' clinical consultation, total 24．5%.In different therapeutic stage, the distribution of TCM syndrome classification was different. The main TCM syndrome classification in each therapeutic stage was: syndrome of the stagnation of liver Qi for preoperation (57．2%), syndrome of deficiency of both Qi and Blood for postoperation (54．6%) and syndrome of deficiency of liver and kidney Yin after tamoxifen treatment (46．2%). In addition, the TCM syndrome classification was correlated with onset age and menstrual status.Amid the patients who were at pre-menopause of onset, more than half were qualified for taking tomoxifen as adjuvant treatment. However, about 1/3 of those who took the drug stopped due to its adverse reactions. Although the overall TCM therapeutic effect is superior in the aspect of curing or preventing the side effects of endocrine drug, further research is still required.As for the rules of application of herbal medicine in breast cancer, we drew them from the Chinese herbs used by the oncologists. It suggested that their general therapeutic principle in breast cancer treatment is tonifiying congenital and postnatal viscera, taking care of stomach Qi, smoothing the liver Qi, and combining diagnosis of disease with diagnosis of TCM syndrome. However, the pragmatic application of herbs at each therapeutic stage is based on the overall analysis of symptoms and signs. For example, they primarily applied herbs which can nourish the Qi and the blood to postoperative patients. To those who were undergoing chemotherapy or radiotherapy, they either used remedy which can strengthen the spleen and stomach Qi and supplement Qi, or remedy which can replenish Qi and blood or remedy which can nourish liver and kidney, etc., according to diagnosis. To the radiotherapy patients, they also applied heat-clearing and detoxicating remedy and Yin-nourishing and body fluid producing remedy. To those on endocrine drug as adjuvant treatment, they normally used those herbs which can nourish liver and kidney Yin. To the patients diagnosed with syndrome of the stagnation of liver Qi during clinical consultation, they used the method of soothing liver and dispersing the depression. Though individual oncologist applied different herbs to treat breast cancer, their way of thoughts for differential syndrome was basically the same. Besides, they were also attentive to applying different types of herbs at different therapeutic stage. Therefore, they can usually obtain better therapeutic effect.
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