| Objective:This study aims to investigate the correlation between blood lipid abnormalities in patients suffering from middle-stage and advanced lung cancer and phlegm syndrome in TCM through observing blood lipid levels in those patients, and further to summarize the clinical experience and academic thoughts of Professor Zhang Peitong in the treatment of lung cancer with elevated levels of blood lipid based on syndrome differentiation.Method:Part I:Ninety inpatients with middle-stage and advanced lung cancer were differentiated based on the diagnostic criteria of phlegm syndrome in TCM as well as the analyses of related clinical researches.1. Ninety patients with primary lung cancer were included and diagnosed according to the Diagnosis Criteria for Primary Lung Cancer (2010) in Western Medicine issued by Ministry of Public Health. Syndrome differentiation in TCM was conducted in accordance with General Diagnosis Criteria of Phlegm Syndrome proposed by Fang Yongqi and with reference to Clinic Terminology of Traditional Chinese Medical Diagnosis and Treatment---Syndromes by People's Republic of China. Blood lipid detection complied with Chinese Guidelines for the Management of Blood Lipid Abnormality in Adults (2007).2. The ninety patients were classified as phlegm syndrome group and non-phlegm syndrome group on the basis of their medical history. Between-group differences were analyzed in terms of gender, age, the history of smoking, tumor-node-metastasis (TNM) staging and pathological patterns.3. Blood lipid indexesincluded TC, TG, HDL-C, LDL-C, apoA I, apoB and Lp(a). According to the results of blood lipid detection, ninety patients were divided into 4 groups: ? Reduced blood lipid group:the level of at least one index was less than the normal value;? Normal blood lipid group:the levels of all the indexes were within the normal range; ? Elevated blood lipid group:the level of at least one index was higher than the normal value;? Blood lipid disorder group:the level of at least one index was less than the normal value and at meantime that of at least one index was higher than the normal value. Between-group differences were analyzed in terms of gender, age, life history, TNM staging and pathological patterns.4. Distribution of phlegm syndrome and non-phlegm syndrome in four blood lipid groups was analyzed and the changes in the levels of apolipoprotein and LP (a) in phlegm syndrome group and non-phlegm syndrome group were examined.5. Numeric data were analyzed with Chi-square test. Part II:Forty-eight formulas by Chief Zhang Peitong were collected from July,2014 to June,2016 in outpatient treatment for lung cancer of elevated blood lipid. The types of medicinal and their appearance frequency in the formulas as well as the commonly-used therapeutic methods were statistically analyzed.Results:Part I:Among the 90 patients with middle-stage and advanced lung cancer, there were 56 cases of phlegm syndrome, accounting for 62.2% and 34 cases of non-phlegm syndrome. Phlegm syndrome and non-phlegm syndrome groups had no statistical significant differences in gender, age gradient, clinic staging and pathological patterns. Blood lipid abnormalities were found in 76.7% patients in different degrees. Specifically, HDL-C concentration was reduced (including single reduction in 16 patients and reduction accompanied by elevation of other indexes in 12 patients), TC and TG concentrations were elevated, and concomitant blood lipid disorder was observed in 23 patients. The level of serum apolipoprotein was abnormal as well. The incidence of LP (a) level increase was 25%. The distribution ofphlegm syndrome and non-phlegm syndrome showed no statistical significant differencesamong the four blood lipid group as well as among apoAI reduction group, apoB reduction group and LP (a) elevation group. Part II:Among the 36 formulas,94 Chinese medicinals were included and their total frequencies of occurrence were 726. Those medicines could be divided into 13 categories including blood activatingmedicinal, medicinal for resolving phlegm and dissipating mass, heat-clearing and detoxicating medicinal, qi tonifying medicine, yin nourishing medicinal, damp removing medicinal, qi-regulating medicinal, medicinal for ventilating lung and relieving cough, medicinal for harmonizing stomach and assisting transportation, collaterals dredging medicinal, yang warming medicinal, purgative medicinal and astringent medicinal, with application frequency of 20.94%,16.39%, 11.02%,10.06%,8.54%,8.40%,7.85%,6.47%,5.65%,2.75%,1.38%,0.28% and0.28% respectively. Among blood activatingmedicinal, stasis-resolving medicinal was used 69 times, blood nourishing medicinal 58 times and blood stasis breaking medicinal 25 times, respectively accounting for 45.39%,39.16%,16.45%.Conclusion:Among the patients with middle-stage and advanced lung cancer,62.2% had phlegm syndrome, and 76.7% were accompanied with blood lipid abnormalities. Phlegm syndrome had no obvious relation with blood lipid. In the treatment of lung cancer of elevated blood lipid based on syndrome differentiation, Professor Zhang advocates the principle of "being not limited by lipid and not deviating from cancer" and emphasizes the comprehensive therapy by disease diagnosis, syndrome differentiation and symptomatic treatment. He regards elevated blood lipid as "intangible phlegm and miniature stasis" based on the pathogenesis of "deficiency, stasis, phlegm, heat and toxin" in patients with lung cancer. On this basis, the method of activating blood and resolving stasis as well as resolving phlegm and dissipating mass is principally adopted; medicinal for heat-clearing and detoxicating, qi-tonifying are commonly used. |
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