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Traditional Chinese Medicine symptom patterns in patients with colorectal carcinoma

更新时间:2016-07-05

INTRODUCTION

Cancer treatment involves a comprehensive treatment protocol including surgery,chemotherapy,radiotherapy,targeted therapy,biotherapy,and immunotherapy,together with the use of Traditional Chinese Medicine(TCM).Colorectal cancer is the third most common cancer in the world,and it accounts for over 9%of all cancer incidences.1The 5-year survival rate in patients with colorectal carcinoma in China is approximately 40%based on data published in 2018.1In China,herbal medicine has been used to treat diseases,including cancer,for more than 2000 years.Due to the improvement of physical,mental and emotional symptoms,the role of TCM in cancer care is widely recognized around the globe.2

Although TCM is commonly used in Chinese patients with colorectal cancer,3-5epidemiological studies on TCM patterns(or syndromes)in colorectal cancer patients have not yet been reported.The identification of TCM patterns is a TCM theory-based summary of patients'signs and symptoms gathered through four diagnostic methods:inspection,auscultation and olfaction,inquiry,and palpation.TCM pattern identification guides the establishment of TCM therapeutic principles,and thus the treatment plan.As the patients'symptoms evolve,the TCM pattern and the corresponding treatment plan are expected to change.Based on more than 30 years of clinical practice and experiences,our group proposed that TCM cancer treatments should follow a four-stage protocol according to the following periods:perioperative,adjuvant treatment,follow-up,and palliative treatment.6However,specific classifications of the TCM pattern in each of the four stages have not been reported.To better classify patient symptoms and signs and thus guide the management of colorectal cancer using TCM,we aimed to use modern mathematical statistics to explore the classification and the dynamic evolution of TCM patterns in patients with colorectal cancer in the perioperative period and the adjuvant treatment period.

METHODS

Diagnostic criteria

The diagnosis of colorectal cancer was confirmed by surgery and pathology.Postoperative pathological stages were diagnosed according to the American Joint Committee on Cancer(2010),NCCN Clinical Practice Guidelines in Oncology:Colon Cancer(2011.V1),and NCCN Clinical Practice Guidelines in Oncology:Rectal Cancer(2011.V1)for staging of Tumor Node Metastasis(TNM).7,8TCM pattern identification was performed according to the GB/T 16751.2-1997 TCM patterns in terms of the national standard(GB).9

Patient selection

1 Siegel RL,Miller KD,Jemal A.Cancer Statistics,2018.CA Cancer J Clin 2018;68(1):7-30.

认真贯彻中央八项规定和水利部的实施办法。制定出台了长江委贯彻落实的具体规定,委党组带头落实规定要求,加强调查研究,精简会议文件,压缩“三公”经费等。积极落实水利部预算管理“三项机制”,不断强化预算执行管理。

Of the 370 included patients,210(56.7%)were patients who were hospitalized in the First Affiliated Hospital of College of Medicine,Zhejiang University and Zhejiang Cancer Hospital from July 2009 to October 2011 to undergo radical resection for colorectal cancer.The remaining 160(43.2%)were patients who were hospitalized in the Second Affiliated Hospital of College of Medicine,Zhejiang University and the First Affiliated Hospital of College of Medicine,Zhejiang University from July 2008 to November 2013 after completion of radical resection for colorectal cancer.

A total of 160 patients were observed in the adjuvant chemotherapy period.The distinction of these patients over a total process of 6 months and patient turnover meant that not all of these patients'pattern-related data were completely collected at the four timepoints(before receiving adjuvant chemotherapy,in the early period of adjuvant chemotherapy,in the mid period of adjuvant chemotherapy,and at the end of adjuvant chemotherapy).Based on the inclusion and exclusion criteria,we investigated 100 patients in the period before receiving adjuvant chemotherapy,120 patients in the early period of adjuvant chemotherapy,114 patients in the mid period of adjuvant chemotherapy,and 110 patients at the end of adjuvant chemotherapy.

Sample size calculation

Analysis of multiple factors required the observation of at least 5 to 10 times the number of variables;this study set used 18 variables.The total number of patients enrolled in the study meets the requirements of sample size calculation.

Questionnaire development

Based on the existing literature and preliminary study results,10-12the'perioperative stage colorectal cancer TCM pattern questionnaire'and 'adjuvantstage colorectal cancer TCM pattern questionnaire'were developed.Questionnaire content include the following aspects:(a)general condition;(b)treatment situation;(c)tumor situation;(d)tumor stage and patient's Karnofsky performance status;(e)past medical history,family history,and individual habits;(f)TCM symptoms,tongue and pulse condition;(g)other supplementary symptoms.Investigators were postgraduate students and doctorate students majoring in medical oncology using combined TCM and Western Medicine.Prior to conducting the survey,all investigators received standardized training for the present study.

Statistical analysis

The collected data were assigned and quantified using EpiData 3.1 database management software(EpiData Association,Odense,Denmark).The database was imported into a SAS 9.2(SAS Institute,Cary,NC,USA)statistical analysis software package.After the removal of symptoms with a frequency of less than 5%,the remaining symptoms were considered as variables.The statistical analysis results contain data from tongue and pulse presentations,TCM pattern classifications acquired from the experts'experience in TCM pattern identification,and statistics and analysis of the number of cases in each TCM pattern.The tongue body and tongue coating as well as pulse patterns based on TCM diagnosis were used only for TCM pattern dialectical analysis by experts,and were not included in the frequency analysis;this is because during the process of pattern identification,the tongue body,tongue coating,and pulse condition were not differentiated by only presence or absence.

RESULTS

Thiswasaprospective,multi-center,large-scale,cross-sectional study.A total of 370 patients with colorectal cancer were recruited from July,2008 to November,2013 in three different hospitals in Hangzhou City,Zhejiang Province,China.The study protocol was approved by the institutional review board,and all patients provided written informed consent prior to study participation.

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A total of 210 patients were observed in the perioperative period.These patients usually had an average hospital stay of 10 d,and were observed at each of four timepoints:1 d before surgery,3 d after surgery,7 d after surgery,and 10 d after surgery.

Clinical characteristics of participants

A total of 430 patients with colorectal cancer were assessed for study eligibility,of which 60 patients were excluded.Detailed reasons for study exclusion are provided in Figure 1.A total of 370 patients were included.Of these 370 patients,210(56.7%)were hospitalized patients in the First Affiliated Hospital of College of Medicine,Zhejiang University and Zhejiang Cancer Hospital from July,2009 to October,2011 who were scheduled to undergo radical resection for colorectal cancer(perioperative patients);the other 160(43.2%)were hospitalized patients in the First and Second Affiliated Hospitals of College of Medicine,Zhejiang University from July,2008 to November,2013 who had undergone radical resection for colorectal cancer(postoperative patients).The clinical characteristics of the included patients are summarized in Table 1.

Figure 1 CONSORT diagram.

Table 1 General information of 210 patients in the perioperative period,and 160 patients in the adjuvant treatment period

Perioperative period Adjuvant treatment period Item Gender Age group(years)Frequency(n)94 66 1 13 35 47 54 Diets and lifestyle habits Male Female 20-30 31-40 41-50 51-60 61-70 71-80 81-90 Sleep(stay up)8 2 3 3 Diet(greasy food)Drink Have Not Have Not Intemperance Drink regularly Drink occasionally No alcohol use Tumor location T stage(depth of tumor invasion)N stage(lymph node metastasis)Histopathologi cal classification Pathologic gross type of tumor Ileocecal region Ascending colon Transverse colon Descending colon Sigmoid colon Rectum T1 T2 T3 T4 N0 N1 N2 Adenocarcinoma Mucoid carcinoma Ulcerative type Invasive type Elevated type Frequency(n)119 91 2 11 37 59 46 46 9 35 175 62 148 5 26 67 112 9 37 9 11 31 113 7 29 105 69 109 61 40 182 28 132 6 72 Percentage(%)56.67 43.33 0.95 5.23 17.62 28.10 21.90 21.90 4.29 16.67 83.33 29.52 70.48 2.38 12.38 31.90 53.33 4.29 17.62 4.29 5.24 14.76 53.81 3.33 13.81 50.00 32.86 51.90 29.05 19.05 86.67 13.33 62.86 2.86 34.28 127 49 111 0 25 67 68 4 19 21 12 18 86 2 10 119 29 68 62 30 140 20 98 30 24 Percentage(%)58.75 41.25 0.63 8.13 21.88 29.38 33.75 5.00 1.25 20.63 79.37 30.63 69.38 0 15.63 41.88 42.50 2.50 11.88 13.13 7.50 11.25 53.75 1.25 6.25 74.37 18.13 42.50 38.75 18.75 87.50 12.50 61.25 18.75 15.00

Table 1 General information of 210 patients in the perioperative period,and 160 patients in the adjuvant treatment period(contined)

Item Perioperative period Adjuvant treatment period Tumor differentiation degree TNM staging Well-differentiated Well-differentiated and moderate-differentiated Moderately differentiated Moderately and poor-differentiated Poorly-differentiatedⅠstageⅡA stageⅡB stageⅢA stageⅢB stageⅢC stage Frequency(n)4 30 63 58 27 31 60 20 4 70 25 Percentage(%)2.20 16.48 34.62 31.87 14.84 14.76 28.57 9.52 1.90 33.33 11.9 Frequency(n)9 16 92 13 10 0 42 26 22 40 30 Percentage(%)6.43 11.43 65.71 9.29 7.13 0.00 26.25 16.25 13.75 25.00 18.75

Cluster analysis

Cluster analysis in the perioperative period:the TCM pattern at 1 day before surgery was divided into three categories(Figure 2).CategoryⅠ:pale white complexion,insufficiency of spirit-Qi,pale nail coloring;categoryⅡ:abdominal pain,bloating,loss of appetite,constipation;categoryⅢ:emaciation,weakness,spontaneous sweating,dizziness,buccal thirst,diarrhea,hematochezia.The 210 patients were classified into three TCM pattern types:blood deficiency(70 cases,33.33%)with a light red tongue,white thin tongue coating,and a thready pulse;dampness-phlegm(40 cases,19.05%)with a light red tongue,greasy tongue coating,and a slippery pulse;and deficiency of bothQiandYin(60 cases,28.57%)with a red tongue with little coating,and a weak pulse.The remaining 40 cases(19.05%)were considered to have a relatively equilibrial constitution ofYin-Yang.

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The TCM pattern on postoperative day 3 was classified into three categories(Figure 2).CategoryⅠ:pale white complexion,lusterless nails,dizziness,abdominal pain,abdominal distension;categoryⅡ:spirit-Qideficiency,fatigue,spontaneous sweating,night sweating;categoryⅢ:hot flushes,mouth thirst.The 210 patients were considered to have three TCM pattern types:blood deficiency(40 cases,19.07%)with a light red tongue,white thin tongue coating,and a thready pulse;Qideficiency(100 cases,47.62%)with a light red tongue,white or greasy tongue coating,and a weak or slippery pulse;and internal heat due toYindeficiency(70 cases,33.33%)with a red tongue with little or white coating,and a thready or rapid pulse.

现阶段致使计算机中病毒的形式有很多种,网络信息的安全性受到威胁。若想要保证计算机网络信息安全性,个人用户、企业集体的合法权益得到保障,就要求计算机网络信息安全管理工作人员在日常工作中,以用户实际需求为主制定合理的网络信息安全管理制度。随着计算机技术的发展与推广应用,威胁计算机网络信息安全的因素在不断增加,甚至已经严重影响了个人用户及企业集体的合法权益。所以,计算机网络信息安全管理工作人员应制定相对健全的制度,保证用户网络信息安全性与利用率,尽量杜绝网络信息被入侵、丢失等现象。

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The TCM pattern on the postoperative day 7 was categorized into four categories(Figure 2).CategoryⅠ:spontaneous sweating,night sweating,hot flushes;categoryⅡ:pale white complexion,lusterless nails;categoryⅢ:abdominal pain,abdominal distension,mouth thirst;categoryⅣ:spirit-Qideficiency,fatigue.The 210 patients were considered to have four TCM pattern types:internal heat due toYindeficiency(70 cases,33.33%)with a red tongue with little or yellow coating,and a thready or rapid pulse;blood deficiency(20 cases,9.53%)with a light red tongue,white thin tongue coating,and a thready pulse;interior dampness-heat(70 cases,33.33%)with a red tongue,yellow or greasy tongue coating,and a slippery pulse;andQideficiency(50 cases,23.81%)with a light red tongue,white or white thin tongue coating,and a weak pulse.The TCM pattern on postoperative day 10 was categorized into two categories(Figure 2).CategoryⅠ:abdominal pain,abdominal distension,mouth thirst;categoryⅡ:fatigue,spontaneous sweating,night sweating.The 210 patients were considered to have two TCM pattern types:interior dampness-heat(70 cases,33.33%)with a red tongue with yellow or greasy coating and slippery or rapid pulse;and deficiency of bothQiandYin(80 cases,38.10%)with a light white or pebbly tongue with little or white coating,and a thready or weak pulse.Sixty patients(28.57%)were judged to have a harmonious TCM pattern ofYinandYang,and did not accord with the diagnostic criteria of any pathological TCM pattern.

Cluster analysis in the adjuvant treatment period

Figure 2 Clustering analysis tree in the preoperative period

A:pattern distribution at 1 d before surgery(14 symptoms with a frequency greater than 5%in descending order):hematochezia,emaciation,loose stool,pale white complexion,abdominal pain,weakness,lack of vitality,pale nail coloring,bloating,thirst,constipation,anorexia,dizziness,and spontaneous perspiration(designated as variables X1-X14).B:pattern distribution on postoperative day 3(11 symptoms with a frequency greater than 5%in descending order):pale white complexion,lack of vitality,pale nail coloring,weakness,spontaneous perspiration,night sweating,hot flashes,dizziness,abdominal pain,bloating,thirst(designated as variables X1-X11).C:pattern distribution on postoperative day 7 after surgery(10 symptoms with a frequency greater than 5%in descending order):pale white complexion,lack of vitality,pale nail coloring,weakness,spontaneous perspiration,night sweating,hot flashes,abdominal pain,bloating,thirst(designated as variables X1-X10).D:pattern distribution on postoperative day 10 after surgery(six symptoms with a frequency greater than 5%in descending order):weakness,spontaneous perspiration,night sweating,abdominal pain,bloating,thirst(designated as variables X1-X6).

The TCM pattern at 1 d before the first cycle of adjuvant chemotherapy was divided into two categories(Figure 3).CategoryⅠ:shortness of breath,spontaneous sweating,pale white complexion,spirit-Qideficiency,loose stools;categoryⅡ:lassitude of the limbs and trunk,night sweating,impaired appetite,mouth thirst,heaviness of the head and body,emaciation,dysphoria in the chest,palms,and soles,insomnia,constipation.The 100 patients were considered to be two TCM pattern types:Qideficiency(30 cases,30%)with a light white tongue with little coating,and a thready or weak pulse;and internal heat due toYindeficiency mixed with dampness retention(40 cases,40%)with a red tongue with little coating,and a thready pulse.There were 30 cases(30%)that were not diagnosed with a TCM pattern,as the patients had no discomfort during the period before adjuvant chemotherapy.

The TCM pattern in the early period of adjuvant chemotherapy was categorized into two categories(Figure 3).CategoryⅠ:spirit-Qideficiency,shortness of breath,pale white complexion,abdominal distension,loose stools or diarrhea,tastelessness,lusterless nails,lassitude of the limbs and trunk,anorexia;categoryⅡ:emaciation,night sweating,mouth thirst,dysphoria in the chest,palms,and soles,insomnia,constipation,nausea and vomiting.The 120 patients were considered to be two TCM pattern types:spleen deficiency with blood deficiency(60 cases,50%)with a light red tongue with a white or thin-white coating and a thready pulse;and internal heat due toYindeficiency(45 cases,37.5%)with a red tongue with little or yellow coating,and a thready or rapid pulse.In addition,15 cases(12.5%)had no discernible TCM pattern,as these patients did not experience any discomfort in the early period of adjuvant chemotherapy.

Figure 3 Clustering analysis tree in the adjuvant treatment period

A:symptom distribution at 1 d before the first cycle of adjuvant chemotherapy(14 symptoms with a frequency greater than 5%in descending order):lassitude of the limbs and trunk,night sweating,impaired appetite,mouth thirst,heaviness of the head and body,emaciation,dysphoria in the chest,palms,and soles,constipation,shortness of breath,spontaneous sweating,insomnia,pale white complexion,spirit-Qideficiency,loose stools or diarrhea(designated as variables X1-X14).B:symptom distribution at the early period of adjuvant chemotherapy(16 symptoms with a frequency greater than 5%in descending order):indigestion and loss of appetite,lassitude of the limbs and trunk,loose stools or diarrhea,mouth thirst,spirit-Qideficiency,pale white complexion,abdominal distension,shortness of breath,dysphoria in the chest,palms,and soles,emaciation,constipation,insomnia,tastelessness,night sweating,nausea and vomiting,lusterless nails(designated as variables X1-X16).C:symptom distribution at the mid period of adjuvant chemotherapy(22 symptoms with a frequency greater than 5%in descending order):impaired appetite,lassitude of the limbs and trunk,mouth thirst,abdominal distension,constipation,nausea and vomiting,spirit-Qideficiency,bitter taste,insomnia,emaciation,loose stools or diarrhea,sensation of rectal tenesmus,abdominal pain,borborygmus,shortness of breath,pale white complexion,tastelessness,spontaneous sweating,numbness of the hands and feet,lusterless nails,heaviness of the head and body,dysphoria in the chest,palms,and soles(designated as variables X1-X22).D:symptom distribution at the period after adjuvant chemotherapy(24 symptoms with a frequency greater than 5%in descending order):impaired appetite,lassitude of the limbs and trunk,hair loss,numbness of the hands and feet,spirit-Qideficiency,emaciation,mouth thirst,insomnia,nausea and vomiting,soreness and weakness of the waist and knees,constipation,dysphoria in the chest,palms,and soles,abdominal distension,bitter taste,pale white complexion,night sweating,shortness of breath,tastelessness,dizziness,lusterless nails,borborygmus,loose stools or diarrhea,abdominal pain,hematochezia(designated as variables X1-X24).

The TCM pattern in the mid period of adjuvant chemotherapy was divided into three categories(Figure 3).CategoryⅠ:bitter taste,constipation,mouth thirst,insomnia,abdominal pain,borborygmus;categoryⅡ:shortness of breath,spirit-Qideficiency,spontaneous sweating,dysphoria in the chest,palms,and soles,heaviness of the head and body,tastelessness,lusterless nails,loose stools or diarrhea,pale white complexion,sensation of rectal tenesmus;categoryⅢ:loss of appetite,lassitude of the limbs and trunk,abdominal distension,nausea and vomiting.The 114 patients were considered to have three TCM pattern types:liver heat and spleen deficiency(51 cases,44.74%)with a red tongue with a yellow or greasy coating,and a slippery pulse;deficiency of bothQiand blood(40 cases,35.09%)with a light red or light white tongue with a thin or thin-white coating,and a thready or weak pulse;and dampness stagnancy due to spleen deficiency(19 cases,16.67%)with a light red tongue with a thin-greasy or white-greasy coating,and a soft or deep thready pulse.Additionally,four cases(3.51%)had no discernible TCM pattern.

The TCM pattern in the period after adjuvant chemotherapy was divided into three categories(Figure 3).CategoryⅠ:shortness of breath,lusterless nails,pale white complexion,dizziness,tastelessness,loose stools or diarrhea,borborygmus,abdominal pain,abdominal distension,hematochezia;categoryⅡ:impaired appetite,lassitude of the limbs and trunk,hair loss,numbness of the hands and feet,spirit-Qideficiency,emaciation;categoryⅢ:soreness and weakness of the waist and knees,constipation,dysphoria in the chest,palms,and soles,night sweating,mouth thirst,bitter taste,insomnia,nausea and vomiting.The 110 patients were considered to have three TCM pattern types:deficiency of bothQiand blood(32 cases,29.09%)with a large fat tongue,and a soft or thready weak pulse;spleen deficiency(29 cases,26.36%)with a bulgy or light red tongue with white or greasy coating,and a thready pulse;andYindeficiency of the liver and kidney(49 cases,44.55%)with a red tongue with little or yellow coating,and a rapid pulse.

女人也喜欢这种薄荷味,她之所以选择了医生做职业,之所以能操刀在手术台上镇定自若,做探囊取物的行当,多半是有男人的胆量和气魄的。这样她就在性格上多多少少的有了些男人化,喝茶喝酒吸烟卷,对她嗤之以鼻的人说不留情面的刻薄话。

TCM patterns in the perioperative period and the adjuvant treatment period of colorectal carcinoma

In total,six TCM patterns were observed in 210 patients during the perioperative period of colorectal carcinoma(Figure 4):interior dampness-heat,internal heat due toYindeficiency,Qideficiency,dampness-phlegm,deficiency of bothQiandYin,and blood deficiency.A small proportion of patients were considered to have a pattern of relative equilibrial constitution ofYin-Yang.The majority of patients sought medical advice due to repeated hematochezia during longterm treatment;therefore,the pattern of blood deficiency was the most common TCM pattern at 1 d before surgery.The most frequent TCM pattern on postoperative day 3 wasQideficiency.The incidence of dampness-phlegm was obviously increased on postoperative day 7.The pattern of interior dampness-heat and the pattern of deficiency of bothQiandYinwere the main TCM patterns experienced on postoperative day 10,due to the marked reduction of every symptom.

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In general,nine TCM patterns were observed in 160 patients in the adjuvant treatment period of colorectal carcinoma(Figure 5):Yindeficiency of the liver and kidney,spleen deficiency,dampness stagnancy due to spleen deficiency,deficiency of bothQiand blood,liver-heat and spleen deficiency,internal heat due toYindeficiency,spleen deficiency with blood deficiency,internal heat due toYindeficiency mixed with dampness retention,andQideficiency.A small proportion of patients were considered to have a TCM pattern of relative equilibrium with no adverse symptoms.The TCM patterns most frequently observed the day before the first cycle of adjuvant chemotherapy wereQideficiency and internal heat due toYindeficiency mixed with dampness retention.The primary TCM pattern observed in the early period of adjuvant chemotherapy was spleen deficiency with blood deficiency,closely followed by internal heat due toYindeficiency.The TCM patterns most frequently observed in the mid period of adjuvant chemotherapy were liver-heat and spleen deficiency,deficiency of bothQiand blood,and dampness stagnancy due to spleen deficiency.In the period after adjuvant chemotherapy,the major TCM patterns were deficiency patterns,includingYindeficiency of the liver and kidney,deficiency ofQiand blood,and spleen deficiency.

DISCUSSION

Figure 4 Dynamic changes in Traditional Chinese Medicine patterns in colorectal carcinoma patients in the preoperative period

Figure 5 Dynamic changes in the traditional chinese medicine patterns in colorectal carcinoma in the adjuvant treatment period

The present results regarding the dynamic presentation and distribution of TCM patterns in patients with colorectal cancer are important for TCM pattern identification and guidance of the management of patients with colorectal cancer.In contrast with the retrospective clinical study design commonly used to research TCM treatments in cancer,13-19we chose the prospective investigation protocol in the present study to gain the advantage of collecting the data almost in real-time,giving consideration to the effects of other factors including time,space,and treatment strategy.We enrolled patients in Hangzhou City with colorectal cancer,with consideration given to the heterogeneity of patients from different genetic backgrounds,climatic environments,dietary habits,personality characteristics,social environment,and other factors;20these factors affect the TCM pattern manifestations during the occurrence and development of tumors.Our study explored the dynamic presentation and distribution of TCM patterns in 370 patients with colorectal cancer via a cross-sectional study at four timepoints in each of two treatment periods.We found that the TCM patterns of patients with colorectal cancer in the perioperative period were mainly those of deficiency,including blood deficiency,Qideficiency,andYindeficiency.The major TCM patterns in the adjuvant period were also those of deficiency,includingQideficiency,blood deficiency,andYindeficiency.In both the perioperative and adjuvant periods,excess TCM patterns were observed,but to a lesser extent.The specific information of the TCM pattern types at the four timepoints in the preoperative period was as follows:blood deficiency and deficiency of bothQiandYinat 1 d before surgery;Qideficiency and internal heat due toYindeficiency on postoperative day 3;internal heat due toYindeficiency and interior dampness-heat at postoperative day 7;interior dampness-heat and deficiency of bothQiandYinat postoperative day 10,showing the combination of a deficiency and an excess pattern,like the pattern of deficiency mixed with dampness.The TCM patterns during the period before receiving adjuvant chemotherapy wereQideficiency and internal heat due toYindeficiency mixed with dampness retention.In the early period of adjuvant chemotherapy,the most frequently observed TCM patterns were internal heat due toYindeficiency,followed by spleen deficiency with blood deficiency.In the mid period of adjuvant chemotherapy,the TCM patterns were liver-heat and spleen deficiency,deficiency of bothQiand blood,and dampness stagnancy due to spleen deficiency.In the period after adjuvant chemotherapy,the overall major type of TCM pattern was deficiency,which manifested asYindeficiency of the liver and kidney,deficiency of bothQiand blood,and spleen deficiency.The present results indicate that chemotherapy does affect the TCM patterns.Therefore,individualized TCM treatment based on pattern identification should be encouraged,as it takes into consideration the changing of symptoms due to chemotherapy.Our study confirmed the dynamic changes in the presentation and distribution of TCM patterns in the preoperative period and the adjuvant treatment period in patients with colorectal carcinoma.

The present results indicate that the general TCM principle and method of treatment of colorectal cancer in the preoperative period should be to supplementQi,nourishYin,nourish blood,clear heat,and dissipate dampness.The present results regarding the TCM pattern in the adjuvant chemotherapy period indicate that the TCM pattern of a weakened spleen and stomach exists in each period after starting chemotherapy treatment.Consequently,the TCM treatment principle for colorectal cancer patients in the adjuvant treatment period should be to strengthen the spleen throughout the whole process,combined with dissipating dampness,regulatingQiactivity,and adjusting the ascending and descending ofQi.Evidence-based cancer treatment should involve controlling the tumor with modern medical treatment,together with adjusting of the tumor microenvironment by TCM treatment.It is important to study the theory of TCM patterns through the methodological tools of evidence-based medicine.Understanding the dynamic presentation and distribution of TCM patterns in cancer patients provides evidence for the standardization of TCM pattern identifi-

cation.Research into TCM pattern characteristics in cancer management at different stages is beneficial for the establishment and improvement of decision-making in TCM treatments,as well as the connection between the dynamic variation of TCM patterns and each patient's endpoint.

In conclusion,further comprehensive study of TCM patterns is necessary to better understand the symptom features and distribution of TCM patterns in various treatment periods of colorectal cancer.

REFERENCES

连刀锋的轨迹都看不清楚,这便意味着,自己连最基本的防守都做不到,自己身体的某个部位,很可能在接下来的交锋中,毫无察觉地被对方扯碎,而自己却只能后知后觉。

Included patients met all of the following criteria:pathological diagnosis of colorectal cancer;expected acceptance radical operation with stagesⅠ-Ⅲ in the perioperative period;expected acceptance adjuvant chemotherapy using the oxaliplatin/capecitabine(XELOX)or oxaliplatin/leucovorin/5-Fu(mFOLFOX)7,8regimen after radical operation in the adjuvant treatment period;no previous chemotherapy,radiation,or TCM therapy before study commencement.Patients with any of the following criteria were excluded from the study:history of primary and serious illnesses of the cardiovascular,cerebrovascular,hepatic,renal,and hematopoietic systems;did not undergo radical operation after study inclusion;could not complete the full chemotherapy course;received Chinese herbal intervention.

2 Zhang H,Wang N,Zheng L.The influence of acceding to WTO on progress of modernization of Chinese material medical in the 21st century.Zhong Guo Yao Fang 2000;11(2):51-53.

3 Chao TH,Fu PK,Chang CH,Chang SN,Chiahuang MF,Lin CH.Prescription patterns of Chinese herbal products for post-surgery colon cancer patients in Taiwan.J Ethnopharmacol 2014;155(1):702-708.

4 Xu Y,Yang YF.Progress in postoperative management of colorectal cancer with integrative medicine.Zhong Guo Zhong Xi Yi Jie He Za Zhi 2008;28(2):182-186.

5 Tan KY,Liu CB,Chen AH,et al.The role of Traditional Chinese Medicine in colorectal cancer treatment.Tech Coloproctol 2008;12(1):1-6.

6 Guo Y.The discussion of the"Four Stages"theory from Chinese medicine oncology.Zhong Hua Zhong Yi Yao Xue Kan 2009;27(2):247-248.

中国电子技术标准化研究院应用技术研究室主任韦莎博士的演讲话题是:智能制造标准化工业进展。她指出,“大家对标准有需求,但是大家对智能制造标准体系,对已经发布和正在制定的标准本身的内容,和能在企业扮演的角色不太清楚。我们希望后面跟大家近距离接触,也希望大家参与到标准制定过程中,真正让智能制造的基础设施为大家的转型升级发挥重要的作用。”

7 Medical Administrative Department of the Ministry of Health of the People's Republic of China.Colorectal cancer diagnostic and treatment practices,2010.Online,2011-09-15,cited 2011-12-20;3(6):5-8 screens.Available from URL:http://kns.cnki.net/KCMS/detail/detail.aspx?dbcode=CJFQ&dbname=CJFD2011&filename=YXQY-201106032&v=MzAyMTdXTTFGckNVUkxLZlpPZHNGQ25sV3J2TlBEWGFkN0c0SDlETXFZOUdab1I4ZVgxTHV4WVM3RGgxVDNxVHI=.

10 Guo Y,Zou Y,Xu YF,et al.Study on Chinese medicine syndrome of colorectal carcinoma in perioperative period.Chin J Integr Med 2015;21(3):183-187.

CONCLUSION:Our study confirmed that variations in the dynamic evolution of TCM symptom patterns exist in patients with colorectal cancer during different treatment periods.This information is of great value in the individualized management of colorectal cancer.

8 National Comprehensive Cancer Network,NCCN Clinical Practice Guidelines in Oncology(NCCN Guidelines®)Colorectal Cancer.Version 1.2011.Online,2011-02-25,cited 2011-05-25;28-37screens.Available from URL:https://www.nccn.org/professionals/physician_gls/default.aspx#colon.

11 Yao NL.Differential diagnosis of Traditional Chinese Medicine pattern.Beijing:People's Medical Publishing House,2002:1-15.

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13 Wang HY,Yang W,Xie YM,Sun Y,Zhuang Y,Wang YY.Real world study on the incidence and TCM pattern characteristics of patients with gastric carcinoma.J Tradit Chin Med 2014;24:2143-2147.

根据指标间的相关系数矩阵计算各个主成分的特征值、贡献率以及累计贡献率提取主成分的因子。结果如表1。根据因子特征值大于或接近1且累计方差贡献率在85%上,从中提取前3个主成分替代原11个指标。通过特征值计算主成分载荷矩阵,并得到12个海岛县经济发展水平的总得分。

14 Wang XF,Li HS.Progress of clinical research into Traditional Chinese Medicine pattern and treatment of large intestinal cancer.Shi Jie Hua Ren Xiao Hua Za Zhi 2007;15(29):3062-3066.

春秋战国,周文疲弊,王纲解纽,诸侯争霸,社会政治天翻地覆的变化,使得原本周代思想观念中“天经地义”的内容受到质疑与审视。这一点在武德观念上表现尤为明显而且无法回避:用武的正义性的标准何在?使用武力的程度如何把握?凡此种种,在乱世中都重新成为重要和亟待解决的问题。

15 Ren XX,Zhou YM,Hou W.Analysis of the efficacy on 103 cases of colorectal cancer treated with integrated Chinese and Western Medicine.Shi Jie Zhong Xi Yi Jie He Za Zhi 2010;5(8):703-705.

16 Lin SY,Shen MH,Shu JN,Lan J.Retrospectively analysis of the characteristics of the TCM patterns of colorectal cancer.Zhejiang Zhong Yi Yao Da Xue Xue Bao 2011;35(3):322-324.

17 Xu Y,Zhao AG,Gu XH,Lu JP,Wu Y,Yang YF.Clinical research on Traditional Chinese Medicine pattern identification of 218 patients with postoperative colorectal cancer.Shi Jie Ke Xue Ji Shu 2011;13(6):938-943.

18 Fan XH,Tan LK,Xu XP,et al.Research on the distribution and dynamic changes of traditional Chinese medical patterns in preoperative patients with colorectal cancer.Xin Zhong Yi 2009;41(10):28-29.

19 Guo HJ,Wang ZJ,Liu YF.Study on TCM Pattern of 230 cancer patients in postoperative period.Zhong Guo Zhong Yi Ji Chu Yi Xue Za Zhi 2008;14(6):451-452.

20 Wang Q,Tian Y.Nine constitutions of Chinese.Beijing:Traditional Chinese Medicine Press,2009:5-12.

Li Yan,Gu Jianzhong,Zhou Huamiao,Wang Hui,Zou Ying,Yang Weihong,Guo Yong
《Journal of Traditional Chinese Medicine》2018年第2期文献

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