| ObjectiveThe aim of this study was to conduct a nation-wide survey in order to explore the frequency of TCM use and the patterns of TCM prescriptions on gynecologic cancer, by analyzing the linkage between NHI data base and the National Cancer Registration System.MethodsThe NHI program was started in1995and covers nearly ninety-nine percent Taiwanese Citizens. People in Taiwan are free to choose Western medicine or TCM, and are allowed to visit either public or private medical clinics or hospitals. The use of TCM has been reimbursed by the NHI since1996. In1999, the Bureau of NHI began to release all claims data in electronic form to the public under the National Health Insurance Research Database (NHIRD) project. We obtained the complete TCM claim datasets linked and processed. The datasets contains comprehensive information, such as demographic data, dates of clinical visits, medical care facilities and specialties, patients’ genders, dates of birth, and the three major diagnoses coded in the International Classification of Disease,9th Revision, Clinical Modification (ICD-9-CM) format, expenditure amounts, and others. The NHI Program has a committee that reviews new treatments, drugs, and procedures, and only those that proved to have evidence-based effectiveness are covered. Statistical analysis SAS9.1was the main software used for data linkage and processing. Excel for Descriptive data, including frequencies, percentage are presented.ResultsA total of708prescriptions were prescribed in the gynecologic cancer out patient clinic visit. It accounted for about1.7%of the total prescription prescribed in the gynecologic cancer out patient visit. Traditional Chinese Medicine Physicians usually prescribed one or two formulae or combination treatment with different kinds of single Chinese herbal medicine.According to our results, the most frequently used Chinese medicine formula prescription are harmonizing formula like Jiawei Xiaoyao San (442times、62%)、tonic formula Buzhong yi qi Tang (118times,16%)、harmonizing formula chai hu shu gantang (112times,15.8%)、purgative formula like Maziren Wan (95times,13.8%)、xiao chengqi tang(89times,12.5%)、blood regulating formula Guizhi fuling Wan (88times,12.4%)、Tonic formula Zhi Gancao tang (31times,4.37%)、phlegm resolving formula Dingchuan tang (9times,1.27%)、blood regulating formula san zhong kui jian tang (8times,1.12%)、exterior relieving formula Canger san (10times,0.98%)、harmonizing formula xiaochaihu tang (5times,0.7%)、tonic formula liu wei di huang wan (5times,0.7%)、blood regulating formula Danggui shao yao san (4times,0.56%)、exterior relieving formula Sang Ju Yin (4times,0.56%)、phlegm resolving formula xin yi qing fei tang (4times,0.56%)、tonic formula sheng yu tang (4times,0.56%)、 blood regulating formula Shaofu Zhuyu tang (3次,0.42%)、exterior relieving formula Liangqe san (3times,0.42%)、phlegm resolving formula wen dan tang (3times,0.42%)、tonic formula si jun zi tan (3times,0.42%) respectively。The most frequently used single Chinese herbal medicine are as follow: bai hua she she cao (289times,40.81%)、dan shen (253times,35.73%)、 da huang (201times,28.38%)、ban zhi lian (190times,26.83%)、er shu (162times,22.88%)、don kui zi (114times,16.1%)、mu li (103times,14.54%) yan hu suo (101times,14.26%)、zhi shi (96times,13.55%)、ye jiao teng (94times,13.27%)、bei mu (83times,11.72%)、du zhong (82times,11.58%) xiao hui xiang (28times,3.95%)、fu ling (25times,3.53%)、fu zi (22times,3.1%)、gan jiang (18times,2.54%)、bai shu (18times,2.54%)、chuan lian zi (14times,1.97%)、hou po (14times,1.97%). cao guo (13times,1.83%) respectively。Our results revealed that most of the gynecologic cancer patients always present with symptoms like nausea, vomiting,cough and chest tightness, abdominal distension and constipation。Other systematic symptoms for instance digestive system, respiratory system, cardiovascular system like palpitation, dyspnea, anemia, insomnia, anxiety, irritability, restlessness,panic attack, poor memory, dream disturbed sleeping etc。 DiscussionTraditional Chinese medicine assumes that the main pathogenesis of malignant tumor is the combination of evil repletion and Qi vacuity pattern. Our study shown that heat clearing pattern is the main treatment whether with or without surgery, radiotherapy, chemotherapy. Harmonizing formula like Jiawei Xiaoyao San to smooth the disharmony between the organs and functions for instance liver qi stagnation and upflaming liver fire。As the nature of the pattern mostly is vacuity. Tonic formula enrich, augment, nourish or replenish the qi, blood, yin and yang of the body when they are deficient or depletion. Tonify the qi like Buzhong yi qi Tang to treat collapse of qi, tonify both qi and blood like sheng yu tang is used for enriching the qi and blood that promote the circulations as well as to correct insufficency, tonify yin like liu wei di huang wan to norish yin defiencies of kidney and liver etcAs a result of anesthesia and surgical trauma leading to qi stagnation and blood stasis that may cause intestinal obstruction, usually present with fullness, distention and pain in the gastric and abdominal regions, constipation, as well as poor appetite. Our study shown that purgative formula like Maziren Wan and exterior relieving formula like Liangqe san not only used as laxatives for relieving intestinal stagnancy, but also for removing heat, fire, toxins and even retained fluids. These formulae break down the interior accumulations through vigorous evacuation of the bowels, clear the heat and calm the mind.Our study also found that tumor deficiency often leading to lung spleen qi deficiency pattern and lung and stomach Yin deficiency pattern. Ear, nose, throat are located in the upper part of the body, are most vulnerable to Yang Evils invasion caused by wind, cold, dampness, dryness, fire and heat etc.Exterior relieving formula like Canger san and phlegm resolving formula like Dingchuan tang may expel wind and heat and alleviate phlegm and swelling. Besides this, they have additional effects including promoting the lung’s dispersing function and strengthening water metabolism, thus they can also clear heat of the stomach and lung.Our study also found that blood regulating formula such as Guizhi fuling Wan, Shaofu Zhuyu tang and san zhong kui jian tang etc, can activate blood, remove stasis and dissolve firmness that may caused by a combined influence of qi stagnation, stasis and phlegm, general or localized stagnated blood circulation, which are characterized by stabbing pain, cyanosis, swelling, bleeding (dark purplish blood with clotting), dark complexion, firmness and a purplish tongue with bloodspots. Our study revealed that when analyzing the formulae herbal nature and their function, as well as the combination of pattern diagnosis and disease entity, therapy will not be chosen according to the disease entity but according to the pattern, as there is a complexion of primay and secondary pattern. All these treatment may improve the clinical symptoms and improve the quality of life.There are several limitations to this study. Firstly, our study is using the NHI database, so there is a lack of information, for instance, no laboratory data and other biomedical index to know the severity of the disease. Though there is a linkage to national cancer registration system, there is no data about the staging of the cancer. Lack of important factors, like smoking, BMI working environment, parity etc Secondly, the differentiation between the method and amount of prescription among the tcm physicians. Coding of the disease and diagnosis procedure may lead to misclassification. Thirdly, the efficacy and use frequencies of the combination treatment with bothintegrative western medicine and tcm are unknown as it may not represent the clinical truth. Finally, there is no information about the TCM physicians whether or not they may prescribe decoction besides finished herbal product for the patients, in order to enhance the efficacy. Some patients may also be taking decoction forms of traditional Chinese medicine, which is not covered by the NHI Program. Hence, the NHIRD data may lead to an underestimation of TCM prescription.ConclusionThere is not much record for the gynecologic cancer in the past, and many empirical studies have been done, especially after treatment with the western medicine, there are changing of the symptoms and signs thus, it can be regarded as a new disease for tcm physician nowadays. This study provides information about the use frequencies of TCM and patterns of prescription, which should be useful for health policy makers and the integration of TCM and Western medicine for the treatment of gynaecologic cancer in clinical practice. |
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