| Purpose and significance:Analyzing the changes of symptoms and the distribution characteristics of related symptoms in patients with non-small cell lung cancer(NSCLC)after intervention by Traditional Chinese Medicine(TCM)alone guided by the theory of"Gu Ben Qing Yuan"and exploring the method of symptom evaluation based on the changes of symptom scores.Better clinical experience inheritance and clinical efficacy evaluation of TCMMethods:Thirty-six NSCLC patients treated with TCM alone in professor Lin Hongsheng’s outpatient clinic from July 2019 to January 2020 were enrolled in a self-controlled before-and-after study.Treatment with TCM:one dose of decoction daily,divided in the morning and evening.Chinese patent medicine should be taken as needed.Prescription Yu Ping Feng San added or subtracted:Yin deficiency&mouth dry added with asparagus,ophiopogonis,etc.;Cough and coughing up phlegm added with fritillary bulb,cortex mori radicis;nausea and poor appetite added Rhizoma Cyperi,fructus aurantii,etc.;chest distress and a short of breath added with finger citron,longstamen onion bulb,etc.;mood not free added bupleurum etc.;abdominal distension added with pericarpium arecae,etc.;deficiency of qi and blood&weakness added with radix codonopsis,spatholobus suberctu,rhodiola,etc.;congestion added with zedoary,pseudo-ginseng,etc.;all prescription added four products that clearing away heat and toxic materials,promoting blood flow,resolving masses,such as akebia fruit,smilax glabra,etc.Specific addition or reduction according to the patient’s condition.Before and after treatment,filling in the MD Anderson clinical Symptom Inventory with Traditional Chinese Medicine(MDASI-TCM)and Lung Cancer Clinical Symptom Classification Table.EPIDATA V4.6.0.2 was used for data entry and SPSS 25.0 was used for data analysis.Results:(1)Symptom frequency and composition:The symptoms with higher frequency in the MDASI-TCM scale were fatigue(34,94.44%),shortness of breath(32,88.89%),cough(30,83.33%),sleep disturbance(29,80.56%),dry mouth(28,77.78%),pain(24,66.67%),and distress(24,66.67%).The symptoms with higher frequency in the lung cancer symptom scale were:fatigue(34,94.44%),shortness of breath(33,91.67%),cough(30,83.33%),dry mouth and throat(27,75.00%),expectoration of sputum(26,72.22%),excessive night urinate(26,72.22%),insomnia(24,66.67%),and loss of appetite(24,66.67%).Chi-square test was conducted for the composition of symptoms before and after treatment,in the MDACI-TCM scale showed fatigue(x2=12.618,P<0.001),shortness of breath(x2=4.504,P=0.034),poor appetite(x2=5.512,P=0.019),drowsiness(x2=13.836,P<0.001),numbness(x2=4.667,P=0.031),palpitation(x2=3.896,P=0.048),and sweating(x2=13.556,P<0.001)were significantly changed,and the moderate and severe patients were significantly reduced.The symptom composition of sputum(x2=4.733,P=0.030),fatigue(x2=13.528,P<0.001),spontaneous sweating(x2=10.564,P=0.001),and constipation(x2=6.982,P=0.008)were significantly changed in the Lung Cancer Symptom Classification scale,and the moderate to severe patients were significantly reduced.After treatment,patients with moderate to severe expectoration,fatigue,sweating and constipation have a greater relief.(2)Symptom score:The average total score of the patients in the MDASI-TCM scale was 51.47± 23.57,and the highest scores were fatigue(4.83 ±2.56),sleep disturbance(4.47±3.07),shortness of breath(4.31 ± 2.82),sweating(3,56±3.38),dry mouth(3.53 ± 2.83),distress(3.47±3.20),and forgetfulness(3.08±3.37).In the Lung Cancer Symptom Classification scale,the symptoms with the highest scores were mental fatigue(1.67 ±0.76),excessive night urination(1.39±1.08),loss of appetite(1.17±1.03),spontaneous sweating(1.14±0.99),shortness of breath(1.00±0.41),and cough(0.94±0.58).(3)Changes in symptom score before and after treatment:The data of each group were statistically non-normal distribution,and Wilcoxon sign rank-sum test was used.The results indicated that the total symptom scores of the two scales were reduced,indicating that the symptoms of the patients were relieved after the treatment with TCM alone.The more obvious symptoms to relieve include fatigue,sweating,poor appetite,poor sleep,shortness of breath,constipation,etc.(4)The effective rate of symptom treatment:In the MDASI-TCM scale,the effective rate of oral pain was the highest,which was 87.50%.The effective rate of palpitation,constipation,fatigue,sweating and dry mouth were at 70.00%or more.Symptoms of Lung Cancer Symptom Classification scale effective rates of symptoms in turn were fever,sweating,constipation,fatigue and insomnia.(5)Among the symptoms with high frequency,the five symptoms of fatigue,shortness of breath,restlessness of sleep,dry mouth and distress were divided into two groups according to the score:mild and moderate to severe.The results suggested that the efficacy of fatigue,sleep disturbance and dry mouth were different in mild patients and moderate to severe patients,and the effective rate of symptom score in patients with moderate to severe sleep disturbance and dry mouth was higher in patients with moderate to severe than in patients with mild.(6)Evaluation method test of the two scales:Chi-square test was conducted for the treatment efficiency of the two scales’ common symptoms.The results indicated that the effectiveness of the total symptom score and the common symptoms of the two scales were consistent in the efficacy evaluation results under different scoring methods,and the MDASI-TCM scale could also effectively evaluate the efficacy.Conclusion and significance:(1)Among the single syndrome elements in this study,qi deficiency syndrome has the highest frequency,followed by Yin deficiency syndrome,and qi and Yin deficiency syndrome are the most common in the composite syndrome type,which is consistent with the clinical understanding of the syndrome of lung cancer.Fatigue,shortness of breath,cough and phlegm,sleep disturbance,dry mouth,distress and other symptoms of high incidence.After treatment,most of the symptoms were relieved to some extent,among which fatigue,sweating,restless sleep,shortness of breath,dry mouth,constipation and loss of appetite were the symptoms that were significantly relieved by the symptom score.Summarize two scale multiple analysis methods,whether it is analysis of the symptoms before and after the treatment,or score changes,efficient,hierarchical analysis,it can reflect effectively symptoms include fatigue,sweating,the two symptoms are in high incidence,treatment effectiveness is higher,they may be the characteristics of TCM treatment of symptoms,has the significance of further study(2)The Lung Cancer Symptom Classification scale is the commonly used scale for Chinese patients with lung cancer symptom curative effect evaluation tool,MADASI-TCM is a good PRO tool.After correlation analysis was carried out on the two scale of project,prompted MDASI-TCM is a good symptom curative effect evaluation tool. |
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