Study On The Regularity Of Syndrome Differentiation And Medication Of Postoperative Breast Cancer In TCM Based On Data Mining

Judging from its geographic distribution in epidemiology, the breast cancer is a worldwide disease. North America and Northern Europe are the high-prevalence area. Southern Europe and South America are the middle-prevalence area. And most of countries in Asian and African belong to the low-prevalence area. Although breast cancer is considered to be the disease happened in developed countries, the major deaths of breast cancer(69%) occur in developing countries. Breast cancer causes about 1.38 million new cases of disease and kills about 458,000 people each year, (from International Agency for research on cancer, Globocan,2008) The incidence rate of breast cancer presents obvious characteristics according to age distribution. It is extremely rare under the age of 20, gradually increase after age 30 and reach a peak from the age of 45 to 50. It fell slightly during the postmenopausal periods, but presents a second peak after the age of 60[1]. Though the incidence of breast cancer is low in China, the rate has increased year after year in recent years. And the incidence rate in urban area is higher than that in the rural area, while the incidence rate in coastal area is also higher than that in mainland. The regions prone to getting breast cancer in China are Shanghai, Beijing, Tianjin and the coastal areas, especially in Shanghai, which has ranked the first in the list of the female malignant tumors. It is reported that the incidence of breast cancer in urban area of Shanghai in 1998 are of 47.0/100,000, and the standardized rate are of 30.9/100,000[2]. By analyzing the incidence trends of Shanghai urban district malignant tumor, standardized incidence of breast cancer are 18.3/100,000 from 1972 to 1974, rose to 31.0/100,000 from 1996 to 1999. Breast cancer has become the first killer among the female tumors[3].At present, the routine therapy of breast cancer is surgery, radiotherapy and chemotherapy in western medicine. To the sequelae or side effects of breast cancer after surgery, however, it can do nothing except some symptomatic treatment. The holism concept is advocated in TCM. TCM is not just limited to the cancer spot itself, but consider patients’ overall condition. Firstly, Chinese medicine not only can recuperate and correct some disorders of the body, but remove the tumor recurrent factors and reduce the likelihood of transfer. Secondly, Chinese medicine is much less harmful to the healthy cells and will generally not produce a new damage on the body caused by the treatment itself. With the improvement of the symptom of the cancer, the patient’s physical power and immunity will get recovered gradually. So the western medicine is the treatment to disease, but traditional Chinese medicine is the treatment to people.A large number of clinical research literature on the treatment for breast cancer after surgical therapy in TCM has sprung out in recent years, such as effective traditional Chinese medicine, TCM syndrome classification, randomized controlled trial to evaluate treatment options. At present, theories lack for thorough and systematic inquiry on breast cancer after surgery by the clinical literature of the postoperative treatment of breast cancer which is mainly about syndrome differentiation and treatment, medication use in TCM, etc. Therefore, this study collected the literature of traditional Chinese medicine in the postoperative treatment of breast cancer nearly 20 years, to explore the rule medication, improve breast cancer surgery clinical symptoms and provide reference for targeted therapy.Objective:To explore the regularity of medication use on the treatment of postoperative breast cancer in TCM.Methods:This study collected the clinical literature of TCM in the treatment of postoperative treatment of breast cancer from Jan.1994 to Jul.2014, sorted the data of the prescriptions and medicine composition, used software named TCM inheritance system to analyze the frequency and correlation of and entropy method of the drugs.Results:The study collected 236 prescriptions and 263 drugs. Result:the most being used herbs were deficiency-tonifying herbs, which was accounted for 19.0%. Heat-clearing herbs rank the second place, which was accounted for 17.1%, followed by herbs with the curative effects of activating blood circulation, eliminating phlegm and cough, regulating qi, dispelling wind-evil and dehumidify, dispelling dampness, relieving exterior syndrome, calming liver to stop endogenous wind, tranquilization and promoting digest, etc. The tonifying qi herbs are the most commonly used herbs in deficiency-tonifying medicine, which was accounted for 45.09%, followed by Yin-nourishing, blood-strengthing and yang-tonifying herbs. Ranked by frequency of usage, the first 15 herbs among the total 263 kinds of drugs were astragalus, atractylodes, poria, angelica, codonopsis pilosula, liquorice, medlar, radix paeoniae alba, radix rehmanniae preparata, radix bupleuri, tangerine peel, caulis spatholobi, pseudostellaria root, chuanxiong rhizome, oldenlandia diffusa, etc. The core drugs respectively were White atractylodes rhizome, Poria, Radix Paeoniae Alba, Radix Astragali, Radix Codonopsis, angelica, wolfberry and licorice. The commonly used couplet medicinesthrough association rule analysis were Rhizoma Atractylodis Macrocephalae and poria, Rhizoma Atractylodis Macrocephalae and poria cocos and astragalus, astragalus, angelica and Radix Astragali, Rhizoma Atractylodis Macrocephalae and Radix Codonopsis, Atractylodes rhizome and angelica, licorice root and astragalus, licorice and Rhizoma Atractylodis Macrocephalae and poria, licorice, angelica and poria, Poria cocos and Codonopsis pilosula, liquorice and Chinese angelica, medlar and Radix Astragali, Radix Paeoniae Alba and poria cocos. Though the analysis of the vast statistic, we draw the conclusion that:Drugs mainly used were those belonging to spleen and liverin channel, and warm and sweet in nature.Though the analysis of the postoperative prescription of breast cancer, we draw the conclusion that through the relevance of the prescription and drugs, syndrome and symptom, the top 5 ranking symptom& syndrome & therapy is bone marrow suppression (which is commonly seen in the white blood cell reduction), gastrointestinal reaction, side upper limb edema, transfer, class of climacteric syndrome & syndrome of deficiency in both qi and blood, spleen and kidney deficiency syndrome, qi stagnation and blood stasis syndrome, qi and Yin deficiency syndrome and liver depression and qi stagnation syndrome & method of supplying qi and blood method, method of tonifying qi and spleen, method of activating blood circulation, method of strengthening spleen and kidney method, method of nourishing qi and yin, method of invigorating spleen and stomach (method for supplementing qi and yin and method for nourishing spleen and stomach are used at the same frequency). Through analysis found that the experienced prescriptions are usually the so-called "leifang(similar prescriptions)"like"siwu decoction ", "sijunzi decoction", "dangguibuxue decoction", "buzhongyiqi decoction", "xiaoyao powder", etc. The new recipe is the modified experience prescription of the basic classical prescription of "liuweidihuang decoction", "Guipi decoction", "XuanfuDaizhe decoction ", "buyanghuanwu decoction", "Xuefuzhuyu decoction", etc. The clinical value of the new prescription which produced by system analysis still need the original and clinical judgment. However, it not only provides useful clues for clinical or basic study of breast cancer, but can explore its clinical effects and possible mechanisms through the clinical and experimental study.Conclusion:By the method of analyzing the statistics frequency of drug use, association rule and entropy, etc, it can be found that clinical medicine for the treatment of breast cancer postoperative syndromes of TCM, from the drug use frequency analysis found that tonifying spleen and replenishing qi, nourishing Yin, nourishing liver and kidney, cultivate, regulating Chong and Ren meridians and strengthening the body resistance are the main therapies, including high frequency and association rules analysis of single drug, represents the core of the treatment of postoperative breast cancer drugs, provide theoretical reference for clinical medication. According to theory which called formula to medicine to syndrome of TCM, through analysis of the traditional Chinese medicine treatment of breast cancer postoperative medication rule, the conclusion is:using deficiency-tonifying medicine to tonify spleen and replenishing qi and make up acquired weakness, followed by the medicine of promoting blood circulation to remove blood stasis and clearing heat, etc. Syndrome mainly from both deficiency of qi and blood, followed by dual deficient condition of spleen and kidney; The first treatment is tonifying qi and nourishing blood method, the second choice is tonifying spleen and replenishing qi. The main method to treat breast cancer postoperative medicine is eliminating pathogens through strengthening qi, which has verified the identity of syndrome differentiation and treatment. Analysis of selected 236 Chinese medicine prescription, excavated 28 core portfolio and 14 new prescription, composed of basic drugs from prescriptions in figure 1-7, for example, the modified Sijunzi decoction, is for basic prescription of replenishing qi and invigorating spleen; the modified Siwu tang is for basis prescription of supplying and regulating blood, etc.From the summary of prescription analysis of breast cancer postoperative can verify the results that the pathogenic factors becoming overwhelming due to the deficiency of healthy qi was the main cause of breast cancer, thus the deficiency or asthenia of the viscera, insufficiency of qi and blood is also the important pathological mechanism of breast cancer. Breast cancer patients’disease appeared due to asthenia, and in turn, the asthenia condition is aggravated by the disease. Blood and qi were consumed after prolonged existence of pathogenic factors,which cause the dual deficiency of qi and blood. The spleen is the foundation of acquired situation and kidney is the congenital foundation, the deficiency of spleen and kidney is vital qi weakness, but most breast cancer patients have the deficiency of spleen and kidney, so enhancing their immunity through tonifying spleen and replenishing qi appears to be a good solution. The book furenliangfangdaquan, which is written by ChenZiming, said that "ifthe beginning of small nuclear, or such as pieces of it, no pain, accumulate the years of gradually,..." and if "the collapse like a ripe pomegranate, or collapse in deep hole, this belongs to the reason of the liver and spleen restrain anger, blood loss, called milk rock". This not only described the signs and symptoms of breast cancer and its development characteristics in detail, but described the pathogenesis as deficiency of qi and blood and liver depression. Up to now, the doctor and the experts also say that liver depression and stasis of qi and blood is one of the cause and pathogenesis of breast cancer, so we can use drugs with the consideration of qi, blood, spleen, kidney, and liver treatment.