| As one of the major cancer categories, colorectal carcinoma is being a rising tendency in China. Because of the difficulty of finding in early stage and the recurrence and metastasis after operation, patients with advanced colorectal carcinoma are constant in clinical work, but the result is poor. Traditional Chinese medicine (TCM) is one of the major methods for the treatment of advanced colorectal carcinoma. In this task, the research of theory and clinical work about TCM for advanced colorectal carcinoma was done, and the status in quo and the principle about TCM for the treatment of the colorectal carcinoma was defined as a principium, and a preferable treatment for advanced colorectal carcinoma was finished in the task.The task is made up of three parts:The first was the review about TCM for advanced colorectal carcinoma. Background: Colorectal cancer is one of the most common cancers in both female and male persons worldwide with rising tendency of incidence and mortality. About 30% of the patients have developed into advanced colorectal cancer at the time of initial diagnosis, and 25% of cases will relapse after the first operation. The five year survival time of advanced colorectal cancer is less than 5%, and the median survival time is about 4-5 months. From clinical research during the last decades, it has been proved that herbal medicines are able to relieve symptoms of patients with colorectal cancer, and side effect of chemotherapy, promote patients to recover from operation, improve the quality of life of patients, increase cure rate and the immunity in advanced colorectal cancer patients. Objective: Assess efficacy of herbal medicines as a treatment for advanced colorectal cancer and safety of herbal medicines and their effects on quality of life. Search strategy: We searched the Chinese Biological Medical disc (from 1978 to 2005) and the Cochrane Controlled Trials Register (to February 2005), Medline (from 1978 to February 2005) and EMBASE (from 1978 to 2005), Biological Abstracts (from 1978 to 2005). We had hand-searched 16 Chinese Journals. These journals have been hand-searched from the first publication date onwards. Unpublished abstracts from meetings in Chinese will also be hand-searched. Results of hand-searching have been submitted to the Cochrane Colorectal Cancer Group. We also contacted the editorial base of the Cochrane colorectal cancer group. Selection criteria: Randomized or quasi-randomized controlled trials regardless of blinding of herbs or herbs combined with chemotherapy compared with chemotherapy in patients with advanced colorectalcarcinoma. Data collection & analysis: Two reviewers (Chenzhanxin and Luolin) independently assessed trial eligibility, methodological quality and abstracted data. Main results: 438 articles had been searched in total. Four trials involving 312 patients were included. In 2 trials, treatment with TCM adding chemotherapy had better effect on three year survival rate(odds ratio 2.50 ,95% confidence interval 1.11 to 5.67), and treatment with TCM adding chemotherapy had no better effect on response rate(odds ratio 1.38,95%confidence interval 0.82 to 2.31) based on four trials. Reviewers' conclusions: TCM combined with chemotherapy shows a better three year survival rate and quality of life than chemotherapy only, but the response rate is almost the same. Implications for practice: Though the methodological quality of trials included in the review is poor, there is evidence to recommend the use of TCM as a method of treatment for advanced colorectal carcinoma, and TCM shows a good efficiency in improving the patients' quality of life and producing more survival rate. So TCM is good for patients with advanced colorectal carcinoma, doctors may adopt TCM in treating patients with colorectal carcinoma. Implications for research: There are so much research have finished on TCM for advanced colorectal carcinoma, but there methodological quality is so poor that seldom trials were included for review, and exact conclusion can not be got, so it is important to improve the methodological quality of clinical research.The second is a theoretical discuss about tumor treatment with TCM. By a systemic review about ancient and present famous doctor's discussions and treatment experience of tumor, results were yielded that the diseased region of tumor belong to the collaterals. As embranchments of the longitudes, the collaterals are regional and the Qi and blood in the collaterals are little. So when evil influence in the longitude for a long time, absolute superiority of evil factors may found in some collaterals, and these collaterals are shut, and the yang qi can't arrive and gasification can't keep up normally, then body fluid and blood belonging to the pathological changes site is condensed and tumor is produced. Because of no yang qi arrived at the sit e of tumor, the nature of tumor belongs to Yin no matter what pathogenic factor is. Just because there are not yang qi in the site of tumor, there are not resistant of yang qi, so no special symptoms are found at the beginning of the tumor. Once symptoms of tumor are found, it means tumor have grown up and blocked the longitude, and resistant of yang qi is shown. Etiological factors include: 1.Innate deficiency. The natural endowment of human being is closely related to the essence acquired before birth and the essence acquired after birth of their parents. The natural endowment is also named kidney- Qi or MING MEN, it is the motive power of the Ql-blood circulation. And the strong or weak of the MING MEN influences the easy and smooth or not of the Ql-blood circulation. If the MING MEN is feeble, and the Ql-blood circulation is hysteresis, and collaterals is easy tobe obstructed when there are evil factor in the longitude and tumor is easy to be produced. 2. Age factor. The healthy energy of a human being is various in the different age stages. During childhood, the healthy energy is nonfilling, and Ql-blood circulation is not easy and smooth. When there is infantile carbuncle or evil factor influences, tumor is easy to be produced. The healthy energy is weak in the aged and the tumor is easy to be produced uniformity. 3. The site of the collaterals. The nearer the collaterals from the longitude, the more the vital energy is. Inversely, evil factor is easy to stay in the collaterals which is far from the longitude and the vital energy is little. 4. Invasion of six evils. When there have not enough vital energy to resist the invasion of six evils, evil factor will stay in the collaterals after long time diseases. 5. Internal injury caused by excess of seven emotions. Through it is inevitable for emotional changes of happiness, angry, worry, anxiety, sorrow, fear, terror in the organisms, the excess emotional influence the normal function of the body, and result in dysfunction of catharsis of the liver. The latter will result in the obstruction of the Ql-blood circulation, and the collaterals may be obstructed, chances for tumor will be increased. 6. Dietary factors. The pungent foods and the roast foods belong to hot, they will hurt the lip, tongue, throat, and the acid, salty, pickle, brew, fat foods belong to cold, they will hurt the esophagus, stomach, intestines, all these resulted in the Increased chances of tumor in the digestive system. The pathogenesis is deficiency of yang qi regionally. Only the condition of completely obstruction of collaterals is met, that is there is no yang qi completely and belong to pure yin, the gasification is ceased, then the body fluid and blood is condensed and the tumor is produced. Just because there is no gasification, there are not special symptoms of early stage tumor, and the tumor is no evident hurt to the body. After the tumor being, it grows up very slowly or stops growing, the reason is there are yang qi around the tumor, so the tumor can not grow up. Only for some reasons the yang qi around the tumor become weak, and gasification is ceased in the end, the tumor will grow up. With the growing up of the tumor, disease appears to be "tumor in the collaterals, stagnant changes in the longitudes, six FU-organs are easy to be obstructed and deficiency of vital energy in the five ZANG-organs. Because the disease of the tumor relate to collaterals, longitudes, six FU-organs, five ZANG-organs, so treatment system about "make out the pathogenic factor, eliminate the tumor in the collaterals; remove the stagnant changes in the longitude; rush down the obstruction in the five FU-organs; supply vital energy in the six ZANG-organs" is raised. Abundance yang qi arrive at the site of tumor and recovered normal gasification in the site of the tumor is the total treatment aim. So the total treatment rule is connecting yang qi. Smooth collaterals with pungent and warm drugs is the main remedy of the tumor. The principle of treatment of tumor based on the etiological factors and the site of the tumor is made through analyzing... |
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