| ObjectiveTo investigate the symptoms and syndromes of patients with advanced colorectal cancer and determine the characteristics of symptoms and the distribution patterns of syndromes;And the intervention study was conducted on patients with advanced colorectal cancer damp-heat accumulation type using the traditional Chinese medicine modified Gegen Qinlian Tang to evaluate the clinical efficacy and safety of modified Gegen Qinlian Tang.Methods1.Collect advanced colorectal cancer patients who visited the oncology department or inpatient department of Shanxi Provincial Hospital of Traditional Chinese Medicine from June 2021 to December 2022,and complete a symptom questionnaire using a questionnaire survey.analyze the distribution patterns of symptoms and syndromes in different sites of onset,metastasis,and treatment methods of advanced colorectal cancer patients.Data entry and organization were performed using Excel software,and statistical description and analysis were performed using SPSS27.0 software.2.Collect 90 patients with advanced colorectal cancer who were hospitalized in the Oncology Department of Shanxi Provincial Hospital of Traditional Chinese Medicine from June 2021 to December 2022 and were classified as damp-heat accumulation type based on syndrome differentiation.They were randomized into a treatment group(modified Gegen Qinlian Tang+Western medicine treatment)and a control group(Western medicine treatment),with 45 patients in each group.Clinical observation trials were conducted,with a treatment cycle of 3 weeks and 4 consecutive treatment cycles;Evaluate the efficacy of traditional Chinese medicine syndrome,progression free survival,recent efficacy,KPS score,tumor markers(CEA,CA19-9),cellular immune function(CD3+cells,CD4+cells,CD8+cells,CD4+/CD8+ratio),and adverse reactions of the two groups of patients before and after treatment.Data entry and organization were performed using Excel software,and statistical description and analysis were performed using SPSS27.0 software.Results1.Finally,400 patients were included in the questionnaire survey.(1)Location of onset:Symptoms that occur more frequently in untreated patients:(1)Rectal cancer:65.38%of patients have frequent desire to defecate,59.62%have sticky stools,55.77%have mucopurulent and bloody stools,53.85%have foul stools,and 48.08%have anal prolapse;(2)Left colon cancer:62.50%frequent bowel movements,58.33%loose stools,56.25%laborious bowel movements,54.17%mucopurulent bloody stools,and54.17%abdominal distension;(3)Right colon cancer:66.67%abdominal distension,64.29%abdominal pain,61.90%fatigue and fatigue,59.52%difficulty in defecation,and59.52%lack of appetite.Traditional Chinese medicine syndromes with higher frequency of occurrence:(1)Rectal cancer:dampness heat accumulation 23.08%>heat toxin stasis 21.15%>spleen stomach disharmony 15.38%;(2)Left colon cancer:dampness heat accumulation 20.83%>heat toxin stasis 18.75%>spleen stomach disharmony 15.38%;(3)Right colon cancer:21.43%with spleen and stomach weakness>19.05%with spleen and kidney yang deficiency>16.67%with qi and blood deficiency.Symptoms that occur more frequently in treated patients include:(1)rectal cancer:loose and irregular 50.00%,sticky stools 49.11%,frequent desire for bowel movements 48.21%,decreased appetite 46.43%,and fatigue 44.64%;(2)Left colon cancer:57.14%have poor bowel movement,54.29%have fatigue and fatigue,52.86%have a lack of appetite,51.43%have obstructed bowel movements,and 50.00%have thinner stools;(3)Right colon cancer:57.58%fatigue and fatigue,56.06%lack of appetite,54.55%weight loss,53.03%lack of complexion,and 51.52%lack of sleep and anxiety.Traditional Chinese medicine syndromes with higher frequency of occurrence:(1)Rectal cancer:Qi and blood deficiency 22.32%>spleen and stomach weakness 20.54%>damp heat accumulation 13.39%;(2)Left colon cancer:spleen and stomach weakness 22.86%>spleen and kidney yang deficiency 20.54%>damp heat accumulation 14.39%;(3)Right colon cancer:spleen and stomach weakness 18.18%>qi and blood deficiency 16.67%=spleen and kidney yang deficiency 16.67%.(2)Location of metastasis:Symptoms that occur more frequently in patients who have not undergone surgical resection of the primary lesion:(1)Liver metastasis:57.14%loose stools,54.76%frequent desire to defecate,52.38%mucopurulent bloody stools,50.00%anal prolapse,and 47.62%pain;(2)Pulmonary metastasis:60.61%abdominal distension,57.58%narrowed stools,56.06%dry stools,53.03%reduced appetite,51.52%chest tightness and wheezing;(3)Multiple metastases:55.00%fatigue and fatigue,53.75%dry stool,53.75%unpleasant bowel movements,52.50%weight loss,and 51.25%abdominal distension.Traditional Chinese medicine syndromes with higher frequency of occurrence:(1)liver metastasis:spleen and stomach weakness 17.86%>damp heat accumulation 16.67%>liver and kidney yin deficiency 14.29%;(2)Lung metastasis:spleen and stomach weakness16.67%>damp heat accumulation 15.15%>heat toxin stasis 13.64%;(3)Multiple metastases:Qi and blood deficiency 16.25%=liver kidney yin deficiency 16.25%>spleen stomach disharmony 13.75%.Symptoms that occur more frequently in patients who have undergone surgical resection of the primary lesion include:(1)liver metastasis:pain 72.00%,fatigue 66.00%,dry stool60.00%,reduced appetite 56.00%,dry mouth 52.00%;(2)Pulmonary metastasis:chest tightness and wheezing 70.37%,bowel discomfort 66.67%,abdominal distension 64.81%,chest distension 62.96%,cough and phlegm 61.11%;(3)Multiple metastases:60.00%of patients were mentally fatigued and weak,60.00%had low energy and lazy speech,58.00%had low appetite and food intake,56.00%had difficulty falling asleep,and 54.00%had nausea and vomiting.Traditional Chinese medicine syndromes with higher frequency of occurrence:(1)liver metastasis:spleen and stomach weakness 20.00%>qi and yin deficiency 18.00%>spleen and stomach disharmony 16.00%;(2)Lung metastasis:18.52%of spleen and stomach weakness>16.67%of qi and yin deficiency>14.81%of qi and blood deficiency;(3)Multiple metastases:spleen and stomach weakness 20.00%=spleen and kidney yang deficiency20.00%>qi and blood deficiency 18.00%.(3)Treatment method:Symptoms that occur more frequently in patients after surgery:(1)Within 6 months after surgery:58.33%of loose stools,56.25%of frequent bowel movements,56.25%of pain,54.17%of fatigue and fatigue,52.08%of anorexia;(2)After 6months of surgery,53.03%of the patients had dry stools,51.52%had unpleasant bowel movements,50.00%had loose stools,48.48%had abdominal distension,and 46.97%had fatigue and fatigue;Traditional Chinese medicine syndromes with higher frequency of occurrence:(1)Within6 months after surgery:spleen and stomach weakness 20.83%>qi and blood deficiency16.67%=spleen and stomach disharmony 16.67%;(2)After 6 months of surgery,there were18.18%spleen and stomach weakness,15.15%qi and blood deficiency,and 13.64%spleen and stomach disharmony.Patients receiving radiation therapy in rectal cancer have a higher frequency of symptoms:72.50%watery diarrhea,70.00%anal prolapse,65.00%internal distress,65.00%postoperative discomfort,and 62.50%occasional desire to defecate;Traditional Chinese Medicine Syndrome:Damp heat accumulation 25.00%>Heat toxin stasis20.00%>Qi and Yin deficiency 15.00%.Symptoms that occur more frequently in patients undergoing systemic treatment include:(1)surgery combined with chemotherapy:nausea and vomiting 50.00%,loose stools 50.00%,fatigue and fatigue 49.22%,lack of appetite 48.44%,and unpleasant bowel movements47.66%;(2)Simple chemotherapy:66.67%of patients with fatigue and fatigue,63.33%of patients with nausea and vomiting,63.33%of patients with chest and abdominal distension,60.00%of patients with anorexia,and 56.67%of patients with pain;(3)Combined treatment:70.00%of patients had fatigue and fatigue,68.33%had pain,66.67%had nausea and vomiting,66.67%had difficulty falling asleep,and 63.33%had soreness and weakness in the waist and knees.Traditional Chinese medicine syndromes with higher frequency of occurrence:(1)Surgical combination chemotherapy:Spleen stomach disharmony 19.53%>Spleen stomach weakness 17.97%>Spleen kidney yang deficiency 13.28%;(2)Simple chemotherapy:Spleen stomach disharmony 20.00%>Qi and blood deficiency18.33%>Liver kidney yin deficiency 15.33%;(3)Combined treatment:Liver and kidney yin deficiency 16.67%>Spleen and stomach weakness 15.00%=Qi and blood deficiency15.00%.According toχ~2test,there is a statistically significant difference in the distribution of traditional Chinese medicine syndromes in different sites of onset,metastasis,and treatment methods(P<0.05).Moreover,there is a significant difference in the distribution of traditional Chinese medicine syndromes in rectal cancer patients with or without treatment(P<0.05).2.A total of 76 patients completed clinical research(8 cases were shed),with 37 cases in the treatment group and 39 cases in the control group.(1)Therapeutic effect of TCM syndromes:after treatment,the scores of symptoms such as abdominal pain,abdominal distention,loose stool,blood in stool,frequency of stool,anal discomfort,Rectal tenesmus,and limb distress in the treatment group were significantly improved,with a significant difference compared with the control group(P<0.05);The effective rate of traditional Chinese medicine syndrome efficacy in the treatment group was 72.98%,which was higher than 38.46%in the control group.There was a significant difference between the two groups(P<0.05).(2)Progression free survival(PFS):The median PFS of the treatment group was 7.865months,which was higher than the control group’s 7.079 months,but there was no significant difference between the two groups(P>0.05).(3)Recent efficacy:The objective response rate(ORR)of the treatment group was43.24%,and the disease control rate(DCR)was 83.78%,which was higher than the ORR(35.90%)and DCR(74.36%)of the control group,but there was no significant difference between the two groups(P>0.05).(4)KPS score:After treatment,the KPS score of the treatment group patients was significantly improved compared to before treatment,which was better than the control group.There was a significant difference between the two groups(P<0.05).(5)Tumor markers(CEA,CA19-9):After treatment,the CEA and CA19-9 levels of both groups of patients decreased significantly(P<0.05),but there was no significant difference between the two groups(P>0.05).(6)Cellular immune function:After treatment,the cellular immune function(CD3+cells,CD4+cells,CD8+cells,CD4+/CD8+ratio)of patients in the treatment group was significantly improved,with a significant difference compared to the control group(P<0.05);The control group showed significant improvement in CD3+cells compared to before treatment(P<0.05),while there was no significant difference in other indicators before and after treatment(P>0.05).(7)Adverse reactions:The incidence of diarrhea,nausea and vomiting,hand foot syndrome,leukopenia,erythrocytopenia,thrombocytopenia,Transaminase elevation and other adverse reactions in the treatment group were lower than those in the control group.There was a significant difference between the diarrhea groups(P<0.05),and there was no significant difference in other adverse reactions(P>0.05).Conclusions1.The condition of advanced colorectal cancer is complex and the symptoms are variable,but regardless of whether the primary lesion,metastatic site,treatment method is the same,and whether treatment has been received,patients all exhibit abnormal bowel movements,such as frequent desire to defecate,loose and loose stools,uncomfortable bowel movements,dry stools,and anal prolapse.At the same time,systemic symptoms such as fatigue,lack of appetite,restlessness,insomnia,and emotional depression may also occur.Traditional Chinese medicine syndromes are closely related to the site of onset,metastasis,and treatment methods.The empirical evidence is mainly dampness and heat accumulation(14.10%),while deficiency syndrome is commonly seen in spleen and stomach weakness(18.21%)and qi and blood deficiency(14.36%).2.The combination of Jiawei Gegen Qinlian Tang and chemotherapy can significantly alleviate the clinical symptoms,improve the physical condition and cellular immune function of patients with advanced colorectal cancer of damp-heat accumulation type,and reduce the incidence and frequency of chemotherapy related adverse reactions.It has a significant clinical advantage compared to simple Western medicine treatment;There is a trend towards benefits in objective evaluations such as prolonging patient survival,controlling solid tumor size,and reducing tumor markers(CEA,CA19-9),but further research is needed to prove this. |
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