| Objective:This study aims to investigate the correlation between the distribution of Traditional Chinese Medicine(TCM)characteristics and psychosomatic rehabilitation needs in patients who underwent radical surgery for early and mid-stage colorectal cancer.Through the Integrated Traditional and Western Medicine Psychosomatic Rehabilitation Group Intervention and observation,the changes in emotions,quality of life,and TCM characteristics before and after intervention were analyzed,and the feasibility and clinical effects of Integrated Traditional and Western Medicine Psychosomatic Rehabilitation were determined,providing clinical evidence for further optimization and improvement of the rehabilitation program for patients with early and mid-stage colorectal cancer after radical surgery.Methods:This article is divided into three parts:a cross-sectional study,a exploratory clinical intervention study,and a mining of TCM prescription patterns.The cross-sectional study included 71 patients with early and mid-stage colorectal cancer after radical surgery who visited the integrated traditional and western medicine psychological rehabilitation clinic of the China Academy of Chinese Medical Sciences Xiyuan Hospital and Beijing Cancer Hospital from October 2020 to December 2022.Patients were classified according to different TCM characteristic factors using the Traditional Chinese Medicine Kidney Deficiency Scale(TCM-SDS)and Traditional Chinese Medicine kidney deficiency scale(TCM-KDS).The Self-rating Axiety Scale(SAS),Self-rating Depression Scale(SDS),and Fear of Cancer Recurrence Inventory Short Form(FCRI-SF)were used to assess the emotional burden of patients,and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire(EORTC QLQ-C30)was used to evaluate their quality of life.Based on the survey of TCM characteristics,the emotional burden and quality of life level and distribution characteristics of patients with early and mid-stage colorectal cancer after radical surgery were analyzed,and their correlation was analyzed.The exploratory clinical intervention study included 44 patients who visited the integrated traditional and western medicine psychological rehabilitation clinic of the China Academy of Chinese Medical Sciences Xiyuan Hospital and Beijing Cancer Hospital from October 2020 to December 2021,and were divided into a integrated traditional and western medicine group,a Western medicine treatment group,and a conventional treatment group according to their preferences.The integrated traditional and western medicine group received a 6-week integrated traditional and western medicine physical and psychosomatic rehabilitation program,the Western medicine treatment group received a 6-week Western medicine group psychological intervention,and the conventional treatment group did not receive any psychological intervention.The SAS,SDS,FCRI-SF,EORTC QLQ-C30,TCM-SDS,and TCM-KDS were used to assess the emotional burden,quality of life,TCM characteristics,and symptom burden of patients,and the differences in emotional burden,quality of life,and TCM characteristics before and after intervention were compared.The mining of TCM prescription patterns included patients with anxiety and depression symptoms who visited the clinic of Professor Yang Yufei from January 2020 to December 2022 and received TCM prescriptions for colorectal cancer.A standardized prescription database was established,and the frequency of medication use,drug properties,and drug combinations were statistically analyzed and associated using the ancient and modern medical case cloud platform V2.3.6.Cluster analysis was performed using IBM SPSS Statistics 26.0,and image processing was performed using Cytoscape 3.9.1 to explore the TCM prescription patterns used by Professor Yang Yufei to treat anxiety and depression symptoms in colorectal cancer patients.Results:1 In the cross-sectional study,the mean score of the TCM-SDS was(2.18 ± 1.69)and the mean score of the TCM-KDS was(2.43±1.57)in the 71 patients with early and mid-stage colorectal cancer included.Accordingly,the 71 patients were divided into the spleen and kidney deficiency group(n=21),the simple spleen deficiency group(n=8),the simple kidney deficiency group(n=15),and the non-spleen and kidney deficiency group(n=27).Among the 71 patients with early and mid-stage CRC,higher SAS,SDS,and FCRI-SF scores were significantly associated with higher degrees of spleen qi deficiency(P<0.01);higher SAS and SDS scores were associated with higher degrees of kidney deficiency(P<0.01)and FCRI-SF scores were not correlated with the degree of kidney deficiency(P>0.05);SAS,SDS and FCRI-SF scores were significantly different between the spleen and kidney deficiency group,the simple spleen qi deficiency group,the simple kidney deficiency group and the non-spleen and kidney deficiency group(P<0.01);a two-by-two comparison showed that SAS scores were different between the spleen and kidney group and the non-spleen and kidney deficiency group(P<0.05);SDS scores in the spleen-kidney deficiency group differed from those in the spleenonly deficiency group,the kidney-only deficiency group and the non-spleen-kidney deficiency group(P<0.05);FCRI-SF scores in the spleen-kidney group differed from those in the kidneyonly and non-spleen-kidney deficiency groups(P<0.05).71 patients with early and mid-stage colorectal cancer had lower somatic,role,emotional.cognitive,social function and total health status quality-of-life scores with higher degree of spleen and kidney deficiency were significantly associated(P<0.01).Significant differences were found between the groups of CRC patients in the spleen and kidney deficiency group,the spleen qi deficiency alone group,the kidney deficiency alone group and the non-spleen and kidney deficiency group in the dimensions of somatic,role,emotional,cognitive,social functioning and total health status quality of life scores(P<0.01).2 A total of 44 patients with early and mid-stage colorectal cancer were included in the exploratory clinical intervention study,including 19 patients in the Western medicine treatment alone group,19 patients in the combined Western and Chinese medicine group,and 6 patients in the conventional treatment group.The differences in baseline characteristics and emotional burden characteristics among the groups were not statistically significant(P>0.05),among which the quality of life characteristics and TCM characteristics of 38 CRC patients who received psychological intervention(hereafter referred to as the treatment group)were not statistically significant(P>0.05).The anxiety,depression and fear of cancer recurrence of 38 patients in the treatment group were reduced after the intervention compared with those before the intervention,and the difference was statistically significant(P<0.05);the differences in anxiety,depression and fear of cancer recurrence between the Western medicine treatment group and the Integrative Traditional Chinese Medicine and Western Medicine group were not statistically significant(P>0.05).The quality of life scores of the 38 patients in the treatment group were higher than those before the intervention(P>0.05);the quality of life scores of the patients in the Integrative Traditional Chinese Medicine and Western Medicine group were higher than those in the Western medicine treatment group,with statistically significant differences in the emotional function dimension(P<0.05)and no statistically significant differences in the remaining function dimensions(P>0.05).The degree of kidney deficiency in the patients was gradually reduced with different visitation viewpoints(P<0.05);the degree of spleen qi deficiency gradually decreased with visitation viewpoints from before the intervention to after 4 weeks,and then increased after 6 weeks(P>0.05);there was a trend of higher degree of spleen qi deficiency in the Integrative Traditional Chinese Medicine and Western Medicine group compared with the Western medicine treatment group after the intervention(P>0.05);there was a trend of higher degree of kidney deficiency in the Integrative Traditional Chinese Medicine and Western Medicine group compared with the Western medicine treatment group.The difference between the two groups after 2 weeks was statistically significant(P<0.05),and the remaining visit nodes were not statistically significant(P>0.05).In a subgroup analysis of 44 patients with early and mid-stage colorectal cancer based on whether they took oral Chinese medicine tonics or not,all patients with early and mid-stage CRC who took oral Chinese medicine tonics accounted for 68.2%of the total,and the difference between the crossover distribution of whether they took oral Chinese medicine tonics and the psychological intervention group was not statistically significant after chi-square test(χ2=3.242,P=0.198).38 patients in the treatment group were treated with oral Chinese medicine tonics and those who did not take oral Chinese medicine tonics.The difference in emotional burden between the two groups was not statistically significant(P>0.05);patients taking oral Chinese medicine tonics had higher quality of life scores than those not taking oral Chinese medicine tonics(P>0.05);patients taking oral Chinese medicine tonics had less spleen qi deficiency and kidney deficiency than those not taking oral Chinese medicine tonics(P>0.05).3 A total of 179 TCM prescriptions for anxiety and depression symptoms in colorectal cancer patients in the outpatient clinic of our supervisor,Professor Yang Yufei,were included in the TCM prescriptions for group prescription pattern excavation study,involving 44 patients and containing 192 drugs with a total frequency of 3318 times.There were 30 drugs used≥35 times,and the top ten were Dang Shen,Fu Ling,Atractylodes Macrocephala,Sour Jujube,Astragalus,Glycyrrhiza,Scutellaria,Chai Hu,Gui Zhi,and Red Peony.The four gases are mainly flat and cold,and the five flavors are mainly sweet,bitter and pungent,and mostly belong to the liver,spleen,lung and kidney meridians.Drug efficacy statistics yielded 15 main effects,with the top three being clearing heat and detoxifying toxins,inducing diuresis and detoxifying fire.There were 16 high-frequency drug pairs with a common frequency of≥75 times,and "Dang Ginseng,Fu Ling","Atractylodes Macrocephala,Dang Ginseng" and "Sour Date Palm,Dang Ginseng" ranked the top three;the confidence level of≥0.70 and the support level of≥0.30 were conducted.The association analysis with confidence≥ 0.70 and support≥0.30 yielded 34 association rules for different drug combinations,among which "Dang Shen-Fu Ling","Bai Zhu-Dang Shen" and "Sour Date Palm-Dang Shen" ranked in the The top three.Systematic cluster analysis of high-frequency drugs yielded six clustering groups.Conclusion:1 Patients with higher levels of anxiety,depression and fear of cancer recurrence in early and mid-stage colorectal cancer were associated with higher levels of spleen qi deficiency,and patients with higher levels of anxiety and depression had higher levels of kidney deficiency;and there were differences in the levels of anxiety,depression and fear of cancer recurrence among the spleen and kidney deficiency group,the simple spleen qi deficiency group,the simple kidney deficiency group and the non-spleen and kidney deficiency group,with the spleen and kidney deficiency group having a heavier emotional burden.Patients with poorer physical,role,emotional,cognitive,social function and total health status had higher degrees of spleen and kidney deficiency in early and mid-stage colorectal cancer;and there were differences in the quality of life scores of physical,role,emotional,cognitive,social function and total health status among the spleen and kidney deficiency group,simple spleen and kidney deficiency group,simple kidney deficiency group and non-spleen and kidney deficiency group,among which patients in the spleen and kidney deficiency group had the lowest quality of life scores.2 The Integrative Traditional and Western Medicine Psychosomatic Rehabilitation Intervention Program and Western medicine group psychological intervention could significantly reduce the level of anxiety,depression and fear of cancer recurrence in patients after radical surgery for early and mid-stage colorectal cancer,improve the symptom burden of kidney and spleen qi deficiency,and enhance patients’ quality of life.Among them,the Integrative Traditional Chinese Medicine and Western Medicine psychosomatic rehabilitation intervention program has certain advantages in reducing emotional burden and improving quality of life by increasing the Integrative Traditional Chinese Medicine and Western Medicine psychosomatic rehabilitation management methods for patients’ rehabilitation needs compared with Western medicine group psychological intervention,and further improvement and promotion are recommended.3 Professor Yang Yufei treated anxiety and depressive symptoms related to colorectal cancer firstly by treating colorectal cancer as the main disease,applying strengthening the spleen and benefiting the qi,tonifying the kidney and filling the essence to support the righteousness,clearing the heat and detoxifying the blood stasis to detoxifying toxins,and then improving the patient’s emotional symptoms by detoxifying the liver and relieving depression,nourishing the heart and calming the mind.We applied the core formulae such as Si Jun Zi Tang,Er Zhi Wan,Liu Wei Di Huang Tang,Yi Yao San and Gui Shen Tang in combination with pairs of medicines like Chai Hu-Huang Qin,Sour date palm-Wu Wei Zi and Salvia DivinorumNei Jin,to intervene in the anxiety and depression symptoms associated with colorectal cancer patients,and the clinical efficacy was remarkable. |
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