Supporting Cancer Management :

Conceptual Framework TCM

Prof. Yunming
•••

Nanjing Medical University Affiliated Hospital of Yangzhou

(Yangzhou, China 225009)
 Preface
§ Chinese medicine treatment of cancer has a long
history
§ the ancient chinese Oracle already has a record
of "tumor"

the ancient Chinese Medical script "Huang Di Nei

Jing" already have specialised doctors and tumor
classification
for 2000 years TCM has abundant experience
in clinical cancer practice
§ A historic breakthrough in the past 60 years is the
Integrate theory and method of conventional
medicine with TCM

§ Modern experimental methods (from the system to

the tissues and organs, cells, molecular level)

§ Evidence
Evidence--based medicine approach

§ Innovation in traditional Chinese medicine as the

concentrated herbal granules
The characteristics of traditional Chinese medicine
- Has their own theoretical system
- Emphasis on human internal factors
- Mainly Using natural medicines (herbal, animal
drugs, mineral drugs, etc.) and combination with
acupuncture theraphy, pshycotherapy,
dietotheraphy, exercise therapy, etc.
 1 .Classifications of Types of adjuvant
therapy for tumors of Chinese medicine

§ Features:

- Reducing surgery, radiotherapy, chemotherapy side effects

- Enhanced the sensitivity of chemotherapy, and radiation

- Many reasons for inoperable lesions, radiotheraphy,

chemotheraphy, the patients administered with TCM can
improve living quility, prolong survival rate
 1 several categories of Chinese
medicine treatment of cancer
§ 1.
1.11 clearing away the heat-
heat-evil and toxic materials
Ying•
ex: herba taraxaci ( Pu Gong Ying•
rhizoma smilacis glabrae (Tu Fu Ling)
 1 Several categories of Chinese
medicine treatment of cancer

§ 1. 2. dissipating a mass
 1 Several categories of Chinese
medicine treatment of cancer
1.3 supporting healthy energy and building up
foundation
 1 Several categories of Chinese
medicine treatment of cancer
1.4. Activating blood circulation to dissipate
1.4.
blood statis
 1.1. Several categories of Chinese
medicine treatment of cancer
§ Mechanism:
-Anti
Anti--tumor activity
(directly terminate cancer cells)
-Regulate the immune function
-Regulate metabolism
(autonomic, endocrine)
-Promote tumor cell differentiation
-Inhibit tumor thrombus formation
 Several categories of Chinese
medicine treatment of cancer
§ Cruciality of efficacy
- Diagnosing the individual indications
- Drug combinations Framework
- Dose administration
- Accumulated doctors experience and basic
theories of TCM
 2. Methodes of integrated TCM and
conventional medicine on cancer treatment
2.1. Combination of surgery and TCM
2.1.1. Pre
Pre--operative : Objective: to improve
the physical condition and create better
conditions for surgery
§ 2.
2.1.2
1.2.. post-
post-operative recovery
Objective: To promote tissue repair, adjust bodily
functions to deal with complications
-, to improve post-
post-operative gastrointestinal
dysfunction
-, regulate autonomic nerve function: post-
post-
operation sweating, sweating after movement.
-, regulate water and electrolyte disorders: in
gastrointestinal surgeries, especially those with
fistula formation, a large number of digestive
juice is lost.
2.1.3 Long-
Long-term post-
post-operative treatment
2.1.3.1. early stage, radical surgery, without radiotherapy or
chemotherapy may be pure traditional Chinese medicine
treatment, long-
long-term follow-
follow-up.
2.1.3.2. patients who need chemotherapy and radiotherapy ,
TCM herbal may reduce side effects, increased efficacy(
ex: lung cancer IIB T2 N1M0)
2.1.3.3. after surgery for various reasons can not accept
chemotherapy, radiotherapy , may have a long-
long-term
maintenance treatment of traditional Chinese medicine to
improve the quality of life and prolong survival time
2.2. Chinese medicine combined with chemotherapy
and radiotherapy
2.2.1. The clinical problems faced by chemotherapy
and radiotherapy
-Toxicity: skin and mucous membrane radiation
damage and nerve injury, pneumonia and
pulmonary fibrosis, colitis and digestive tract
ulcers, cystitis; gastrointestinal response to
chemotherapy, bone marrow suppression,
immune suppression, neurological damage, organ
damage and skin, hair damage and so on.
2.2.1. The clinical problems faced by
chemotherapy and radiotherapy

-Desensitization and drug resistance:

radiation--induced tumor blood supply
radiation
shortage, hypoxic tumors cells on the
radiation induced multi-
multi-drug resistivity
resistance (MDR) and so on.
2.2.2. TCM reduces radiation toxicity

- Prevention and control of radiation-

radiation-induced
skin reactions and ulcers:

- Treatment of radiation proctitis and

- Radiation cystitis;
2.2.3. TCM reduces chemotherapy toxicity

-Reduces Chemotherapy induced gastrointestinal

reactions (nausea, vomiting, poor appetite,
abdominal distension, etc.;

-Improve the bone marrow suppression;

-Reduce nerve injury

2.2.4 Mechanisme of TCM synergistic effect to
chemotherapy and radiaotheraphy

-Mechanisme :

- Reversal of multidrug resistance (MDR)

- Affecting the cell cycle distribution
- Improve the tumor surrounding tissue and tumor
microcirculation:
2.2.4. Researches Result of Synergistic effect of
2.2.4
TCM to chemotherapy and radiotherapy

- Research results
Over the years, in TCM to enhance tumor
chemotherapy and radiotherapy effects, our
clinical and experimental studies have conducted
extremely broad, deep and intriguing results. Here
are some of the introduction.
Experimental data (1) Beijing Chinese Medicine
Hospital with building up healthy energy and
activating blood circulation and dissipate blood
statis, combined with chemotherapy, not only
reduced chemotherapy side effects, but also
improved the successful completion rate of
chemotherapy (treatment group completed the
rate of 79.59% in the control group 52.63, P
<0.05, statistically significant differences), and
also improved the cancer patient's blood
hypercoagulability, improved cellular immune
function in patients: compared to chemotherapy
alone, there are obvious advantages;
§ Data (2) Liu Jiaxiang, etc. with the formula
"anti--tumor Yifei Yin" Treatment of 271
"anti
cases of non-
non-small cell lung cancer,
§ group 1: "anti-
"anti-tumor Yifei Yin“group:
§ group 2: "anti-
"anti-tumor Yifei Yin" plus
chemotherapy group,
§ group 3: chemotherapy group,
randomized controlled.
the results showed :
A. TCM group and TCM plus chemotherapy group was significantly
superior to chemotherapy group.

B. TCM group and TCM plus chemotherapy group significantly inhibit

metastasis of lung cancer in stage III.

C. TCM group 1,2,3,5-

1,2,3,5-year survival rates were 73.21%, 33.06%,
13.96% and 11.17%
11.17%, with a median survival time of 406 days;

D. TCM plus chemotherapy group 1,2,3,5-

1,2,3,5-year survival rates were
73.24% and 40.54%, 52.04%
52.04% and 18.43%
18.43%, the median survival
period 449 days

E. Chemotherapy group 1,2,3,5-

1,2,3,5-year survival rates 39.03% and
11.06%, 35.78% and 0% 0%, the median survival period 267 days. Has
significant statistic diferences.

F. The result Showed that anti-

anti-tumor Yifei can prolong survival and
improve life span, improving symptoms and quality of life, combined
with chemotherapy for lung cancer significantly attenuated the
synergistic effect.
§ Data (3) the author himself in Nanjing University
of Traditional Chinese Medicine Hospital with
Astragalus, Ganoderma lucidum etc in formula
"Rectifying Xiaoliu" combined with
chemotherapy for 69 cases diagnostically
confirmed by pathology or CT examination as
advanced cancer patients were randomly
divided as treatment group and the
chemotherapy control group,
§ treatment group, the effective (CR + PR) is
31.58% in the control group effective rate was
22.58%, statistically significant differences (P
<0.05 ). Immune function before and after
treatment is seen in the table below:
 Comparison of immune function in both
groups before and after treatment (X ± S)

group time T L c T R(%) N K c A(%)

TCM before 49.38±4.02 9.39±4.38

Plus
after 53.72±5.28•• 12.71±4.71••
chem
o
chem Before 47.59 ±0.61 9.34±4.66
o
after 49.81±3.51• 10.21±5.57•

Compared with TCM plus chemotherapy group : before treatment, •P <0.01;

compared with chemotherapy group after treatment ,compared to • P <0.01;
Compared with chemotherapy group before treatment, € P> 0.05
§ Data (4) Beijing Guang An Men Hospital, observed 669
cases of advanced gastric cancer patients with
"Jianpiyishenfang powder" (from Codonopsis, Atractylodes,
Ligustrum lucidum, etc) into the attenuated toxicity effect of
chemotherapy, suggesting that usage of the formula can
elevate patients chemotherapy complition rate to 94.44
percent, while chemotherapy alone is only 73.73%.
Gastrointestinal reactions, systemic reactions, blood and
immune indicators shows that the former are better than
the latter, followed up 303 cases, the 1,3,5,10-
1,3,5,10-year survival
rates were 99.01%, 77.31%, 53.40% and 47.37%.
 2.3 TCM Research on anti-
anti-metastasis and anti-
anti-
recurrence

2.3.1. Known TCM ways to prevent recurrence and anti-

anti-metastasis
mechanisme

-Antimutagenic

-Direct cytotoxicity

-Immunoenhancement

-Inhibit tumor cell proliferation, induction differentiation of cells tumor

-Induced apoptosis of tumor cells

-Affecting telomerase activity

- Inhibit tumor angiogenesis

2.3.2 Anti-
Anti-recurrence and metastasis
of research results

Data (1) Yang Guo Wang using Chinese

herbal compound, "Guben Xiaoliu Capsule"
in research of Inhibition of mouse Lewis lung
cancer growth and anti-
anti-angiogenesis
research found that: there is significant
resistance effect to mouse Lewis lung
cancer, neovascularization generation
2.3.2 TCM anti-
anti-metastatis and recurrance
suppression research results

Data (2) Xu Ling and friends, with "Yi Fei anti-

anti-tumor”
compound ( astragalus, North Adenophora, winter days,
Ligustrum lucidum, etc) in the treatment of 45 cases of lung
cancer stage • , and TCM plus chemotherapy group 22
cases and chemotherapy group 27 cases as control
group,
3 months later the metastatis rate is respectively 13
cases, 5 cases, and 17 cases. indicates that TCM, TCM
plus chemotherapy group effect in stabilising lesion,
suppression of distant metastasis was superior to
chemotherapy group (P <0.05 and 0.01), while increasing
natural killer cell activity in patients, OKT3, OKT4 value.
2.3 TCM Research on anti-
anti-metastasis and
anti--recurrence
anti
Data (3) In experimental studies, it is observed
that fermentation of natural Cordyceps sinensis
and water extract fermentated Cordyceps
sinensis has significantly inhibited subcutaneous
transplanted Lewis lung cancer local growth and
spontaneous lung metastasis. Probably caused by
Chinese caterpillar fungus that regulates immune
function; Rhizoma cnidi with the active ingredients
TMP significantly inhibited melanoma cells
C57/BL6 in the mice spontaneous lung cancer
metastasis.
2.3 TCM Research on anti-
anti-metastasis
and anti-
anti-recurrence
Data (4) Lin Hongsheng reported,with the
Chinese herbal compound lung cancer
inhibitor 2 , with high, medium and low-
low-dose
respectively inhibited Lewis lung cancer
metastasis rates as 39.7%, 54.6%, 64.1%,
as compared with the control group were
significantly different (P <0.05 and 0.01).
 2.4. TCM Research of long term
extending survival rate results

TCM goal to treat malignant tumors are

not limited by reducing tumor size, In recent
years, along with molecular targeted
therapies in clinical application, the length of
survival as the efficacy evaluation is more
and more attentive.
 2.4. TCM Research of long term
extending survival rate results
§ Data (1
(1) Guo-
Guo-Rong Chen reported for non-
non-
small cell lung cancer, TCM plus
chemotheraphy treatment group, 60 cases ,
and chemotherapy control group, 60 cases,
§ Results of the treatment group: CR + PR
58%, with a median survival period of 19
months , while the control group was only 35
%, and 10 months.
§ Data (2
(2) Yu Guiqing observed 669 cases of
advanced gastric cancer with "Jianpiyishenfang
powder" (radix Codonopsis pilosulae,
Atractylodes, Ligustrum lucidum, etc) combined
with chemotherapy, 303 cases of long-
long-term follow-
follow-
up , the 1,3 , 5,10-
5,10-year survival rate reached
99.01%, 77.31%, 53.4%, 47.37%.
§ Data (3
(3) Zhou Jianhua with "Nourishing Yin and
Yang Wei Fang" compound (radix adenophorae
herba Dendrobium, rhizoma dioscorea
batatis,rhizoma curcumae, radix Ophiopogonosis,
Polygonatum, etc) combined with radiotherapy in
85 patients with esophageal cancer patients . And
50 cases of radiotheraphy as control, the results
showed of treatment group 1,3,5-
1,3,5-year survival
rates were 74.12%, 30.16%, 21.05% , while the
control group 44%, 22.27%, 0%.
 3. The strengths and limitations of
Chinese medicine on cancer treatment
§ 3.1 The advantages of Chinese medicine to treat cancer
A, emphasises on "the whole body concept", focusing on tumor
with the patients body as part and the overall relationship, starting the
anti--cancer from the regulation of homeostatis environment
anti

B, Less toxicity effects, wide indications

C, on the Western radiotherapy, chemotherapy, interventional

therapy has attenuated synergistic effect;

D, has abundant methodes for anti-

anti-metastasis and recurrence

E, can improve symptoms, improve quality of life and prolong

survival;

F, right precancerous lesions have some preventive effect.

3.2 The limitations of Chinese medicine to treat cancer
A, weak effect of partial debridement

B, although according to specific diagnostic

treatment is difficult to adjust the specific indicator,
mainly rely on TCM theory and doctor’s experience
effects between different individuals is various;

C formula are complicated, the determination of active

ingredients is relatively difficult.
 Summary
TCM can assist the conventional
treatment as complimentary means on
oncology, in tumor prevention and
treatment has very broad prospects, and
we look forward to more Western medical
experts and Chinese medicine experts to
join hands. to do more international
cooperation, in order to effectively control
the malignancy of human cancer.
Thank you!

•••