最常见的是白细胞和血小板减少，有的病人还出现红细胞减少及血色素下降，严重时全血减少并发再障。治疗总则是健脾补肾，白细胞减少临床表现以气虚居多，如头昏、乏力、易出汗等，药用人参、黄芪、麦冬、五味子、冬术、山药、必要时加用滋补肝肾药，如女贞子、杞子、菟丝子、补骨脂、紫河车等。血小板减少一般表现为气血两亏，气不摄血，血虚生热，血热妄行，引起出血等症。治以调补气血，凉血止血，药用生芪、仙鹤草、生地、元参、大枣、鸡血屯、紫河车、女贞子、龟胶、必甲胶。红细胞减少出现头昏目弦，面色苍白少华，心悸怔忡，梦扰，给予气血双补，药用党参、人参、生芪、熟地、当归、白芍、龟板、紫河车、阿胶、大枣、杞子、桂圆肉、萸肉、五味子。
（3）消化道反应
化疗药品几乎都能引起消化道不同程度的反应，常见症状有：食欲减退，上腹饱胀，恶心呕吐，腹痛腹泄，严重时出现血性腹泻而危及性命，其因在于化疗药品直接抑制了肠道粘膜上皮细胞，以及对植物神经系统和延髓化学感受器官作用所致，中医常用健脾理气和胃、降逆止呕治疗，药用党参、茯苓、米仁、陈皮、竹茹、姜夏、佩兰、神曲、焦山楂、鸡金、炒二芽，腹痛腹胀用广木香、白芍、元胡、砂仁、豆蔻、腹泻用煨果、山药、冬术、莲肉、诃子肉，苔腻色黄用佩兰、藿香、茯苓，苔腻色白用川朴、苍术，打呃用公丁香、柿蒂、代赭石、旋复花等。
（4）多种脏器及组织损伤
治疗胃癌的化疗药物阿霉素等对心肌有损伤，中毒时出现心悸、气短、胸闷不适、严重的可发生心力衰竭，心电图ST波改变，中医给于益气安神，活血化瘀治疗，药用生晒参、麦冬、五味子、参三七、丹参、菖蒲、川芎。有些化疗药长期使用。容易引起肝脏损害，产生中毒性肝炎，临床表现纳差，肝区胀痞不适，上腹饱满，乏力，转氨酶升高，严重时出现皮肤巩膜黄染，中医给于清热利湿、疏利肝胆辅以健脾益气，活血化瘀，药用垂盆草，丹参、平地木、虎杖、柴胡、茵陈、金钱草、茯苓、郁金、太子参、半支连。植物药生物碱类药物如长春新碱等。对周围末梢神经有损害，出现肢端麻木，中医给于活血通络，补肾益气，药用忍冬屯、鸡血屯、络石屯、川牛夕、白花蛇、乌梢蛇、川断、萸肉、生芪、党参。大剂量的顺铂，对肾脏功能可引起损害。中医给予清热通淋，药用甘草、土茯苓、泽泻、黄柏、车前草、瞿麦、扁蓄。
中医药对胃癌的治疗原则，是在整体观念和辨证论治的精神指导下制定的，特别要注意处理好正与邪，标与本的关系。经曰："正气存内，邪不可干，邪之所凑，其气必虚。"胃癌患者大都属於本虚标实之候，故治之大法当以扶正培本，抗癌祛邪为务。一般而言，早期机体正气尚盛，多属正盛邪轻，治当以攻为主，或兼以扶正，或先攻后补、即祛邪以扶正之法。中期正气多已受损，但正尚能与邪抗争，治当攻补兼施。晚期多属正衰邪盛，治当扶正为主，或兼以祛邪，或先补后攻，即扶正以祛邪。同时亦应注意到扶正固然有"正足则邪自去"的一面，若扶正药物过早，过量，过长使用，反有引起留邪（或恋邪）的可能。例如有的病人过量服用人参、阿胶引起腹胀，鼻衄，同样祛邪谨防伤正，祛邪固然有邪去则正自安的治疗效果，然而祛邪药物的过量使用，常有耗伤正气的弊端，因祛邪药物大都属于苦寒攻伐或伤精耗气之品，害人非浅，例如个别患者全蝎一天剂量15克引起血尿。
胃癌除本腑受累外，与其它癌症一样因扩散与转移而出现全身伴随症状，或累及相近组织器官而发生局部症候，如发热，出血，贫血，昏迷，黄疸，胸腹水等，因而在治疗时针对伴随症状，根据急则治其标原则，宜作相应治疗。
3、癌症放疗后的中医药防治
癌症放疗期间采用中医药能有效防治或减轻毒副反应，已被大家公认，放疗后的中医药防治并未得到应有的重视，致使为数不少的患者前功尽弃。因此，放疗后的中医药防治则显得更为重要；发挥中医药之长，弥补放疗伤正之不足，对患者来说是一种应该选择的接力性治疗。
1．放疗后的中医药预防
恶性肿瘤是全身疾病在局部的表现，放疗是局部治疗，最好的疗效只能达到可见病灶消失，对中度敏感的癌细胞，要彻底消灭确有困难，G0期细胞及乏氧细胞仍然存在，部分患者本身仅能作姑息性放疗。以鼻咽癌为例：远处转移率4．8％--27％，尸检高达76％，长期生存率不足50％。因此，放疗后应该考虑到机体免疫功能和抗病能力降低，毒副作用没有消失，癌毒之邪尚未彻底清除，本虚标实仍然是患者的根本危害。坚持较长时间的中医药防治，可以提高机体免疫功能，增加内分泌和体液调节功能，保护骨髓并提高其造血功能，增强消化吸收功能，改善物质代谢，增强机体自动控制系统能力，从而激发杀伤性T细胞对癌细胞的歼灭能力，动员更多的免疫淋巴细胞和抗体包围癌组织使其受到抑制，让其潜伏、稳定、不增殖或减慢增殖，起到带瘤生存的作用、。治之大法扶正培本贯穿于始终，组方用药要选择具有抑制肿瘤的药物。据笔者30余年、数万病例的摸索，辨证分型归纳、概括为下列5型。
{1}气阴两虚型症见头昏乏力，少气懒言，心悸自汗，纳少倦怠，夜寐少宁，面色萎黄，苔薄舌淡红，脉细弱。常见于肺癌、脑瘤、淋巴肉瘤、食管癌放疗后。治宜补气养阴，方选八珍汤加减。
{2}阴亏血瘀型
症见咽干舌燥，五心烦热，吞咽不畅，胸胁疼痛，周身酸楚，形体消瘦，面色淡白或晦滞，苔薄舌暗有紫斑，脉沉涩。常见于食管癌、鼻咽癌、肺癌、喉癌、扁桃体癌放疗后，治宜补阴化瘀，方选桃仁四物汤加减。
{3}肺肾两虚型
症见胸闷气短，动则咳喘加剧，咳痰无力，腰腿酸软，纳少多汗，时有潮热，面色晄白，苔薄白，舌淡红或暗，脉细。常见于肺癌、纵隔肿瘤、脑瘤放疗后，治宜益肺补肾，方选人参蛤蚧散加减。
{4}肝肾两亏型
症见头晕目眩，口苦咽燥，腰痛肢懈，胸胁胀痛，低热盗汗，苔微黄或糙，舌红边有齿痕，脉沉弦。常见于宫颈癌、卵巢癌、乳腺癌、骨癌放疗后，治宜滋补肝肾，方选知柏地黄汤加减。
{5}阴虚热毒型
症见头痛耳鸣，心烦失眠，口干且苦，虚火上炎，口腔溃烂，手足心热，纳呆神倦，盗汗便秘，尿黄赤，苔糙或光剥，舌干少津，脉细数。常见于扁桃体癌、喉癌、鼻咽癌、舌癌、软腭癌放疗后，治宜滋阴生津、清热解毒，方选沙参麦冬汤合复方半枝莲汤加减。
2、放疗后复发与转移的中医治疗
向外蔓延和转移是癌症的特性，放疗后多有复发和转移的可能，再行放疗亦难以奏效。患者一旦了解到自身治疗手段的受限，体质下降，后遗症、合并症、继发症的困扰，产生绝望心态在所难免，求得对这些患者减少痛苦、延长生命、良好生存的有效治疗，中医药是最佳选择，也为患者所乐意接受。放疗后转移与复发，正气衰败，毒陷邪深，故治之大法需攻补兼施，补有力度，攻则峻猛，急则治标，缓则治本，根据病位不同，结合辨证分型施治，方能奏效。
{1}脑转移：
多见于鼻咽癌、肺癌、头颈部癌放疗后。因毒积脏腑，营衍壅塞，寒热相搏，导致清阳之气不得升，浊阴之气不得降，格于奇恒之腑的脑内，肿大成积发生转移性脑瘤。原发灶无论来自何方或放疗后复发，都会直接引起脑组织的局部损害，影响脑血液循环，阻塞脑脊液循环的通路，造成颅内积水或脑水肿，甚至发生脑疝，威胁生命，出现头痛、昏迷、眩晕呕吐、意识障碍、口眼歪斜、半身不遂、耳蒙失聪等症状。临床分型以肝肾阴虚，肝风内动，脾肾阳虚，湿浊内阻，肝胆湿热，瘀毒内结常见。组方选药用桃仁、红花、赤芍、水蛭、虻虫、守宫、蜈蚣、川芎活血化瘀；苏合香丸、局方至宝丹、紫雪散、麝香、石菖根开窍醒脑；全蝎、钩藤、天麻、僵蚕、青龙齿、羚羊角、地龙、夏枯草、蜂房平肝熄风。
{2}骨转移：
多见于肺癌、乳腺癌、鼻咽癌放疗后。因禀赋不足，肾精亏损，复加放疗射线伤阴耗精，骨髓空虚，邪毒乘虚内侵，阻于骨内，日久化热，热毒交加，气血运行不畅，引发骨转移的发生。临床上以疼痛为主症，间歇加重，难消难溃，坚硬如石，疼痛如刺，痛有定处，按之有灼热感，有的易发生病理性骨折。临床上病因与肾关系最为密切，寒多热少，治法应温阳补肾，生髓填精，增强人体的正气和生髓功能为主，切忌单纯以毒攻毒、清热散结、活血化瘀的攻法。组方选药用三骨汤合《济生》肾气丸化裁。
{3}肺转移：
多见于食管癌、鼻咽癌、乳腺癌、纵隔肿瘤放疗后。因放疗后正气虚弱，邪乘于肺，郁结胸中，肺气喷郁，宣降失司，痰凝气滞，瘀阻脉络，久而成块，乃致转移性肺癌发生。常出现疲乏、食欲不振、消瘦、咳嗽、痰中带血或咯血，甚者呼吸困难出现局限性哮喘及水肿、发热、转移灶压迫喉返神经引起声音嘶哑，压迫食管引起吞咽困难，上腔静脉被癌肿压迫或癌栓栓塞，则颜面、上部胸壁肿胀和静脉曲张，皮肤红紫为上腔静脉综合征。组方选药常用黄芪、茯苓、山药、黄精、灵芝、冬虫夏草等益气补肺扶正抗癌；干蟾皮、蛇舌草、败酱草、七叶一枝花、龙葵、猪苓、半枝莲、八角金盘、鱼腥草、淡芩清肺解毒；天麦冬、南北沙参、川石斛、百合、炙鳖甲养阴生津。
3、小结
癌症放疗后生存期长者，大多是采用中草药治疗坚持较长时间的病人，就是复发或转移的，仍有病灶消失及带瘤长期良好生存的可能。
此文发表于《中国中医药信息》1998年第5卷第1期
4, 化疗药物常见毒副作用的辨证施治
化学治疗已经与手术、放疗并重，成为治疗恶性肿瘤的主要手段之一。但化疗药物几乎都有毒副作用，主要表现在胃肠道反应，骨髓抑制，心、肝、肾、肺及神经系统损害等。由于化疗药物的毒副作用，致使相当一部分患者被迫中止化疗，甚至丧失生命。弥补化疗伤正之不足，发挥中医药扶正之长，能有效防治和减轻化疗毒副作用，帮助疗程顺利进行，疗效得以巩固和提高。据笔者30余年数万病例的摸索，将化疗药物常见毒副作用及防治方、药归纳如下。
1、消化道反应
化疗药物引起的消化系统反应，主要表现为恶心、呕吐、食欲减低、腹胀、腹泻、便秘，也有部分病人引起粘膜炎或溃疡，大多数化疗药物都有明显的致吐性，尤其是DDPDTIC、ACD、烷化剂及蒽环类抗生素。发生原因主要由激活胃肠道中5HT3受体所致，也有些化疗药物可直接损害肠粘膜，干扰其功能引起腹泻，常见有抗代谢药、如5一Fu、5一DFUR、MTX、ACD、HU及亚硝脲类药，其中以氟脲嘧啶类引起腹泻最常见。中医治疗常以健脾理气和胃、降逆止呕为主，药用四君子汤加减，止呕降逆加姜半夏、代赭石、旋复花、沉香、公丁香、柿蒂等，腹胀加乌药、枳壳、大腹皮，腹痛加制元胡、杭白芍、广木香，腹泻加炒鸡金、山药、肉豆蔻、炒诃子肉，食欲减低加焦三仙、川石斛，苔腻湿困加川朴、藿佩兰。大剂量化疗药物会灼伤津液，虚火上炎，发生口腔溃疡，症见口腔糜烂、口干咽燥、吞咽不畅、舌红苔少脉数。轻者阴虚宜滋阴清火，重者热盛宜清热解毒。常用沙参麦冬汤、增液汤、黄连解毒汤加减，再投入马勃、淡芩、知母、青黛，口腔溃烂处可用冰硼散、珍珠粉、锡类散吹敷。
2、骨髓造血抑制
大多数抗癌药物可引起不同程度、持续不同时间的骨髓抑制，表现为外周血象白细胞总数，特别是粒细胞减少，继而血小板减少，长期用药可致血红蛋白下降，严重时骨髓再生不良，可发生粒细胞缺乏症和血小板严重低下，容易并发感染和出血倾向，常见药物有亚硝脲类（BCNU、CCNU、Me一CCNU）MMC、CAB、Mx和鬼臼毒素类（VP一16、VM--26）等。因骨髓抑制而被迫中止或推迟化疗是影响疗效的常见原因。治疗以健脾补肾、益气养血疗效最佳，药用四物汤加减。脾虚用冬术、茯苓、炒扁豆、红枣。肾亏用萸肉、蛤蚧、女贞子、旱莲草、巴戟天，严重气血两虚、全血低下用别直参、紫河车、阿胶，气不摄血者用炙黄芪、山药、仙鹤草、新开河参，血热妄行者用丹皮炭、紫草、大黄炭，其中鼻衄用白茅根、黑山支、制大黄，咳血用白芨、侧柏炭，呕血用地榆炭、三七粉、白芨粉，便血用黄柏炭、槐米炭，尿血用蒲黄炭、大小蓟、车前草，血虚失眠时应用炒枣仁、桂圆肉、五味子。
3、心脏损害
最常见的是白细胞和血小板减少，有的病人还出现红细胞减少及血色素下降，严重时全血减少并发再生障碍性贫血。治疗的总原则是健脾补肾。白细胞减少的临床表现以气虚居多，如头昏、乏力、易出汗等，用药用人参、黄芪、麦冬、五味子、白术、山药，必要时加用滋补肝肾的药，如女贞子、枸杞子、菟丝子、补骨脂、紫河车等。血小板减少一般表现为气血两亏，气不摄血，血虚生热，血热妄行，引起出血等症状。治疗以调补气血、凉血止血为主，药用生黄芪、仙鹤草、生地、玄参、大枣、鸡血藤、紫河车、女贞子、龟甲胶、鳖甲胶。红细胞减少出现头昏目眩，面色苍白少华，心悸怔忡，多梦，给予气血双补，药用党参、人参、生黄芪、熟地、当归、白芍、龟板、紫河车、阿胶、大枣、枸杞子、桂圆肉、山茱萸、五味子。
（3）消化道反应
化疗药品几乎都能引起消化道不同程度的反应，常见症状有：食欲减退，上腹饱胀，恶心呕吐，腹痛腹泻，严重时出现血性腹泻而危及性命，其病因在于化疗药品直接抑制了肠道粘膜上皮细胞，以及对植物神经系统和延髓化学感受区作用所致，中医常用健脾理气和胃、降逆止呕治疗，药用党参、茯苓、薏苡仁、陈皮、竹茹、姜半夏、佩兰、神曲、焦山楂、鸡内金、炒麦芽、炒谷芽，腹痛腹胀用广木香、白芍、元胡、砂仁、豆蔻，腹泻用煨诃子、山药、白术、莲子肉、诃子肉，苔腻色黄用佩兰、藿香、茯苓，苔腻色白用厚朴、苍术，打呃用公丁香、柿蒂、代赭石、旋覆花等。
（4）多种脏器及组织损伤
治疗胃癌的化疗药物阿霉素等对心肌有损伤，中毒时出现心悸、气短、胸闷不适、严重的可发生心力衰竭，心电图ST段改变，中医给予益气安神，活血化瘀治疗，药用生晒参、麦冬、五味子、三七、丹参、石菖蒲、川芎。有些化疗药长期使用容易引起肝脏损害，产生中毒性肝炎，临床表现纳差，肝区胀痞不适，上腹饱满，乏力，转氨酶升高，严重时出现皮肤巩膜黄染，中医给予清热利湿、疏利肝胆辅以健脾益气，活血化瘀，药用垂盆草、丹参、平地木、虎杖、柴胡、茵陈、金钱草、茯苓、郁金、太子参、半枝莲。植物药生物碱类药物如长春新碱等对周围末梢神经有损害，出现肢端麻木，中医给予活血通络，补肾益气，药用忍冬藤、鸡血藤、络石藤、川牛膝、白花蛇、乌梢蛇、续断、山茱萸、生黄芪、党参。大剂量的顺铂，对肾脏功能可引起损害。中医给予清热通淋，药用甘草、土茯苓、泽泻、黄柏、车前草、瞿麦、扁蓄。
中医药对胃癌的治疗原则，是在整体观念和辨证论治的精神指导下制定的，特别要注意处理好正与邪，标与本的关系。《内经》说：“正气存内，邪不可干，邪之所凑，其气必虚。”胃癌患者大都属于本虚标实之候，故治之大法当以扶正培本，抗癌祛邪为务。一般而言，早期机体正气尚盛，多属正盛邪轻，治当以攻为主，或兼以扶正，或先攻后补，即祛邪以扶正之法。中期正气多已受损，但正尚能与邪抗争，治当攻补兼施。晚期多属正衰邪盛，治当扶正为主，或兼以祛邪，或先补后攻，即扶正以祛邪。同时亦应注意到扶正固然有“正足则邪自去”的一面，若扶正药物过早、过量、过长使用，反有引起留邪（或恋邪）的可能。例如有的病人过量服用人参、阿胶引起腹胀，鼻衄，同样祛邪谨防伤正，祛邪固然有邪去则正自安的治疗效果，然而祛邪药物的过量使用，常有耗伤正气的弊端，因祛邪药物大都属于苦寒攻伐或伤精耗气之品，害人非浅，例如个别患者全蝎一天剂量15克引起血尿。
胃癌除本腑受累外，与其它癌症一样因扩散与转移而出现全身伴随症状，或累及相近组织器官而发生局部症候，如发热，出血，贫血，昏迷，黄疸，胸腹水等，因而在治疗时针对伴随症状，根据急则治其标原则，宜作相应治疗。
3、癌症放疗后的中医药防治
癌症放疗期间采用中医药能有效防治或减轻毒副反应，已被大家公认，放疗后的中医药防治并未得到应有的重视，致使为数不少的患者前功尽弃。因此，放疗后的中医药防治则显得更为重要；发挥中医药之长，弥补放疗伤正之不足，对患者来说是一种应该选择的接力性治疗。
1．放疗后的中医药预防
恶性肿瘤是全身疾病在局部的表现，放疗是局部治疗，最好的疗效只能达到可见病灶消失，对中度敏感的癌细胞，要彻底消灭确有困难，G0期细胞及乏氧细胞仍然存在，部分患者本身仅能作姑息性放疗。以鼻咽癌为例：远处转移率4.8％--27％，尸检高达76％，长期生存率不足50％。因此，放疗后应该考虑到机体免疫功能和抗病能力降低，毒副作用没有消失，癌毒之邪尚未彻底清除，本虚标实仍然是患者的根本危害。坚持较长时间的中医药防治，可以提高机体免疫功能，增加内分泌和体液调节功能，保护骨髓并提高其造血功能，增强消化吸收功能，改善物质代谢，增强机体自动控制系统能力，从而激发杀伤性T细胞对癌细胞的歼灭能力，动员更多的免疫淋巴细胞和抗体包围癌组织使其受到抑制，让其潜伏、稳定、不增殖或减慢增殖，起到带瘤生存的作用。治之大法扶正培本贯穿于始终，组方用药要选择具有抑制肿瘤的药物。据笔者30余年、数万病例的摸索，辨证分型归纳、概括为下列5型。
{1}气阴两虚型症见头昏乏力，少气懒言，心悸自汗，纳少倦怠，夜寐少宁，面色萎黄，苔薄舌淡红，脉细弱。常见于肺癌、脑瘤、淋巴肉瘤、食管癌放疗后。治宜补气养阴，方选八珍汤加减。
{2}阴亏血瘀型
症见咽干舌燥，五心烦热，吞咽不畅，胸胁疼痛，周身酸楚，形体消瘦，面色淡白或晦滞，苔薄舌暗有紫斑，脉沉涩。常见于食管癌、鼻咽癌、肺癌、喉癌、扁桃体癌放疗后，治宜补阴化瘀，方选桃仁四物汤加减。
{3}肺肾两虚型
症见胸闷气短，动则咳喘加剧，咳痰无力，腰腿酸软，纳少多汗，时有潮热，面色晄白，苔薄白，舌淡红或暗，脉细。常见于肺癌、纵隔肿瘤、脑瘤放疗后，治宜益肺补肾，方选人参蛤蚧散加减。
{4}肝肾两亏型
症见头晕目眩，口苦咽燥，腰痛肢懈，胸胁胀痛，低热盗汗，苔微黄或糙，舌红边有齿痕，脉沉弦。常见于宫颈癌、卵巢癌、乳腺癌、骨癌放疗后，治宜滋补肝肾，方选知柏地黄汤加减。
{5}阴虚热毒型
症见头痛耳鸣，心烦失眠，口干且苦，虚火上炎，口腔溃烂，手足心热，纳呆神倦，盗汗便秘，尿黄赤，苔糙或光剥，舌干少津，脉细数。常见于扁桃体癌、喉癌、鼻咽癌、舌癌、软腭癌放疗后，治宜滋阴生津、清热解毒，方选沙参麦冬汤合复方半枝莲汤加减。
2、放疗后复发与转移的中医治疗
向外蔓延和转移是癌症的特性，放疗后多有复发和转移的可能，再行放疗亦难以奏效。患者一旦了解到自身治疗手段的受限，体质下降，后遗症、合并症、继发症的困扰，产生绝望心态在所难免，求得对这些患者减少痛苦、延长生命、良好生存的有效治疗，中医药是最佳选择，也为患者所乐意接受。放疗后转移与复发，正气衰败，毒陷邪深，故治之大法需攻补兼施，补有力度，攻则峻猛，急则治标，缓则治本，根据病位不同，结合辨证分型施治，方能奏效。
{1}脑转移：
多见于鼻咽癌、肺癌、头颈部癌放疗后。因毒积脏腑，营卫壅塞，寒热相搏，导致清阳之气不得升，浊阴之气不得降，格于奇恒之腑的脑内，肿大成积发生转移性脑瘤。原发灶无论来自何方或放疗后复发，都会直接引起脑组织的局部损害，影响脑血液循环，阻塞脑脊液循环的通路，造成颅内积水或脑水肿，甚至发生脑疝，威胁生命，出现头痛、昏迷、眩晕呕吐、意识障碍、口眼歪斜、半身不遂、耳蒙失聪等症状。临床分型以肝肾阴虚，肝风内动，脾肾阳虚，湿浊内阻，肝胆湿热，瘀毒内结常见。组方选药用桃仁、红花、赤芍、水蛭、虻虫、守宫、蜈蚣、川芎活血化瘀；苏合香丸、局方至宝丹、紫雪散、麝香、石菖根开窍醒脑；全蝎、钩藤、天麻、僵蚕、青龙齿、羚羊角、地龙、夏枯草、蜂房平肝熄风。
{2}骨转移：
多见于肺癌、乳腺癌、鼻咽癌放疗后。因禀赋不足，肾精亏损，复加放疗射线伤阴耗精，骨髓空虚，邪毒乘虚内侵，阻于骨内，日久化热，热毒交加，气血运行不畅，引发骨转移的发生。临床上以疼痛为主症，间歇加重，难消难溃，坚硬如石，疼痛如刺，痛有定处，按之有灼热感，有的易发生病理性骨折。临床上病因与肾关系最为密切，寒多热少，治法应温阳补肾，生髓填精，增强人体的正气和生髓功能为主，切忌单纯以毒攻毒、清热散结、活血化瘀的攻法。组方选药用三骨汤合《济生》肾气丸化裁。
{3}肺转移：
多见于食管癌、鼻咽癌、乳腺癌、纵隔肿瘤放疗后。因放疗后正气虚弱，邪乘于肺，郁结胸中，肺气壅郁，宣降失司，痰凝气滞，瘀阻脉络，久而成块，乃致转移性肺癌发生。常出现疲乏、食欲不振、消瘦、咳嗽、痰中带血或咯血，甚者呼吸困难出现局限性哮喘及水肿、发热、转移灶压迫喉返神经引起声音嘶哑，压迫食管引起吞咽困难，上腔静脉被癌肿压迫或癌栓栓塞，则颜面、上部胸壁肿胀和静脉曲张，皮肤红紫为上腔静脉综合征。组方选药常用黄芪、茯苓、山药、黄精、灵芝、冬虫夏草等益气补肺扶正抗癌；干蟾皮、蛇舌草、败酱草、七叶一枝花、龙葵、猪苓、半枝莲、八角金盘、鱼腥草、淡芩清肺解毒；天麦冬、南北沙参、川石斛、百合、炙鳖甲养阴生津。
3、小结
癌症放疗后生存期长者，大多是采用中草药治疗坚持较长时间的病人，就是复发或转移的，仍有病灶消失及带瘤长期良好生存的可能。
此文发表于《中国中医药信息》1998年第5卷第1期
4, 化疗药物常见毒副作用的辨证施治
化学治疗已经与手术、放疗并重，成为治疗恶性肿瘤的主要手段之一。但化疗药物几乎都有毒副作用，主要表现在胃肠道反应，骨髓抑制，心、肝、肾、肺及神经系统损害等。由于化疗药物的毒副作用，致使相当一部分患者被迫中止化疗，甚至丧失生命。弥补化疗伤正之不足，发挥中医药扶正之长，能有效防治和减轻化疗毒副作用，帮助疗程顺利进行，疗效得以巩固和提高。据笔者30余年数万病例的摸索，将化疗药物常见毒副作用及防治方、药归纳如下。
1、消化道反应
化疗药物引起的消化系统反应，主要表现为恶心、呕吐、食欲减低、腹胀、腹泻、便秘，也有部分病人引起粘膜炎或溃疡，大多数化疗药物都有明显的致吐性，尤其是DDP、DTIC、ACD、烷化剂及蒽环类抗生素。发生原因主要由激活胃肠道中5HT3受体所致，也有些化疗药物可直接损害肠粘膜，干扰其功能引起腹泻，常见有抗代谢药、如5-Fu、5-DFUR、MTX、ACD、HU及亚硝脲类药，其中以氟脲嘧啶类引起腹泻最常见。中医治疗常以健脾理气和胃、降逆止呕为主，药用四君子汤加减，止呕降逆加姜半夏、代赭石、旋覆花、沉香、公丁香、柿蒂等，腹胀加乌药、枳壳、大腹皮，腹痛加制元胡、杭白芍、广木香，腹泻加炒鸡金、山药、肉豆蔻、炒诃子肉，食欲减低加焦三仙、川石斛，苔腻湿困加川朴、藿佩兰。大剂量化疗药物会灼伤津液，虚火上炎，发生口腔溃疡，症见口腔糜烂、口干咽燥、吞咽不畅、舌红苔少脉数。轻者阴虚宜滋阴清火，重者热盛宜清热解毒。常用沙参麦冬汤、增液汤、黄连解毒汤加减，再投入马勃、淡芩、知母、青黛，口腔溃烂处可用冰硼散、珍珠粉、锡类散吹敷。
2、骨髓造血抑制
大多数抗癌药物可引起不同程度、持续不同时间的骨髓抑制，表现为外周血象白细胞总数，特别是粒细胞减少，继而血小板减少，长期用药可致血红蛋白下降，严重时骨髓再生不良，可发生粒细胞缺乏症和血小板严重低下，容易并发感染和出血倾向，常见药物有亚硝脲类（BCNU、CCNU、Me-CCNU）、MMC、CAB、Mx和鬼臼毒素类（VP-16、VM-26）等。因骨髓抑制而被迫中止或推迟化疗是影响疗效的常见原因。治疗以健脾补肾、益气养血疗效最佳，药用四物汤加减。脾虚用白术、茯苓、炒扁豆、红枣。肾亏用山茱萸、蛤蚧、女贞子、旱莲草、巴戟天，严重气血两虚、全血低下用别直参、紫河车、阿胶，气不摄血者用炙黄芪、山药、仙鹤草、新开河参，血热妄行者用丹皮炭、紫草、大黄炭，其中鼻衄用白茅根、黑山栀、制大黄，咳血用白芨、侧柏炭，呕血用地榆炭、三七粉、白芨粉，便血用黄柏炭、槐米炭，尿血用蒲黄炭、大小蓟、车前草，血虚失眠时应用炒枣仁、桂圆肉、五味子。
3、心脏损害
The most common manifestations are leukopenia (reduction of white blood cells) and thrombocytopenia (reduction of platelets). Some patients also present with erythropenia (reduction of red blood cells) and decreased hemoglobin levels. In severe cases, pancytopenia (reduction of all blood cell types) occurs, complicated by aplastic anemia (bone marrow failure). The general principle of treatment is to invigorate the Spleen and tonify the Kidney. Clinical manifestations of leukopenia are predominantly due to Qi deficiency, such as dizziness, fatigue, and easy sweating. Herbs used include Renshen (Ginseng Radix et Rhizoma), Huangqi (Astragali Radix), Maidong (Ophiopogonis Radix), Wuweizi (Schisandrae Chinensis Fructus), Baizhu (Atractylodis Macrocephalae Rhizoma), and Shanyao (Dioscoreae Rhizoma). When necessary, herbs that nourish the Liver and Kidney are added, such as Nvzhenzi (Ligustri Lucidi Fructus), Gouqi (Lycii Fructus), Tusizi (Cuscutae Semen), Buguzhi (Psoraleae Fructus), and Zihewang (Placenta Humana). Thrombocytopenia generally manifests as dual deficiency of Qi and Blood, where Qi fails to control Blood, Blood deficiency generates Heat, and Blood Heat causes reckless bleeding, leading to hemorrhagic symptoms. Treatment focuses on regulating and tonifying Qi and Blood, cooling Blood, and stopping bleeding. Herbs used include Sheng Huangqi (Raw Astragali Radix), Xianhecao (Agrimoniae Herba), Shengdi (Rehmanniae Radix), Xuanshen (Scrophulariae Radix), Dazao (Zizyphi Fructus), Jixueteng (Spatholobi Caulis), Zihewang (Placenta Humana), Nvzhenzi (Ligustri Lucidi Fructus), Guijiao (Colla Testudinis), and Biejiajiao (Colla Carapacis Testudinis). Erythropenia presents with dizziness and blurred vision, pale and lusterless complexion, palpitations, and restless sleep. Treatment involves dual tonification of Qi and Blood. Herbs used include Dangshen (Codonopsis Radix), Renshen (Ginseng Radix et Rhizoma), Sheng Huangqi (Raw Astragali Radix), Shudi (Prepared Rehmanniae Radix), Danggui (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba), Guiban (Carapax Testudinis et Plastrum), Zihewang (Placenta Humana), Ejiao (Colla Corii Asini), Dazao (Zizyphi Fructus), Gouqi (Lycii Fructus), Guiyuanrou (Longan Arillus), Yurou (Corni Fructus), and Wuweizi (Schisandrae Chinensis Fructus).
(3) Gastrointestinal Reactions
Chemotherapeutic agents almost invariably cause varying degrees of gastrointestinal reactions. Common symptoms include anorexia, epigastric fullness, nausea, vomiting, abdominal pain, and diarrhea. In severe cases, bloody diarrhea may occur, endangering life. The etiology lies in the direct inhibition of intestinal mucosal epithelial cells by chemotherapeutic agents, as well as their effects on the autonomic nervous system and the chemoreceptor trigger zone in the medulla oblongata. Traditional Chinese Medicine (TCM) commonly employs methods to invigorate the Spleen, regulate Qi, harmonize the Stomach, and descend rebellious Qi to stop vomiting. Herbs used include Dangshen (Codonopsis Radix), Fuling (Poria), Yiren (Coicis Semen), Chenpi (Citri Reticulatae Pericarpium), Zhuru (Bambusae Caulis in Taeniam), Jiang Banxia (Pinelliae Rhizoma Praeparatum cum Zingibere et Alumine), Peilan (Eupatorii Herba), Shenqu (Massa Medicata Fermentata), Jiao Shan Zha (Crataegi Fructus Praeparatus), Jijin (Galli Gigerii Endothelium Corneum), and Chao Er Ya (Stelis Germinatus). For abdominal pain and distension, Guang Muxiang (Aucklandiae Radix), Baishao (Paeoniae Radix Alba), Yuanhu (Corydalis Rhizoma), Sharen (Amomi Fructus Rotundus), and Doukou (Amomi Fructus) are used. For diarrhea, Wei Hezi (Praeparated Terminalia Chebulae Fructus), Shanyao (Dioscoreae Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Lianrou (Nelumbinis Semen), and Hezirou (Terminalia Chebulae Fructus) are used. For greasy yellow coating, Peilan (Eupatorii Herba), Huoxiang (Agastaches Herba), and Fuling (Poria) are used. For greasy white coating, Houpo (Magnoliae Officinalis Cortex) and Cangzhu (Atractylodis Rhizoma) are used. For hiccups, Gong Dingxiang (Caryophylli Flos), Shidi (Kaki Calyx), Daizheshi (Ochra), and Xuanfuhua (Inulae Flos) are used.
(4) Damage to Multiple Organs and Tissues
Chemotherapeutic agents for gastric cancer, such as Doxorubicin (Adriamycin), can damage the myocardium. Toxicity presents with palpitations, shortness of breath, chest tightness and discomfort; severe cases may develop heart failure and ST-segment changes on electrocardiogram. TCM treatment involves benefiting Qi, calming the Spirit, and invigorating Blood to resolve stasis. Herbs used include Shengshaishen (Fresh Panax Ginseng Radix et Rhizoma), Maidong (Ophiopogonis Radix), Wuweizi (Schisandrae Chinensis Fructus), Sanqi (Notoginseng Radix et Rhizoma), Danshen (Salviae Miltiorrhizae Radix et Rhizoma), Changpu (Acori Tatarinowii Rhizoma), and Chuanxiong (Ligustici Chuanxiong Rhizoma). Long-term use of some chemotherapeutic agents easily causes liver damage, resulting in toxic hepatitis. Clinical manifestations include poor appetite, distending discomfort in the liver area, upper abdominal fullness, fatigue, and elevated transaminases. Severe cases present with jaundice of the skin and sclera. TCM treatment involves clearing Heat and draining Dampness, soothing the Liver and promoting bile flow, assisted by invigorating the Spleen and benefiting Qi, and invigorating Blood to resolve stasis. Herbs used include Chuipencao (Sedis Sarmentosae Herba), Danshen (Salviae Miltiorrhizae Radix et Rhizoma), Pingdimu (Ardisiae Japonicae Herba), Zhangzhu (Polygoni Cuspidati Rhizoma et Radix), Chaihu (Bupleuri Radix), Yinchen (Artemisiae Scopariae Herba), Jinqiancao (Lysimachiae Herba), Fuling (Poria), Yujin (Curcumae Radix), Taizishen (Pseudostellariae Radix), and Banzhilian (Scutellariae Barbatae Herba). Plant alkaloid drugs, such as Vincristine, damage peripheral nerves, causing numbness in the extremities. TCM treatment involves invigorating Blood to unblock collaterals, tonifying the Kidney, and benefiting Qi. Herbs used include Rendongteng (Lonicerae Japonicae Caulis), Jixueteng (Spatholobi Caulis), Luoshiteng (Trichosanthes Caulis), Chuan Niuxi (Achyranthis Bidentatae Radix), Baihua She (Bungarus multicinctus), Wushao She (Zaocys), Duanyang (Drynariae Rhizoma), Yurou (Corni Fructus), Sheng Huangqi (Raw Astragali Radix), and Dangshen (Codonopsis Radix). High-dose Cisplatin can impair renal function. TCM treatment involves clearing Heat and promoting urination to unblock painful urinary dysfunction. Herbs used include Gancao (Glycyrrhizae Radix et Rhizoma), Tufuling (Smilacis Glabrae Rhizoma), Zexie (Alismatis Rhizoma), Huangbai (Phellodendri Chinensis Cortex), Cheqiancao (Plantaginis Herba), Qumai (Dianthi Herba), and Bianxu (Polygoni Avicularis Herba).
The principles of TCM treatment for gastric cancer are formulated under the guidance of holistic concepts and syndrome differentiation. Special attention must be paid to handling the relationship between Zheng (Righteous Qi) and Xie (Pathogenic Factors), and between Biao (Branch/Symptoms) and Ben (Root/Etiology). The Classic states: "When Righteous Qi exists within, Pathogenic Factors cannot invade; where Pathogenic Factors gather, there must be a deficiency of Qi." Most gastric cancer patients present with a pattern of Root Deficiency and Branch Excess. Therefore, the major therapeutic method should focus on supporting Righteous Qi and cultivating the Root, while eliminating cancerous toxins and expelling Pathogenic Factors. Generally, in the early stage, the body's Righteous Qi is still robust, representing Excess of Righteous Qi and mild Pathogenic Factors. Treatment should primarily attack (expel pathogens), or combine with supporting Righteous Qi, or attack first then tonify, i.e., expelling Pathogens to support Righteous Qi. In the middle stage, Righteous Qi is often damaged, but it can still contend with Pathogenic Factors. Treatment should combine attacking and tonifying. In the late stage, it is mostly characterized by decline of Righteous Qi and excess of Pathogenic Factors. Treatment should primarily support Righteous Qi, or combine with expelling Pathogens, or tonify first then attack, i.e., supporting Righteous Qi to expel Pathogens. At the same time, it should be noted that while supporting Righteous Qi has the aspect of "when Righteous Qi is sufficient, Pathogens will naturally depart," premature, excessive, or prolonged use of tonifying drugs may instead cause retention of Pathogens (or lingering Pathogens). For example, some patients who take excessive amounts of Renshen (Ginseng Radix et Rhizoma) and Ejiao (Colla Corii Asini) experience abdominal distension and epistaxis. Similarly, when expelling Pathogens, one must guard against damaging Righteous Qi. Although expelling Pathogens has the therapeutic effect of "when Pathogens are gone, Righteous Qi becomes tranquil," excessive use of expelling drugs often has the drawback of consuming Righteous Qi, because expelling drugs mostly belong to bitter-cold purgatives or substances that injure Essence and consume Qi, causing significant harm. For instance, an individual patient taking 15 grams of Quanxie (Scorpio) per day developed hematuria.
Besides involvement of the primary organ, gastric cancer, like other cancers, presents with systemic accompanying symptoms due to diffusion and metastasis, or local syndromes due to involvement of adjacent tissues and organs, such as fever, hemorrhage, anemia, coma, jaundice, pleural and ascites effusion, etc. Therefore, during treatment, corresponding therapies should be applied to accompanying symptoms based on the principle of "treating the Branch in acute conditions."
3. TCM Prevention and Treatment after Radiotherapy for Cancer
The use of TCM during radiotherapy for cancer to effectively prevent or alleviate toxic side effects is widely recognized. However, post-radiotherapy TCM prevention and treatment have not received due attention, causing many patients' previous efforts to go to waste. Therefore, post-radiotherapy TCM prevention and treatment appears even more important; leveraging the strengths of TCM to compensate for the damage to Righteous Qi caused by radiotherapy constitutes a relay therapy that patients should choose.
1. TCM Prevention after Radiotherapy
Malignant tumors are local manifestations of systemic diseases. Radiotherapy is a local treatment. The best efficacy can only achieve the disappearance of visible lesions. It is indeed difficult to completely eradicate moderately sensitive cancer cells. G0 phase cells and hypoxic cells still exist. Some patients can only undergo palliative radiotherapy themselves. Taking nasopharyngeal carcinoma as an example: the distant metastasis rate is 4.8%--27%, autopsy rates reach up to 76%, and the long-term survival rate is less than 50%. Therefore, after radiotherapy, one should consider that the body's immune function and disease resistance capacity are reduced, toxic side effects have not disappeared, and the cancerous toxin pathogen has not been thoroughly cleared. Root Deficiency and Branch Excess remain the fundamental harm to the patient. Adhering to long-term TCM prevention and treatment can improve the body's immune function, increase endocrine and humoral regulation functions, protect bone marrow and enhance its hematopoietic function, enhance digestive and absorptive functions, improve material metabolism, enhance the body's automatic control system capabilities, thereby stimulating the ability of cytotoxic T cells to annihilate cancer cells, mobilizing more immune lymphocytes and antibodies to surround cancer tissue to inhibit it, allowing it to lie latent, stabilize, not proliferate, or slow proliferation, achieving the role of living with the tumor. The major therapeutic method of supporting Righteous Qi and cultivating the Root runs throughout. Formula composition and herb selection should choose those with anti-tumor inhibitory properties. Based on the author's exploration over 30 years and tens of thousands of cases, syndrome differentiation is summarized and generalized into the following 5 types.
{1} Qi and Yin Dual Deficiency Type: Symptoms include dizziness and fatigue, shortness of breath and reluctance to speak, palpitations and spontaneous sweating, poor appetite and lassitude, restless sleep at night, sallow complexion, thin coating, pale-red tongue, and fine-weak pulse. Commonly seen after radiotherapy for lung cancer, brain tumor, lymphosarcoma, and esophageal cancer. Treatment should benefit Qi and nourish Yin. Formula selected: Bazhen Tang (Eight Treasure Decoction) modified.
{2} Yin Deficiency with Blood Stasis Type: Symptoms include dry throat and tongue, five-palm heat, difficulty swallowing, chest and hypochondriac pain, generalized soreness, emaciation, pale or dull complexion, thin coating, dark tongue with purple spots, and deep-choppy pulse. Commonly seen after radiotherapy for esophageal cancer, nasopharyngeal cancer, lung cancer, laryngeal cancer, and tonsillar cancer. Treatment should tonify Yin and transform stasis. Formula selected: Tao Ren Si Wu Tang (Peach Kernel Four Substance Decoction) modified.
{3} Lung and Kidney Dual Deficiency Type: Symptoms include chest tightness and shortness of breath, aggravated coughing and wheezing upon exertion, weak expectoration, soreness and weakness of waist and legs, poor appetite and profuse sweating, occasional tidal fever, pale-white complexion, thin-white coating, pale-red or dark tongue, and fine pulse. Commonly seen after radiotherapy for lung cancer, mediastinal tumor, and brain tumor. Treatment should benefit the Lung and tonify the Kidney. Formula selected: Renshen Gejie San (Ginseng and Gecko Powder) modified.
{4} Liver and Kidney Dual Deficiency Type: Symptoms include dizziness and vertigo, bitter taste and dry throat, lower back pain and limb flaccidity, distending and painful chest and hypochondrium, low-grade fever and night sweats, slightly yellow or rough coating, red tongue with teeth marks on the edges, and deep-wiry pulse. Commonly seen after radiotherapy for cervical cancer, ovarian cancer, breast cancer, and bone cancer. Treatment should nourish and tonify the Liver and Kidney. Formula selected: Zhi Bai Di Huang Tang (Anemarrhena, Phellodendron, and Rehmannia Pill) modified.
{5} Yin Deficiency with Heat-Toxin Type: Symptoms include headache and tinnitus, irritability and insomnia, dry and bitter mouth, defluxion of deficient Fire, oral ulceration, heat in palms and soles, poor appetite and mental fatigue, night sweats and constipation, yellow-red urine, rough or peeled coating, dry tongue with little fluid, and fine-rapid pulse. Commonly seen after radiotherapy for tonsillar cancer, laryngeal cancer, nasopharyngeal cancer, lingual cancer, and soft palate cancer. Treatment should nourish Yin, generate fluids, clear Heat, and detoxify. Formula selected: Shashen Maidong Tang combined with Compound Ban Zhi Lian Tang modified.
2. TCM Treatment for Recurrence and Metastasis after Radiotherapy
Outward spread and metastasis are characteristics of cancer. After radiotherapy, there is a high possibility of recurrence and metastasis, and re-radiotherapy is difficult to be effective. Once patients realize the limitations of their own treatment methods, declining physical constitution, and the困扰 of sequelae, comorbidities, and secondary complications, generating a mindset of despair is inevitable. Seeking effective treatments to reduce suffering, prolong life, and ensure good quality of life for these patients, TCM is the best choice and is willingly accepted by patients. After radiotherapy, recurrence and metastasis involve the collapse of Righteous Qi and the entrapment of deep-seated toxins and pathogens. Therefore, the major therapeutic method requires combining attacking and tonifying, with strength in tonification and vigor in attacking. Treat the Branch in acute conditions and the Root in chronic conditions. Based on different lesion sites and combined with syndrome differentiation, efficacy can be achieved.
{1} Brain Metastasis:
Commonly seen after radiotherapy for nasopharyngeal cancer, lung cancer, and head and neck cancers. Due to toxin accumulation in Zang-Fu organs, obstruction of Ying and Wei circulation, and struggle between Cold and Heat, leading to the inability of Clear Yang Qi to ascend and Turbid Yin Qi to descend, being blocked in the brain, which is a "Strange Ful" (Extraordinary Fu Organ), swelling into masses causing metastatic brain tumors. Regardless of the origin of the primary lesion or recurrence after radiotherapy, it directly causes local damage to brain tissue, affects cerebral blood circulation, blocks cerebrospinal fluid circulation pathways, causing intracranial hydrocephalus or cerebral edema, and even cerebral herniation, threatening life. Symptoms include headache, coma, vertigo and vomiting, consciousness disorders, facial deviation, hemiplegia, deafness, and loss of hearing. Clinical subtypes commonly include Liver-Kidney Yin Deficiency with internal stirring of Liver Wind, Spleen-Kidney Yang Deficiency with internal obstruction of Damp-Turbidity, Liver-Gallbladder Damp-Heat, and internal binding of Blood Stasis and Toxin. Formula selection includes herbs for invigorating Blood and resolving stasis: Tao Ren (Persicae Semen), Hong Hua (Carthami Flos), Chi Shao (Paeoniae Radix Rubra), Shui Zhi (Hirudo), Meng Chong (Blatta), Shou Gong (Gekko), Wu Gong (Scolopendra), and Chuanxiong (Ligustici Chuanxiong Rhizoma); herbs for opening orifices and awakening the brain: Suhexiang Wan (Styrax Pill), Jufang Zhibao Dan (Official Formule Treasured Pellet), Zixue San (Purple Snow Powder), Shexiang (Moschus), and Shichangpu (Acori Tatarinowii Rhizoma); herbs for pacifying the Liver and extinguishing Wind: Quanxie (Scorpio), Gouteng (Uncariae Ramulus cum Uncis), Tianma (Gastrodiae Rhizoma), Jiangcan (Bombyx Batryticatus), Qinglongchi (Draco Ossis Parietalis), Lingyangjiao (Rhinocerotis Cornu), Dilong (Pheretima), Xiakucao (Prunellae Spica), and Fengfang (Vespa).
{2} Bone Metastasis:
Commonly seen after radiotherapy for lung cancer, breast cancer, and nasopharyngeal cancer. Due to congenital insufficiency and depletion of Kidney Essence, compounded by radiotherapy rays injuring Yin and consuming Essence, leaving bone marrow empty, allowing pathogenic toxins to invade internally through the deficiency, blocking inside the bones. Over time, Heat transforms, and Heat-Toxin combines, causing poor circulation of Qi and Blood, triggering bone metastasis. Clinically, pain is the main symptom, intermittently worsening, difficult to dissipate or suppurate, hard as stone, stabbing pain, fixed location, burning sensation upon pressure, and some are prone to pathological fractures. Clinically, the etiology is most closely related to the Kidney, with more Cold than Heat. The treatment method should warm Yang and tonify the Kidney, generate Marrow and fill Essence, primarily enhancing the body's Righteous Qi and Marrow generation function. It is strictly forbidden to solely use toxic-to-counteract-toxic, clearing Heat and dissipating nodules, or invigorating Blood and resolving stasis attacking methods. Formula selection: Sanggu Tang (Three Bones Decoction) combined with modified Jisheng Shenqi Wan (Kidney Qi Pill from the Benefiting Life Formulas).
{3} Lung Metastasis:
Commonly seen after radiotherapy for esophageal cancer, nasopharyngeal cancer, breast cancer, and mediastinal tumors. Due to weakened Righteous Qi after radiotherapy, pathogens invading the Lung, stagnating in the chest, causing Lung Qi congestion, loss of dispersing and descending functions, phlegm condensation and Qi stagnation, Blood stasis blocking collaterals, forming masses over time, leading to metastatic lung cancer. Symptoms often include fatigue, loss of appetite, emaciation, cough, blood-streaked sputum or hemoptysis. Severe cases present with dyspnea, localized asthma and edema, fever. Metastatic foci compressing the recurrent laryngeal nerve cause hoarseness; compressing the esophagus causes dysphagia. Compression or embolism of the superior vena cava by cancer masses or tumor emboli results in swelling of the face and upper chest wall, varicose veins, and reddish-purple skin, known as Superior Vena Cava Syndrome. Formula selection commonly uses herbs to benefit Qi, tonify the Lung, support Righteous Qi, and fight cancer: Huangqi (Astragali Radix), Fuling (Poria), Shanyao (Dioscoreae Rhizoma), Huangjing (Polygonati Rhizoma), Lingzhi (Ganoderma), and Dongchongxiacao (Cordyceps); herbs to clear the Lung, detoxify, and eliminate pus: Gan Chan Pi (Toad Skin), She Ye Cao (Hedyotis Diffusa Herba), Baijiang Cao (Patriniae Herba), Qiyeyihua (Paris Polyphylla), Long Kui (Solanum Nigrum), Zhu Ling (Polyporus), Ban Zhi Lian (Scutellariae Barbatae Herba), Bajiao Jinpan (Fatsia Japonica Leaf), Yuxingcao (Houttuyniae Herba), and Dan Qin (Scutellariae Radix) to clear Lung Heat; herbs to nourish Yin and generate fluids: Tian Maidong (Ophiopogonis Japonici Radix), Nan Sha Shen (Adenophorae Radix), Bei Sha Shen (Glehniae Radix), Chuan Shi Hu (Dendrobii Caulis), Baihe (Lilii Bulbus), and Zhi Biejia (Prepared Carapax Testudinis et Plastrum).
3. Summary
Patients with longer survival periods after radiotherapy for cancer are mostly those who persisted with TCM herbal treatment for a relatively long time. Even if they recur or metastasize, there is still a possibility of lesion disappearance and long-term good survival with the tumor.
This article was published in "China Journal of Information on Traditional Chinese Medicine," Vol. 5, No. 1, 1998.
4. Syndrome Differentiation and Treatment for Common Toxic Side Effects of Chemotherapeutic Drugs
Chemotherapy has become equally important with surgery and radiotherapy, becoming one of the main means of treating malignant tumors. However, chemotherapeutic drugs almost all have toxic side effects, mainly manifested as gastrointestinal reactions, bone marrow suppression, and damage to the heart, liver, kidneys, lungs, and nervous system. Due to the toxic side effects of chemotherapeutic drugs, a considerable number of patients are forced to中止 chemotherapy, or even lose their lives. Compensating for the damage to Righteous Qi caused by chemotherapy, leveraging the strength of TCM in supporting Righteous Qi, can effectively prevent and alleviate chemotherapeutic toxic side effects, help the course of treatment proceed smoothly, and consolidate and improve curative effects. Based on the author's exploration over 30 years and tens of thousands of cases, common toxic side effects of chemotherapeutic drugs and their preventive and treatment formulas and herbs are summarized as follows.
1. Gastrointestinal Reactions
Digestive system reactions caused by chemotherapeutic drugs mainly manifest as nausea, vomiting, decreased appetite, abdominal distension, diarrhea, and constipation. Some patients also develop mucositis or ulcers. Most chemotherapeutic drugs have obvious emetogenic properties, especially DDP (Cisplatin), DTIC (Dacarbazine), ACD (Actinomycin D), alkylating agents, and anthracycline antibiotics. The cause of occurrence is mainly attributed to the activation of 5-HT3 receptors in the gastrointestinal tract. Some chemotherapeutic drugs can directly damage intestinal mucosa, interfering with its function and causing diarrhea. Common examples include antimetabolites, such as 5-Fu (5-Fluorouracil), 5-DFUR (5-Deoxy-5-Fluorouridine), MTX (Methotrexate), ACD (Actinomycin D), HU (Hydroxyurea), and nitrosoureas, among which fluoropyrimidines most commonly cause diarrhea. TCM treatment mainly focuses on invigorating the Spleen, regulating Qi, harmonizing the Stomach, descending rebellious Qi, and stopping vomiting. Herbs used: Sijunzi Tang (Four Gentlemen Decoction) modified. To stop vomiting and descend rebellious Qi, add Jiang Banxia (Pinelliae Rhizoma Praeparatum cum Zingibere et Alumine), Daizheshi (Ochra), Xuanfuhua (Inulae Flos), Chenxiang (Aquilariae Lignum Resinatum), Gong Dingxiang (Caryophylli Flos), and Shidi (Kaki Calyx). For abdominal distension, add Wuyao (Linderae Radix), Zhi Ke (Aurantii Fructus), and Dafupi (Arecae Pericarpium). For abdominal pain, add Zhi Yuanhu (Corydalis Rhizoma Processed), Hang Baishao (Paeoniae Radix Alba), and Guang Muxiang (Aucklandiae Radix). For diarrhea, add Chao Jijin (Galli Gigerii Endothelium Corneum Praeparatus), Shanyao (Dioscoreae Rhizoma), Rou Doukou (Myristicae Semen), and Chao Hezirou (Terminalia Chebulae Fructus Praeparatus). For decreased appetite, add Jiao San Xian (Fried Three Immortals), Chuan Shi Hu (Dendrobii Caulis). For greasy coating and dampness encumbering, add Houpo (Magnoliae Officinalis Cortex) and Huo Peilan (Agastaches Herba and Eupatorii Herba). Large doses of chemotherapeutic drugs scorch Body Fluids, causing deficient Fire to flare upward, resulting in oral ulcers. Symptoms include oral erosion, dry mouth and throat, difficulty swallowing, red tongue, scant coating, and rapid pulse. Mild Yin deficiency should be treated by nourishing Yin and clearing Fire. Severe Heat Excess should be treated by clearing Heat and detoxifying. Commonly used formulas: Shashen Maidong Tang (Glehnia and Ophiopogon Decoction), Zengye Tang (Increase Fluids Decoction), Huanglian Jiedu Tang (Coptis Detoxification Decoction) modified. Additionally, employ Bobo (Macrostemonis Herba), Dan Qin (Scutellariae Radix), Zhimu (Anemarrhenae Rhizoma), and Qingdai (Indigo Naturalis). Oral ulcers can be dusted with Bingpeng San (Ice Borax Powder), Zhenzhu Fen (Pearl Powder), or Xilei San (Silk Thread Powder).
2. Bone Marrow Hematopoietic Suppression
Most anti-cancer drugs can cause varying degrees and durations of bone marrow suppression, manifested as a decrease in total white blood cell count in peripheral blood, especially granulocytes, followed by thrombocytopenia. Long-term use can lead to decreased hemoglobin. In severe cases, bone marrow regeneration is poor, potentially causing agranulocytosis and severe thrombocytopenia, prone to concurrent infections and bleeding tendencies. Common drugs include nitrosoureas (BCNU, CCNU, Me-CCNU), MMC (Mitomycin C), CAB (Cyclophosphamide, Adriamycin, Bleomycin?), Mx (Mitoxantrone?), and podophyllotoxins (VP-16, VM-26). Forced cessation or delay of chemotherapy due to bone marrow suppression is a common reason affecting efficacy. Treatment with the best efficacy involves invigorating the Spleen, tonifying the Kidney, benefiting Qi, and nourishing Blood. Herbs used: Siwu Tang (Four Substance Decoction) modified. For Spleen deficiency, use Baizhu (Atractylodis Macrocephalae Rhizoma), Fuling (Poria), Chao Bian Dou (Lablab Album Seed Praeparatus), and Hong Zao (Jujubae Fructus). For Kidney deficiency, use Yurou (Corni Fructus), Gejie (Gecko), Nvzhenzi (Ligustri Lucidi Fructus), Hanliancao (Ecliptae Herba), and Bajitian (Morindae Officinalis Radix). For severe dual deficiency of Qi and Blood and pancytopenia, use Biezhi Shen (Korean Ginseng), Zihewang (Placenta Humana), and Ejiao (Colla Corii Asini). For Qi failing to control Blood, use Zhi Huangqi (Honey-fried Astragali Radix), Shanyao (Dioscoreae Rhizoma), Xianhecao (Agrimoniae Herba), and Xin Kaihe Shen (New River Ginseng). For Blood Heat causing reckless bleeding, use Danpi Tan (Charred Moutan Cortex), Zicao (Arnebiae Radix seu Lithospermi Radix), and Dahuang Tan (Charred Rheum Palmatum Radix et Rhizoma). Specifically for epistaxis, use Baimaogen (Imperatae Rhizoma), Hei Shanzhi (Charred Gardeniae Fructus), and Zhi Dahuang (Processed Rheum Palmatum Radix et Rhizoma). For hemoptysis, use Baiji (Bletillae Rhizoma) and Ce Bai Tan (Charred Biota Top Fructus). For hematemesis, use Duyu Tan (Charred Ulmi Cortex) and Sanqi Fen (Notoginseng Powder) and Baiji Fen (Bletillae Rhizoma Powder). For melena, use Huangbai Tan (Charred Phellodendri Chinensis Cortex) and Huaimi (Robiniae Semen). For hematuria, use Puhuang Tan (Charred Pollen Typhae), Daxiao Ji (Great and Small Sedge), and Cheqiancao (Plantaginis Herba). For Blood deficiency insomnia, use Chao Zaoren (Fried Ziziphus Spinosa Seed), Guiyuanrou (Longan Arillus), and Wuweizi (Schisandrae Chinensis Fructus).
3. Cardiac Damage