Transcript Chinese herbal medicine Run Fei Decoction

Traditional Medicine-2015
Birmingham, UK
August 03 – 05, 2015
Yongling Gong
Therapeutic Value of Chinese Herbal Decotion
in Radiation Pneumonia of Oesophageal Carcinoma
-------a retrospective observational clinical case report
Yongling Gong, MD
Department of Oncology
Nanjing 1st Hospital
Nanjing Medical University
Nanjing 210006
China
China is located in the high area of oesophageal
carcinoma, but in recent years the incidence has
been increasing significantly.
Oesophageal carcinoma might be the first
leading cause of death from cancer in some
Chinese metropolis such as Linxian County,
Henan Province, where the situation is more
serious, there are currently high morbidity of
about 100/100,000, with increasing mortality of
32.22/100,000 .
Background
More patients with advanced recurrent oesophageal
carcinoma are now encountered.
Efforts to develop more effective drugs for treatment
of recurrent or metastatic oesophageal carcinoma
have been intensifying.
Background
Chinese medicine is a medical system that is capable of
treating a very wide range of conditions .
Together with acupuncture, massage, and food cures,
they form the four distinct methods of treatment in
traditional Chinese medicine (also known as TCM or
T.C.M.)
Today, TCM still plays a major part of health care in
China, and is provided in state hospitals alongside with
Western medicine.
Basic differences between Western medicine and TCM:
Western medicine
→treatment of symptoms
TCM
→ causes of those symptoms
Background
Few reports are available regarding treatment and
outcome with the combination of chemo/radio-therapy
and Chinese herbal medicine.
Here, we report on a retrospective observational clinical
case :
Therapeutic Value of Chinese Herbal Decotion
in Radiation Pneumonia of Oesophageal Carcinoma.
Background
Chinese herbs might be an additional choice with its
better benefits and tolerability in the treatment of
radiation pneumonia (RP) of oesophageal carcinoma.
Aiming at starting the ball rolling and contributing
humble effort to promote traditional Chinese medicine,
we performed the present study to observe the curative
effect of Chinese herbal Decoction of Runfei combined
with hormone and antibiotic drugs in treating RP of
oesophageal carcinoma.
Case presentation
A
A 56-year-old
56-year-old male
male underwent
underwent surgery
surgery for
for cancer
cancer of
of the
the
uper
uper easophagus
easophagus (T3N2M0)
(T3N2M0) in
in Aug.
Aug. 2014.
2014.
Case presentation
Pathology
poorly-differentiated
squemous cell arcinoma
lymphnoid metastasis(3/9)
IHC :
Diagnosis
Esophageal carcinoma (T3N2M0)
Case presentation
Postoperative chemotherapy
No
Following postsurgery adjuvantradiotherapy of three
dimensional conformal radiotherapy was administered.
51 Gy/28f.
Final date of radiotherapy
2014-11-22
Case presentation
Two months later, severe pneumonia had been found
by Chest X-ray
Diffuse patchy shadows / ground glass appearance
Case presentation
The end of 2014
•Complaint
dry cough, chest pain, dyspnea
palpitations , headedness
weakness and fatigue, etc
Dec, 2014
•Hospitalized in the oncological depatment
Case presentation
Accompanied complications
pleural effusion
hypoxyia/arrhythmia
pericardial effusion
Clinical signs and symptoms, such as cough, bronchial
asthma, back pain, vomiting , fever, tachycardia,
and leukocytosis, are relatively nonspecific.
Clinical Impression
Radiation Pneumonia (RP)
Case presentation
Treatment of hormone and antibiotic.
Hydroprednisone Injection
Fluconazole Injection
Cefminox Sodium for Injection
60mg qd ivgtt
0.1 qd ivgtt
2 bid ivgtt
(sputum smear: double infection)
Superinfection was related with the age of patients, hypoimmunity, extensiveusage of
the antibiotics and neutropenia.
In the meantime, we administered Chinese herbal
medicine(Run Fei Decoction, mixed a variety of effective
herbal components) to help him to recover from the poor
condition.
Case presentation
Objection
Get far better bebefits and tolerability.
Chinese herbal medicine
Run Fei Decoction
mixed a variety of effective herbal components
Fei Decoction 1
Fei Decoction 2
Material and methods
Decoction of Run Fei(Unit: gram ):
Get far better bebefits and tolerability
Membranous milkvetch root (50-120) Chinese angelica root 10 Red peony root 10
Peach seed 10 Safflower 10
Pangolin 10
Pollen 10
Cassia twig 6
Processed radix aconiti lateralis 5 Ligusticum wallichii 6 Codonopsis 30
Fructus aurantii 8 Salvia miltiorrhiza 10 Platycodon grandiflorum 6
Radix bupleuri 12 Rhubarb 6 (to be decocted later)
Sig: decoct medicinal herbs in 300 ml water per day, 150ml,
bid(9:00/am, 15:00 pm).
Effect:
Decoction 1
Tonifying Qi and lifting yang
Inducing diuresis for removing edema
Clearing lung and expelling pus
Decoction 2 (on the basis of Fei Decoction1 )
Increasing efficiency of purgation
Poison-discharging
Sig:
Decoct medicinal herbs in 300 ml water qd
150ml, bid(9:00/am, 15:00/pm)
After taking the Chinese herbs for 2 weeks,
• Decrease of diffuse patchy shadows and ground glass
appearance on Chest X-ray
• Diminsh of pleural and pericardial effusion
• the patient felt free from the complaint of pulmanory
and cardiac discomfort.
• Conventional lab test: normal range
• QOL→improved.
• Patient → discharged from hospital
• Further maintenance monotherapy with
Chinese herbal medicine(Run Fei Decoction)
• Follow-up
interval history
physical examination
conventional laboratory test
determination of tumor markers
chest X ray and CT.
Case presentation
Discussion
Abnormal activation and infiltration of tumour
cell are leading causes of patient death.
Therefore, clearing about the pathogenesis and
seeking effective treatments are quite
significant.
Discussion
Radiotherapy is the most basic treatment, but it is
difficult to completely remove the lesions, and easy to
induce RP after this radiation treatment.
The curative rate of RP with conventional antibiotic drug
therapy after radical radiotherapy is dismay, and a
majority of patients mostly suffer from clinical
complications.
Discussion
Evaluations to
unsatisfactory.
the
curative
effect
of
radiotherapy
are
squemous cell arcinoma is sensitive
Glandular cell arcinoma is moderately sensitive
other types are not sensitive to radiotherapy.
The impact of radionecrosis to lung function also presented
clinically.
Discussion
However, drug resistance, toxic and side effects with coventional
therapies, and it is difficult to ensure the drug perfusion within the
lesion area.
Even the horometherapy is restricted in its application in clinical
medicine due to its complexity and high side effects.
The later immunological therapy and molecular targeting
treatment once became the hotspots, but their existing limitations
often made them merely an armchair strategist and made it
difficult for them to be widely applied clinically.
Discussion
It has become an indisputable fact that the
treatment of RP is characterized by poor clinical
efficacy and adverse outcome
Here, enumerating the typical case which
decoction of Run Fei used to treat RP and then
making relevant discussions.
Consent
Written informed consent was
obtained from the patient for
presentation of this case report and
any accompanying images.
Summary
Our RP patient reported is completely cured
we chose the other way and selected a CTM
participation in clinical anti-RP treatment
Further Chinese traditional treatment
decoction /powder
We managed to have prolonged
PFS (Progression-Free-Survival)
TTP(Time-to-Progression
CTM considers human body as a dynamic platform in which all organs are
correlative and bind each other. Relationship among heart, liver, spleen,
lung and kidney is like interlinking between mother and son.
Discussion
Clincal treatment of Chinese traditional medicine
take into consideration patient's whole condition, including both body and
mental condition, rather than confines to the lesion itself
Distinguished prescriptions →individual
Effect
increase energy
heighten sense of well-being
reduce the side effect of radiation and chemotherapy
refresh marrow function
improve appetite and sleep.
Discussion
The research of Chinese traditional medicine anti-tumor
effect has made great achievements in recent years.
With the development of science, it has obtained a new
understanding of etiology ， pathogenesis ， and
treatment of the tumor for human beings, who will pay a
great deal of attention to the molecular mechanism of
the anti-tumor effect in traditional Chinese medicine.
Conclusions
It is clear that traditional Chinese medicine has a good
prospect in the treatment of RP, and it is of great value
to be applied. And the traditional Chinese medicine also
has the effect of anti tumor, and has the advantages of
multiple approaches, multiple targets, more efficacy and
less side effects
An additional choice with better benefits and
tolerability in the treatment of RP
Acknowledgements
At the College
Liling Zhu (Clinincal treatment with Chinese herbal decoction)
Congfeng Niu (Collection of patients’ materials treated with decoction)
Haijun Wan(Analysis of prescription and paper writing )
Guangmei Lv (Evaluation of treatment with decoction)
Collaborators
Xudong Xia, Chinese medicine specialist, Wuxi, Jiangsu
Qiang Wang, Prof , Dept of ICU, Tiantan Hospital , Beijing
Yuanxing Xiong, Prof, Provical Traditional Hospital ,Nanjing
Ping Li, Prof, Dept of Gastroenterology , Changhai Hospita l, Shanghai
Funding
Ministry of Health and Welfare of Nanjing Award ZKX-13013
Jiangsu Provincal Traditional Medical Foundation〔YB2015071〕
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