Yue Lian1 ZeMin Wang1 Rui Xiong2 Cong Fu2 WenLi Zhou2
Abstract: TAccording to the 2018 International Agency for Research on Cancer (IARC) survey data, the incidence rate of breast cancer in the global female cancer is 24.2%, ranking first among female cancers. In recent years, the incidence rate of breast cancer has been gradually increasing, with a rate of 3% ~ 4% per year, and the incidence of breast cancer in first-tier cities located in the eastern seaboard is particularly obvious. In terms of the age of incidence, it tends to be younger and younger, with most of the cases rising gradually from the age of 20 and reaching a high value at the age of 40~50. At present, the treatment of breast cancer is mainly based on surgery, radiotherapy, chemotherapy and targeted therapy, but the toxic side effects of radiotherapy and chemotherapy after surgery are huge and the aesthetic problems bother the patients, and the cost of treatment is high, so to a part of the patients refused to radiotherapy, chemotherapy and other western medical treatment means. Chinese medicine has a long history and rich experience in treating breast cancer, and the price is low and easy to be accepted by common people.
Keywords: breast cancer; pure Chinese medicine treatment; breast rock; Xianfang Livestrong Drink
Chinese medicine refers to breast cancer as “breast stone”. Song-Chen Ziming “Complete Prescriptions for Women” says: “Initially it is like a small binding kernel, or like a soft shell turtle, or a small stone token, and is not red or painful. Accumulating over time it gradually enlarges, and the rock breaks open like a ripe pomegranate, or there may be internal ulceration forming a deep hole. This presentation pertains to depression of the liver and spleen depression, and anger, and detriment and taxation of the qi and blood. It is called breast stone. The principle treatment is to soothe the liver and relieve depression, dissolve phlegm and disperse binding.” In the modern day the principal treatments for breast cancer include surgery, radiotherapy, chemotherapy and targeted therapy, while traditional Chinese medicine (TCM) is an adjuvant treatment［1］. Due to the high cost of traditional treatment, some patients choose TCM ［2］. According to Professor Wang Zemin, the treatment of breast cancer should focus on prevention, focusing on correcting negative lifestyle, and dietary habits, insist on physical exercise, and maintaining a good mental disposition. Diseases such as breast hyperplasia should be actively treated if they occur, and TCM herbal treatment should be used throughout treatment if breast cancer is found. As modern people work under great pressure and have a lot of social obligations, they are prone to Qi stagnation, blood stasis and phlegm congelation, which leads to the occurrence of mammary gland diseases. Wu Qian in the Qing Dynasty said in his book “Golden Mirror of Medicine”: “People with depletion and deficiency of spleen and kidney are prone to suffer from symptoms of agglomerations and accumulations”. Kidney is the foundation of the innate nature and spleen is the foundation of the acquired nature, and deficiency of spleen and kidney is deficiency of positive qi, and deficiency of positive qi is prone to suffer from masses. Therefore, for the treatment of breast cancer, it is mainly to adopt the treatment methods of dredging the liver and regulating qi, softening hardness and dispersing the accumulations, strengthening the spleen and benefiting the kidney and other treatments. For some of the breast cancer patients who choose purely traditional Chinese medicine for treatment, significant curative effects have been achieved through the pattern discrimination and treatment with traditional Chinese medicine. For patients treated with pure Chinese medicine, Prof Wang Zemin also requires patients to do appropriate exercise, and in the process of taking Chinese medicine, cooperate with the exercise of traditional movement practices such as the Eight Brocades, Taiji, etc. Treatment based on the concept of “three parts treatment, seven parts nourishment”, implying his emphasis on supportive lifestyle measures in the healing process, has a good prognosis in the clinic. Chinese medicine treatment of breast cancer can avoid the toxic side effects of radiotherapy, improve the quality of life, reduce the treatment cost and prolong the survival period.
Treatment principles
1） Soothe the liver and regulate qi, strengthen the spleen and benefit the kidneys.
“All diseases are caused by qi”, and qi stagnation, blood stasis, and phlegm coagulation are the main patho-mechanisms of breast cancer. The Nei Jing says, “Anger moves upward, sadness moves downward, shock is chaotic, thought is binding of the qi”, and “uncontrolled joy/excitement and anger injure the organs”, which indicates that rebellious qi can affect the ascent and descent of qi in the internal organ system, and can lead to fullness, distention, and pain in the breast. By dredging the liver and regulating qi, activating blood circulation, and removing blood stasis, one can restore the liver’s functional nature, and achieve the efficacy of supporting the right qi to expel evils.
2） Open the chest to remove phlegm, eliminate swelling and dissipate lumps.
“All diseases are caused by phlegm’”: Phlegm is an important pathogenic factor in Chinese medicine, and many diseases are related to phlegm, with breast cancer being no exception. Phlegm is a Yin evil, so it should be warmed from the middle and dispelled, the chest should be opened, and the knots dispersed, so that the phlegm can be discharged out of the body or dispersed in the body to make it disappear such that the disease can be cured. The combination of Er Chen Tang and Ruan Jian Tang (Soften Hardness Formula) can be used to add and subtract, Rian Juan Tang consists of Chai Hu, Bai Shao, Xiang Fu, Zhi Shi, Fu Ling, Ban Xia, Calcined Corrugated Ziziphi, Hai Fu Shi, Jie Geng, Chen Pi, and Zhi Gan Cao. Ruan Jian Tang is a clinical formula created by Professor Sun Yimin which is effective in softening and dispersing masses in nodular diseases. Er Chen Tang is an effective formula for phlegm-fluids diseases. Ruan Jian Tang can eliminate nodules, reaching the disease foci and get the therapeutic effect, together with Er Chen Tang, it can open the chest and remove phlegm.
3） When there are ulcerations and discharges from breast cancer the treatment should be focused on clearing heat and eliminating toxins, subduing swelling and dispersing knots. Traditional Chinese medicine believes that discharge from ulcerations is mostly caused by stasis and fire, and one can use clearing heat and detoxification, eliminating swelling and dissipating knots, together with Gu Bu Tang (顧步湯) to generate flesh in the area and close the mouth of the ulceration. This formula is from the book “Notes on Effective Formulas for Women”, which is “highly efficacious medicine for sores and ulcers, and first among formulas for external medicine applications”. It is suitable for all kinds of sores, ulcers, and expressions of toxic heat, where there is a clear Yang pattern and a robust patient. This formula’s main attributes are clearing heat and eliminating toxins, activating blood circulation and removing blood stasis, and clearing the channels and breaking up masses, with the supporting actions of opening the surface, moving qi, and removing phlegm and dispersing knots, and its combination of Medicinals comprehensively embodies the methods used for internal treatment of sores and ulcers in the yang syndromes in external medicine. Gu Bu Tang is from Volume XIII of the “Record of Discriminatory Evidence.” It has the effect of tonifying qi and blood and draining poison. It is mainly used for treating gangrene of the feet. When there is a great loss of qi and blood, qi and blood fail to travel through the meridians and channels, and the fire poison, and evils cause gangrene of the feet; and swelling and toxicity. Traditionally it is said that Gu Bu Tang treats gangrene of the feet, with one dose the black color is dispersed, the pain stops with two doses, and it is cured with three doses.
Case Study
Overview of The Case
Patient Zhu was a 48-year-old female from Hunan, first seen on January 7th, 2021. In August 2020, a nodule was found in the right breast, and the nodule disappeared after taking Lactobacillus and Dispersing Tablet（RU BI XIAO and SAN JIE PIAN）. Later, she became aware of a pulling sinking sensation within her right breast, and it the breast began to harden and bleed, then in January 2021, it ulcerated and bled and pus appeared.
Later on 4 January 2021, she went to Hunan Xiangya Hospital for consultation and examination. A CT scan of the chest and abdomen showed: 1）Right breast cancer with bilateral axillary, mediastinal, hilar, hepatogastric hiatus and retroperitoneal lymph node metastasis, bilateral lung, and intrahepatic metastasis, and metastasis to the left pubic bone and multiple thoracic and lumbar vertebral bones. 2） Small amount of pleural effusion in the right chest cavity. Ultrasound report: 1) multiple irregular non-homogeneous masses in the right breast, the largest one located in the right breast at 3, 4, and 5 o’clock in the nipple area, with unclear margins, lobulated, roughly 42×29×38mm. 2) Bilaterally in the axillary region several hypoechoic nodules were observed, the largest one on the right side the size of about 17.2×12.6mm, and the left side of the largest one the size of about 15.3×13.4mm.3) Multiple hypoechoic nodules were seen in the right supraclavicular region, with the largest one on the right measuring 22.5×14.3mm and the largest one on the left measuring 6.4×3.8mm.〖JP〗
MRI of the hepatobiliary tract showed: 1) Multiple metastases in the liver and multiple lymph node enlargements in the hilar region and retroperitoneum.2) Multiple masses in both breasts and multiple nodal foci in both lungs and spine as seen on the scan were consistent with breast cancer with extensive metastases.
Pathological examination report: 1) Special findings: E-Cad+P120membrane+CK5/6-EGFR-CK+GA
TA-3+SOX-10-GCDFP-15 region+P53 missense mutation ER-CerbB(3)AR (about 90% strong) Ki-67 about 30% PR (repeated about 50% weak.) 2. (Medium) 2. Pathological diagnosis: (right breast mass puncture material) tendency invasive carcinoma, need immunohistochemistry co-diagnosis; Supplementary immunohistochemistry report: (right breast mass puncture material) invasive ductal carcinoma grade II.
Therefore, the final diagnosis was a huge mass in the right breast consistent with breast cancer with involvement of the skin and muscular layer of the chest wall, accompanied by multiple metastases.
Treatment history
Because the patient did not want to do surgery or chemotherapy (her attending doctor’s persuasion is ineffective and the patient signed off), she sought Professor Wang Zemin of Beijing Sihui Hospital of Traditional Chinese Medicine for conservative treatment with Chinese medicine.
The first visit was on 7 January 2021. His findings were: palpation: a firm mass in the lower right breast, accompanied by piercing pain and bleeding, pulling pain in the right axillary lymph node, distension and pain on the right side of the back, bowel and urine regular, decent appetite, sleep poor, menstruation is regular, the edges and tip of the tongue are red, with a thin white coat, the underside of the tongue shows evidence of blood stasis, the pulse is stringlike and rapid, the face is yellowish. The effect is typically impatient, there is a tendency to get angry, and she is overworked. According to the tongue, coating, pulse, and the patient’s daily life habits, the Chinese medicine diagnosis is phlegm congealing, stagnation of qi, and blood stasis causing breast rock.
Treatment: clear heat and eliminate toxins, eliminate swelling and dispersing knots, stop bleeding, and relieve pain.
Proposed prescription: Xian Fang Huo Ming Yin combined with Gu Bu Tang with alterations.
Prescription: Chen Pi 10g, Jin Yin Hua 90g, (Cu) Ru Xiang 10g, (Cu) Mo Yao 10g, Chuan Bei Mu 30g, Tian Hua Fen 30g, Tai Zi Shen 10g, (Fu Chao) Bai Zhu 10g, Fu Ling 30g, Xia Ku Cao 15g, Chai Hu 12g, (Jiao) Shen Qu 10g, (Jiao) Shan Zha 10g, (Jiao) Mai Ya 10g, Bai Hua She She Cao 30g, Ban Zhi Lian 15g, Ling Zhi 6g, Hong Dou Shan pi 6g, Pu Gong Ying 30g, Gua Lou 30g
Decoction with water makes one dose which should be divided and taken twice in the morning and evening.
March 4, second diagnosis: the above symptoms were clearly reduced, the ulceration was closed, and the pain decreased. Observations: The tongue was light red, with less fluid, the coating was white, the bottom of the tongue reflected blood stasis, the pulse was as before, the color of the face is slightly dark, the sleep is poor, and the bowel movement was regular. The original formula was modified increasing Jin Yin Hua to 90g.
At the April 29 appointment, the patient had been to Hunan Xiangya Hospital on April 13 (after taking more than 30 doses of medication) for a follow-up examination, a whole chest CT scan which was compared with the 2021-1-19 imaging. ①The result was that the multiple soft tissue mass shadows that had been seen in both breasts were significantly reduced compared, shrinking by as much as 21mm; the nipple invagination, right supraclavicular node was shrunken by 11mm; both axillae, the largest on the right side was shrunken by nearly 11mm, and the largest on the left side was The bilateral midclavicular nodes were reduced by about 15mm; the mediastinum and both pulmonary hilums and the multiple enlarged retroperitoneal lymph node shadows shown were reduced to different degrees compared with the previous ones by about 10mm; the right peritoneal thickening was reduced compared with the previous ones, and no obvious enlarged lymph nodes were seen at present. The high-density nodules in both lungs were significantly smaller and reduced compared with the previous ones.②The pleural effusion on the right side was significantly reduced.③The multiple low-density nodular shadows seen in the liver were significantly reduced compared with the previous ones.
Hepatobiliary tract MRI showed 1) Multiple intrahepatic metastases were significantly smaller and reduced compared with before; multiple lymph node metastases in the hepatoportal area and retro-abdominal area were significantly smaller and disappeared compared with before.2) Multiple breast masses in both breasts as detected by the scan were significantly reduced compared with before; multiple lung metastases in both lungs were significantly reduced compared with before; multiple thoracolumbar spinal bone metastases in multiple thoracic and lumbar vertebrae were significantly reduced compared with before; and oedema of the right chest wall was relieved compared with before.
Chest ultrasound: 1) Multiple solid masses in the right breast, significantly smaller than before.2) Multiple slightly larger lymph nodes in the axillary region bilaterally and in the supraclavicular region bilaterally, significantly smaller than before.
August 12, follow-up: the patient reported that she went to the hospital for review on July 28, and the right breast lump was once again reduced by 10mm, with no obvious changes in the lungs and other nodules. The right breast ulcer was completely healed, pain in the lumbar area at night, bowel movements were fine, and sleep was fine, a white tongue with red tip and edges and stasis in the network vessels at the root of the tongue. Continue to follow the prescription, adding 30g of Mu Li in the formula to soften and disperse the nodules.
Conclusion
This case is an example of long-term phlegm congealing, stagnation of Qi and blood stasis, with stasis and fire, stasis blocking ying-blood, and heat corrupting the flesh leading to ulceration. Since the tongue was red with thin white coating on the edge of the tip, and the pulse string-like, the pattern was identified as heat and toxicity within. The treatment is to clear away heat and toxicity, dissipate nodules and swelling, and activate blood circulation to relieve pain. Therefore, we used Xian Fang Huo Ming Yin and Gu Bu Tang to clear heat and toxicity and eliminate swelling and nodules. Jin Yin Hua is sweet and cold and enters the heart, clearing heat and eliminating toxicity, eliminating swelling, and dispersing knots. Huang Qi assists in wound healing. Ru Xiang and Mo Yao reduce swelling and relieve pain. The patient in this case has been treated for only 8 months, and her symptoms have basically disappeared without obvious discomfort, and she is still in the process of consolidation treatment. The use of Chinese medicine in the treatment of breast cancer has broad applicability, and efforts should be made to explore the great treasures of the motherland’s medicine and to use the ancient for the present to benefit more patients.
參考文獻
References
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Author information:
Wang Zemin, Chief Physician of Oncology Department, Wangjing Hospital, China Academy of Traditional Chinese Medicine, Professor and Master’s tutor of Beijing University of Traditional Chinese Medicine, and Vice President of Difficult Diseases Branch of Chinese Society of Ethnomedicine.
Lian Yue, Professional Master of Wangjing Hospital, China Academy of Traditional Chinese Medicine, China.
2.Rui Xiong， Cong Fu, WenLi Zhou,Beijing Sihui Hospital of Traditional Chinese Medicine.
