Hui-Li Shui, Zhu Yang, Feng-Xi Long, Wen-Qi Huang, Bing Yang, Zhen Zhang, Dong-Xin Tang, 2,*

Hui-Li Shui1, Zhu Yang1, Feng-Xi Long1, Wen-Qi Huang1, Bing Yang1, Zhen Zhang1, Dong-Xin Tang1, 2,*

1Guiyang College of traditional Chinese medicine, Guiyang 550002, China.2Key Laboratory of Chronic Pain Treatment by Miao Medicine, State Administration of traditional Chinese medicine, Guiyang 550002, China.

REM and TCM are both important parts of traditional medicine in China, and they have their own characteristics in the understanding and prevention of diseases. This article compares the understanding, the theoretical prevention and treatment guidance and the clinical application of the REM and TCM on the cancer pain.

Regional ethnic medicine, Traditional Chinese medicine, Tumor, Cancer pain, Similarities and differences

Regional ethnic medicine (REM) and traditional Chinese medicine (TCM) have unique experience in the treatment of cancer pain.

There are many different aspects of the treatment of cancer pain in REM and TCM.

Introduction

According to the latest statistics of the National Cancer Center, the number of new cancer cases in China is nearly 3.804 million [1]. The incidence of pain is the highest, and the incidence of cancer pain is nearly 25%, the incidence of pain in advanced cancer patients is about 60% to 80% [2]. The “three-step drug analgesic therapy” advocated by WHO is the main way to intervene in cancer pain, but it has not been able to ideally control the pain of all cancer patients. Its side effects such as nausea, vomiting, constipation, respiratory depression, and poor tolerance bring great pain to patients and their families. Limited choices have reduced the quality of life of patients to some extent, especially for the end-stage care stage of patients with advanced cancer. Therefore, how to prevent cancer pain safely and effectively has always been a difficult problem to be solved in the field of cancer treatment. In recent years, traditional Chinese medicine (TCM) has guided its diagnosis and treatment of cancer pain with its unique theoretical system. Because of its multi-target, individualized and comprehensive intervention, it has gradually achieved good clinical results. At the same time, it has the advantages of low drug resistance, no addiction, and sustainability. It can reduce the use of opioids and reduce the adverse reactions caused by opioids. Regional ethnic medicine （REM） and TCM are important components of traditional medicine in China. Although they are independent medical theoretical systems, they have many similarities in history. Therefore, this article is based on REM and TCM. The understanding of pain, the guidance of theoretical prevention and treatment, and the clinical application level are compared, and the similarities and differences are discussed to enrich and develop our national medicine.

Comparison of REM and Chinese medicine on cancer pain

Due to the limitations of historical conditions, ethnic medicine and Chinese medicine have no clear name for cancer pain. Miao believes that cancer pain is a category of "Meng disease" [3], and is closely related to "Gonggui disease" [4]. The "Gonggui disease” is caused by the "four major poisons", and the body is weak and cannot work effectively. After a certain stage, the body gradually loses weight, and the affected part and the adjacent parts and even the whole body produces severe pain, and finally, tumor formatted [5]. Therefore, the Miao doctor is mainly responsible for the treatment of "poison". Tujia doctor believes that qi and blood disorders are the basis of tumor production. “Bada” venom is the main cause of tumor formation. “Bada” venom can cause normal tissues to grow bad meat. As the dying meat grows, the body becomes thinner. “Bada” poisonously invades the stomach, liver, uterus and other organs. If it is found in the stomach, it is called "bee disease [6]". It is found in the uterus and is called "nursing infantile stone sputum [7]". "Bada poison" is the key to pain. Therefore, Tujia doctors still take the treatment of "poison" as the core, supplemented by seven methods and eight interventions. Zhuang doctor believes that the tumor belongs to the category of "Baez", and that "Baez" is caused by physical weakness, poisonous evil invading. Therefore, the treatment of Zhuang medicine is based on “detoxification”, “tonic” and “regulation of qi” [8].

TCM classifies cancer pain into the category of "pain syndrome". TCM believes that the incidence of tumors is related to factors such as congenital endowment, six ecstasy, eating disorders, seven emotions, and qi deficiency. The pathogenesis of tumor pain is mainly divided into two kinds, the deficiency of qi and blood, which is caused by the deficiency of yin and yang, and the pain caused by poisonous evil, cold coagulation, blood stasis, dampness, and qi stagnation. In addition, from the perspective of the "toxic" theory of TCM, the lack of “zheng qi” (ability to fight disease) is the basis of the onset of cancer pain, and the long-term stagnation of cancer and pathological products is a necessary condition for the onset of cancer pain. Therefore, in the treatment, TCM is mainly based on "insufficient replenishment, weakening excess". In general, "insufficient replenishment" Supplementing the deficiency of blood and internal organs; "weakening excess" is mainly detoxification, promoting blood circulation, phlegm, dampness, and qi. At the time of clinical trial, according to the stage of the tumor, the painfulness, urgency, and location of the pain are treated according to syndrome differentiation [5, 9].

Comparison of REM theory and TCM theory to prevent cancer pain

Dialectical treatment intervention for cancer pain

Although there is no uniform standard for the dialectical classification of cancer pain by REM and TCM, they have their own classifications under the guidance of their unique theories. The treatment methods mainly include internal treatment, external treatment and emotion (Psychological) treatment of three categories.

Miao doctor divides the disease into the category of “cold and hot”. The cold pain is treated with heat, and the heat pain is treated with cold. In the early stage of the tumor, the treatment is mainly based on high-efficiency medicine to eliminate the viciousness to the utmost extent. In the middle and late stage of the tumor, the qi is often imaginary, and the cultivation of qi is the main treatment. The treatment methods are mainly oral administration of Miao medicine, external treatment of Miao medicine, which can be used alone or in combination [5]. According to the theory of “surplus and wane”, Yao doctor divides the tumor into four types: 1) the surplus and the wane have a quiet strength; 2) the surplus is not strong, but the wane is weak; 3) surplus is strong but the wane is not weak; 4) surplus is strong but the wane is weak. Cancer pain is a difficult disease to treat in Yao medicine. A single treatment method is difficult to work. It is often necessary to use internal treatment and external treatment [10]. Zhuang medical treatment of cancer pain is based on the stage of cancer development, the nature of the pain, the location and the “three-gas” (immunity) condition [11].

Chinese medicine treatment of cancer pain advocates discrimination and treatment. Cheng Hao[9] divided the cancer pain into five types, (1) poor air-conditioning, liver qi stagnation; (2) Blood stasis, choroidal obstruction (3) Evil condensation, wet turbidity; (4) Hot poisonous sputum and internal organs injury; (5) Insufficient qi and blood, shape and dystrophic. Che Yong[12] found that TCM syndromes of cancer pain are mainly divided into six categories: spleen and kidney deficiency, qi and blood deficiency, lung qi deficiency, yin deficiency internal heat, blood stasis internal resistance, and liver qi stagnation. Although the TCM practitioners have subtle differences in the syndrome differentiation of cancer pain, they are consistent with the TCM theory that "no nourishment of blood or poor passage can cause pain". Its treatment methods mainly include oral administration of TCM, external treatment of TCM, emotional therapy,. The techniques and dosage forms are also quite rich.

The concept of prevents cancer pain

Prevention of pathogenic factors

The REM and Chinese medicine are mainly preventing the occurrence of tumors by regulating the diet, drugs, and emotions of susceptible people.

The key to preventing cancer pain is to prevent tumor generation. The theory of Tibetan medical treatment (Naimai Caisang) believes that the prevention of tumor formation should start from the emotional, the physical and mental principles, and identify individualized prevention of diet, seasonality, evil spirits, and daily life by identifying physical classification [13]. The "Ya Jie" doctrine of the Dai doctors believes that before the tumor is generated, avoiding the contact of external poisons, the formation of internal poisoning, keeping the three plates open, and the dynamic balance of the whole body can effectively prevent the tumor [14]. The Uyghur Medicine "Mizazha Theory" and "Hai Li Tuo Theory" believe that the prevention of tumor should proceed from the aspects of body fluid regulation, physical fitness identification, and clearing the source of solidification, and early intervention of sub-healthy people from diet, emotion, and daily life [15].The theory of prevention in TCM is originally derived from the "" (ancient book of TCM, the Warring Kingdoms Period 475-221 B.C.E.). Chinese medicine believes that any disease has related pathogenic factors, such as breast cancer is related to emotional, lung cancer is associated with smoking. Therefore, prevention against the cause of the disease is crucial. TCM prevention therapy is also rich, such as through diet, psychology, drugs, acupuncture, massage, Qigong and other methods to prevent disease [16].

Prevent disease progression

For patients with existing tumor pain, intervention should be avoided as early as possible to prevent tumor metastasis and increase the extent of pain. Yao Medicine's "Time Medicine" believes that the prevention and treatment of lung cancer can be treated at the noon of the Dragon Boat Festival (at the time of the fire), which is intended to be blazing, to prevent the carcinogenic internal environment and improve the function of the organs [10]. The theory of "Yu Jie" of Dai doctors believes that once the tumor has formed, and the detoxification food and antidote can be taken first to eliminate the body toxin to prevent further changes [14]. According to Mongolian doctors, bloodletting therapy can treat "blood-heat" tumors [17].TCM believes that if the basis of the disease is removed before the tumor metastasis, the transfer pathway can be stopped to prevent the metastasis of the tumor" Plain questions " (Tang Dynasty, 762 C.E.), and thus reducing the range of pain in patients [14].

Prevent disease recurrence

From the perspective of modern medicine, REM and TCM are mainly to strengthen the body's immunity and eliminate residual cancer cells.

Most of the cancer pain intervention failures are due to tumor recurrence. Tujia doctor believes that when the tumor is healed, the pain disappears. However, at this time, the body suffered severe damage, the immunity was low, and the tumor may recur at any time. Therefore, the treatment is mainly to improve the body's immunity and enhance the patient's physical condition [18]. Miao doctor believes that although the tumor is actively treated, the body's viciousness has not been removed, it will recur in case of inducement. In order to prevent tumor recurrence, it is still necessary to take the drug for a long time after the symptom is relieved [19]. Zhuang doctor believes that the treatment of tumors should be continued although the clinical symptoms disappeared [20].

TCM believes that "post-surgery prevention" is a process of enhancing the patient's body constitution. It can proceed from the following aspects: (1) Regulating spirit; (2) Adjust diet; (3) moderate exercise; (4) anti-tumor and pain relief. TCM treatment aims to allow tumor patients to survive with a tumor for a long time [16].

Comparison of clinical application between REM and TCM in treating cancer pain

Clinical research

From the perspective of modern literature research, the clinical research of REM mainly focuses on the external treatment method, and the internal treatment method is relatively few. For example, Qi Gang[21] used Mongolian medicine compound to treat 50 cases of cancer pain, the total effective rate was as high as 94.0%, and the analgesic time lasted for 24 hours, which was significantly better than the control group, and had no obvious side effects. Li Hongliang[22] randomly divided 84 patients with cancer pain into the indomethacin group and the Lamiophlomis rotata Kudo group. The results showed that there was no significant difference in the analgesic effect, but the Lamiophlomis rotata Kudo could be used as an alternative to first-line therapy. Mo Yanfang[23] used Yao medicine pain relief external application combined with Leihuo moxibustion to treat 40 cases of cancer pain, and the results showed that the total effective rate of the treatment group was 92.5%, which is significantly higher than the control group of 70.0%.

There are many studies on the treatment of pain in TCM. For example, Zhou Lei[24] used Yishen Gukang decoction combined with hyperthermia to assist western medicine in the treatment of 90 cases of bone metastasis cancer pain, the results showed that the total effective rate of the treatment group was 77.8%, which is significantly higher than the control group of 53.3% (< 0.05). The physical status and quality of life scores of the treatment group were better than those of the control group (< 0.05). Li Qi[25] combination of TCM with the three-step analgesic treatment for 42 cases of severe cancer pain, and their study demonstrate that the NRS score of the treatment group was lower than the control group, and the quality of life improvement was better than the control group. Besides, TCM also attaches importance to emotional therapy, such as music therapy can significantly reduce the pain of patients with cancer pain [26].

The national medicine and Chinese medicine have a good curative effect on the treatment of cancer pain, and three-step analgesic therapy is effectively supplemented.

Empirical formula

REM and TCM treatment of cancer pain mostly use "simplified, convenient, effective, and inexpensive" treatment measures.

REM treatment of cancer pain is more simple and convenient, such as Mongolian medicine treatment of cancer pain [27]:50g, liquor 500ml, initially 10 times/day outside the pain area, which is used for the treatment of advanced cancer pain. Jing nationality doctor [27] treatment of cancer pain:(Qiyelian) 100g,(Youziguopi) 50g,(Huangguaguoye) 100g,(ganguopi) 30g. After decocting these medicines, apply them to the affected area. This decoction has a certain effect on lung cancer, liver cancer, breast cancer, and other pain relief.Wa doctor [27] treatment of cancer pain: acid vinegar and bear bile powder are applied to the affected area, and this method can relieve nasopharyngeal cancer, rectal cancer pain.

The history of TCM has a long history, and relevant experience has been promoted and applied in the private sector. For example, the application of TCM treatment technology in rural clinical cancer prevention and treatment found that the external application of self-made pain block cream has an obvious curative effect on moderate and severe cancer pain. It can effectively reduce the use of opioids and decrease adverse reactions and is more suitable for rural cancer patients [28]. According to data mining, the top three treating methods for the treatment of cancer pain in Chinese medicine are borneol, frankincense (Ruxiang), and myrrh (Moyao), mainly for promoting blood circulation, removing phlegm, and the medicinal properties are mostly warm and pungent [29].

Discussion

REM and TCM are an indispensable part of comprehensive prevention and treatment of cancer pain in the future. Although they have learned from each other and infiltrated in history, they have many similarities, but they have their own unique features. In general, the prevention and treatment of cancer pain by ethnic medicine has a distinct regional, national and traditional nature, and is a pure land for one of the "local cultures" in China. TCM has systemic and complete control of cancer pain, and it is worthy of mainstream medicine in TCM. In the understanding of cancer pain, REM has limitations due to differences in cultural background and regional environment, but the understanding is also different. Due to the spread and application of TCM, the number of documents related to cancer pain is far more than that of national medicine. In theory, theoretical research on REM is relatively simple. On the contrary, it is relatively unified in clinical syndrome differentiation and treatment and is beneficial to the standardization in the future. However, because of the phenomenon of contending for TCM, the phenomenon of syndrome differentiation has been seen, but it is difficult to unify and standardize. In terms of treating diseases, both REM and TCM have embodied prevention is more important than treatment, which coincides with Western Medicine's three-level prevention theory. In terms of clinical application, empirical formula and techniques are rich and unique, but there are few clinical studies, mainly due to factors such as the passage of modern times and insufficient inheritance. The research and teaching started relatively late and the development process is slow. Furthermore, the clinical and basic research of TCM is relatively more than the REM, but TCM still lacks multi-center, large sample randomized controlled study and scientific efficacy evaluation criteria.

Finally, the author believes that although REM and TCM have the irreplaceable advantages of modern western medicine, the status of analgesic effect of REM and TCM is still not enough, and it is still in the auxiliary position in the prevention and treatment of moderate to severe cancer pain. I hope that in the future theoretical research, we should unify the classification of cancer and syndrome differentiation between ethnic medicine and TCM, establish objective, systematic and standardized evaluation criteria, strictly abide by the principles of evidence-based medicine, and carry out multi-center, large-scale, randomized clinical trials to clarify their efficacy and improve their credibility. With the rapid development of modern medicine and advanced instruments, REM and TCM should advance with the times on the basis of complementary advantages, actively absorb the essence of modern western medicine, and make full use of modern technology to carry out theoretical and experimental research on cancer pain.

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27 September 2018,

19 October 2018,

January 2019.

Construction Project of the Key Laboratory of the State Administration of TCM: “Key Laboratory of Miao Medicine Miao Medicine for Chronic Pain” (Guozhong Medicine Letter [2009] No. 95); National Administration of TCM Project: Research on Technical Standards for Diagnosis and Treatment of Miao Medicine (QZY-FJS-2017-53); National Administration of TCM Project: Classification and Code of Minority Diseases and Formulation of Clinical Diagnosis and Treatment Terminology (GZY-FJS-2018-229); State Administration of TCM Project Public Health Special Central Subsidy Fund Project: Construction of Miao Medicine Standardization Base (Qiancaishe [2016] No. 117).

Authors declare that they have no competing interests.

?2019 TMR Publishing Group Limited. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License.

TCM and REM are important cancer-assisted treatments in China. Especially for the treatment of cancer pain, TCM and REM are important alternatives.

Dong-Xin Tang, Guiyang College of Traditional Chinese Medicine, Huaxi District University City, Guiyang, Guizhou 550002, China. E-mail: tangdongxin@sina.com.