Huan-Huan Wen,Hui-Yuan Wu,Yan-Fei Yi,Lu Xiao,Zi-Yang Li,Xi-Ya Yuan,Yang Liu,Zi-Yan Huang

1Ganzhou Tumor Hospital, Ganzhou, China.2The Affiliated Hospital of Jiangxi University of Chinese Medicine, Nanchang 330006, China.3Jiangxi University of Chinese Medicine,Nanchang 330006,China

Abstract The treatment of malignant tumor is mainly based on modern medical treatment, after treatment, there are many adverse reactions, such as dizziness, headache, fever, numbness of limbs, pruritus, rash, spasm, phalacrosis, elevated blood pressure,anemia,myelosuppression, impaired functions of liver and kidney."Endogenous wind" is a part of Traditional Chinese medicine, and the researches are mainly focused on tumor metastasis and treatment.The researches on the adverse reactions associated with the treatment of malignant tumors are less.This paper is built on the theory of"endogenous wind" of Chinese medicine, and initially analyzes the progress of the research on adverse reactions of malignant tumors after treatment by modern medical means.

Keywords: “Endogenous wind” theory; malignant tumor; adverse reactions; research progress

"Endogenous wind "Theory

The "endogenous wind" theory of traditional Chinese medicine refers to the systematic theory of a series of physiological and pathological changes caused by the lack of righteous qi in the body, and wind evils are prepared in the body.During the development of the disease, the body’s Yang Qi moves in the opposite direction or the muscles and veins are dysfunctional, so that symptoms characterized by "shaking",such as dizziness, numbness, convulsions, tremors, etc.appear, are consistent with the good deeds of "wind evil" The clinical characteristics of the number change, and it occurs in the body, so it is called the "Endogenous wind ".It came from the "Huangdi Nei Jing",which sprouted in the Jin and Yuan Dynasties and developed and matured in the Ming and Qing Dynasties, until the modern Zhang Shanlei clearly defined the name "Endogenous Wind" [1].InSuwen?Nineteen pathology[2], there is "all wind and dizziness belong to the liver, and all the storms are strong and all belong to the liver."Therefore, the liver is the most closely related to Endogenous wind.InSuwen?Yin-Yang Yingxiang Theory[2], there are sayings that "the wind and qi pass through the liver" and "the liver is the viscera of the wind and wood".Doctors in the past believed that "endogenous wind" and"liver wind"is one body.With the development of the time, syndromes of Endogenous wind are constantly enriched, and the syndromes are not limited to shake, dizziness, convulsions, tremors and the like [3].Liu Xiaozhuang [4] considers that there is a difference between"endogenous wind" and liver wind.Modern research has further developed the "endogenous wind" theory, which is not simply related to the liver, but also to other viscera.Zhao Yonghua [5] put forward the theories of "Yang deficiency produces wind" and "Liver reversal into the wind".Sun Jiming [6] believes that "Endogenous wind " can also take place in the lungs.Professor Liu Zhaochun summed up the theoretical basis of the predecessors, and based on the clinical experience of using a large number of activating blood and removing blood stasis drugs to treat the syndrome of Endogenous wind , he put forward the hypothesis of "blood stasis generating wind" [7], and believed that the method of activating blood and removing blood stasis can be used to treat Endogenous wind [8].Jiang Xiao's [9]research focuses on "spleen deficiency and wind".Yang Meilian [10]believes that "endogenous wind"can also produce phlegm.Yu Jie[11]put forward a case analysis of "Endogenous wind disturbing the kidney".Zhang Jingyue put forward by the "non-wind" view of"deficiency in the core, phlegm and cold and heat as the standard".He thinks that the main body of deficiency can be divided into the deficiency of blood, qi, and yin.Among them, yin-deficiency is the major,and phlegm is the root.In the spleen and kidney,it is caused by a deficiency of vitality [12].

Common adverse reactions to malignant tumor treatment

Common adverse reactions of tumor immunotherapy include endocrine toxicity, gastrointestinal toxicity and skin toxicity [13].Cui Ming conducted a meta-analysis of the adverse reactions of targeted therapy of malignant tumors and found that it mainly involved nausea, vomiting and skin adverse reactions [14], for example,attained mesylate can inhibit the formation of blood vessels, and is widely used clinically in a variety of malignant tumors.It can cause adverse reactions such as high blood pressure, fatigue, proteinuria,hand-foot syndrome and hemorrhage, among which hand-foot syndrome is manifested by fingers or Obvious keratosis, erythema,swelling, herpes, and chapped skin appear on the curved part of the toe, accompanied by varying degrees of numbness and burning sensation [15].The highest incidence of chemotherapy-related symptoms in patients with malignant tumors is as follows:poor appetite, fatigue, nausea, disturbed sleep, and the most significant severity is fatigue, nausea, vomiting, disturbed sleep, distress, and poor appetite [16].Tetracycline chemotherapy causes cardiomyopathy damage [17].Due to different antibody and cytotoxicity of antibody drugs, there are various side effects such as hematological adverse reactions, infusion reactions, peripheral neuropathy,liver toxicity,pulmonary toxicity,gastrointestinal adverse reactions, and cardiologists [18].Although radiotherapy can reduce the burden caused by tumors, it also has a negative impact on food intake, digestion, absorption and metabolism [19].Percutaneous radiofrequency ablation combined with 125I radioactive seed implantation in the treatment of liver malignant tumors also has symptoms of abdominal pain, fever,nausea and vomiting, fatigue,thrombocytopenia, elevated transaminase and ascites [20].Adverse reactions not only affect the quality of life of cancer patients, but also cause the discontinuation of related treatment plans and affect the development of malignant tumor treatment.

"Endogenous wind " theory and the treatment of adverse reactions of malignant tumors

Pathogenic characteristics of Endogenous wind pathogens are similar to those of wind pathogens.They are liable to attack the yang position.A series of muscle surface skin symptoms may occur when they invade the muscle surface, such as limb numbness, convulsions,tremor, itching, hair loss, etc, which appear after anti-tumor treatments.The hand-foot syndrome, skin toxicity, neurotoxicity and endocrine toxicity are comparable.The qi of Weiyang fights against the evil of Fengyang, so that the body's yang cannot take care of it,causing anorexia, nausea, vomiting, diarrhea, etc.which are linked to the gastrointestinal toxicity and hematological toxicity of anti-tumor therapy.Patients with malignant tumors have obvious gastrointestinal reactions, and it is therefore difficult to obtain adequate nutrition.They may experience fatigue, anemia, and even develop cachexia.

Inductive"endogenous wind" theory

In summary, the theory of "endogenous wind" can be summarized as heat-extreme wind, liver-yang to transform wind, yin deficiency wind,Blood deficiency produces wind and blood dryness produces wind,yang deficiency to generate wind, liver against wind, blood stasis to generate wind, and spleen deficiency wind.

Heat-extreme wind

Liu Wansu advocated the "fire heat theory", which is the first to open heart and generate wind.The wind movement is caused by excessive evil heat and burns the liver and tendons belong to the high fever stage of fever and are more common in solid lesions.Based on the basic theories of traditional Chinese medicine, some scholars classify contemporary treatments for malignant tumors according to their attributes.They believe that chemotherapy is a"drug poison"and have the characteristics of being mixed with cold and heat [21].Depending on the adverse effects of radiotherapy on the human body, it is attributed to heat evil [22].In the same way, interventional therapy and radiofrequency ablation have hot medicinal properties [23].Targeted drugs such as definitive and agglutinin may show signs of positive fever after use.PD-1/L1 can also be ascribed to Thermal [24,25].The ablation treatment and seed implantation method can be linked to the fire needle cautery method of external treatment of traditional Chinese medicine [26].After the above-mentioned treatment of malignant tumors, heat toxin decoction to burn body fluid, damage to Yin and blood, can burn the liver and tendons, focus on the Jueyin Liver Meridian, dizziness, swelling, pain, hand and foot crumples, and can also be caused by excessive heat and wind.Bleeding in multiple parts, severe cases may have symptoms of delirium.Combining the heat image of the tongue and veins, you can use the method of clearing heat and dredging the collateral, cooling the liver and extinguishing the wind to treat related adverse reactions.Commonly used drugs such as antelope horn, Uncaria, Gastrodia,Chuanzi, Moutan cortex, chrysanthemum, and Cassia seed.

Liver-yang to transform wind

Liver-yang transforms wind into liver yin, which cannot restrict liver-yang, but hyperactivity of liver-yang counteracts it, and causes wind movement.Most of the disease are a mixture of virtual and actual.The principal clinical manifestations are numbness of the limbs, numbness of the limbs, tremor of the limbs, dizziness and headache.Emotions and overwork to cause insufficient liver-yin, and the yin of liver and kidney cannot restrict liver-yang, so that hyperactive liver-yang can dissolve wind.Among them, liver-yang disturbs clear orifice, dizziness, headache, tinnitus, etc.Commonly used drugs for suppressing the liver and suppressing yang, such as aeschynanthus bidentate, raw ocher, raw keel, raw oysters, raw tortoise shells, etc., such as the use of Tianma Gouteng Decoction for the treatment of hypertension of the liver-yang hypertension [27].

Yin-deficiency wind

Deficiency of yin and wind movement are due to body diseases,long-term consumption of yin fluid, insufficient liver-yin, dystrophy of muscles and veins, and acute fascia.Dry, red tongue and less fluid;Deficiency and internal steaming, so five upset hot, hot flashes and night sweats.Specifically, it can be observed in the middle and late stages of radiotherapy, and it is mainly caused by lung and stomach yin injuries.The radiation effect of radiotherapy is severe, and the accumulation of dose and time, the greater the degree of gas consumption and yin injury [28].The total effective rate of nourishing yin, clearing heat and detoxifying method in treating skin rashes related to epidermal growth factor receptor tyrosine kinase inhibitors(EGFR-TKIs) is 90%, far exceeding the total effective rate of 30% in the control group [29], It can be seen that the methods of nourishing yin, clearing heat, and calming the liver and extinguishing wind can also achieve good clinical effects in the prevention and treatment of anti-tumor treatment-related adverse reactions that belong to yin-deficiency and wind movement.

Blood deficiency produces wind and blood dryness produces wind

Blood deficiency and wind are due to blood deficiency.The pathogenesis of the body is insufficient blood production, excessive blood loss, long-term illness and wasting, and even blood deficiency can not nourish the skin of the limbs, numbness of the limbs, chills of the limbs, and tremor of the limbs; Blood dryness and wind can cause skin itching, discomfort and desquamation."Hair is not only blood",hair loss can be apparent, and even alopecia areata.Wang Zheng [30]take 10g each of raw and rehmannia, 10g of Angelica, 15g of Astragalus, 10g of Erdong, 10g of pollen, 10g of Polygonum multiflora, 10g of Tribulus terrestrial, 8g of Parsnip, 15g of Sophora florescence, 8g of Nepeta It relieves skin, soothes wind and relieves itching, and treats rashes caused by taking definitive, and has achieved good results.

Yang deficiency to generate wind

Yang-deficiency generating wind refers to the Endogenous wind syndrome caused by the body's weak Yang Qi [31].Suwen?Shengqitongtian Theory[2] says that “Yangqi people will nourish the mind while being soft, and nourish the muscles when soft”, combined withSuwen?Tiaojing Theory[2] "Yang receives qi from the upper Jiao and divides the flesh by warming the skin.The argument of "between" shows that the flexibility of the muscles and veins of the limbs has to be driven by Yang Qi."Getting heat will do,and get cold will condense." This is the act of movement of qi, blood and body fluid in the human body.The yang energy is not enough to promote the circulation of qi and blood, and the muscles and veins are lost in nourishment.Yang-deficiency causes the body to lose warmth,unable to control the cold and condense the veins and veins,and it can also provide the skin veins and muscles and joints move flexibly and fluently.If yang-deficiency persists, cold damp and turbid toxins accumulate in the body,which can cause itching to deploy on the skin,and the limbs will twitch when it infringes on muscles and joints.Dislocation of Yang Qi can show signs of Yin Sheng Ge Yang, sore mouth and tongue, sore throat, sore throat, and muscle tremor [32].Professor Huang Jinchang used the treatment method of removing pathogens, dredging collateral, nourishing blood and warming yang.Specifically, he used Huangqi Guizhi Wuwu Decoction to be taken orally, plus Chuanwu and Caowu external use to treat the peripheral neurotoxicity caused by paclitaxel and oxalacetate chemotherapy.Reach a miraculous effect [33].

Liver against wind

Liver reversal of wind refers to wind movement owing to stagnation of qi, stagnation of qi, blood stasis, and blockage.It can be viewed clinically that depression, mental depression, head shaking and limb tremor, chest and hypochondriac pain, anorexia, not thinking about eating, thin and greasy tongue coating, and stringy pulse [34].The liver is the viscera of the wind, which controls the drainage, the body is yin and the yang is utilized to regulate emotions and the circulation of qi, blood and body fluid throughout the body.Liver-qi stagnation occurs due to poor emotions, and the fire will go upside down for a long time, and the boss will be swollen and painful when the upper orifice is cleared; qi stagnation and cold and blood stasis hinder the circulation of qi and blood, unable to reach the whole body, and pain if blocked; qi and blood stagnation in the local area Local fever,numbness and coldness of the distal limbs.Commonly used turmeric,soothing the liver and relieving depression, such as the treatment of evolution in the treatment of rash caused by lung adenocarcinoma with the method of clearing the heart, suppressing the liver and strengthening the spleen, runs through the liver-soothing Bupleurum and the liver-suppressing Gastrodia errata, with good curative effect[35].

Blood stasis to generate wind

Wind caused by blood stasis refers to Endogenous wind syndrome caused by blood stasis in the body.The cause is blood stasis, which is both a pathological product and a pathogenic factor.Therefore,Endogenous wind caused by blood stasis is more common after other diseases.The basic pathogenesis is that blood stasis blocks the circulation of qi and blood, and the blood does not follow the normal path; and the blood does not return to the meridian, there is no blood to hide in the liver, and it cannot reach the whole body.This makes the body deficient local yin and blood, and cannot nourish the brain,meridians, muscles and muscles.Metaplasia Endogenous wind; Or blood stasis for a long time,loss of yin fluid, yin does not control yang,new blood regeneration disorder, and Endogenous wind [36].Blood stasis blocks the channels of the meridians, and when Suihai Qingqiao loses nourishment, dizziness and headache may occur, and even fainting may occur; Loss of moisturizing tendons and muscles will result in unfavorable activity and decreased sensation; blocking the meridians and qi machine will be disordered, blood circulation can be seen in blood dysfunction; blood stasis will block the body, the Qi machine will rise and fall abnormally, affect normal viscera function,and cause growth Phlegm drinking, phlegm and blood stasis are both trapped,the brain is cleared by the upper orifice, and the upper orifice is blinded, then the gods are lost, and the head and wind will come;Pan Chuanfanget al[37] took Qiteng Tongluo Recipe orally and subtracted Hongai Decoction for external use of nourishing blood,promoting blood circulation and Tongluo to treat peripheral neurotoxicity caused by oxalacetate as the treatment group.The effectiveness of the treatment of peripheral neurotoxicity in the group was 82%, much higher than 40% of the control group; The conduction velocity of median nerve and common peroneal nerve in the treatment group was higher than before treatment and higher than that in the control group.

Spleen deficiency wind

Insufficiency of the spleen and generating wind refers to the syndrome of Endogenous wind caused by weak spleen.Spleen soil suppresses the liver wood, and the soil deficiency is easily carried by the liver wood.The spleen deficiency and wood multiply form wind; spleen failure can cause turbid phlegm and cause turbid phlegm; Reverse the wind;the spleen is the foundation of the acquired, the spleen governs the transportation and transformation, the spleen deficiency cannot transport the blood to the whole body and the blood stasis becomes a wind.The spleen is the basis of acquired nature, the kidney governs the bones to produce marrow and hematopoiesis, and the blood deficiency should be mainly from the spleen and kidney.The treatment of blood deficiency and wind-generating patients cannot ignore blood supplementation.The presence of bone marrow suppression can be evaluated by blood test analysis.After chemotherapy, bone marrow suppression is expressed as white blood cell, platelet, hemoglobin decline, and anemia.The two can be made for diagnosis and treatment evaluation.Zhu Weiet al[38].Summarized the treatment of myelosuppression after radiotherapy and chemotherapy, mainly with Angelica, Astragalus, Atractylodes,Codonopsis, etc.to invigorate the spleen and kidney, and qi and blood.

Conclusion

The curative effect evaluati on of malignant tumors is not only to evaluate the tumor lesions, but also requires reference to the unfavorable reactions accompanying anti-tumor treatment.Traditional Chinese medicine has unique advantages for the adverse reactions that take place in anti-tumor treatment.Traditional Chinese medicine "Endogenous wind " theory can prevent and treat many adverse reactions in anti-tumor therapy, such as dizziness, headache(hypertension), fever, numbness of limbs, itching and discomfort,rash, hand and foot twitching, hair loss, anemia, bone marrow suppression, etc.Application prospects.