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05 October 2016, Volume 1 Issue 4 Previous Issue    Next Issue
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Review
Challenges and opportunities of applying P4 medicine and traditional Chinese medicine for cancer treatment and prevention in the 21st century: A medical oncologist’s perspectives
Edward H. Lin
1Traditional Medicine Research. 2016, 1 (4): 168-176.   https://doi.org/10.12032/TMR201604023
Abstract ( 662 )   HTML ( 15 )     PDF (626KB) ( 294 )  

Being one of the deadliest diseases, cancer needs a stronger dose of P4 medicine (Predictive, Preventive, Personalized and Participatory) first proposed by Dr. Hood and TCM intervention, as cancer treatment still largely relies on the decade-old cytotoxic chemotherapy, radiation and surgery. This overview uses colorectal cancer model to discuss pitfalls in current cancer prevention and treatment strategies, which saw many randomized phase III studies failing to meet the study primary endpoints or marginally meeting the study objectives. Complete sequencing of whole human genome provided much of the hopes as well as hypes for precision medicine, as genomic diversity, ever changing tumor mutation landscape, SNP and complex microRNA regulation from the intron region and epigenetics make genotype to phenotype correlation study increasingly challenging. As a participant of One hundred Persons Pioneers Project, I witnessed first hand how a comprehensive scientific wellness study that integrates whole genomics, microbiome, and metabolome nutrition along with comprehensive laboratory examinations can be used to diagnose pre-illness in all “healthy” participants. Pre-illness can be best intervened by none pharmaceutical means and traditional Chinese Medicine (TCM) adept in restoring internal healing mechanisms, opening up the blocked network and balancing the five-elements homeostasis. Following TCM principles, we were able to design a therapy that effectively targets colon cancer stem cells and its microenvironment leading to more doubling of overall survival with reduction in overall toxicities. Pre-illness diagnosis, cancer immunotherapy, TCM medicine is about restoring internal healing power by letting go brakes on “good” immune systems to go after the “bad” cancer cells. Time is ripe to integrate our knowledge in genomics immune systems, stem cell biology, nutrition, inflammation, metabolism, systems medicine, and modern TCM to deliver a level of care that most of major illness including cancer are now minor pre-illness and are delayed, prevented, or cured at their earliest stages along with elevation in healthy index in the individual, their families and society as a whole globally.
Keywords: P4 Medicine, Traditional Chinese medicine, Cancer treatment, Cancer prevention

Orginal Article
A new idea of electro-acupuncture treatment for peripheral facial paralysis and the nerve-endocrine hypothesis
Wu Chao-Yong, Wu Guang-Fu, Wang Xin-Yu
Traditional Medicine Research. 2016, 1 (4): 177-182.   https://doi.org/10.12032/TMR201604024
Abstract ( 500 )   HTML ( 8 )     PDF (280KB) ( 240 )  

Highlights:

According to the distribution of facial nerve and its dominant muscles, 10 acupoints were selected. Prefrontal area: Acupoint 1, move inward 0.5cm horizontally from Yangbai (GB 14). Acupoint 2, the medial point on the line linking Xuanlu (GB 5) and Sizhukong (TE 23). Cheek area: Acupoint 3, the same position as Shangyingxiang (EX 5). Acupoint 4, move outward 0.5cm horizontally from Yingxiang (LI 20). (Level with Yingxiang (LI 20) and move outward 0.5cm.)(0.5cm lateral to Yingxiang (LI 20)). Acupoint 5, move outward 2mm horizontally from Dicang (ST 4). Acupoint 6, move outward 0.5cm horizontally from Quanliao (SI 8). Acupoint 7, move outward 0.5cm horizontally from Juliao (ST 3). Acupoint 8, the medial point on the line linking acupoint 4 and acupoint 5. Mandibular area: acupoint 9 and acupoint 10. Draw vertical lines from the corner of the mouth and outer canthus, and draw a curve level with the Mandibular margin from 1cm below the corner of the mouth. The two connecting points are the acupoints. The intermittent wave of electro-acupuncture was performed for treatment of peripheral facial paralysis.It is speculated that the possible mechanism of action is mainly dependent on the regulation of neuroendocrine system.

Based on the traditional Chinese medicine treatment of peripheral facial paralysis (PFP), this paper presents a new method of PFP. According to facial nerve distribution and innervation of the muscle, 10 points were selected and the intermittent wave of electro-acupuncture was performed for treatment of peripheral facial paralysis. It is speculated that the possible mechanism of action is mainly dependent on the regulation of neuroendocrine system.

Effects of acupuncture treatment for irritable bowel syndrome: a systematic review and meta-analysis
Liu Ji-Ye, Chen Ying-Hua
Traditional Medicine Research. 2016, 1 (4): 183-194.   https://doi.org/10.12032/TMR201604025
Abstract ( 475 )   HTML ( 8 )     PDF (370KB) ( 235 )  

Highlights:

This article has selected a variety of major medical retrieval system. Based on the Meta-Analysis of the 17 documents, the effect of different types of acupuncture on irritable bowel syndrome in 4 evaluation criteria was systematically summarized. Evidence of evidence-based medicine for treatment of irritable bowel syndrome with acupuncture was provided. It broadens the treatment of irritable bowel syndrome.

Objective: To evaluate the effectiveness and safety of acupuncture treatment for irritable bowel syndrome (IBS). Method: Seven databases including PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP database), Wanfang Database, and Chinese Biomedical Literature Database (Sinomed) were searched to identify relevant randomized controlled trials (RCTs). The data were extracted and assessed independently. The risk of bias was assessed using the Cochrane risk of bias assessment tool. Review Manager Software (V5.3) was used for data synthesis. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to grade the quality of evidence. This trial is registered with CRD42016037769. Results:Seventeen RCTs with 1032 participants were included with poor methodological quality. We found acupuncture plus drug showed superior effects to sham acupuncture plus drug on symptom severity (n=120, RR=1.29, CI=1.11-1.50, P=0.001). One trial showed no statistically significant difference between acupuncture plus drug and drug alone on symptom severity (n=48, RR=1.28, CI=1.00-1.63, P=0.05). Twelve RCTs showed that acupuncture was superior to drug therapy on symptom severity (n=705, RR=1.20, CI=1.09-1.32, P=0.0002). One RCT on IBS-SSS failed to show statistically significant difference between acupuncture and drug (n=73, SMD=-0.45, CI=-0.91-0.02). Two RCTs on global symptom score didn’t show statistically significant difference between acupuncture and drug (n=100, SMD=-2.41, CI=-4.07-0.75). Five RCTs on quality of life showed that acupuncture showed superior effects to control condition on quality of life (n=288, SMD=0.51, CI=0.17-0.86, P=0.04). Conclusion: For the included studies with poor methodological quality, no firm conclusion can be drawn regarding the effects of acupuncture for IBS.

A Literature Review of the Acupoint Plaster Therapy for Asthma in Summer
Wang Kai, Du Ya-Jun, Sun Zeng-Tao, Li Xiao-Juan, Liu En-Shun
Traditional Medicine Research. 2016, 1 (4): 195-199.   https://doi.org/10.12032/TMR201604026
Abstract ( 337 )   HTML ( 8 )     PDF (353KB) ( 207 )  

Highlights:

Treating winter diseases in summer is characterized by warming Yang, which is recuperating in summer, to treat some chronic diseases commonly seen in winter. This treatment belongs to the chronomedicine of Traditional Chinese Medicine. After reviewing ancient literature and modern research, this essay illustrates the mechanism and prescription of Dog days Plaster.

Treating winter diseases in summer is characterized by warming Yang, which is recuperating in the summer, to treat some chronic diseases commonly seen in winter. This treatment belongs to the chronomedicine of TCM. This theory originates from Plain Questions, which puts forward the theory of the harmony of the human body and nature as well as the theory of maintaining Yang in spring and summer. In addition, Beiji Qianjin Yaofang puts forward the theory of treating winter diseases by taking oral medicine during dog days; Taiping Shenghui Fang puts forward the theory of treating winter diseases by using external medicine during dog days; choosing medicine according to season is proposed in Compendium of Materia Medica and Zhangshi Yitong puts forward using acupoint plaster therapy for treating asthma in midsummer. Based on meta-analysis reviews, current research has been focused on the mechanism, composition, and compatibility of the prescription.

A prospective, randomized controlled trial of sanguisorba oil in the treatment of tamoxifen-related vaginitis in breast cancer patients
Zhao Yuan-Hong, Han Su-Heng, Li Zheng, Luo Xiao-Yao, Long Xiu-Li, Li Shuai
Traditional Medicine Research. 2016, 1 (4): 200-205.   https://doi.org/10.12032/TMR201604027
Abstract ( 397 )   HTML ( 4 )     PDF (255KB) ( 237 )  

Highlights:

This study provides further insights into the clinical efficacy of sanguisorba oil in the treatment of tamoxifen-related (TAM) vaginitis in breast cancer patients. Sanguisorba oil for external use was effective in the treatment TAM related vaginitis and/or urinary irritation in breast cancer patients. External use of Sanguisorba oil improves the compliance of breast cancer patients with TAM-related vaginitis, and this should be promoted in clinical.

Objective: To evaluate the clinical efficacy of sanguisorba oil in the treatment of tamoxifen-related (TAM) vaginitis in breast cancer patients.

Methods:

This prospective, randomized controlled trial (from April 2012 to April 2015) included 112 breast cancer patients with TAM-related vaginitis. Patients were randomized 1:1 to the sanguisorba oil group or control group. Patients in the sanguisorba oil group were treated with conventional basic therapy followed by 2g sanguisorba oil for external application after cleaning the vulva in the morning and at night, while patients in the control group were treated with conventional basic therapy alone. Clinical symptom score and curative effect evaluation were collected at two time points (e.g. before treatment and after 7 days at end of treatment). All the data were calculated by using SPSS17.0 software.

Results:

The clinical symptom score between two groups was not statistically significant before treatment (P>0.05). After treatment, however, the sanguisorba oil group had a better clinical symptom score compared to control group (P<0.05). In addition, the main symptoms in the sanguisorba oil group including colpoxerosis, vaginal itching or burning, frequency, urgency or urodynia were largely alleviated after 10 days of treatment (P<0.05). No significant difference of clinical symptom score was found in control group after treatment (P>0.05). The clinical cure rate of the sanguisorba oil group and the control group were 7.1% and 0%, respectively, with significant difference (P<0.05). No adverse reaction was found during the treatment process in the two groups.

Conclusions

:Taken together, external use of sanguisorba oil was effective in the treatment of TAM-related vaginitis and/or urinary irritation in breast cancer patients. With the advantage of convenience, safety and low price, sanguisorba oil treatment improves the compliance of breast cancer patients with TAM-related vaginitis, and should be promoted in clinical practice for oncologists.

Pharmacokinetic study of dl-tetrahydropalmatine patches by UPLC-MS/MS in rabbits
Xie Wei-Jie, Zhang Yong-Ping, Xu Jian
Traditional Medicine Research. 2016, 1 (4): 206-212.   https://doi.org/10.12032/TMR201604028
Abstract ( 330 )   HTML ( 3 )     PDF (653KB) ( 242 )  

Highlights:

The paper established the determination method of the plasma concentration of dl-tetrahydropalmatine patch via rabbit skin. When treating a blood sample, the study mainly researched chloroform and ethyl acetate as the purified extraction solvent. By comparison, It’s found that chloroform dissolution rate and solubility to dl-tetrahydropalmatine were higher than ethyl acetate, and it could be extracted completely within a few seconds. Whereas extracted dl-tetrahydropalmatine using chloroform , the residual degree in the vessel wall was far less than the ethyl acetate. Through the average recovery test, it was found that extraction and purification using chloroform could fully meet the test requirements. For the dl-tetrahydropalmatine patch, it can be found that the water content was a great impact factor on the transdermal efficiency, so it must be controlled more than 33% in the experiment, and primarily with the stratum corneum (SC) water-related. Appropriately increasing the humidity can affect skin SC hydration and then the skin SC cells loosely arranged, meaning enhancing the transdermal effect. According to the authentication and related data, it was indicated that using UPLC-MS/MS to determine plasma concentrations of the dl-tetrahydropalmatine patch via rabbit skin is simple, convenient and fast.

Objective: To establish the measurement method of the plasma concentration and inspect the pharmacokinetic of the dl-tetrahydropalmatine patches. Method: Tandem mass spectrometric detection (UPLC-MS/MS) was employed for the detection of the plasma concentration. Results: We established the mass spectrometry conditions of dl-tetrahydropalmatine, all of which could meet the requirements of analysis of biological samples. The distribution law of dl-tetrahydropalmatine patches accorded with the single compartment model; Tmax=5.0h, Cmax=153.12ng/ml, MRT=10.0h, AUC0-inf=2.10 ug/ml·h, AUMC=21.15ug/ml·h2. Conclusion: The UPLC-MS\MS method was useful in the pharmacokinetic study of dl-tetrahydropalmatine patches. It was simple, rapid, accurate and reliable and had high sensitivity and good reproducibility. Consequently, the method could be available for quantitative analysis and pharmacokinetic studies of dl-tetrahydropalmatine patches.

Dynamic changes of circulating Th1 and Th17 cells in psoriasis patients:a report of 3 cases treated by Chinese herbal medicine
Li Ya-Jun, Zhou Tao, Zhang Jing, Bai Yan, Zhang Cang, Li Ping
Traditional Medicine Research. 2016, 1 (4): 213-218.   https://doi.org/10.12032/TMR201604029
Abstract ( 349 )   HTML ( 9 )     PDF (392KB) ( 229 )  

Highlights:

This is the first report observing the TCM treatment in psoriasis vulgaris with FACS monitoring of the circulating lymphocytes every two weeks. The data indicated a similar variation trend between the change of PASI score and T cell subsets in blood-heat psoriasis patients. The T cell changes could be detected somewhat earlier than obvious recovery of the skin. In a particular situation, Liang-Xue-Jie-du decoction (LXJD) could overcome infection induced Th1 and Th17 increasing and ameliorate psoriatic lesions.

Psoriasis is a chronic inflammatory skin disease, characterized by increased T cell response. Liang-Xue-Jie-Du Decoction (LXJD), a classic Chinese herb formula, have been proved effective for blood-heat type psoriasis by clinical trials. But there is little information related to its role on patients’ T helper cells. Here, we report 3 patients who were diagnosed as blood heat psoriasis and were treated by LXJD for 8 weeks. With evaluating the Psoriasis Area and Severity Index (PASI) and detecting the peripheral lymphocytes by flow cytometry every two weeks, changes of circulating Th1 and Th17 subsets and their association with skin lesions were monitored. As to patient 1, the decrease of Th1 and Th17 cells was detected 2 weeks after the treatment, followed with 83% decrease of PASI at week 4. Patient 2 and 3, a clear decrease of Th1 and Th17 was detected at week 6, accompanying with the improvement of PASI score, achieving PASI70 and PASI90 at week 8, respectively. The results indicated a similar variation trend between the change of PASI score and T cell subsets, which occurred somewhat earlier than obvious recovery of the skin. In addition, though both Th1 and Th17 of the patient 1 rebounded due to upper respiratory infection at week 6, the lesions kept fading away and achieved 90% improvement of PASI (PASI90) at week 8. The phenomena indicated that T helper cells might not be the only target of LXJD. Our individual case reports give a clue on discovering the mechanism of LXJD decoction. Additional studies will be necessary to fully evaluate the role of LXJD decoction in T cell differentiation and psoriatic skin recovery.

A Hemorrhoids Topical Formula
Fan Yi-Hua
Traditional Medicine Research. 2016, 1 (4): 219-221.   https://doi.org/10.12032/TMR201604030
Abstract ( 254 )   HTML ( 2 )     PDF (204KB) ( 176 )  

Composition

Wu Mei (Fructus Mume) 30g, Huang Lian (Rhizoma Picrorhizae) 10g, Ce Bai Ye (Cacumen Platycladi) 10g (stir-bake to scorch), Sheng Da Huang (Radix et Rhizoma Rhei) 10g (decoct later), Ku Shen (Radix Sophorae Flavescentis) 10g, Shi Liu Pi (Pericarpium Granati) 10g, Ku Fan (Alumen) 15g, Huai Jiao (Fructus Sophorae) 10g, Wu Bei Zi (Galla Chinensis) 15g, Zao Jiao Ci (Spina Gleditsiae) 15g, Bai Xian Pi (Cortex Dictamni) 15g, Bo He Nao (Menthol) 5g

Directions

All herbs except for Bo He Nao (Menthol) and Sheng Da Huang (Radix et Rhizoma Rhei) are needed to be processed into powder (just for better effects, not necessary). Cook the powder for 30min with water, and add Sheng Da Huang (Radix et Rhizoma Rhei) when there's 5min left. After the medicine is decocted, pour the clear medicine liquid out and add Bo He Nao (Menthol) in it. The liquid could be used externally several times a day.

The boiled liquid of one package should be divided into 2 portions and each portion is a day dose. Wash the focus twice a day, one time at noon and one in the evening. Heat the medicine liquid before using.Indications Internal hemorrhoids, External hemorrhoids and Mixed hemorrhoids.

Contraindications

During the treatment, do not eat spicy food and lamb.

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