Systemic therapies such as chemotherapy and targeted therapy form the cornerstone of treatment for malignant hematologic disease. However, they often face efficacy limitations in treating refractory localized bulky masses, extramedullary infiltrations, or lesions in specialized sites. Cryoablation is a localized minimally invasive physical therapy and provides a new option for "targeted eradication" of such local lesions, boasting multiple advantages such as rapid tumor reduction and alleviation of compressive symptoms. However, its cryogenic effects act as a potent "exogenous cold pathogen, " leading to several complications, such as microvascular constriction and coagulation dysfunction. Furthermore, existing Western medical supportive measures remain relatively limited. To the best of our knowledge, this article is to systematically propose that the core pathogenesis of post-cryoablation injury involves the direct invasion of cold pathogen, leading to congealing and stagnation of qi and blood, damage to yang qi, and involvement of the zang-fu organs. The pathological process is summarized into five key phases: cold damaging yang qi leading to cold syncope; cold congealing and stagnating leading to blood stasis; cold inducing pain; cold damaging spleen yang leading to bleeding; and cold damaging the five zang organs leading to deficiency and failure. This framework constructs a syndrome differentiation system focused on cold, stasis, and deficiency. A sequential treatment protocol based on Danggui Sini Decoction from the Treatise on Cold Pathogenic Diseases is recommended for the post-operative acute phase, subacute/recovery phase, and complications (e.g., hemorrhage, fever, and myelosuppression). This approach establishes a synergistic diagnostic and therapeutic model that combines targeted lesion eradication via cryoablation with holistic regulation of bodily function via traditional Chinese medicine (TCM). This model can alleviate post-operative cold congealing and blood stasis, prevent and treat related complications, and promote the recovery of bodily functions, thereby enhancing the safety of local therapy and the overall therapeutic efficacy. It provides a integrated TCM and Western medicine pathway for the comprehensive treatment of localized refractory lesions in malignant hematologic diseases.
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Open Access
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Open Access
Original Article
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To explore new mechanisms of the traditional Chinese medicine (TCM) spleen-based treatment of immune thrombocytopenic purpura (ITP) from the perspective of blood neurotransmitters.
In this randomized controlled multi-center clinical study, 271 ITP patients who met the diagnostic criteria of “syndrome of spleen failing to manage blood” were randomized into three groups: group A administered Jianpi Yiqi Shexue (JYS) granules, 1 bag per treatment, bid; group C administered prednisone as a draught at an initial dose of 1.0–1.5 mg/kg/day at 8:00 AM; and group B administered a combination of the interventions in groups A and C. Each treatment cycle lasted 21 days.
After treatment, scores of platelet distribution width (PDW) were significantly decreased in groups B and C, and there were significant differences among the three groups (P = .0131). Pairwise comparisons showed that PDW was significantly different between group A and group B (P = .005) and between group A and group C (P = .041) but not between group B and group C. Hemorrhage grading scores were significantly different between day 1 and day 7 in group A and group B (P < .001) but not in group C. The hemorrhage grading scores on day 14 and day 21 were significantly different from that on day 1 in all three groups (P < .001). Serum 5-hydroxytryptaminelevels did not change significantly before and after treatment in the three groups (P > .05). Serum β-endorphin and vasoactive intestinal peptide levels were significantly different between group A and group B (both P < .001).
The JYS prescription may regulate the expression levels of blood neurotransmitters via the brain-gut axis in patients with “spleen deficiency” ITP and thus activate hemostatic mechanisms to promote hemostasis. β-EP and VIP are key neurotransmitters of the JYS-induced functional regulation.
Open Access
Original Article
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To explore the effects of three classic traditional Chinese medicine (TCM) formulae, Dahuang Huanglian Xiexin Decoction (DHXD), Fuzi Lizhong pills (FLP) and Liushen pills (LSP), in suppressing gastric cancer growth in mice and provide evidence for their clinical applications.
MGC-803 cells (5 × 106 per mouse) were injected into the subcutaneous tissues of the neck and back of nude mice. One week later, the mice were divided into three batches (9 total groups) based on tumor size and a random number table. Within each batch, the mice were subdivided into control, low- and high-dose groups for the three classic formulae. After 21-d treatment, the mice were observed for their general conditions, and then sacrificed. Tumor tissues were harvested and weighed, and the tumor inhibition rate was calculated.
Compared with the control group, body weight in the low- and high-dose DHXD and FLP groups showed no significant change (P > .05), while the high-dose LSP group had significantly lower body weight (P = .049). Compared with the control group, the low- and high-dose DHXD groups showed no significant inhibitory effect on xenograft tumor growth (P > .05); low-dose FLP showed an inhibitory effect on tumor growth (P = .039), while high-dose LSP had a more significant effect (P = .004).
DHXD did not inhibit xenograft tumor growth in mice. In contrast, low-dose FLP had a measurable inhibitory effect, and high-dose LSP more significantly suppressed xenograft tumor growth in mice.
Open Access
Original Article
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To explore the feasibility of establishing the disease-syndrome combined animal model for immune thrombocytopenic purpura (ITP) without additional conditions.
Three batches of data related to the ITP model mice obtained by replication at different time were analyzed, and whether the APS-injected model mice replicated through the passive immune modeling method could simulate the pathogenesis and clinical characteristics of human ITP was evaluated according to the differentiation criteria for disease-syndrome combined model.
The APS-injected replicated ITP model mice possessed the following traits: (1) Compared with the normal group, the platelet count was significantly decreased, and coagulation time was significantly increased in the model group (P < .01). (2) Compared with the normal group, the medullary thrombocytogenous megakaryocytes were significantly decreased (P < .05,.01,.001). (3) The APS-injected sites and other parts of the model mice had spontaneous hemorrhage. (4) Behavioral changing signs were observed 1 week after the modeling (i.e. low activity, delayed activity, poor appetite, skin petechia/hemorrhage and spontaneous hemorrhage at the injected sites or other parts), and were getting more and more severe.
According to the syndrome differentiation criteria for disease-syndrome combined model of ITP, the APS-injected animal model of ITP replicated through the passive immune modeling method without additional conditions possesses the characteristics of disease-syndrome combined model. It provides an ideal tool for the development of traditional Chinese medicine pharmacology experiment.
Open Access
Original Article
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To observe the hemostatic effect of the Spleen-invigorating, Qi-replenishing and Blood-arresting Formula on simvastatin-induced zebrafish hemorrhage model compared with that of the Heat-clearing and Blood-cooling Formula.
AB strain wild type zebrafish were treated with 0.5 μM simvastatin for 24 hours to establish the zebrafish hemorrhage model. Under strictly blind experimental conditions, the zebrafish were then treated with experimental agents in different concentration within the maximum non-lethal dose. The intervention effect of the Spleen-invigorating, Qi-replenishing and Blood-arresting Formula was comprehensively assessed by examining the main observational parameters such as the bleeding reduction rate and hemostatic rate while referring to the additional parameters such as blood flow, improvement rate of blood flow, velocity of movement, improvement rate of motion under spleen-qi deficiency.
Hemostatic effect: The bleeding rate and hemostatic rate in the zebrafish were respectively, 30%, 15%, 45%, 40% and 60%, 80%, 40%, 47% when equal concentration of 500 μg/mL, 1000 μg/mL were used. This showed that the experimental herbs B1 was superior to B2 in decreasing the bleeding rate and improving hemostatic effect in the zebrafish. Improvement of blood flow: With equal concentration, the experimental herb B1 was superior to B2 in increasing the blood flow and improvement rate of blood flow in hemorrhagic zebrafish. Promotion of the improvement of motion: With equal concentration of 500 μg/mL and 1000 μg/mL, the experimental herb B1 was superior to B2 in promoting the velocity of motion in the zebrafish and promoting the improvement rate of motion.
The manifestations of simvastatin-induced zebrafish hemorrhage are basically similar to that of failure of the spleen to control blood in human beings. The Spleen-invigorating, Qi-replenishing and Blood-arresting Formula has good hemostatic effect on simvastatin-induced hemorrhage in the zebrafish. It also boasts the functions of improving blood flow and velocity of motion in the hemorrhagic zebrafish. Such a conclusion provides the experimental basis for the treatment of the syndrome of failure of the spleen to control blood by this formula.
Open Access
Original Article
Issue
This consensus statement is organized into six parts: 1) Definitions: cancer-related depressed mood state is defined as a group of depressive symptoms, rather than major depressive disorder. Thus, “cancer-related depression” or “depressed mood state” is introduced as standard terminology and associated with the Chinese medicine concept of “yu zheng” (depression syndrome). 2) Pathogenesis: factors including psychological stress, cancer pain, cancer fatigue, sleep disorders, surgery trauma, chemotherapy, and radiation therapy are strongly associated with cancer-related depressed mood state. Crucial elements of pathogenesis are cancer caused by depression, depression caused by cancer, and the concurrence of phlegm, dampness, and stasis from constrained liver-qi and spleen deficiency. 3) Symptoms: these include core symptoms, psychological symptoms, and somatic symptoms. Depressed mood and loss of interest are the main criteria for diagnosis. 4) Clinical evaluation: based on the Mini-International Neuropsychiatric Interview and a numeric rating scale, and taking mood changes during cancer diagnosis and treatment into consideration, a questionnaire can be drafted to distinguish between major depressive disorder and cancer-related depression. The aim is to assist oncology clinicians to identify, treat, and refer patients with cancer-related depression. 5) Diagnosis: diagnosis should be based on the Chinese Classification for Mental Disorders (CCMD-3), taking patients’ mood changes during diagnosis and treatment into consideration. 6) Treatment: treatments for cancer-related depression must be performed concurrently with cancer treatment. For mild depression, non-pharmacologic comprehensive therapies, including psychological intervention, music therapy, patient education, physical activity, and acupuncture, are recommended; for moderate depression, classical Chinese herbal formulas based on syndrome pattern differentiation combined with antidepressants are suggested; for severe depressive symptoms that have progressed to major depressive disorder, patients should be referred to a psychiatric clinician for specialized care.
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