Colorectal cancer

　　The etiology of rectal cancer is not yet fully understood by Western medicine, but it is believed that the following factors are closely related to carcinogenesis:

　　1. Dietary factors:High-fat, high-meat, and low-fiber diets are closely related to the occurrence of rectal cancer. High-fat diet not only stimulates the increase of bile secretion but also promotes the growth of certain anaerobic bacteria in the intestinal tract. Once cholesterol and bile salts are decomposed into unsaturated cholesterol by anaerobic bacteria, such as deoxycholic acid and lithocholic acid, they both increase in the intestinal tract, and the latter two are carcinogens or co-carcinogens, therefore, they can lead to the occurrence of rectal cancer.

　　2. Genetic factors:In the family history of rectal cancer patients, about 1/4 have a family history of cancer, half of which are gastrointestinal tumors. Due to the genetic change of normal cells, the cancer patients have a genetic susceptibility obtained from heredity, and with certain triggering factors, the rapid growth of tissue cells will develop into cancer. The mutation of the cell's genetic genes becomes malignant cells with tumor genetic characteristics, manifested as the familial nature of cancer.

　　3. Polyps:The occurrence of colorectal cancer is closely related to polyps. Some people believe that rectal polyps are early lesions of cancer, especially familial multiple adenomatous polyps, which have a very high possibility of canceration; papillary adenomatous polyps also have a relatively high chance of canceration.

　　4. Chronic Inflammatory Stimulation:Chronic inflammatory stimulation can lead to the occurrence of colorectal cancer. For example, schistosomiasis, amebic dysentery, chronic nonspecific ulcerative colitis, chronic bacillary dysentery, and other diseases can undergo canceration through granuloma, inflammatory, and pseudopolyp stages. Patients with ulcerative colitis whose course exceeds 10 years are prone to evolution, and the malignancy of canceration is high, easy to metastasize, and the prognosis is poor; according to relevant statistics, the incidence of colitis in colorectal cancer patients is 8-10 times higher than that in patients without colitis.

　　In addition, the occurrence of tumors is also closely related to psychological factors, age, endocrine factors, environmental stress resistance, climatic factors, immune dysfunction, and viral infection, but it requires certain conditions to occur in colorectal cancer.

　　1. Colonic Obstruction:It is one of the late complications of colorectal cancer, which can occur suddenly or gradually. It is often caused by tumor growth blocking the intestinal lumen or narrowing of the intestinal lumen, or can also be caused by acute inflammation, congestion, edema, hemorrhage, and other conditions at the tumor site.

　　2. Rectal Perforation of Colorectal Cancer:There are two situations of perforation in complications, perforation occurs locally at the site of the tumor; proximal colonic perforation, which is a complication of tumor obstruction. After perforation, clinical manifestations may include diffuse peritonitis, localized peritonitis, or the formation of local abscesses. Diffuse peritonitis is often accompanied by toxic shock and has a very high mortality rate. The prognosis of colorectal cancer is not related to the patient's gender and age, but is closely related to the course of the disease, the extent of tumor infiltration, the degree of differentiation, and whether there is metastasis.

　　Early Symptoms

　　Colorectal cancer lacks symptoms in the early stage, and patients do not show obvious abnormal changes. When the tumor reaches 1-2 cm in size, due to the erosion of the tumor, the intestinal mucosa is stimulated by the foreign body of the tumor, resulting in increased secretions. Therefore, there is also a small amount of mucus excreted during defecation, most of which is attached to the front end of the feces or outside the feces. As the tumor grows larger, the secretion of mucus also increases, and sometimes when the abdominal pressure increases with the exhaust or sudden cough, mucus may be discharged from the anus. When the tumor grows larger, forms ulcers, or has necrosis with concurrent infection, obvious rectal irritation symptoms will appear, accompanied by changes in the frequency and nature of defecation. The frequency of defecation increases, reaching 2-3 times a day, and the stool is sticky, loose, and may contain mucus and blood. It is often misdiagnosed as 'enteritis', 'dysentery', 'ulcerative colitis', and other diseases. However, the diarrhea symptoms of colorectal cancer are not as acute as those of colitis, nor do they improve rapidly; nor are they as typical as the symptoms of dysentery. The rectal irritation symptoms of colorectal cancer are slow and gradually progressive. When complications with infection occur, the irritation symptoms are obvious. Once treated symptomatically, they can temporarily improve, but if there is still mucus and blood in the stool after a relatively long period of treatment, it should be given sufficient attention. When patients have the following conditions, they should go to the hospital for detailed examination.

　　1. Abnormal defecation habits, increased frequency of defecation, accompanied by small amounts of mucous stools, mucous hematochezia, without improvement after treatment, or recurrence after treatment, should be diagnosed and treated in a timely manner.

　　2. Those with a history of mucous stools and diarrhea, but with mild symptoms, suddenly become severe, and when the frequency and nature of defecation change, they should also be re-examined and diagnosed.

　　3. Alternating constipation and diarrhea without obvious cause, without improvement after short-term treatment, when there is no abnormality found in the stomach after barium meal examination, it is necessary to go to the hospital for rectal examination.

　　4. Difficulty in defecation, the stool is pressed, showing grooved strip-like, flat strip-like, thin strip-like, etc., it is necessary to do rectal examination. In any of the above four cases, it is necessary to go to the hospital for examination in a timely manner. Where possible, it is best to have an examination by a surgeon or proctologist.

　　Second, symptoms in middle and late stages

　　1. The clinical features of early colorectal cancer are mainly hematochezia and changes in defecation habits. When the tumor is limited to the rectal mucosa, hematochezia as the only early symptom accounts for 85%, unfortunately, it is often not paid attention to by patients. At that time, digital rectal examination can often feel a mass. In addition to the common systemic symptoms such as anorexia, weight loss, and anemia in patients with middle and late-stage colorectal cancer, there are also local symptoms of the tumor, such as increased frequency of defecation, incomplete defecation, frequent desire to defecate, and tenesmus. The enlargement of the tumor can lead to intestinal stricture and the appearance of signs of intestinal obstruction.

　　2. In the late stage, colorectal cancer often invades surrounding tissues and organs, such as the bladder and prostate, causing frequent urination, urgency, and difficulty in urination. It can also affect the sacral plexus, causing sacral and lumbar pain. Colorectal cancer can also metastasize to distant organs such as the liver, causing liver enlargement, ascites, jaundice, and even cachexia.

　　3. Colorectal cancer is easily misdiagnosed. An increase in the frequency of bowel movements, mucus, and pus in the stool in the early stage is often misdiagnosed as dysentery, enteritis, or hemorrhoids, thereby losing the opportunity for early treatment. Therefore, when adults have abnormal defecation, they should be vigilant and, if necessary, undergo rectal or sigmoidoscopy examination.

    The important method to prevent colorectal cancer is to eliminate carcinogenic factors, maintain a healthy diet, and eat more foods rich in carbohydrates and rough fiber such as sweet potatoes, potatoes, corn, fruits, and fresh vegetables. These foods have a short stay time in the intestines, which is beneficial for the elimination of intestinal toxins. Try to eat less fried, smoked, high-fat, and high-protein foods, and do not eat possible rotten fruits, vegetables, and foods. Maintain a healthy lifestyle in detail: increase physical activity appropriately, maintain a regular rhythm of life, quit smoking and drinking, and control weight.

　　1. Medical history and symptoms

　　Changes in defecation habits or stool characteristics, mostly manifested as increased frequency of defecation, loose or watery stools, bloody or mucous stools. Sometimes constipation or diarrhea alternating with constipation, stools becoming narrower. Abdominal pain in the lower abdomen, varying in severity, mostly dull or bloating pain. Patients with right hemi-colon cancer often have an abdominal mass. Pay attention to systemic symptoms such as anemia, weight loss, fatigue, edema, hypoproteinemia, etc., and fever in patients with tumor necrosis or secondary infection.

　　2. Physical examination findings

　　Abdominal mass can be palpated or a mass can be found during duodenal finger examination, which is often hard, painful, and irregular in shape. Anemia, weight loss, cachexia. In patients with lymphatic metastasis, compression of venous return can cause ascites, lower limb edema, jaundice, etc.

　　3. Auxiliary examination

　　Blood routine shows microcytic anemia, elevated erythrocyte sedimentation rate. Fecal occult blood test is persistently positive. X-ray shows filling defect of barium, stiffened intestinal wall, decreased or absent peristalsis, irregular haustra, intestinal stricture or dilation. Colonoscopy can clearly determine the nature of the lesion, size, and even early lesions. In addition, serum carcinoembryonic antigen (CEA), ultrasound, and abdominal CT scans are also helpful for diagnosis.

　　1. After colon cancer surgery, no food should be eaten for 3 to 4 days, waiting for intestinal peristalsis to recover and artificial anus exhaust, with bubbles exuding from the stoma, then liquid food can be consumed. The selected food should be easy to digest and nutritious, such as vegetable soup, rice soup, lotus root powder, etc. It is best to eat in small and frequent meals, every 2 to 3 hours, 6 to 7 times a day.

　　2. After one week, semi-liquid food can be consumed, choosing foods rich in protein and low in fiber, such as noodles, congee, wontons, and should be eaten in small and frequent meals, 5 to 6 times a day.

　　3. After two weeks, easy-to-digest, low-fiber common food can be eaten, coarse grains and vegetables with high fiber content, such as celery, should be avoided to reduce the burden on the intestines.

　　1. Basic Treatment Plan

　　The treatment of colorectal cancer primarily involves surgical resection of the tumor, supplemented by radiotherapy, chemotherapy, traditional Chinese medicine treatment, and other methods; recently, many scholars have adopted endoscopic resection for early-stage colorectal cancer and achieved good efficacy. As for how to choose the best treatment plan, it must be based on different clinical and pathological stages. A large number of clinical practice has proven that the integrated traditional Chinese and Western medicine treatment plan is as follows: for Dukes′A stage, surgery can be performed, and traditional Chinese medicine can be administered without chemotherapy; for Dukes′B stage, surgery can be performed, followed by chemotherapy and traditional Chinese medicine after surgery, and radiotherapy can also be administered for rectal cancer; for Dukes′C stage, surgical treatment can be performed for colon cancer, followed by chemotherapy and traditional Chinese medicine after surgery, and preoperative or postoperative radiotherapy can be administered for rectal cancer, along with chemotherapy and traditional Chinese medicine; for Dukes′D stage, radiotherapy, chemotherapy, traditional Chinese medicine, and immunotherapy are the main treatments, while surgery is only palliative resection or symptomatic treatment. Traditional Chinese and Western medicine have their respective strengths in the treatment of tumors, so it is necessary to give full play to the advantages of traditional Chinese medicine, adhere to long-term treatment, alleviate the psychological state of patients, do a good job in psychological treatment, increase dietary nutrition, and improve the body's immune function. Only in this way can a good therapeutic effect be achieved.

　　1, Surgical treatment:

　　It is the most effective method for the radical treatment of colon and rectal cancer. For patients who are suitable for surgery, surgical resection treatment should be carried out as soon as possible.

　　2, Chemotherapy:

　　After the radical resection of colorectal cancer, 50% of the cases still recur and metastasize, so preoperative and postoperative chemotherapy may increase the 5-year survival rate after radical resection. The first choice of anti-cancer drugs is fluorouracil, followed by mitomycin and doxorubicin.

　　3, Radiotherapy:

　　Preoperative radiotherapy can shrink the tumor and improve the resection rate, and postoperative radiotherapy can kill residual tumor cells. Radiotherapy alone is only used for advanced rectal cancer cases, with the effects of hemostasis, analgesia, and prolonging survival.

　　4, Endoscopic treatment:

　　For early mucosal layer cancer, it can be resected under endoscopy. For advanced tumors, stents can be placed under endoscopy to prevent stenosis and obstruction.

　　5, Traditional Chinese medicine and herbal medicine treatment:

　　It can be used as adjuvant and supportive treatment to improve symptoms and prolong survival time.

　　Two, differential diagnosis and typing treatment

　　1, According to the clinical manifestations of colorectal cancer, traditional Chinese medicine treatment can refer to diseases such as intestinal accumulation, intestinal wind, anal fistula, internal toxicity, and dysentery for syndrome differentiation and treatment. Most of these diseases are characterized by 'deficiency in the root and excess in the branch', with most being due to spleen and stomach deficiency or both spleen and kidney deficiency, and the excess being due to damp-heat and blood stasis. Therefore, the treatment should take both the root and branch into account. In the content of the pathological mechanism of colorectal cancer, we have elaborated on spleen deficiency, kidney deficiency, and insufficient vital energy, even saying that 'yang deficiency' is the root of colorectal cancer. Damp-heat, fire toxicity, and blood stasis are the signs of the disease. Therefore, the herbal formulas for treating colorectal cancer should reflect the root treatment principle of warming the yang, invigorating the kidney, and regulating the spleen and Qi. As for the treatment methods and approaches such as 'sheding ben zhi mo' (treating the end instead of the root) with the characteristics of clearing and purging, I dare not agree with them, so I will not list the methods and herbs, please refer to the relevant books.

　　2, Traditional Chinese medicine theory has clearly told us that most accumulation diseases are due to deficiency, leading to accumulation from deficiency, and further deficiency due to accumulation. Both are interrelated causes and effects, with deficiency being the root cause. The main treatment approach for tumors is the supplementation and invigoration method, which should be implemented throughout the treatment process. We in traditional Chinese medicine are most concerned about syndrome differentiation, which refers to looking at the essence through appearances. The differentiation in syndrome differentiation is the root, and many of our colleagues should absolutely know these basic issues (or theories), but when applying them in practical clinical use, 'syndrome differentiation' becomes 'symptom differentiation'. It is named to differentiate the essence of the disease, but actually it stays at the surface and does not go deep enough. Guiding clinical practice with this, the effectiveness is predictable. The view that 'clearing and purging' is the main treatment approach falls into this category. It is bound to fail in clinical practice. For example, in breast cancer, the use of purgative drugs alone may lead to an increase in the size of the tumor. As recorded in Xue Ji's 'Xue Shi Medical Records' in the Ming Dynasty: 'Taking the invigorating agent, the tumor becomes as large as a bowl, with clear pus coming out every day, but it does not subside and eventually dies.' Professor Yu Erxin, a renowned expert in integrated Chinese and Western medicine, has already discovered such problems in the exploration of the pathogenesis of liver cancer. They believe that the 'root of the disease' in liver cancer is spleen deficiency, not 'blood stasis' or 'heat toxicity', 'cancer toxicity'. Treating liver cancer with健脾益气 (invigorating the spleen and Qi) is more effective than treating it with活血化瘀 (blood circulation and blood stasis removal) and清热解毒 (clearing heat and detoxifying). And in terms of survival rate, survival period, and quality of life, the difference is significant. Now we are also repeating such mistakes in the treatment of other cancers. We hope that our colleagues will seriously reflect on this to improve and develop further.

　　3. In the treatment of colorectal cancer, such errors are more obvious. Although it is known that the disease is fundamentally deficiency, the treatment focuses on 'clearing and expelling methods'. We analyze that it may be related to the above points.

　　(1) Because colorectal cancer is scattered in the disease of 'enteric wind', 'enteric mass', 'viscera toxin', and 'subcutaneous blood stasis' in traditional Chinese medicine, it has a greater impact on traditional treatment.

　　(2) The clinical symptoms of colorectal cancer are typical and obvious. Such as hematochezia, purulent stool, tenesmus, even fever, yellow greasy fur, influenced by the appearance, and in a hurry for quick success, forgetting the essence.

　　(3) Being misled by the idea of treating 'cancer mass' as a heat-toxin evil, it is advisable to clear heat and detoxify, and clear heat and expel fire.

　　4. Colorectal cancer is mostly seen in middle and late stages in clinical practice. Common types can be divided into spleen deficiency and dampness-toxin type, blood stasis and toxin accumulation type, and cancer toxin泛滥 type.

　　(1) Spleen deficiency and dampness-toxin type

　　Symptoms: Yellowish complexion, loss of appetite, weight loss, abdominal pain or anal soreness, feces showing thick blood mucus, frequent defecation, thin or flat stools, or tenesmus, pale tongue, thin greasy fur, slippery and rapid pulse.

　　Treatment method: Invigorating the spleen and promoting diuresis, detoxifying and anti-cancer.

　　The above main symptoms belong to Qi deficiency of the spleen and stagnation of cancer toxin in the intestines. It is often seen in middle and late stages of cancer with ulcerative mass type or cancer with ulcer as the main type. Taiizi, cangzhu, coix seed, poria, and yam are used to invigorate the spleen and benefit the Qi, and yam also has the effect of protecting the mucosa. Portulaca oleracea, patrinia, dioscorea, xianhecao, salvia, and huaihua have the effects of cooling blood, stopping bleeding, detoxifying, and anti-cancer. The combination of these herbs invigorates the spleen and benefits the Qi, promotes diuresis, cools blood, stops bleeding, and detoxifies, thus forming the anti-cancer effect.

　　(2) Blood stasis and toxin accumulation internally

　　Symptoms: Dark complexion, abdominal distension and pain, pain in a fixed location, or radiating downward, palpable mass in the abdomen, difficulty defecating, gradually producing intestinal obstruction or dysentery with purple and black pus and blood, feces becoming thin or flat, purple tongue with ecchymosis, thin yellow fur, wiry or涩 pulse.

　　Treatment method: Dissolving blood stasis, attacking masses, and relieving pain.

　　The above main symptoms are often seen in infiltrative colon cancer. It belongs to dampness-heat blocking the intestines, with internal accumulation of cancer toxin, so it is common to have difficulty defecating, or progressive obstruction, and during infection, feces show purulent mucus, or purple and dark stools, abdominal distension and pain. Spatholobus suberectus, curcuma, and prepared myrrha can unblock and dissolve phlegm, and red peony root, peach kernel, safflower can activate blood circulation and remove blood stasis, fructus magnolia officinalis, Corydalis yanhusuo, and huoxiu can regulate Qi and relieve pain, patrinia, porophyllum, salvia, semi-leaved st johnswort, and snake tongue grass can stop bleeding and detoxify.

　　(3) Cancer toxin泛滥

　　Symptoms: Weak spirit, pale complexion, emaciated body, or呈恶病质, lack of warmth in the limbs, abdominal distension and pain, or multiple masses can be felt in the abdomen, or anal prolapse and soreness, dysentery with pus and blood, after defecation feeling slightly relieved, pale or glossy tongue, deep and weak pulse.

　　Treatment method: Supplementing Qi and Yin, inhibiting cancer and detoxifying.

　　Herbal medicine: 5g of ginseng or red ginseng, 5g of fenghu, 15g of ejiao (melted separately), 100g of raw oyster shell, 100g of raw oyster, 100g of raw oyster shell, 10g of baizhu, 30g of yam, 30g of coix seed, 10g of chicken gizzard, 2g of wuzhuyu, 3g of huanglian, 10g of paojiang.

　　This syndrome is commonly seen in the late stage of colorectal cancer (stage D), belonging to deficiency of Qi, blood, and body fluid, with widespread infiltration of cancer cells. The physical characteristics are progressive weight loss or cachexia. During this period of treatment, it is necessary to first focus on alleviating symptoms, improving survival function, and strive to control the development of the tumor and prolong life. Therefore, it is advisable to use the method of greatly replenishing Qi, blood, and Yin and Yang, assisted by softening hard lumps and consolidating the spleen and harmonizing the middle. Use ginseng or red ginseng, Fenghu, Ejiao to invigorate Qi and Yin, nourish essence and blood as the main medicine. Among them, Ejiao is rich in gelatin and various amino acids, which, combined with ginseng and Fenghu, can improve the immune function of patients and is the main medicine for invigorating the body and inhibiting cancer; use Geke, Shengmuli, Shengwanling to supplement biological calcium, improve lymph permeability, and have the effects of removing blood stasis, reducing edema, relieving smooth muscle spasm and analgesia; use Wuzhuyu, Huanglian, Paojiang, cold and warm in combination, which is conducive to improving the dysfunction of Qi and blood circulation; use Baizhu, Yiyiren, Jinianjin to invigorate the spleen and eliminate dampness, which can play a neutralizing role.

　　(4) Symptomatic medication

　　For purulent and sticky stool, add Mashang, Dijincao, Baijiangcao, Xianhecao, Sanqi, Ditu, Huaihua.

　　For urgent stool, add Huangbai, Huanglian, Qinpi, Chishao, Muxiang.

　　For edema of the intestinal wall, add Cangzhu, Zhu ling, Fu ling, Zexie.

　　For poor appetite and abdominal distension, add Jinianjin, Shanyao, Jiaoshanzha, Shengqu, Gumaiai.

　　For pain and distension, add Chuanlianzi, Yanhusuo, Wu ye, Baishao, Gancao, Paojiang.

　　For anal prolapse, add Huangqi, Ge gen, Sheng ma, Zhigancao.

　　For red and delicate tongue, add Xiyangshen.

　　For oral ulceration, add Ku shen, She chuang zi, Xuan shen, Bai Ying, Wu bei zi, decoct the juice to gargle, and take a small amount of Zhuhuang powder.

　　Through the discussion on the pathogenesis of colorectal cancer, the treatment methods of the above types should all be added with 'Wenyang Yishen' (warming the Yang and nourishing the kidney), and the medicine should also be appropriately added with 'Wenyang Yishen' prescriptions, so as to hit the root of the pathogenesis of colorectal cancer.

　　According to the treatment principles of this disease, the author also formulated a basic prescription for colorectal cancer:

　　10g of Taiizi (Panax), 10g of Baizhu, 10g of Cangzhu, 15g of Yiyiren, 20g of Shanyao, 10g of Paojiang, 30g of Paozufu (decoct first), 10g of Rougui, 30g of Baijiangcao, 30g of Qicao, 30g of Mashang, 30g of Xianhecao.

　　Clinically, according to specific syndromes, refer to the above dialectical treatment for various types of colorectal cancer, and the efficacy is relatively ideal.