VIII. Interventional Therapy and Radiofrequency Ablation for Lung Cancer

(VEGF), only after the activity of VEGF increases does tumor growth begin. Later, other researchers discovered an epidermal growth factor receptor (EGFR) at the site of tumor growth; once EGFR is activated, epidermal cells proliferate. One aspect is tumor growth, and the other is blood supply. Subsequently, further research led to the development of VEGF inhibitors and EGFR inhibitors. Examples of VEGF inhibitors include sorafenib and bevacizumab; EGFR inhibitors include gefitinib, primarily used for targeted therapy of lung cancer. To date, it has demonstrated definite efficacy against non-small cell lung cancer (squamous cell carcinoma, adenocarcinoma, and alveolar carcinoma). The usual dosage is 150 mg, orally, once daily. Recently, a formulation of 50 mg has been introduced: 50 mg, orally, once daily. It can be taken for 3–5 months or up to half a year and shows relatively good efficacy in treating lung cancer. Its key feature is its targeted action, which spares normal cells; however, its major drawback is systemic allergic reactions, manifesting as generalized skin itching and dermatological conditions, as well as vascular thrombosis. Currently, these side effects are being addressed. VIII. Interventional Therapy and Radiofrequency Ablation for Lung Cancer Interventional therapy refers to TACE. This involves vascular intervention—specifically, the injection of embolic agents through the bloodstream, preceded by angiography. Experts generally do not recommend interventional treatment for localized lung cancer, nor do I, though some still perform it. The primary indication is intervention on mediastinal lymph nodes. As we know, enlarged mediastinal lymph nodes cause significant patient discomfort: when they compress the sympathetic nerves, Horner’s syndrome occurs, resulting in one eye being larger than the other; when they compress the trachea, shortness of breath and cough develop; when they compress the esophagus, dysphagia ensues; when they compress the superior vena cava, superior vena cava syndrome arises; and when they compress the recurrent laryngeal nerve, hoarseness results. Therefore, enlargement of mediastinal lymph nodes poses a considerable threat to lung cancer patients, making interventional therapy essential for their management. Interventional therapy essentially means vascular intervention. Radiofrequency ablation, X-knife, and ?-knife can also be used to treat lung cancer. We know that visible light ranges from red to violet, with progressively shorter wavelengths, greater amplitude, and stronger penetration. Beyond red lies infrared, which is invisible; beyond infrared lies microwaves, which cannot be called “knives” but rather radiofrequency, sometimes referred to as microwave radiofrequency or simply radiofrequency ablation. Beyond violet lies ultraviolet, followed by X-rays, then ?-rays; each subsequent type has shorter wavelengths, greater amplitude, and stronger penetration. Thus, X-rays can be called “X-knives,” and ?-rays can be called “?-knives.” Their strong penetrating power makes them particularly effective for mediastinal lymph nodes. Small lymph nodes can be treated with X-knives or ?-knives, whereas microwaves are not suitable—they cannot be termed “knives” but only “radiofrequency ablation.” What exactly does it ablate? It removes small skin warts, and for patients with atrial fibrillation, it can effectively block the arrhythmia. Therefore, managing mediastinal lymph nodes is a very important issue in lung cancer treatment. Accordingly, the U.S. NCCN guidelines stipulate that any hospital performing open-chest surgery or minimally invasive lung cancer surgery must meet the following five criteria: first, thoracoscopic examination—without thoracoscopy, open-chest surgery cannot be performed, since the second station of lymph nodes in open-chest surgery comprises thoracic lymph nodes (mediastinal lymph nodes); second, positron emission tomography–computed tomography (PET-CT); third, bronchoscopy; fourth, bronchoscopic examination; fifth, pulmonary function testing. Our province currently meets only two of these requirements: bronchoscopy and pulmonary function testing. The Gansu Provincial People’s Hospital has one PET-CT scanner, thus fulfilling three criteria; thoracoscopy has also been purchased and is currently undergoing trials, although it was unavailable at least a year ago. However, endoscopic ultrasound of the trachea is still lacking. Consequently, the thoracic surgery department in our province remains relatively underdeveloped. IX. Traditional Chinese Medicine Treatment for Lung Cancer Traditional Chinese Medicine does not classify lung cancer as either a cancer or a mass, but it has left us with excellent prescriptions. Over the years, I have applied these formulas in the treatment of lung cancer, achieving effects that Western medicine alone cannot provide. First, we address the symptoms directly. Ancient texts offer numerous prescriptions for symptom relief; among them, the most famous is “Taiyang Zhongfeng”: “If the pulse is floating and tight, accompanied by fever, chills, body pain, lack of sweating, and irritability, Daqinglong Tang is the principal formula.” Daqinglong Tang is a crucial remedy for acute fever and cough in lung cancer. Additionally, “After inducing sweating, Guizhi Tang should not be administered again; if there is profuse sweating and wheezing without high fever, Maxing Ganshi Tang is indicated.” Maxing Ganshi Tang is another classic prescription for symptomatic treatment of lung cancer. Furthermore, the “Phlegm-Dampness Chapter” provides many formulas for symptomatic adjustments. For example, “There are four types of fluid accumulation: phlegm-dampness, suspended dampness, branch dampness, and overflowing dampness. When fluid flows through the intestines, producing audible rumbling sounds, it is called phlegm-dampness; when fluid accumulates in the limbs and fails to dissipate through sweat, it is called overflowing dampness; when fluid gathers beneath the ribs, causing coughing and pain upon movement, it is called suspended dampness; and when fluid accumulates above the diaphragm, leading to coughing, shortness of breath, and difficulty lying down, it is called branch dampness. For mild shortness of breath caused by minor fluid accumulation, it should be eliminated through urination, with Linggui Zhugan Tang as the main formula. If phlegm-dampness accumulates in the lower abdomen, causing chest and flank fullness and shortness of breath, Linggui Zhugan Tang is the appropriate choice. When fluid accumulates throughout the body but fails to dissipate through sweat, Daqinglong Tang or Xiaoqinglong Tang may be used. For severe coughing and shortness of breath that make it difficult to lie down, Qianlao Dazao Xiefei Tang is recommended. If the pulse is deep and taut, indicating internal pain from suspended dampness, Shizao Tang is the prescribed remedy. All these formulas can be adapted for use in treating lung cancer. Moreover, the prescriptions in the chapter on chest oppression and heart pain remain highly effective symptomatic treatments for lung cancer. “Chest oppression manifests as shortness of breath, cough, chest and back pain, and a deep, slow pulse at the cun position, with a tight, rapid pulse at the guan position. Gualou Saba Baijiu Tang is the principal formula.” The ancient texts describe symptoms such as shortness of breath, coughing, and chest/back pain—symptoms characteristic of lung cancer. Shortness of breath, as mentioned earlier, often appears early in lung cancer, when mediastinal lymph nodes have already metastasized and compressed the trachea, causing breathing difficulties—a distinction from ordinary colds. Shortness of breath, coughing, expectoration, and chest/back pain all indicate irritation of the pleura, and Gualou Saba Baijiu Tang is the appropriate remedy. “When chest oppression prevents lying down and causes excruciating back pain, Gualou Saba Banxia Tang is the prescribed remedy.” Patients with lung cancer often find it difficult to lie flat; when chest pain radiates to the back, Gualou Saba Banxia Tang is the recommended treatment. If there is a feeling of fullness in the chest, qi stagnation, chest fullness, and rebellious qi in the flanks, Zhi Shi Saba Gui Zhi Tang is the appropriate choice; Ren Shen Tang is also effective. Zhi Shi Saba Gui Zhi Tang is an excellent symptomatic remedy for lung cancer. For cases of chronic chest oppression, Yi Yi Fuzi San is recommended. “Chronic chest oppression alternates between periods of improvement and worsening.” “For chest fullness and various rebellious pains, Gui Zhi Sheng Jiang Zhi Shi Tang is the prescribed remedy.” “For chest congestion and shortness of breath, Fu Ling Xing Ren Gan Cao Tang is the recommended formula, along with Ju Zhi Jiang Tang.” “For severe chest pain that radiates to the back, Wu Tou Chi Shi Zhi Wan is the prescribed remedy.” These formulas can also be used to treat chest oppression—when the chest becomes blocked and congested, just as tumors can obstruct the flow of qi. They are equally effective for treating coronary heart disease and lung cancer. Based on my experience, adding blood-circulating and stasis-resolving herbs—such as red peony root, chuanxiong, safflower, agarwood, and salvia miltiorrhiza—makes them excellent remedies for coronary heart disease. If we add Xie Bai San, Xing Su San, San Zi Yang Qin Tang, and Jin Shui Liu Jun Jian, these formulas can be employed in lung cancer treatment as well. In fact, in terms of symptomatic treatment for lung cancer, traditional Chinese medicine offers advantages unmatched by modern medicine. This addresses the symptoms. Now let’s turn to addressing the root cause. Traditional Chinese medicine holds that “accumulation arises from deficiency of vital energy; only when vital energy is deficient does accumulation occur.” This is a statement made by Chen Zhiming in “The Authentic Principles of Surgery.” “Accumulation arises from deficiency of vital energy”—accumulation refers to the buildup of pathological tissue, and its formation is rooted in a deficiency of vital energy. It is precisely because of this deficiency that lumps and pathological accumulations form. “Accumulation arises from deficiency of vital energy; only when vital energy is deficient does accumulation occur.” So how can we achieve long-term therapeutic effects in treating lung cancer? We must strengthen and consolidate vital energy. Thirty-five years ago, I used Liu Wei Di Huang Tang combined with Sheng Mai San and added four ginseng varieties to treat a case of leukemia, achieving an unexpected cure. In 1973, at the National Hematology Conference in Suzhou, I presented this case, and the conference chairman, Chen Yue Shu, was highly impressed. He arranged for bone marrow aspiration of the patient in our Jinta County—back then, Ma Chang Sheng was only in his twenties, and I treated him when he was just 16, ten years younger than me. Now I am 75, while he is 65, and his child has graduated from Lanzhou Medical College. At the time, Chen Yue Shu personally conducted a bone marrow biopsy, comparing the original bone marrow sample and confirming the cure. This single case of successful treatment fully demonstrates the theoretical principles of traditional Chinese medicine: using methods that strengthen and consolidate vital energy to treat tumors and blood cancers. Subsequently, I adapted this formula according to individual cases and applied it in oncology hospitals, successfully treating numerous cancer patients—including gastric cancer, liver cancer, hematologic diseases, multiple myeloma, and myelodysplastic syndromes—with varying degrees of efficacy. For instance, one gastric cancer patient, whom I treated with a combination of Xiang Sha Liu Jun Zi and Ban Xia Xie Xin Tang, came back to see me 15 years later. After much thought, I finally realized he had been diagnosed with gastric cancer and could no longer undergo surgery, yet he was still alive and in good health. He even brought out a handwritten note, pasted onto cardboard, with faint, mottled handwriting clearly identifying my script. This unexpected cure for a gastric cancer patient confirmed that using methods that strengthen and consolidate vital energy can indeed cure gastric cancer. Later, I also used this approach to successfully treat liver cancer patients, and I frequently apply it to lung cancer patients as well. Since this formula proves so effective in treating blood diseases, gastric cancer, liver cancer, and lung cancer, I decided to test its application in alleviating the side effects of radiotherapy and chemotherapy. The adjustments made to this formula are particularly effective in mitigating the adverse effects of radiation and chemotherapy. At the Suzhou Hematology Conference, this formula was named the “Lanzhou Formula” and subsequently adopted by hospitals across the country, including Tangdu Hospital in Xi’an. There, my sixteen-character guideline—“Western diagnosis, Chinese differentiation, herbal medicine as the mainstay, Western medicine as the adjunct”—was officially designated as the guiding principle for establishing the integrated Chinese-Western medicine department at Tangdu Hospital. Many other hospitals nationwide have also followed my approach in treating patients. Thus, this formula, by strengthening and consolidating vital energy, has proven capable of curing tumors. Recently, an agricultural expert in our province developed pancreatic cancer, and I applied the same method of strengthening vital energy, extending his life by nine months. Former Director of the Gansu Provincial Health and Family Planning Commission, Liu Wei Zhong, was also deeply interested and repeatedly discussed this case at conferences. In summary, traditional Chinese medicine offers symptomatic treatment for lung cancer, as well as methods to address the root cause and complement radiotherapy and chemotherapy. Therefore, traditional Chinese medicine has great potential in the treatment of lung cancer. A practitioner of traditional Chinese medicine must understand Western medicine; otherwise, it’s like a blind man riding a blind horse—how can one possibly treat lung cancer? How can you truly understand what lung cancer is if you rely solely on guesswork and intuition? Can you really diagnose and treat lung cancer with just three fingers and a pillow? That’s why I propose the sixteen-character guideline of “Western diagnosis, Chinese differentiation, herbal medicine as the mainstay, Western medicine as the adjunct.” Under this principle, there is immense potential for treating lung cancer. 91 The Necessity and Inevitability of Integrating Traditional Chinese and Western Medicine Pei Zhengxue speaks, Zhang Guiqiong records Traditional Chinese and Western medicine emerged on different socio-economic foundations; the nature of the economic base determines the corresponding superstructure. As a superstructure, medicine differs in content and form due to the distinct economic bases on which it relies for existence and development. Western medicine employs experimental research methods to conduct in-depth studies on the local, microscopic, and pathogenic aspects of disease, whereas Traditional Chinese Medicine uses logical reasoning to analyze the overall, macroscopic, and organismic response characteristics of disease. Although the two approaches have fundamentally different features, it turns out that the strengths of Traditional Chinese Medicine happen to compensate for the weaknesses of Western medicine, and vice versa. If this obvious complementarity can be realized in clinical practice, it will have immeasurable positive effects on the advancement of human medicine. I. Before the advent of large-scale industry, Eastern and Western medical thinking and methodologies were broadly similar. Prior to the 16th century, neither the East nor the West had modern large-scale industry, so the developmental models of the two medical systems were entirely identical. Engels stated in “Anti-Dühring” that “the economic base determines the superstructure, and the superstructure changes—either rapidly or slowly—in response to changes in the economic base.” As a superstructure, the form and content of medicine are absolutely dependent on the economic base upon which it develops. In the 4th–5th centuries BC, the East, with China as its cultural center, produced a group of outstanding cultural figures who exerted a profound influence on posterity, including Confucius, Qin Yue Ren, Mencius, Han Feizi, and Xunzi. Similarly, the West, with ancient Greece as its cultural center, also saw the emergence of remarkable thinkers such as Socrates, Plato, Aristotle, Hippocrates, Alexander, Pythagoras, and Archimedes. Among the former, Qin Yue Ren stood out as a medical giant; among the latter, Hippocrates was likewise a medical luminary. Looking at the development of Eastern and Western cultures, how strikingly similar are certain details? Both groups of eminent figures emerged during the same period—the 3rd, 4th, and 5th centuries BC. During Qin Yue Ren’s era (Bian Que), the classic texts of Eastern medicine—namely, the “Yellow Emperor’s Inner Canon” and the “Difficult Classic”—were compiled; during Hippocrates’ time, the canonical works of Western medicine—such as the “Hippocratic Corpus”—were established. Confucius, Mencius, Xunzi, and others in China left behind invaluable cultural legacies for the Eastern world, providing guiding maxims and modes of thinking for humanity; similarly, Socrates, Plato, Aristotle, and others in the West also bequeathed inspiring sayings and ways of thinking. However, because Westerners lived in the Mediterranean and Aegean regions, their maritime lifestyle fostered a habit of practical experimentation and bold risk-taking. Consequently, the writings of Western philosophers, beyond mere logical reasoning, bore the imprint of experimental research from the very beginning, laying the groundwork for the emergence of great physicists like Archimedes and great mathematicians like Pythagoras. In the West, the medical ethics outlined in the “Hippocratic Corpus” were inherited and further developed by Galen, the renowned Roman physician known as the “King of Medicine,” thereby establishing the foundation of Western medicine. Galen was the first to propose the diagnostic methods of inspection, palpation, percussion, and auscultation, and he also invented a simple stethoscope. His extensive body of work includes seminal texts such as “Anatomy” and “Clinical Diagnosis.” Meanwhile, in China, there emerged a great medical practitioner known as the “Sage of Medicine”—Zhang Zhongjing. Zhang Zhongjing fully inherited the ideas of the “Yellow Emperor’s Inner Canon,” further developed them, and authored the widely celebrated “Treatise on Cold Damage and Miscellaneous Diseases.” This work became the cornerstone of both the theory and practice of Traditional Chinese Medicine, with later generations proclaiming, “Every word in the ‘Treatise on Cold Damage’ is golden and immutable—not a single character may be altered” (according to Xu Lingtai); “Since the Tang and Song dynasties, physicians have consistently violated the classics and offered nothing of value” (according to Chen Xiuyuan), meaning that only the classic “Treatise on Cold Damage” qualifies as the sole monumental work of Traditional Chinese Medicine. Galen and Zhang Zhongjing lived in the same era: Galen was born in 130 AD, while Zhang Zhongjing was born in 150 AD, a difference of 20 years. Galen passed away in 200 AD, and Zhang Zhongjing in 219 AD, both living to the age of 70—an astonishing similarity. Whether it’s Hippocrates, Galen, Qin Yue Ren, or Zhang Zhongjing, their academic perspectives are all products of logical reasoning and evidence-based inquiry, with no foundation in large-scale industry. Western medicine proposes observation, palpation, percussion, and auscultation; Eastern medicine advocates inspection, auscultation, inquiry, and pulse diagnosis, with wood, fire, earth, metal, and water as the five elements. The two approaches are almost entirely identical. Over the next thousand-plus years, however, the rampant spread of religious authority in the West and the prevalence of Christianity hindered further development of Hippocrates’ and Galen’s medical achievements. In China, during the reign of Emperor Wu of the Han Dynasty, the renowned statesman and philosopher Dong Zhongshu proposed the policy of “abolishing all schools of thought and exclusively venerating Confucianism,” asserting that only studying the Four Books and Five Classics constituted true learning. As a result, people focused solely on the teachings of Confucius and Mencius, preventing Chinese medicine from entering the realm of experimental research—another surprising parallel between the two traditions. II. After the 16th century, as large-scale industry gradually emerged in the West, Eastern and Western medical thinking and methodologies began to diverge. In the 17th century, the development of the glass and mining industries in the West led to the creation of the world’s first microscope by British physician Robert Hooke. Subsequently, Dutch physician Antonie van Leeuwenhoek used a microscope with 270-fold magnification to observe human skeletal cells. In the early 18th century, German philosopher Oken proposed the theory that the human body is composed of cells. At the same time, biologists Schleiden and Schwann conducted in-depth research on Oken’s concept of the cell and discovered the nucleus, providing a detailed description of it. They argued that although the external forms of organisms differ, their internal structures are completely consistent—that is, all are composed of cells. In the mid-19th century, building on the work of his predecessors, another great German pathologist, Virchow, launched his own groundbreaking research in “cell pathology,” asserting that “every animal is the sum of countless units of life, and each unit exhibits all the characteristics of life.” Disease, he believed, is the result of cellular changes within the body, a comprehensive manifestation of various microscopic alterations, thereby laying the foundation for Western medicine’s microscopic understanding of disease. Concurrently, French physician Pasteur suggested that microorganisms could cause wine to turn sour; British physician Lister observed that postoperative wounds could become infected due to bacterial invasion; Austrian physician Semmelweis noted that puerperal fever in women could be caused by infection from decaying substances. These observations highlighted the possibility of microbial presence within the body, paving the way for the emergence of Germany’s great bacteriologist Koch, who invented techniques for staining and culturing bacteria, later refined by his student Gram. In the late 19th century, Western medicine established the concept of pathogenic microorganisms, a notion bolstered by advances in industrial technology. With the rise of immunology, Western medicine’s understanding of pathogenicity deepened steadily, gradually forming a complete academic system that moves from practice to theory, serving as a standard for identifying the causes and pathology of disease. This enabled Western medicine to make further progress on the microscopic level. Later, with the development of mechanical and electronic industries, Western medicine successively created various endoscopes and, starting in the 20th century, began applying ERCP (endoscopic retrograde cholangiopancreatography) in clinical practice. Western medicine thus boarded the express train of modern large-scale industry, advancing rapidly from macro to micro, from whole to part, and from organismic response to pathogenic causation. Whenever modern large-scale industry achieved a new breakthrough, it was quickly reflected in Western medicine—for example, the atomic bomb.