VII. A Synthesis of Ancient and Modern Theories

VII. A Synthesis of Ancient and Modern Theories
“Plain Questions · On the True Storehouse of Vital Energy”: “When the large bones become withered and the flesh sinks in, the chest feels full of qi, breathing becomes difficult, internal pain radiates to the shoulders and neck, body heat rises, and the flesh wastes away—when the true storehouse is exposed, death will occur within ten months.”
“Revised Yan’s Jisheng Formula · Chapter on Accumulation and Mass”: “The symptom of this condition is a mass in the right hypochondrium, as large as an overturned cup, with labored breathing and rapid exhalation—this is called lung accumulation. Upon palpation, the pulse is floating and wiry, the complexion is pale, there is reverse qi causing pain, shortness of breath, forgetfulness, drowsiness, cold skin, intermittent pain in the skin, sometimes like being bitten by lice, sometimes like being pricked by needles.”
“Complete Works of Jing Yue · Deficiency Damage”: “If one suffers from labor-induced cough, hoarseness, inability to produce sound, or shortness of breath, it indicates that the lungs are failing and death is inevitable.”
“Introduction to Medicine · Chapter on Accumulation and Mass”: “Qi cannot form a lump or mass; such lumps are formed by phlegm, food stagnation, and stagnant blood—these are tangible substances, and this is what we call accumulation and mass.”
Liu Weisheng: In TCM diagnosis of lung cancer, the main pattern is phlegm-heat and blood stasis. In the early stage, the focus is on expelling pathogenic factors, often combining three methods: clearing heat and detoxifying, activating blood circulation and resolving stasis, and using poison to attack poison. Later, the treatment shifts to strengthening the spleen and replenishing qi, combined with transforming phlegm and resolving stasis to consolidate the effect. If the lesion disappears, the emphasis then moves to strengthening the spleen and replenishing qi, nourishing the liver and kidneys to reinforce the body’s vital energy and prevent recurrence and metastasis.
Liu Jiaxiang: Lung cancer is classified into five types based on the patient’s presentation: yin deficiency with internal heat, qi-yin dual deficiency, spleen deficiency with phlegm-dampness, dual deficiency of yin and yang, and qi stagnation with blood stasis. Treatment plans are formulated according to the individual patient’s condition, fully utilizing the strengths of both Chinese and Western medicine at different stages of treatment, complementing each other’s advantages while minimizing their weaknesses. When diagnosing lung cancer, attention should be paid to tongue coating and tongue color, balancing tonification and pathogen elimination, and integrating syndrome differentiation with disease identification. Syndrome differentiation mainly relies on observing changes in tongue body and tongue coating, allowing for flexible prescriptions and precise combinations.
Zhou Daihan: Throughout the entire course of lung cancer, the three elements of phlegm, heat, and deficiency are constantly present. All symptoms of lung cancer are caused by phlegm, so treating lung cancer necessarily involves addressing phlegm. Heat pathogen scorching the lungs is one of the causes of lung cancer, so treatment focuses on clearing heat, draining the bowels, transforming phlegm, and relieving asthma. Deficiency refers to lung yin deficiency and lung qi deficiency; lung deficiency is caused by phlegm and heat, which in turn exacerbate the degree of phlegm and heat. In advanced stages, patients exhibit qi-yin dual deficiency.

Anatomical, physiological, and pathological aspects:
The female breast is mostly located anterior to the pectoralis major muscle, with a small portion inferior and lateral to the anterior serratus muscle. Its upper and lower boundaries lie between the 2nd–6th ribs or the 3rd–7th ribs, with the medial boundary being the parasternal line and the lateral boundary being the axillary line. The center of the breast is the nipple, surrounded by the areola. The areola contains multiple raised areolar glands that secrete sebum during lactation to lubricate the nipple. The basic physiological function of the breast is to secrete milk and nurse infants; additionally, it is an important sexual characteristic organ, representing the secondary sexual characteristics of women.

Pathological types:
① Non-invasive cancer: Includes ductal carcinoma in situ, lobular carcinoma in situ, and nipple eczema-like breast cancer. This type is early-stage and has a relatively good prognosis. ② Early invasive cancer: Includes early invasive ductal carcinoma and early invasive lobular carcinoma. This type is still early-stage and has a relatively good prognosis. ③ Special invasive cancer: Includes papillary carcinoma, medullary carcinoma, tubular carcinoma, adenoid cystic carcinoma, mucinous carcinoma, apocrine carcinoma, squamous cell carcinoma, etc. Non-special invasive cancer: Includes invasive lobular carcinoma, invasive ductal carcinoma, hard carcinoma, medullary carcinoma, simple carcinoma, adenocarcinoma, etc. This type generally has low differentiation and a poorer prognosis than the above types, but it is also the most common type of breast cancer, accounting for 80% of cases. However, determining the prognosis still requires considering factors such as the stage of the disease.

II. Diagnosis and Treatment (---) Clinical Diagnosis
Diagnosing breast cancer when a clear mass is present is usually straightforward, but we must not overlook some early signs of breast cancer, such as localized thickening of the breast tissue, nipple discharge, nipple erosion, and localized skin indentation. For women with high-risk factors, auxiliary examinations can be used. Early manifestations include a painless, solitary small mass appearing in the affected breast, often discovered incidentally by the patient and leading to medical consultation. The mass is hard, indicating an uneven surface and clear boundaries with surrounding tissues, making it difficult to move within the breast. As the tumor grows, it may cause local bulging of the breast. If it involves Cooper’s ligament, it can shorten the ligament, resulting in skin depression on the tumor surface—known as the “dimple sign.” Cancer near the nipple or areola, by invading the ducts and shortening them, can pull the nipple toward the tumor side, causing the nipple to flatten, retract, and become indented. As the tumor continues to grow, if subcutaneous lymphatic vessels are blocked by cancer cells, lymphatic return is obstructed, leading to dermal edema and a “orange-peel” appearance of the skin. In advanced stages, breast cancer can invade the thoracic fascia and chest muscles, eventually fixing the tumor to the chest wall and making it difficult to move. If cancer cells invade large areas of skin, multiple small nodules may appear, even merging together. Sometimes the skin breaks down and forms ulcers, which often have a foul odor and bleed easily.
Mammography findings include star-shaped masses, asymmetrical dense shadows, structural distortion, or calcification. Ultrasound is currently the most convenient and practical method for examining the breast, non-invasive, and can be repeated frequently. CT scans can be used for preoperative staging of breast cancer, checking for lymph node metastasis and distant metastasis. Tumor marker CA153 testing has certain diagnostic value for breast cancer. Biopsy provides a cytological diagnosis in about 90% of cases. For cases where no mass is found but nipple discharge is present, a cytological examination of the nipple discharge smear can be performed. If nipple erosion is suspected to be eczema-like breast cancer, a cytological examination of the eroded area can be conducted. Core needle biopsy can obtain strip-shaped tissue samples, with high reliability and accuracy, making it an important examination method for breast cancer.

(2) Western Medical Treatment

1. Surgical Treatment
   Surgical treatment is one of the main methods for treating breast cancer. For stage I and II patients, surgery is the primary treatment; for stage III breast cancer patients, chemotherapy is administered before surgery, followed by radiotherapy and chemotherapy after surgery. Stage V is primarily treated medically.
2. Chemotherapy
   Breast cancer is one of the solid tumors for which chemotherapy is most effective, playing an important role throughout the entire treatment process. Since surgery aims to remove as much tumor burden as possible, remaining tumor cells are more susceptible to destruction by chemotherapeutic drugs. It is generally believed that adjuvant chemotherapy should be administered early after surgery, with combination chemotherapy showing better results than single-drug therapy. Adjuvant chemotherapy should reach a certain dosage, and the treatment period should not be too long—about six cycles is ideal. Common chemotherapy regimens include CMF regimen (cyclophosphamide, methotrexate, fluorouracil), CAF regimen (cyclophosphamide, doxorubicin, fluorouracil), CA regimen (cyclophosphamide, doxorubicin), TA regimen (paclitaxel, doxorubicin). For patients resistant to doxorubicin, TX regimen (paclitaxel, capecitabine) or TG regimen (paclitaxel, gemcitabine) can be used.
3. Endocrine Therapy
   For cases positive for estrogen receptors and/or progesterone receptors, or those with only one type of receptor positive, endocrine therapy should be applied. Traditional medications include tamoxifen and toremifene. Aromatase inhibitors such as letrozole (Fure) and anastrozole (Ruiting) can inhibit the aromatization process by which adrenal androgens are converted into estrogens, thereby reducing estradiol levels. They are mainly used for postmenopausal patients. Fulvestrant is recommended for postmenopausal patients with metastatic breast cancer and for subsequent treatment of patients resistant to third-generation AI drugs.
4. Radiotherapy
   Radiotherapy is one of the local treatments for breast cancer. After breast-conserving surgery, radiotherapy is an important component.
5. Targeted Therapy
   Currently, drugs for anti-HER2 treatment of breast cancer include trastuzumab, lapatinib, pertuzumab, TDM-1, pyrotinib, etc.
6. Immunotherapy
   Immune checkpoint inhibitors such as atezolizumab, pembrolizumab, and avelumab have shown good efficacy in the treatment of breast cancer.
7. Interventional Therapy
   There are relatively few reports on interventional treatment for breast cancer. Some researchers have attempted catheterization through the femoral artery for patients who cannot undergo surgery or for those with postoperative recurrence, infusing medication into the internal thoracic artery and intercostal arteries. Studies have shown that this can significantly shrink the tumor, clarify its borders, and even give some patients the opportunity to undergo surgery, but further research with larger sample sizes is needed to confirm these results.

III. Professor Pei Zhengxue’s Approach to Thinking
Professor Pei Zhengxue believes that the breast is governed by the Yangming meridian, while the nipple belongs to the Jueyin liver meridian. The liver governs wood, primarily regulating the flow of qi and ensuring smoothness; the spleen and stomach are responsible for transportation and transformation, as well as the ascending and descending movement of qi. Qi is the commander of blood, and blood is the mother of qi—when qi flows, blood flows; when qi stagnates, blood stasis occurs. Breast cancer patients, firstly, due to emotional trauma, experience liver qi stagnation, which over time leads to blood stasis. Secondly, due to irregular diet, the spleen and stomach lose their ability to transform and transport, leading to phlegm-dampness over time. Blood stasis and phlegm-dampness block the meridians, forming accumulations that gradually grow larger. Over time, blood stasis and phlegm-dampness generate heat, corroding the skin and gradually causing ulceration, ultimately developing into suppurative breast cancer. Insufficient righteous qi and disharmony of the Chong and Ren channels, along with qi and blood deficiency, are the internal causes of this disease; emotional trauma and liver qi stagnation are also important factors in its onset and development; insufficient liver and kidney function, weak qi and blood, and disharmony of the Chong and Ren channels make the body more susceptible to external pathogenic factors, leading to various pathological products and disrupting normal physiological functions, thus developing into breast cancer. Therefore, the onset and development of breast cancer is a process of deficiency leading to excess, excess leading to further deficiency, and a mixture of deficiency and excess—its root cause is deficiency, while its manifestation is excess.

IV. TCM Syndrome Differentiation and Formulas

1. Liver Qi Stagnation Type
   Symptoms: Breast mass, distension and pain in both flanks, chest tightness and discomfort, irritability and anger, bitter taste in mouth and dry throat, red tongue with little coating, string-like pulse. Treatment: Soothe the liver and resolve qi stagnation, soften hard masses and disperse knots. Formula: Chai Shan He Ji: Bupleurum 10g, pangolin scales 6g (can be replaced with water buffalo horn or omitted), Aristolochia 6g, Clematis 6g, Paeonia lactiflora 10g, Sparganium 10g, Curcuma 10g, seaweed 10g, kelp 10g, angelica 10g, Prunella vulgaris 15g, curcuma 6g, frankincense 6g, myrrh 6g, Fritillaria thunbergii 10g, Cistanche deserticola 15g. Decoct in water and take one dose per day, divided into several servings. For areas with fixed pain, add 10g of Panax notoginseng to be dissolved in water; for localized redness and heat, add 15g of dandelion and 15g of houttuynia.
2. Heat-Toxin Accumulation Type
   Symptoms: Breast mass enlarges, ulcerates and hurts, oozes blood, has a foul odor, face turns red and eyes become bloodshot, headache and insomnia, red tongue without coating, rapid pulse. Treatment: Clear heat and detoxify, dissolve tumors and disperse knots.
   Formula: Xian Fang Huo Ming Yin combined with Anti-Cancer Five-Scent Detox Drink and Tuoli Tou Nong San: Honeysuckle 15g, white snake tongue herb 15g, half branch lotus 15g, tiger stick 15g, flea rest 15g, grass river car 15g, windproof 10g, white angelica 6g, frankincense 10g, myrrh 10g, angelica 10g, red peony 10g, Fritillaria thunbergii 15g, dried tangerine peel 6g, pangolin scales 10g, soapberry thorns 15g, astragalus 30g, codonopsis 10g, lemongrass 5g, green peel 6g, licorice 6g. Decoct in water and take one dose per day, divided into several servings. For hard breast masses that do not move, add 15g of Wang Bu Liu Xing and 10g of pangolin scales. For severe local redness and heat, add 15g of half branch lotus and 15g of white snake tongue herb.
3. Qi and Blood Deficiency Type
   Symptoms: Breast mass continues to grow, extending to the armpit and supraclavicular region, palpitations and shortness of breath, pale complexion, fatigue and weakness, insomnia and night sweats, loose stools, pale tongue, deep and weak pulse. Treatment: Tonify qi and nourish blood, detoxify and disperse knots.
   Formula: Lanzhou Fang combined with Fu Yuan Huo Xue Tang with added ingredients: Prince ginseng 15g, northern sand ginseng 15g, ginseng roots 15g, codonopsis 15g, Ophiopogon japonicus 10g, Schisandra chinensis 3g, cinnamon 10g, red peony 15g, bupleurum 12g, Paeonia lactiflora 10g, angelica 10g, peach kernel 10g, safflower 6g, pangolin scales 3g, Fritillaria thunbergii 10g, half branch lotus 15g, white snake tongue herb 15g. Decoct in water and take one dose per day, divided into several servings. For severe shortness of breath and fatigue, add 15g of astragalus; for localized pain, add 10g of yuanhu and 15g of chuanzi; for excessive sweating, add 15g of cinnamon and 30g of floating wheat.
   These three types summarize the clinical manifestations of breast cancer at different stages of development. The formulas provided are only suitable for symptomatic treatment at each stage. Type one mostly applies to the early stage of breast cancer, type two has already reached the middle and late stages, accompanied by lymph node metastasis, and type three involves infection, tumor infiltration, and widespread metastasis. Chai Shan He Ji (Bupleurum 10g, pangolin scales 6g, Aristolochia 6g, Clematis 6g, Paeonia lactiflora 10g, Sparganium 10g, Curcuma 10g, seaweed 10g, kelp 10g, angelica 10g, Prunella vulgaris 15g, curcuma 6g, frankincense 6g, myrrh 6g, Fritillaria thunbergii 10g, Cistanche deserticola 15g), Xian Fang Huo Ming Yin, Anti-Cancer Five-Scent Detox Drink, Tuoli Tou Nong San, Lanzhou Fang, and Fu Yuan Huo Xue Tang are all commonly used formulas by Professor Pei Zhengxue, adjusted according to clinical conditions. For patients with enlarged lymph nodes, soapberry thorns and purple grass are added. Traditional Chinese medicine plays a significant role in the treatment of breast cancer, especially when combined with radiotherapy, chemotherapy, and interventional therapy. Using TCM formulas to strengthen the body’s vital energy (such as Lanzhou Fang) can not only reduce the toxic side effects of radiotherapy, chemotherapy, and interventional therapy, but also enhance their therapeutic effects.