II Western Medical Treatment

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Gastric cancer may present with palpable lymph nodes when there is distant lymph node metastasis. Generally speaking, superficial gastric cancer has mild clinical symptoms and few physical signs, whereas non-superficial gastric cancer exhibits more severe symptoms and numerous physical signs. Complications of gastric cancer include pyloric and cardia obstruction, bleeding, and perforation.

Gastroscopy: It allows direct observation of gastric wall lesions and tissue biopsy, with a diagnostic accuracy exceeding 90%; CT and MRI examinations can reveal gastric cancer invasion of the serosa and adjacent organs, as well as peritoneal and lymphatic metastases; PET/CT scans can rapidly obtain whole-body images to detect small lesions; endoscopic ultrasound combines endoscopic and ultrasonic techniques, enabling direct endoscopic observation along with real-time ultrasonic scanning; serum biomarkers such as CEA, CA724, CA199, CA50, SF, AFP, and SA are commonly used and have certain significance in monitoring the prognosis of gastric cancer. (II) Western Medical Treatment

1. Surgical Treatment Stage I and II gastric cancer are best treated with radical surgery, with adjuvant chemotherapy considered after Stage I surgery. In principle, no chemotherapy is given after Stage I surgery, but adjuvant chemotherapy should be considered for patients with the following conditions: highly malignant pathological type, vascular tumor emboli, tumor area greater than 5 cm², multiple tumors, or patients under 40 years of age. Stage III patients generally undergo extended radical surgery, which is the focus of adjuvant chemotherapy after surgical radical treatment.
2. Chemotherapy The main role of chemotherapy is to complement surgical treatment. Preoperative and postoperative adjuvant chemotherapy for gastric cancer can inhibit tumor activity, prevent postoperative cancer cell metastasis, thereby prolonging survival time and increasing the 5-year survival rate. Postoperative chemotherapy usually begins 2–3 weeks after surgery, and combination chemotherapy can enhance anti-cancer effects. In addition to systemic chemotherapy, local interventional chemotherapy is also available, with common regimens including ECF, FLOT, and SOX.
3. Radiation Therapy Most gastric cancer cells are relatively well-differentiated, so radiation therapy alone is rarely used to treat gastric cancer. Some use radiation therapy when gastric cancer has metastasized and obstruction symptoms are obvious to relieve the obstruction, while others use it when pain is severe to alleviate pain.
4. Targeted Therapy Trastuzumab has been approved for first-line treatment of advanced HER2-positive gastric cancer; Apatinib, a small-molecule anti-angiogenic targeted drug, has been approved for third-line treatment of advanced gastric cancer.
5. Immunotherapy PD-1 monoclonal antibodies pembrolizumab and nivolumab have been approved for third-line treatment of advanced gastric adenocarcinoma, while immunotherapy combinations are still in the exploratory stage for first- and second-line treatment of gastric cancer.
6. Interventional Therapy For gastric cancer, interventional infusion chemotherapy embolization combined, simple infusion chemotherapy (TAI), or embolization (TAE) are more commonly used. For advanced gastric cancer with poor blood supply, residual stomach recurrence, or metastatic cancer—such as signet-ring cell carcinoma, undifferentiated cell carcinoma, and gastric cancer classified as Borramann type 4—the percutaneous transarterial drug delivery system (PCS) should be chosen for treatment. Non-vascular interventional therapies are less frequently applied; for metastases to the liver, lungs, and other organs, treatment can be carried out according to relevant sections. III. Professor Pei Zhengxue’s Thinking Method Professor Pei Zhengxue believes that “human life depends on stomach qi.” The Yellow Emperor’s Classic of Internal Medicine states, “With stomach qi, one lives; without stomach qi, one dies.” When spleen and stomach qi are sufficient, the postnatal foundation is strengthened, the functions of ascending and descending of the spleen and stomach operate normally, external pathogenic factors cannot invade, and internal pathogenic factors cannot proliferate. Spleen and stomach qi can be weakened due to various factors, such as insufficient innate endowment, invasion of external pathogenic factors, qi injury, and imbalance of yin and yang among the zang-fu organs. Deficiency of spleen and stomach qi manifests clinically as pale yellow complexion, loss of appetite, fatigue, shortness of breath, and reluctance to speak. The Plain Questions says, “Where evil gathers, qi must be deficient,” and “If righteous qi resides within, evil cannot invade.” Therefore, when symptoms of spleen and stomach qi deficiency appear, it indicates a potential early stage of gastric cancer. In fact, most patients in the early stages of gastric cancer exhibit these symptoms of spleen and stomach qi deficiency. The spleen is damp earth, while the stomach is dry earth; when spleen qi is deficient, dampness prevails, and when stomach qi is deficient, dry fire rises. Dampness and fire combine to form spleen-stomach damp-heat syndrome, characterized by red tongue, greasy yellow coating, fullness and pain in the stomach, nausea and vomiting in some patients, and constipation or diarrhea in others. Approximately, patients in the middle and late stages of gastric cancer often experience these symptoms. When damp-heat combines in the stomach, it eventually obstructs the flow of qi. This obstruction has two meanings: first, “spleen qi does not ascend, stomach qi does not descend”—when spleen qi does not ascend, there is intestinal rumbling and diarrhea; when stomach qi does not descend, there is nausea and vomiting; second, qi stagnation and blood stasis—this exacerbates stomach pain, with fixed location and tenderness to pressure. In severe cases, qi and blood become stagnant, forming masses that can be palpated in the abdomen, at which point gastric cancer has reached the late stage. During this disease mechanism transformation, some patients, due to excessive stomach fire and spleen yin deficiency, present with red tongue and little coating, even dark red tongue with no coating, accompanied by obvious burning sensation in the stomach—this is stomach yin deficiency. Other patients, in addition to discomfort in the stomach, also experience discomfort in both flanks, especially right flank pain, along with bitter taste in mouth, dry throat, irritability, and chest tightness—this is liver wood overcoming earth, also known as liver-stomach disharmony. Patients with liver wood overcoming earth often have liver metastasis of gastric cancer; patients with stomach yin deficiency often have electrolyte disturbances. Strengthening the body's righteous qi and consolidating the foundation is the fundamental principle for treating malignant tumors. The Yellow Emperor’s Classic of Internal Medicine says, “With stomach qi, one lives; without stomach qi, one dies,” which echoes Professor Pei Zhengxue’s “All diseases depend on the stomach” theory. When spleen and stomach qi are sufficient, the postnatal foundation is strengthened. Therefore, Professor Pei Zhengxue always uses formulas such as Xiangsha Liujunzi Tang, Banxia Xiexin Tang, and Xiaodanshen Yin to protect stomach qi when treating gastric cancer. Moreover, after tumor occurrence, qi and blood are depleted, and surgeries and chemotherapies indiscriminately kill both normal and tumor cells, further affecting the function of zang-fu organs and qi and blood, making righteous qi even weaker and creating a vicious cycle. IV. Traditional Chinese Medicine Syndrome Differentiation and Formulas
7. Spleen-Stomach Qi Deficiency Type Symptoms: Stomach pain varies in intensity, relieved by warmth and pressure, improved after eating, sometimes accompanied by nausea and diarrhea. Most patients show pale yellow complexion, loss of appetite, fatigue, shortness of breath, reluctance to speak, sensitivity to cold, and excessive sweating. Tongue is plump and pale, coating thin and white, pulse deep, fine, and slippery. Treatment: Tonify spleen and benefit qi, warm the stomach and relieve pain. Formula: Xiangsha Liujunzi Tang and Xiaojianzhong Tang with modifications. Formulas: Dangshen 10g, Baizhu 10g, Fuling 12g, Gancao 6g, Banxia 6g, Chenpi 6g, Muxiang 3g, Caodoukou 3g, Guizhi 10g, Baishao 20g, Danshen 10g. Decoction to be taken once daily. Adjustments: Add dried ginger 6g and fupian 6g for abdominal distension; add sanleng 10g and ezhushi 10g for severe bloating; add hanzhiqu 3g (to be decocted separately) for stomach pain; add processed frankincense 3g and processed myrrh 3g for severe pain.
8. Spleen-Stomach Damp-Heat Type Symptoms: Persistent stomach pain, with paroxysmal exacerbations; fullness and burning sensation in the stomach, mostly accompanied by nausea and vomiting, diarrhea or constipation, and some patients experiencing gastrointestinal obstruction. Patients are emaciated and mentally exhausted, sometimes with fever. Pulse is string-like, slippery, and rapid; tongue is red with thick, greasy coating. Treatment: Clear heat and dry dampness, regulate qi and relieve pain. Formulas: Wumei mixture, Jinlingzi powder mixture, and Banxia Xiexin Tang with modifications. Formulas: Wumei 4 pieces, Chuanjiao 6g, Huanglian 6g, Banxia 6g, Ganjiang 6g, Yujin 6g, Danpi 6g, Baishao 15g, Weilingxian 10g, Foshou 10g, Jineijin 10g, Danshen 10g, Muxiang 3g, Caodoukou 3g, Xiahukuo 15g, HaiZao 10g, Kunbu 10g, Huangbo 6g, Huanglian 3g, Huangqin 10g, ShanZhi 10g, Ganjiang 6g, Banxia 6g, Danshen 10g, Muxiang 3g, Caodou 3g, Danggui 10g, Baishao 20g, processed frankincense 3g, processed myrrh 3g, Huangjing 20g, Gaoliangjiang 6g, Quanke 10g, Gancao 6g. Decoction to be taken once daily. Adjustments: Add rhubarb 10g for constipation; add xianhecao 20g and tudahuang 15g for black stools; add shengzheshi 20g (pre-decocted) and cinnamon 3g for hematemesis; add baihuasheshi 20g and banzhilian 20g for abdominal masses; add yuanhu 10g and chuanzi 10g for severe stomach pain.
9. Qi Stagnation and Blood Stasis Type Symptoms: Persistent stomach pain, with paroxysmal exacerbations, localized pain, tenderness to pressure, and palpable masses in the upper abdomen. Patients have dark complexions, frail bodies, occasional fever, and either constipation or loose stools. Tongue is dark red with ecchymoses, coating sparse or absent, or thick and greasy, pulse is string-like but weak, both cun pulses are deep and fine. Treatment: Regulate qi and activate blood circulation, strengthen the body's righteous qi and consolidate the foundation. Formulas: Jinlingzi powder mixture with modifications. Formulas: Yuanhu 10g, Chuanlianzi 20g, Yujin 10g, Taoren 10g, Honghua 3g, Wulingzhi 6g, Danggui 10g, Chuanxiong 10g, Huangqi 15g, Gaoliangjiang 6g, processed frankincense 6g, processed myrrh 6g, Puhuang 10g, HaiZao 10g, Kunbu 10g, Baishao 15g, Dangshen 10g, Baizhu 10g, Fuling 12g, Gancao 6g, Xiahukuo 15g, Sanleng 10g, Ezhushi 10g, Danshen 10g, Muxiang 3g, Caodou 3g. Decoction to be taken once daily. Adjustments: For persistent high fever, add raw gypsum 60–100g (pre-decocted); can also add Five Flavors Disinfecting Drink for anti-cancer purposes; For nausea and vomiting, add ginger 10g, Banxia 10g, Xuanfuhua 15g, and shengzheshi 15g (pre-decocted).
10. Stomach Yin Deficiency Type Symptoms: Burning-like stomach pain, continuous and with paroxysmal exacerbations. Patients have dry mouth and no desire to drink, general fatigue, bone-steaming heat, five-heart vexation, excessive sweating, emaciation, weakness, and dull complexion. Tongue is dark red with no coating, tongue body is large, pulse is fine and rapid, all dimensions are weak. Treatment: Nourish yin and benefit the stomach, clear heat and drain fire, regulate qi and relieve pain. Formulas: Ye’s Stomach-Nourishing Soup combined with Xiaodanshen Yin and Banxia Xiexin Tang with modifications. Formulas: Beisha Shen 30g, Maidong 10g, Yuzhu 10g, Shihu 10g, Danshen 10g, Muxiang 3g (added later), Banxia 3g, Huanglian 3g, Huangqin 10g, Ganjiang 6g, Zizhi 10g, Yuanhu 10g, Chuanzi 10g, processed frankincense 10g, processed myrrh 10g. Decoction to be taken once daily. Adjustments: For high fever, add raw gypsum 30–100g (pre-decocted), Baihuasheshi 30g, Banzhilian 30g, Huzhang 15g; for severe stomach pain, add hanzhiqu 3g (to be taken in two doses); for gastric bleeding, add tudahuang 20g, shengdahuang 6g, and shengzheshi 15g (pre-decocted). The above four syndrome differentiation treatments summarize the therapeutic formulas for different stages of gastric cancer. In the early stage of gastric cancer, patients in generally good condition are mostly of the spleen-stomach qi deficiency type; in the middle stage, when there is already metastasis to adjacent organs and concurrent cancer-related or infectious fever, they are mostly of the spleen-stomach damp-heat type;