Objective

2

To explore the characteristics of traditional Chinese medicine （TCM） syndromes in pancreatic cancer patients based on syndrome hierarchical diagnosis mode.

Methods

2

The general condition， previous treatment， clinical stage， primary location of tumor， with or without distant metastasis， instant TCM symptoms， past history， tongue and pulse manifestations on first admission were retrospectively collected from 223 patients with pancreatic cancer. The hierarchical diagnosis mode of TCM syndromes was adopted. The first level diagnosis differentiated excess from deficiency syndrome. The second level diagnosis included interior excess and interior deficiency syndromes （exterior excess and exterior deficiency syndromes were not involved in this study）. The third level diagnosis under interior excess syndrome includes

qi

excess， blood excess， fluid excess， excess cold， and excess heat patterns， while interior deficiency syndrome was classified into

qi

deficiency， blood deficiency，

yin

deficiency，

yang

deficiency， fluid depletion， essence depletion， and deficiency heat patterns. The fourth level and fifth level diagnosis differentiation were further performed after meeting previous diagnosis levels. The number of cases and percentages of different syndromes were statistically analyzed. The distribution of TCM syndromes in different patients groups were analyzed in terms of with or without distant metastasis， with or without liver metastasis， different clinical stages， and different primary locations of tumor.

Results

2

Among the 223 cases of pancreatic cancer， there were 214 cases （96.0%） with interior excess syndrome， and 198 cases （88.8%） with interior deficiency syndrome. For interior excess syndrome， blood excess/blood stasis/liver blood stasis pattern was mostly common seen （84.3%）， followed by

qi

excess/

qi

stagnation/stomach

qi

stagnation pattern （61.9%） and blood excess/blood stasis/liver blood stasis pattern （37.2%）. The most common pattern of interior deficiency syndrome was

qi

deficiency/spleen

qi

deficiency pattern （58.7%）， followed by

qi

deficiency/stomach

qi

deficiency pattern （34.1%） and

yin

deficiency/spleen

yin

deficiency pattern （21.5%）. For patients with distant metastasis，

qi

excess pattern， stomach

qi

deficiency pattern， liver blood stasis pattern， ascending counterflow of stomach

qi

pattern， large intestine

qi

stagnation pattern， and lung blood stasis pattern were all less common compared to those in patients without distant metastasis （

P

＜0.05）. The distribution of

qi

excess pattern， blood excess pattern， blood stasis pattern， spleen

qi

deficiency pattern， stomach

qi

deficiency pattern， gallbladder

qi

deficiency pattern， spleen blood stasis pattern， liver blood stasis pattern and large intestine

qi

stagnation pattern in patients at different clinical stages were statistically different （

P

＜0.05）. Patients with liver metastases from pancreatic cancer had more patterns of stomach

qi

deficiency， gallbladder

qi

deficiency， large intestine

qi

stagnation， ascending counterflow of stomach

qi

and liver blood stasis than those without liver metastasis， as well as less patterns of blood excess and excess heat （

P

＜0.05）. Blood stasis pattern and spleen blood stasis pattern were more common in patients with carcinoma in head than in tail of pancreas， while fluid depletion pattern， spleen

yin

deficiency pattern and ascending counterflow of stomach

qi

pattern were less common （

P

＜0.05）.

Conclusion

2

The TCM syndromes of pancreatic cancer are mostly deficiency-excess complex， with

qi

stagnation， blood stasis，

qi

deficiency and

yin

deficiency as the main patterns， and stomach， spleen and liver as the major locations of disease.