Evidence-Based Complementary and Alternative Medicine / 2019 / Article / Tab 5

Research Article

Hong Kong Chinese Medicine Clinical Practice Guideline for Cancer Palliative Care: Pain, Constipation, and Insomnia

Table 5

Herbal treatment on cancer pain.

PatternPathogenesis and treatment principleRecipe and ingredient herbsGrading and level

Qi movement stagnationPathogenesis: Liver qi depression, qi depression and blood stagnation
Principle: Soothe the liver and regulate qi, activate blood to relieve pain
Modified Chai Hu Shu Gan San:
Chai Hu (Bupleuri Radix), Qing Pi (Citri Reticulatae Pericarpium Viride), Chen Pi (Citri Reticulatae Pericarpium Viride), Ba Yue Zha (Fruit of Fiverleaf Akebia), Wu Yao (Linderae Radix), Xiang Fu (Cyperi Rhizoma), Chuan Lian Zi (Toosendan Fructus), Hou Pu (Magnoliae Officinalis Cortex), Yan Hu Suo (Corydalis Rhizoma), Zhi Shi (Aurantii Fructus Immaturus), Bai Shao (Paeoniae Radix Alba), Fo Shou (Citri Sarcodactylis Fructus)
Modified Si Ni San:
Chai Hu (Bupleuri Radix), Bai Shao (Paeoniae Radix Alba), Zhi Shi (Aurantii Fructus Immaturus), Gan Cao (Glycyrrhizae Radix Et Rhizoma)
Grading of recommendation: A§
 Level of evidence: Ib [6]

Phlegm-dampness congealingPathogenesis: Water-fluid retention, qi movement stagnation
Principle: Purge the lung to remove water, direct qi downward to relieve pain
Modified Ting Li Da Zao Xie Fei Tang:
Ting Li Zi (Descurainiae Semen Lepidii Semen), Bai Jie Zi (White Mustard Seed), Ban Xia (Pinelliae Rhizoma), Zhe Bei Mu (Fritillariae Thunbergii Bulbus), Dan Nan Xing (Arisaema Cum Bile), Kun Bu (Laminariae Thallus Eckloniae Thallus), Gua Lou (Trichosanthis Fructus), Huang Yao Zi (Dioscorea Bulbifera), Da Zao (Jujubae Fructus), Chen Pi (Citri Reticulatae Pericarpium Viride)
Grading of recommendation: C§
 Level of evidence: IV

Static blood obstructingPathogenesis: Static blood retention, meridians and collaterals obstruction
Principle: Activate blood and resolve stasis, dispel stasis to relieve pain
Modified Tao Hong Si Wu Tang:
Dang Gui (Angelicae Sinensis Radix), Chi Shao (Paeoniaeradix Rubra), Chuan Xiong (Chuanxiong Rhizoma), Dan Shen (Salviae Miltiorrhizae Radix Et Rhizoma), Yan Hu Suo (Corydalis Rhizoma), San Qi (Notoginseng Radix Et Rhizoma), Ru Xiang (Olibanum), Mo Yao (Myrrha)
Modified Fu Yuan Huo Xue Tang:
Chai Hu (Bupleuri Radix), Tian Hua Fen (Trichosanthis Radix), Dang Gui (Angelicae Sinensis Radix), Hong Hua (Carthami Flos), Gan Cao (Glycyrrhizae Radix Et Rhizoma), Chuan Shan Jia (Manis Squama), Da Huang (Rhei Radix Et Rhizoma), Tao Ren (Persicae Semen)
Grading of recommendation: B§
 Level of evidence: IIa [6]

Qi stagnation and blood stasisPathogenesis: Qi movement stagnation, static blood retention
Principle: Activate blood and resolve stasis, move qi to relieve pain
Modified Ge Xia Zhu Yu Tang:
Wu Ling Zhi (Faeces Trogopterpri), Dang Gui (Angelicae Sinensis Radix), Chuan Xiong (Chuanxiong Rhizoma), Tao Ren (Persicae Semen), Mu Dan Pi (Moutan Cortex), Chi Shao (Paeoniaeradix Rubra), Wu Yao (Linderae Radix), Yan Hu Suo (Corydalis Rhizoma), Gan Cao (Glycyrrhizae Radix Et Rhizoma), Xiang Fu (Cyperi Rhizoma), Hong Hua (Carthami Flos), Zhi Qiao (Aurantii Fructus)
Modified Xue Fu Zhu Yu Tang:
Tao Ren (Persicae Semen), Hong Hua (Carthami Flos), Dang Gui (Angelicae Sinensis Radix), Di Huang (Rehmanniae Radix), Niu Xi (Achyranthis Bidentatae Radix), Chuan Xiong (Chuanxiong Rhizoma), Jie Geng (Platycodonis Radix), Chi Shao (Paeoniaeradix Rubra), Zhi Qiao (Aurantii Fructus), Gan Cao (Glycyrrhizae Radix Et Rhizoma), Chai Hu (Bupleuri Radix)
Grading of recommendation: B§
 Level of evidence: IIa [710]

Combination of phlegm and blood stasisPathogenesis: Depressed gallbladder with harassing phlegm, static blood internal bind
Principle: Regulate qi to resolve phlegm, activate blood to relieve pain
Modified Wen Dan Tang:
Ban Xia (Pinelliae Rhizoma), Zhu Ru (Bambusae Caulis In Taenias), Zhi Shi (Aurantii Fructus Immaturus), Chen Pi (Citri Reticulatae Pericarpium Viride), Gan Cao (Glycyrrhizae Radix Et Rhizoma), Fu Ling (Poria)
Modified Xue Fu Zhu Yu Tang:
Tao Ren (Persicae Semen), Hong Hua (Carthami Flos), Dang Gui (Angelicae Sinensis Radix), Di Huang (Rehmanniae Radix), Niu Xi (Achyranthis Bidentatae Radix), Chuan Xiong (Chuanxiong Rhizoma), Jie Geng (Platycodonis Radix), Chi Shao (Paeoniaeradix Rubra), Zhi Qiao (Aurantii Fructus), Gan Cao (Glycyrrhizae Radix Et Rhizoma), Chai Hu (Bupleuri Radix)
Modified Si Wu Tang plus Er Chen Tang:
Dang Gui (Angelicae Sinensis Radix), Chi Shao (Paeoniaeradix Rubra), Chuan Xiong (Chuanxiong Rhizoma), Di Huang (Rehmanniae Radix), Chen Pi (Citri Reticulatae Pericarpium Viride), Fa Ban Xia (Pinelliae Rhizoma Praeparatum), Fu Ling (Poria), Gan Cao (Glycyrrhizae Radix Et Rhizoma), Hai Zao (Sargassum), Hong Hua (Carthami Flos), Xiang Fu (Cyperi Rhizoma), Mu Dan Pi (Moutan Cortex)
Grading of recommendation: B§
 Level of evidence: IIa [811]

Qi and blood deficiencyPathogenesis: Dual deficiency of qi and blood, viscera and bowels with cachexia
Principle: Tonify and harmonize the blood, resolve stasis to relieve pain
Modified Si Wu Tang:
Shu Di Huang (Rehmanniae Radix Praeparata), Bai Shao (Paeoniae Radix Alba), Dang Gui (Angelicae Sinensis Radix), Chuan Xiong (Chuanxiong Rhizoma), Huang Qi (Astragali Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma)
Grading of recommendation: C§
 Level of evidence: IV