Chinese Herbal Medicine Combined With Liuzijue Exercise in Physiological Rehabilitation After Video-assisted Lung Lobectomy for Cancer: A Prospective Propensity Score Matching Study

Abstract

Objective:

To observe the clinical efficacy of Chinese herbal medicine combined with Liuzijue exercise on the physiological symptoms and quality of life (QoL) in postoperative patients with early-stage lung cancer.

Methods:

One hundred and eighty-three lung cancer patients who underwent video-assisted thoracoscopic surgery (VATS) were categorize into either a traditional Chinese medicine treatment group (CM) or a control group (non-traditional Chinese medicine treatment, NC), among whom 73 underwent Chinese herbal medicine and Liuzijue therapy, while 110 underwent no comprehensive treatment with traditional Chinese medicine. The propensity score matching (PSM) method with a 1:2 ratio was used to balance the baseline characteristics and evaluate the efficacy of CM in improving postoperative symptoms and QoL.

Results:

Cough, dyspnea, chest pain, and fatigue were the most common clinical symptoms after VATS. Except for chest pain, they were all correlated with the scope of operation (P < .05). After PSM, 165 patients were identified in the matched cohort, and the covariates of gender, age, operative site, and scope of operation were balanced between the 2 groups (P > .05). In the domain of global health status, the improvement in QoL in CM was greater than that in NC (6.06 ± 15.83 vs −1.06 ± 14.68, P = .005). In terms of symptoms, improvements in cough (1.69 ± 3.15 vs 0.38 ± 2.63, P = .006), dyspnea during climbing stairs (−10.30 ± 16.82 vs −1.82 ± 17.97, P = .004), and pain (−0.76 ± 1.32 vs −0.08 ± 1.31, P = .002) in CM were better than in NC.

Conclusion:

Comprehensive treatment with traditional Chinese medicine (TCM) can provide therapeutic benefits in physiological rehabilitation after VATS for cancer.

Keywords

Chinese medicine comprehensive treatment lung cancer postoperative physiological rehabilitation quality of life

Introduction

Lung cancer continues to be the leading cause of cancer-related deaths in 2023.¹ Radical operation remains the most effective treatment for early-stage non-small cell lung cancer (NSCLC), and VATS has been firmly established as the preferred operative approach for curative resection.^2,3 Compared to the traditional thoracotomy approach for lobectomy, VATS offers numerous advantages, including a shorter hospital stay, faster recovery, fewer perioperative complications, and improved long-term survival.⁴

Khullar et al⁵ found that 1 month after the operation, lung cancer patients experienced a significant increase in pain, fatigue, and sleep disorders, resulting in a decline in their physical functions. Over 70% of postoperative patients reported symptoms such as fatigue, dyspnea, cough, and expectoration during the first month. Although these symptoms tended to subside between the second and fourth months, >60% of the patients still experienced them.⁶

Pulmonary rehabilitation programs can enhance respiratory muscle strength and aerobic capacity, thereby alleviating symptoms.⁷ However, despite patients’ willingness to participate in exercise after lung cancer surgery, participation remains insufficient due to misconceptions.⁸

Chinese herbal medicine, with its multi-component and multi-target characteristics and strong safety profile, is guided by a holistic concept and syndrome differentiation and demonstrates remarkable clinical effects in improving symptoms.⁹ Traditional Chinese exercises, including tai chi, Liuzijue, Wuqinxi, and Yijinjing, have a positive impact on patients with lung diseases.¹⁰ Among them, Liuzijue is a type of traditional recreational exercise known as “qigong” that promotes both physical and mental health.¹¹ Liuzijue is distinguished by its unique set of special breathing and pronunciation techniques, which involve exhaling with the sounds “Xu,” “He,” “Hu,” “Si,” “Chui,” and “Xi.” These techniques are unique in balancing the energy and functions of the internal organs, particularly the lungs. The movements are simple and soothing, making it easier for postoperative patients to embrace them.

As our previous study demonstrated, for patients with stage Ia to Ib NSCLC who underwent VATS, the combination of Chinese herbal medicine and lung rehabilitation training (such as cycling or jogging) was found to alleviate cough and fatigue symptoms more effectively than a placebo combined with rehabilitation education.¹² This study further examined the clinical efficacy of combining Chinese herbal medicine with Liuzijue exercise in terms of physiological symptoms and quality of life (QoL) among postoperative patients with early-stage lung cancer. Here, we present the findings on symptoms and QoL outcomes.

Methods

Study Population

The inclusion criteria were as follows: (1) NSCLC patients 4 to 6 weeks after VATS with stage Ia to Ib; (2) no adjuvant Western medicine treatment, such as chemotherapy, radiotherapy, or targeted therapy after surgery; (3) has a performance status (PS) score of 0 to 2 points; and (4) signed informed consent. The exclusion criteria were as follows : (1) more than 6 weeks after VATS; (2) with a mental illness or has difficulty completing the QoL scale; and (3) allergic to the study drug or is undergoing other clinical trials.

Trial Design and Treatment

The trial was based on the principles of contemporaneous, parallel and control, and used the method of prospective PSM. The patients were divided into CM and NC groups according to their willingness to receive the comprehensive treatment with TCM. The clinical trial was retrospectively registered: ChiCTR2100044843. This project was approved by the Ethics Committee of Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine (No: 2020-038). All participants signed the informed consent before taking part in this study and any intervention.

All enrolled patients received symptomatic and supportive Western medicine treatment following the Chinese Guidelines for Perioperative Airway Management in Thoracic Surgery (2020 edition). NC patients were treated with rehabilitation education and allowed to do their own breathing training at home at least once a day for 30 minutes each time. CM patients were treated with the comprehensive TCM treatment, including oral Chinese medicine and improved Liuzijue exercise. Both groups were treated and observed for 8 weeks after enrollment.

CM Prescription and Improved Liuzijue Exercise

Symptoms after lung cancer surgery are divided into 3 basic syndromes: wind invading the lung, stagnation of Qi and accumulation of phlegm, or deficiency of the lung and spleen (Table 1). One experienced TCM physician with a senior professional title was assigned to syndrome differentiation. Details of the specific medication and dosage of the prescription are shown in Supplemental Table S1. All the oral Chinese medicine decoctions came from the TCM pharmacy of Yueyang Hospital. The decoction process strictly followed the Good Manufacturing Practice (GMP) system. The herbs were decocted with water and divided into 2 bags of 150 mL of liquid. Patients took it twice a day, one bag each time, for 8 consecutive weeks.

Table 1.

TCM Syndrome Differentiation and CM Prescription*.

TCM syndrome differentiation	Main symptoms	Tongue and pulse manifestation	CM prescription
Wind invading the lung	Itchy throat and dry cough, no phlegm or little phlegm and sticking into strands, unpleasant expectoration	Red tongue with thin and dry coating, floating pulse	Modified Sangju Decoction
Stagnation of Qi and accumulation of phlegm	The throat seems to be blocked by something, unable to vomit or swallow, chest and flank fullness and pain, or coughing and wheezing, or nausea and vomiting, or dizziness	Pale red tongue with white or greasy coating, stringy pulse	Banxia Houpo Decoction
Deficiency of lung and spleen	Shortness of breath, or struggling to breathe, wheezing, coughing with phlegm, or abdominal distension and loose stools, or chest tightness, or dizziness and forgetfulness	Pale red tongue with thin white coating, thin or weak pulse	Shengxian Decoction

Based on the Chinese medicine industry standard of the People’s Republic of China “Traditional Chinese Medicine Syndrome Diagnosis and Efficacy Standards” (ZY/T001.1-94).

Improved Liuzijue exercise included warm-up, breathing training, qigong, and relaxation. The specific training method is shown in Supplemental Table S2 and Figure S1. Professional doctors provided guidance on improved Liuzijue exercise and distributed teaching videos to ensure that each patient could master and independently complete them. Patients exercised at least once a day for 30 minutes each time for 8 consecutive weeks, and they were required to record their exercise duration, location, and completeness. Daily exercise was supervised separately by 3 follow-up physicians.

Outcomes

The primary endpoint of this trial was QoL, which was assessed using the QLQ-C30 and QLQ-LC13 scales¹³ developed by the European Organization for Research and Treatment of Cancer (EORTC) to assess QoL. The secondary endpoint was physiological symptom assessment, such as using the Leicester cough quality of life questionnaire (LCQ)¹⁴ to evaluate cough, Q3-Q5 in QLQ-LC13 to evaluate dyspnea, and the numerical rating scale (NRS)^15,16 to evaluate pain. Following the Common Terminology Criteria for Adverse Events (CTCAE) 5.0, routine blood examinations and serum biochemical tests were used to determine the safety of test administration.

Statistical Analysis

According to the previous research results of this trail, based on the validity hypothesis, QoL improved by 40% in CM and 22% in NC. The ratio of cases between CM and NC was 1:1. Using PASS 11.0 software with α = .05 and 1-β = .80, the sample size was calculated to be 113 cases in each group. However, due to the COVID-19 epidemic, we ultimately enrolled 73 patients in CM and 110 patients in NC.

This was a non-randomized intervention study. Gender, age, and the scope and site of operation were used as variables for balancing and matching groups for PSM. PSM was performed with Stata/SE. For the comparability of the 2 cohorts and to reduce censoring, CM and NC were nearest-neighbor matched at a ratio of 1:2 to obtain the final cohort for analysis.

SPSS 26.0 software was used for statistical processing. Normally distributed measurement data were analyzed using a t-test, while measurement data that did not conform to the normal distribution were analyzed using the Wilcoxon rank-sum test. Enumeration data were analyzed using a chi-squared test. Correlation analysis was done using Spearman’s correlation coefficient, and multivariate analysis was done using linear regression or logistic regression. P < .05 was considered statistically significant.

Results

Patient Disposition and Characteristics

From July 2020 to January 2022, there were 203 patients screened at Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine and Shanghai Pulmonary Hospital. Twenty cases failed the screening, and 183 patients who met the inclusion criteria were subjected to PSM. Ultimately, 55 and 110 patients were included in CM and NC, respectively (Figure 1).

Figure 1.

Study flow diagram.

Before PSM, the distributions of patients in CM and NC were different, and the baseline was unbalanced. After PSM, there was no significant difference between the 2 groups in terms of gender, age, operative site, and scope of operation (P > .05) (Table 2). It was found that the matching effect was good after testing the matching common support domain (Supplemental Figure S2).

Table 2.

Baseline demographic and clinical characteristics before and after PSM.

Domain	Before PSM				After PSM
Domain	CM (n = 73)	NC (n = 110)	Total (n = 183)	P-value	CM (n = 55)	NC (n = 110)	Total (n = 165)	P-value
Gender, n (%)				.010				.069
Male	17 (23.28)	46 (41.82)	63 (34.43)		15 (27.27)	46 (41.82)	61 (36.97)
Female	56 (76.72)	64 (58.18)	120 (65.57)		40 (72.73)	64 (58.18)	104 (63.03)
Age, n (%)				.005				.085
Mean ± SD	57.64 ± 10.97	52.35 ± 13.14	54.46 ± 12.56		55.91 ± 10.86	52.35 ± 13.14	53.54 ± 12.51
Age < 65	48 (65.75)	93 (84.55)	141 (77.05)		40 (72.73)	93 (84.55)	133 (80.61)
Age ≥ 65	25 (34.25)	17 (15.45)	42 (22.95)		15 (27.27)	17 (15.45)	32 (19.39)
Operative site, n (%)				.950				.395
Left lung	25 (34.25)	46 (41.82)	71 (38.80)		20 (36.36)	46 (41.82)	66 (40.00)
Right lung	46 (63.01)	63 (57.27)	109 (59.56)		33 (60.00)	63 (57.27)	96 (58.18)
Bilateral lungs	2 (2.74)	1 (0.91)	3 (1.64)		2 (3.64)	1 (0.91)	3 (1.82)
Scope of operation, n (%)				.001				.079
Lobectomy	31 (42.45)	39 (35.46)	70 (38.25)		18 (32.73)	39 (35.46)	57 (34.54)
Segmentectomy	25 (34.25)	19 (17.27)	44 (24.04)		20 (36.36)	19 (17.27)	39 (23.64)
Wedge resection	10 (13.70)	6 (5.45)	16 (8.75)		10 (18.18)	6 (5.45)	16 (9.70)
Partial resection	7 (9.60)	46 (41.82)	53 (28.96)		7 (12.73)	46 (41.82)	53 (32.12)

Characteristics of Physiological Changes After VATS

The EORTC QLQ-C30 and QLQ-LC13 scales were used to analyze the total QoL of 183 patients before PSM. Before treatment, the Global Health Status score of patients was 70.81 ± 19.08. In terms of function, the scores from low to high are role, social, physical, emotional, and cognitive, and the differences in various domains are statistically significant (Figure 2A, P < .01). In terms of symptoms, fatigue, dyspnea, and insomnia scored higher than others(Figure 2B, P < .01). For the lung cancer module, cough, dyspnea, and chest pain scored higher than others (Figure 2C, P < .01).

Figure 2.

(A-C) EORTC QLQ-C30 and QLQ-LC13 scores before PSM. Univariate ANOVA analysis was performed on the 3 parts of data in (A-C) P < .01. (D) Heat Map. Spearman’s rho was performed. *Correlation is significant at the .05 level (2-tailed). **Correlation is significant at the .01 level (2-tailed).

The most obvious postoperative symptoms included fatigue, dyspnea, cough, and chest pain, which were selected to explore the correlation between symptoms and gender, age (<65 years old or ≥ 65 years old), and surgical methods. Spearman correlation analysis showed that fatigue was correlated with gender, age, and scope of operation, dyspnea was correlated with age and scope of operation, and cough was correlated with scope of operation. Then, statistically significant indicators were analyzed by linear regression analysis, which showed that gender and age were independent influencing factors of fatigue, and scope of operation was an independent influencing factor of dyspnea and cough (Figure 2D).

Comprehensive Treatment With TCM in Physiological Rehabilitation

The influence of comprehensive treatment with TCM on QoL

The scores before and after treatment (8 weeks) are shown in Supplemental Table S3. The difference value was obtained by subtracting the score before treatment from that after treatment. In the domains of global health status and dyspnea, the improvement of QoL in CM was greater than that in NC (Figure 3A-C, P < .01). An analysis of the proportion of patients whose QoL scores improved, remained stable, or worsened in the 2 groups revealed that in domains such as global health status, cough, dyspnea, and pain, the curative effect of CM was superior to that of NC. (Figure 3D-F).

Figure 3.

(A-C) The mean change from baseline of QLQ-C30 and QLQ-LC13 scores. (A) EORTC QLQ-C30 function domains and global health status; (B) EORTC QLQ-C30 symptom domains; (C) EORTC QLQ-LC13 scales. All items were consistent with normality, and independent sample T test was used. (D-F) Proportion of patients with improved, stable and worsened quality of life. * P < .05,** P < .01.

The influence of comprehensive treatment with TCM on common symptoms

Cough The LCQ is a 19-item questionnaire that assesses cough. After 8 weeks, the total score increased by 1.69 ± 3.15 in CM and 0.38 ± 2.63 in NC (P = .006). The variations in domain scores between the 2 groups were statistically significant (Figure 4A and B).

Figure 4.

(A) The LCQ domain scores to assess cough. (B) The mean change from baseline of LCQ. (C) The Q3-Q5 in QLQ-LC13 scores to assess dyspnea. (D) The mean change from baseline of Q3-Q5. All items were consistent with normality, and independent sample T test was used.* P < .05,** P < .01 . (E) The NRS pain intensity.

Dyspnea Q3-Q5 in QLQ-LC13 were used to assess dyspnea during rest, walking, and climbing stairs. After treatment, the difference in scores when climbing stairs between the 2 groups was statistically significant (Figure 4C and D, P = .004).

Pain The NRS was used to assess pain. There were no significant differences in NRS scores and pain intensity between the 2 groups before and after treatment (Supplemental Table S4, Figure 4E). However, the difference values were statistically significant: −0.76 ± 1.32 in CM and −0.08 ± 1.31 in NC (P = .002).

Improvements in common symptoms such as cough, dyspnea, and pain in CM were better than in NC.

Safety Assessment of Comprehensive Treatment With TCM

Before PSM, 73 patients received comprehensive treatment with TCM. The safety of comprehensive treatment was evaluated through hematology examinations of these 73 patients. Abnormal hematological indicators were observed both before and after treatment. Specifically, before treatment, 4.69% of patients exhibited abnormal white blood cell (WBC) counts, with a maximum of 18.28 × 10⁹/L; 10.94% had abnormal neutrophils (NEUT) levels, with a maximum of 14.73 × 10⁹/L; 12.50% had abnormal hemoglobin (HGB) levels, ranging from a minimum of 91 g/L to a maximum of 151 g/L; 15.62% showed abnormal alanine amino transferase (ALT) levels, ranging from a minimum of 6 U/L to a maximum of 124 U/L; 12.50% had abnormal aspartate amino transferase (AST) levels, ranging from a minimum of 11 U/L to a maximum of 60 U/L; and 3.12% had abnormal creatinine (Cr), with a maximum of 98 µmol/L. Following treatment, the values were closer to normal.

According to the evaluation using CTCAE 5.0, there were some adverse events (AEs) both before and after treatment, all of which were Grades 1 to 2 (Table 3). During the entire treatment process, there were no Grade 3-5 AEs, no severe adverse events (SAEs), no AEs related to the medication, no participants who withdrew from the study or stopped the trial, and no deaths that occurred due to AEs.

Table 3.

Summary of adverse events (Grade 1-2) [n (%)].

	Before treatment(baseline)	After treatment(8 wk)
Hemoglobin concentration decrease	7 (12.73)	5 (9.09)
Hemoglobin concentration increase	1 (1.82)	0 (0)
ALT increase	9 (16.36)	0 (0)
AST increase	5 (9.09)	0 (0)
Creatinine increase	2 (3.64)	0 (0)

Discussion

This study revealed that the most troublesome symptoms experienced by patients with lung cancer after surgery were fatigue, dyspnea, cough, and chest pain, which seriously impact the QoL of these patients. Following VATS, lung tidal volume decreases, while the residual volume increases due to chest wall damage, respiratory muscle ruptures, and nerve reflex inhibition.¹⁷ Ventilation function decreases, resulting in a subsequent reduction in maximum oxygen consumption and a significant decline in exercise tolerance.¹⁸ Therefore, postoperative lung cancer patients often experience chest tightness, dyspnea, and fatigue. The cause of postoperative cough is related to the depth and scope of lymph node dissection. During this process, the main trachea is affected to some extent. After the cleaning, the lymph node fossa remains empty and lacks support around the main trachea. The receptors are exposed, causing irritation and cough.¹⁹ In addition, anatomical and physiological changes resulting from pulmonary resection are other crucial factors, and alterations in airflow dynamics or airway sensitivity during respiration can also trigger coughing.²⁰ Chronic persistent pain after surgery represents a significant clinical challenge in 25% to 60% of patients, with neuropathic components stemming from injury or irritation of the intercostal nerve. This pain is primarily described as aching, tender, numb, and, to a lesser extent, burning.²¹ Although VATS reduces acute postoperative pain by minimizing surgical incision, mitigating intercostal nerve damage, and preserving the integrity of the chest wall, chronic persistent pain following surgery still persists.

Previous studies have confirmed that the most prominent postoperative symptoms can be traced to specific causes, emphasizing the significance of physiological rehabilitation after surgery. In 2013, the American Thoracic Society (ATS) and the European Respiratory Society (ERS) proposed the concept of “pulmonary rehabilitation.”²² In addition to taking antispasmodic cough and analgesic drugs, effective breathing, active coughing, and other lung function training can help smooth the discharge of sputum, effusion, and gas; reduce the pain caused by respiratory dilation exercise; and greatly improve lung ventilation.^23,24 Surgeons encourage patients to climb stairs, blow balloons, or use respiratory trainers early after surgery to improve lung function. They also recommended performing incision-site stretching exercises to prevent chronic pain resulting from pleural adhesions, thereby promoting postoperative recovery.

However, we found that patients do not receive timely pulmonary rehabilitation training due to various issues. After surgery, patients are prone to fatigue, and even slight activities can lead to dyspnea. Consequently, they are typically more inclined to rest in bed or in a sitting position, neglecting lung rehabilitation training. Furthermore, patients tend to resist local stretching exercises due to incision pain or fear of incision rupture. In this study, regardless of whether the patients were in CM or NC, we conducted close follow-ups for each patient. This approach helped dispel any misunderstandings, encouraged patients to adhere to postoperative pulmonary rehabilitation training, and contributed to the physiological recovery of patients to a certain extent.

According to the TCM theory, Qi (vital energy) is regarded as the driving force behind biological activities in the human body, encompassing both nutrient substances and organ functions.²⁵ Qi deficiency, Qi depression, Qi stagnation, Qi inversion, and other states affect the normal physiological functions of the patient’s body. A Sangju decoction can inhibit wind, diffuse lung Qi, and suppress cough,²⁶ which is suitable for patients with Qi inversion based on syndrome differentiation. A Banxia Houpo decoction can improve the cough reflex of patients²⁷ and is suitable for patients with Qi stagnation. A Shengxian decoction has been reported to improve energy metabolism and have anti-cancer activity,^28,29 which is suitable for patients with Qi deficiency. Chinese herbal medicine treatment based on syndrome differentiation makes postoperative physiological rehabilitation more targeted. Taking the Banxia Houpo decoction as an example, the Pinellia Tuber in the prescription can regulate Qi and dispel phlegm and is a Chinese herbal medicine that is used to treat cough, insomnia, nausea, inflammation, and epilepsy.³⁰ The Perilla Leaf has been widely used to treat various diseases, such as colds, headaches, and cough, and Perilla leaf ethanolic extract has been proven to suppress the expression and production of TNF-α/IFN-γ-stimulated proinflammatory chemokines by blocking NF-κB, STAT-1, and MAPK activation.³¹ The Poria cocos polysaccharide (PCP) is the major active constituent of Poria; PCP and its derivatives exhibit diverse biological functions, such as antitumor, antioxidant, anti-inflammatory, immune-regulatory, and hepatoprotective functions.³² Research has confirmed that PCP may exhibit immunomodulatory activity through TLR4/TRAF6/NF-κB signaling both in vitro and in vivo.³³ At the same time, Liuzijue exercise can regulate and control the rise and fall of Qi inside the body and related inhalation and exhalation. The exercises are based on the pronunciation of 6 sounds during exhalation, accompanied by typical and simple movements. Safety and efficiency are the strengths of Liuzijue. First, the movements are simple and easy to perform, the exercise load is not too heavy, and the amount and duration of exercise is easy to control, so it is easier to be accepted by patients who neglect or resist postoperative exercise. Second, Liuzijue could improve QoL, exercise tolerance, and lung function,³⁴ which can improve symptoms such as fatigue and dyspnea. Compared with aerobic training, Liuzijue exercise can improve immune homeostasis.³⁵

The results showed that Chinese herbal medicine combined with improved Liuzijue exercise had a good curative effect on physiological rehabilitation, and their safety was also confirmed. No adverse events related to the medication occurred during the whole treatment process. The expression levels of inflammatory markers, such as WBC and NEUT, were correlated with bacterial infection.³⁶ Serum ALT and AST levels increased when hepatocytes were damaged.³⁷The damage was typically caused when the intraoperative administration of fat-soluble and non-depolarized anesthetic drugs surpasses the liver metabolic capacity. This abnormal liver function is most obvious 1 to 3 days after the operation and returns to normal after 7 to 10 days.³⁸ Cr is a product of muscle metabolism. During operation, patients maintain the same position for a long time, and muscle injury easily occurs via muscle pulling and lung tissue excision, which may result in physiologic Cr increase.³⁹

However, due to the limitations of PSM research, only hematological indicators of patients with TCM comprehensive intervention were obtained, and outliers were not excluded during inclusion. Since it was observed that the patients had a tendency to heal themselves in terms of liver function, we did not use liver-protecting drugs to intervene. During the investigation and analysis of these patients, abnormal ultra-high indexes showed a downward trend, and most returned to normal. Additionally, due to the lack of control, the influence of comprehensive treatment with TCM on hematological indicators could not be confirmed exactly, and further randomized controlled trials are needed to prove.

Conclusion

In conclusion, the clinical symptoms exhibited by patients after undergoing VATS for early-stage lung cancer primarily consist of lung-related symptoms, including dyspnea, cough, and phlegm. These symptoms are often accompanied by systemic manifestations, such as fatigue, and local discomforts, such as pain. A comprehensive treatment program utilizing TCM can effectively alleviate these prominent symptoms and enhance the QoL of patients, thus contributing significantly to their physiological recovery.

Supplemental Material

sj-docx-1-ict-10.1177_15347354241261977 – Supplemental material for Chinese Herbal Medicine Combined With Liuzijue Exercise in Physiological Rehabilitation After Video-assisted Lung Lobectomy for Cancer: A Prospective Propensity Score Matching Study

Supplemental material, sj-docx-1-ict-10.1177_15347354241261977 for Chinese Herbal Medicine Combined With Liuzijue Exercise in Physiological Rehabilitation After Video-assisted Lung Lobectomy for Cancer: A Prospective Propensity Score Matching Study by Ao Qi, Yiyun He, Yifeng Gu, Congmeng Zhang, Xiong Qin, Yichao Wang, Yong Yang, Jialin Yao, Huiling Zhou, Wenxiao Yang, Lingzi Su, Qin Wang, Jiajun Song, Lijing Jiao, Yabin Gong, Jiaqi Li and Ling Xu in Integrative Cancer Therapies

Footnotes

Acknowledgements

We thank all patients for participating in this study, completing data collection, and providing laboratory samples.

Authors’ Contributions

AQ, YYH, JQL drafted the paper, LX, YBG designed the study, LJJ critically revised the paper, YFG, CMZ, XQ, YCW, YY, JLY, HLZ, WXY, LZS, QW, JJS provided research materials, patients, laboratory samples, or other analytical tools. All authors read and approved the final manuscript.

Availability of Data and Material

All relevant data and materials are within the manuscript and its additional files.

Consent for Publication

All authors agree to publish this article.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Shanghai Science and Technology Commission “Science and Technology Innovation Action Plan” medical innovation research special project (No. 22Y31920400); Clinical Collaboration Pilot Project of Traditional Chinese and Western Medicine from Shanghai Municipal Health Commission (ZXYXZ-201901); Shanghai University of Traditional Chinese Medicine combined project (YYKC-2021-01-155); and National Natural Science Foundation of China (No. 82104948).

Ethics Approval and Consent to Participate

This project was approved by the Ethics Committee of Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine (No: 2020-038). All participants signed the informed consent before taking part in this study and any intervention.

ORCID iD

Ao Qi

Supplemental Material

Supplemental material for this article is available online.

References

Siegel

Miller

Wagle

Jemal

Cancer statistics, 2023. CA Cancer J Clin. 2023;73:17-48. doi:10.3322/caac.21763

Saito

Hatakeyama

Konno

, et al. Impact of pulmonary rehabilitation on postoperative complications in patients with lung cancer and chronic obstructive pulmonary disease. Thorac Cancer. 2017;8:451-460. doi:10.1111/1759-7714.12466

Howington

Blum

Chang

Balekian

Murthy

SC.

Treatment of Stage I and II non-small cell lung cancer. Chest. 2013;143:e278S-e313S. doi:10.1378/chest.12-2359

Detterbeck

Molins

Video-assisted thoracic surgery and open chest surgery in lung cancer treatment: present and future. J Vis Surg. 2016;2:173-173. doi:10.21037/jovs.2016.11.03

Khullar

Rajaei

Force

, et al. Pilot study to integrate patient reported outcomes after lung cancer operations into the Society of Thoracic Surgeons Database. Ann Thorac Surg. 2017;104:245-253. doi:10.1016/j.athoracsur.2017.01.110

ChunYu

GuangHui

Jie

Symptoms distribution rules of postoperative non-small cell lung cancer patients and intervention effect of modified Shengxian decoction. J Tradit Chin Med. 2020;61:601-606.

Zeng

Jiang

Chen

Cai

Exercise assessments and trainings of pulmonary rehabilitation in COPD: a literature review. Int J Chron Obstruct Pulmon Dis. 2018;13:2013-2023. doi:10.2147/COPD.S167098

Granger

Morris

Holland

AE.

Practical approach to establishing pulmonary rehabilitation for people with non-COPD diagnoses. Respirology. 2019;24:879-888. doi:10.1111/resp.13562

Jiang

, et al. Post-infectious cough of different syndromes treated by traditional Chinese medicines: a review. Chin Herb Med. 2022;14:494-510. doi:10.1016/j.chmed.2022.09.002

10.

Luo

Zhang

Castelberg

, et al. The effects of traditional Chinese exercise in patients with chronic obstructive pulmonary disease: a meta-analysis. PLoS One. 2016;11(9):e0161564. doi:10.1371/journal.pone.0161564

11.

Zhang

, et al. Efficacy of liuzijue qigong in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Complement Ther Med. 2022;65:102809. doi:10.1016/j.ctim.2022.102809

12.

Wang

Jiao

Zhang

, et al. Analysis of clinical efficacy and related factors of ‘treating qi first’ rehabilitation therapy for postoperative symptoms of lung cancer. CJTCMP. 2021;36:2694-2698.

13.

Wan

Zhang

, et al. Validation of the simplified Chinese version of the quality of life instrument EORTC QLQ-LC43 for patients with lung cancer. Cancer Investig. 2008;26:504-510. doi:10.1080/07357900701781788

14.

Lin

Che

Validation of the Mandarin Chinese version of the Leicester Cough Questionnaire in non-small cell lung cancer patients after surgery. Thorac Cancer. 2018;9:486-490. doi:10.1111/1759-7714.12602

15.

Hawker

Mian

Kendzerska

French

Measures of adult pain: Visual Analog Scale for pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), short-form McGill Pain Questionnaire (SF-MPQ), chronic pain grade scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and measure of intermittent and constant osteoarthritis pain (ICOAP). Arthritis Care Res. 2011;63 Suppl 11:S240-S252. doi:10.1002/acr.20543

16.

Hjermstad

Fayers

Haugen

, et al. European Palliative Care Research Collaborative (EPCRC). Studies comparing numerical rating scales, verbal rating scales, and visual analogue scales for assessment of pain intensity in adults: a systematic literature review. J Pain Symptom Manag. 2011;41:1073-1093. doi:10.1016/j.jpainsymman.2010.08.016

17.

Sebio Garcia

Yáñez Brage

Giménez Moolhuyzen

Granger

Denehy

Functional and postoperative outcomes after preoperative exercise training in patients with lung cancer: a systematic review and meta-analysis. Interact Cardiovasc Thorac Surg. 2016;23:486-497. doi:10.1093/icvts/ivw152

18.

Roman

Rossiter

Casaburi

Exercise, ageing and the lung. Eur Respir J. 2016;48:1471-1486. doi:10.1183/13993003.00347-2016

19.

Xing

Chen

, et al. Lymph node dissection is a risk factor for short-term cough after pulmonary resection. Curr Oncol. 2022;29:294-307. doi:10.3390/curroncol29010027

20.

Lavietes

Smeltzer

Cook

Modak

Smaldone

GC.

Airway dynamics, oesophageal pressure and cough. Eur Respir J. 1998;11:156-161. doi:10.1183/09031936.98.11010156

21.

Wildgaard

Ravn

Kehlet

Chronic post-thoracotomy pain: a critical review of pathogenic mechanisms and strategies for prevention☆. Eur J Cardiothorac Surg. 2009;36:170-180. doi:10.1016/j.ejcts.2009.02.005

22.

Spruit

Singh

Garvey

, et al. An official American Thoracic Society/European Respiratory Society Statement: Key Concepts and advances in Pulmonary Rehabilitation. Am J Respir Crit Care Med. 2013;188:e13-e64. doi:10.1164/rccm.201309-1634ST

23.

LSK

Butler

Goldstein

Brooks

. Comparing the impact of different exercise interventions on fatigue in individuals with COPD: A systematic review and meta-analysis. Chron Respir Dis. 2019;16:1479973119894855. doi:10.1177/1479973119894855

24.

Gloeckl

Jarosch

Leitl

, et al. Influence of an acute exacerbation during pulmonary rehabilitation in patients with chronic obstructive pulmonary disease awaiting lung transplantation. J Cardiopulm Rehabil Prev. 2021;41:267-270. doi:10.1097/HCR.0000000000000613

25.

Wang

Peng

Impact of Qi-invigorating traditional Chinese medicines on intestinal flora: A basis for rational choice of prebiotics. Chin J Nat Med. 2017;15:241-254. doi:10.1016/S1875-5364(17)30041-9

26.

Yang

Liu

, et al. Efficacy and influencing factors of Sangju cough mixture in the adjuvant treatment of adult patients with Mycoplasma pneumoniae infection: A retrospective study. Infect Drug Resist. 2024;17:275-282. doi:10.2147/IDR.S438202

27.

Iwasaki

Cyong

Kitada

, et al. A traditional Chinese herbal medicine, banxia houpo tang, improves cough reflex of patients with aspiration pneumonia. J Am Geriatr Soc. 2002;50:1751-1752. doi:10.1046/j.1532-5415.2002.50479.x

28.

You

Zhang

, et al. Chemical and biological evidence of the efficacy of Shengxian decoction for treating human lung adenocarcinoma. Front Oncol. 2022;12:849579. doi:10.3389/fonc.2022.849579

29.

Yang

Han

Gao

, et al. Shengxian decoction protects against chronic heart failure in a rat model via energy regulation mechanisms. BMC Complement Med Ther. 2023;23:200. doi:10.1186/s12906-023-04035-3

30.

Zhang

Ruhsam

, et al. A nucleotide signature for the identification of pinelliae Rhizoma (Banxia) and its products. Mol Biol Rep. 2022;49:7753-7763. doi:10.1007/s11033-022-07600-0

31.

Yang

Yoo

Lee

, et al. Anti-inflammatory effects of perillae herba ethanolic extract against TNF-α/IFN-γ-stimulated human keratinocyte HaCaT cells. J Ethnopharmacol. 2018;211:217-223. doi:10.1016/j.jep.2017.09.041

32.

Zhang

Wang

, et al. A review on the advances in the extraction methods and structure elucidation of Poria cocos polysaccharide and its pharmacological activities and drug carrier applications. Int J Biol Macromol. 2022;217:536-551. doi:10.1016/j.ijbiomac.2022.07.070

33.

Tian

Liu

Bao

Immunomodulatory effects exerted by Poria Cocos polysaccharides via TLR4/TRAF6/NF-κB signaling in vitro and in vivo. Biomed Pharmacother. 2019;112:108709. doi:10.1016/j.biopha.2019.108709

34.

Gao

Wang

, et al. Effect of liuzijue on pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: study protocol for a multicenter, non-randomized, prospective study. BMC Complement Med Ther. 2022;22:296. doi:10.1186/s12906-022-03789-6

35.

Zheng

Liu

, et al. Liuzijue training improves hypertension and modulates gut microbiota profile. Front Cardiovasc Med. 2023;10:1075084. doi:10.3389/fcvm.2023.1075084

36.

Chen

Zhao

Niu

, et al. [The diagnostic value of different pro-inflammatory factor in early diagnosis of sepsis in patients with bloodstream infection]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2014;26:165-170. doi:10.3760/cma.j.issn.2095-4352.2014.03.008

37.

Liu

Feng

, et al. PPARγ alleviates sepsis-induced liver injury by inhibiting hepatocyte pyroptosis via inhibition of the ROS/TXNIP/NLRP3 signaling pathway. Oxid Med Cell Longev. 2022;2022:1-15. doi:10.1155/2022/1269747

38.

Zhang

Shen

Influence of combined acupuncture and drug anesthesia with different pulse frequency on protection of liver function. J Liaoning Univ TCM. 2012;14:64-67.

39.

Cardinale

Cosentino

Moltrasio

, et al. Acute kidney injury after lung cancer surgery: Incidence and clinical relevance, predictors, and role of N-terminal pro B-type natriuretic peptide. Lung Cancer Amst Neth. 2018;123:155-159. doi:10.1016/j.lungcan.2018.07.009

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

3.04 MB