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  • br According to TCM theory the TCMBC of individuals is


    According to TCM theory, the TCMBC of individuals is formed by Yin and Yang, and an imbalance between Yin and Yang in the body can render them more prone to certain diseases.28–30 Several abnormalities underlie the pathogenesis of cancer-related fatigue, including the pro-motion of inflammatory cytokines imbalance, hypothalamus-pituitary-adrenal axis dysfunction, anemia, and cachexia have been postu-lated.31,32 In addition, Yang-deficiency may not only be related to hy-pothalamic-pituitary-adrenal axis and hypothalamic-pituitary-thyroid axis dysfunction, but also to functional disorders of the cyclic nucleo-tide and immune systems.33
    The present study found that patients with Yang-deficiency TCMBC were strongly associated with a higher risk of moderate-to-severe cancer-related fatigue. Yang is the INCB018424 needed for maintaining proper body function, and Yang deficiency can be defined as the decline of energy level. Symptoms of Yang deficiency typically include cool extremities, weak pulse, and aversion to cold temperatures.15 It should be noted that the CCMQ should not be used as a diagnostic tool, but rather as a way to assist syndrome differentiation in TCM practice. The CCMQ is a well-validated instrument that can be used for guiding the treatment approach by Chinese medicine practitioners during disease consultation.
    Fatigue is a highly common and often treatable problem that affects a cancer patient’s quality of life. Therefore, all cancer patients should routinely be screened for fatigue using patient-reported outcome mea-sures.34 Patients with moderate or severe fatigue may benefit from pharmacologic and nonpharmacologic interventions.35 Increasing evi-dence showed that TCM can safely be used as a helpful adjunct to conventional care in the treatment of cancer-related fatigue.10,36 Clin-ical studies have also shown that Yang-deficiency TCMBC could be improved by acupuncture and moxibustion.37,38 Chen et al.39 reviewed the evidence for using TCM in the treatment of chronic fatigue syn-drome. The authors indicated that ginseng root has been the most widely studied herb for fatigue because of its effect of invigorating Qi and Yang. A recent systematic review of Panax ginseng concluded that it is a viable and promising treatment for fatigue in people with chronic 
    illness.40 Moreover, Leong et al. proposed that Yang- and Qi-in-vigorating tonic herbs, such as Cistanches Herba and Schisandrae Fructus, might be beneficial in the treatment of chronic fatigue syndrome through their enhancement in mitochondrial function and regulation.41 It should be noted that while a question on “Do you get tired ea-sily?” was included in the calculation of both the Qi-deficiency TCMBC and Gentleness TCMBC, it measured a different aspect of fatigue com-pared with the BFI-T. The former is an overall subjective feeling of fatigue over a long period of time (in the past year) whereas the BFI-T reflects the short-term (in the past 24 h) symptoms of fatigue. In other words, the one question on fatigue in the TCMBC and the BFI-T are not
    merely overlapped items on fatigue-related issues.
    Some limitations of the current study should be mentioned. First, the sample size is relatively small and thus precluded further subgroup analyses to examine the association of TCMBC with different types of cancer. Second, the study participants were recruited based on con-venience sampling from one regional hospital and therefore, the pos-sibility of selection bias cannot be ruled out.
    5. Conclusions
    The findings of this study indicated that patients with Qi-deficiency TCMBC and Yang-deficiency TCMBC were more susceptible to mod-erate-to-severe cancer-related fatigue. The CCMQ could be served as a clinical tool to identify and cancer patients who are prone to experience moderate-to-severe cancer-related fatigue, and to provide Chinese medicine practitioners a basis for selecting an appropriate treatment approach based on TCMBC. Further studies on effects of prescriptions for balancing Yang and Qi on alleviating moderate-to-severe cancer-related fatigue in cancer patients are warranted.