益气养阴化痰祛瘀法治疗中晚期胃癌的研究
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摘要
胃癌是发生在胃上皮组织的恶性肿瘤，是全世界最常见的恶性肿瘤。在中国胃癌死亡率占所有恶性肿瘤死亡的23.02％，居各类肿瘤之首。临床病理切片根据其转移与浸润深度分为四期。胃癌临床表现隐匿，诊断后能手术根治者仅占35％左右，根治切除后的5年生存率仅为50％-60％，因此寻求更加有效的治疗方法，已成为迫在眉睫的问题。论文以中医理论为指导，基于导师刘沈林教授研究诊治中晚期胃癌的学术思想，探索和深化中医药对中晚期胃癌的认识，防治理论和临床研究。
通过中国传统中医学对中晚期胃癌的认识历代文献梳理，可以看出，中医对这类病证的认识分为四个时期，(1)春秋战国至东汉末年，为初步形成时期，对于胃癌相关的症状，病因与发病，诊治与预后的有了一定的认识。(2)晋、隋、唐是研究与发展时期，关于胃癌相关病证的体征上有了更深一步的描述，治疗上出现了更多的方法。(3)宋金元是充实时期，这个时期产生了诸多医学流派，也产生了很多学术观点，充实了胃癌相关病症认识。(4)明、清是一个系统与初步完善时期，出现了许多关于前人观点的系统记载的著作，不论是在理论上，还是临床运用上都达到了系统与初步完善的程度。充分挖掘中国医学文献宝库，并以此为切入点，探讨传统中医对于中晚期胃癌的辨证论治规律并指导临床实践，将对当代中晚期胃癌中医治疗学的发展具有重要意义。通过总结分析古代文献，研究了古代中医关于胃癌的论述，并结合现代医家研究成果，分析了中晚期胃癌的病因病机，论述了胃癌的传统中医之辩证治疗方法。
恩师刘沈林教授在运用中医药调治中晚期胃癌的实践中，探索出一条行之有效的辨治之路，形成了别具一格的学术思想和用药特色。本文以临床侍诊体会为基础，主要从治法着手，兼顾病因病机、组方、用药，采用理论研究和经验介绍相结合的方法，力求在深层次上展示和探析刘沈林教授辨治中晚期胃癌的学术思想。导师认为脾虚是该病的发病根本，基本病机是气阴两虚、痰湿毒瘀。包括舌诊经验、扶正健脾、温振阳气等治法特点和临床治疗路径等。并据此，确立了益气养阴，化痰祛瘀法的治疗方法，拟复方芪冬汤为部分胃癌患者提供更为有效的治疗方法，亦能为进一步研制抗中晚期胃癌中药制剂打下基础。最后例举了导师诊治中晚期胃癌的病隅4例。综述对目前中晚期胃癌治疗存在的问题作了探讨。
Currently Gastric Cancer (GC) is one of the most commonly foundmalignant tumor worldwide, it refers to the malignant tumor arisingfrom gastric epithelial tissue. Among all the diseased death rate,23.02％of death is due to malignant tumors, it also rank top amongall malignant tumors. GC has four distinctive stages depending bythe depth of its transference and infiltration. After radical surgery andright treatment, 50％-60％of patients can survive for another five years.Therefore, seeking an effective treatment has become a priority need.
The renowned Professor Liu Shen Lin has made a break throughacademic theory for the GC patients. In his research, he investigatedthe etiology, pathogenesis and treatment of midst-late gastric cancerfrom Tradition Chinese Medicine (TCM) point of view, through clinicalresearch and animal studies, created Shen Yi Jian Zhong Tang (SYJZ)and tested efficaciously for the midst-late gastric cancer patients.According to the ancient TCM gastric cancer, this particular diseaseand syndrome can be divided into four stages:
1) Initial Forming Period
It evolved around Spring/Autumn Period and Warring States Period tothe late years of the Eastern Han Dynasty.
2) Investigation & Development Period
This took place in the Jin, Sui and Tang Dynasty.
3) The Substantial Period
It was officially substantiated during Song Dynasty to the Jin/YuanDynasties.
4) The Consummate Period
During the Ming and Qing Dynasties, ancient TCM scholars started tofocus on theoretic study and analyzed the etiology and pathogenesis ofadvanced midst-late gastric cancer, discussed the different treatmentmethods with ancient TCM theories and precise medical prescriptions.
With Professor Liu's excellent academic research and experience oftreating gastrointestinal carcinoma, he successfully created aneffective treatment in accordance to differentiation. After two yearsof intensive learning in his clinic and guidance, I completed thisdoctoral thesis, mainly focused on treatment principle, etiology,formula and prescription.
By reviewing his theory and experience simultaneously, my thesiselevated professor Liu's treating gastrointestinal carcinoma to ahigher lever. Through two years of thorough research, I concludedthat insufficiency of spleen is the intrinsic factor of this disease. Itsbasic pathogenesis is the deficiency of spleen Qi and the obstructionof dampness, poison and stasis.
Besides that my experiences in precise tongue diagnosed is alsoincluded in my thesis, through the tongue analysis, it enable me cureproblem differently according to different patients symptoms, whichrange from strengthening the body resistance, invigorating the spleenand warming and inspiring Yang Qi. Also, experiences in selecting thecorrect prescription, etc.
All in all, the main therapeutic principle for advanced gastric canceris benefiting vital energy, nourishing Yin, eliminating sputum andremoving blood stasis. Fu Fang Qi Dong Tang is created particularly tosolve the above problems. Not only this prescription has beenclinically tested effective, it has also been manufactured andcirculated to patients. To support my theory, four typical cases areintroduced in detail, problems are also being highlighted and how theyare being solved clinically.
通过中国传统中医学对中晚期胃癌的认识历代文献梳理，可以看出，中医对这类病证的认识分为四个时期，(1)春秋战国至东汉末年，为初步形成时期，对于胃癌相关的症状，病因与发病，诊治与预后的有了一定的认识。(2)晋、隋、唐是研究与发展时期，关于胃癌相关病证的体征上有了更深一步的描述，治疗上出现了更多的方法。(3)宋金元是充实时期，这个时期产生了诸多医学流派，也产生了很多学术观点，充实了胃癌相关病症认识。(4)明、清是一个系统与初步完善时期，出现了许多关于前人观点的系统记载的著作，不论是在理论上，还是临床运用上都达到了系统与初步完善的程度。充分挖掘中国医学文献宝库，并以此为切入点，探讨传统中医对于中晚期胃癌的辨证论治规律并指导临床实践，将对当代中晚期胃癌中医治疗学的发展具有重要意义。通过总结分析古代文献，研究了古代中医关于胃癌的论述，并结合现代医家研究成果，分析了中晚期胃癌的病因病机，论述了胃癌的传统中医之辩证治疗方法。
恩师刘沈林教授在运用中医药调治中晚期胃癌的实践中，探索出一条行之有效的辨治之路，形成了别具一格的学术思想和用药特色。本文以临床侍诊体会为基础，主要从治法着手，兼顾病因病机、组方、用药，采用理论研究和经验介绍相结合的方法，力求在深层次上展示和探析刘沈林教授辨治中晚期胃癌的学术思想。导师认为脾虚是该病的发病根本，基本病机是气阴两虚、痰湿毒瘀。包括舌诊经验、扶正健脾、温振阳气等治法特点和临床治疗路径等。并据此，确立了益气养阴，化痰祛瘀法的治疗方法，拟复方芪冬汤为部分胃癌患者提供更为有效的治疗方法，亦能为进一步研制抗中晚期胃癌中药制剂打下基础。最后例举了导师诊治中晚期胃癌的病隅4例。综述对目前中晚期胃癌治疗存在的问题作了探讨。
Currently Gastric Cancer (GC) is one of the most commonly foundmalignant tumor worldwide, it refers to the malignant tumor arisingfrom gastric epithelial tissue. Among all the diseased death rate,23.02％of death is due to malignant tumors, it also rank top amongall malignant tumors. GC has four distinctive stages depending bythe depth of its transference and infiltration. After radical surgery andright treatment, 50％-60％of patients can survive for another five years.Therefore, seeking an effective treatment has become a priority need.
The renowned Professor Liu Shen Lin has made a break throughacademic theory for the GC patients. In his research, he investigatedthe etiology, pathogenesis and treatment of midst-late gastric cancerfrom Tradition Chinese Medicine (TCM) point of view, through clinicalresearch and animal studies, created Shen Yi Jian Zhong Tang (SYJZ)and tested efficaciously for the midst-late gastric cancer patients.According to the ancient TCM gastric cancer, this particular diseaseand syndrome can be divided into four stages:
1) Initial Forming Period
It evolved around Spring/Autumn Period and Warring States Period tothe late years of the Eastern Han Dynasty.
2) Investigation & Development Period
This took place in the Jin, Sui and Tang Dynasty.
3) The Substantial Period
It was officially substantiated during Song Dynasty to the Jin/YuanDynasties.
4) The Consummate Period
During the Ming and Qing Dynasties, ancient TCM scholars started tofocus on theoretic study and analyzed the etiology and pathogenesis ofadvanced midst-late gastric cancer, discussed the different treatmentmethods with ancient TCM theories and precise medical prescriptions.
With Professor Liu's excellent academic research and experience oftreating gastrointestinal carcinoma, he successfully created aneffective treatment in accordance to differentiation. After two yearsof intensive learning in his clinic and guidance, I completed thisdoctoral thesis, mainly focused on treatment principle, etiology,formula and prescription.
By reviewing his theory and experience simultaneously, my thesiselevated professor Liu's treating gastrointestinal carcinoma to ahigher lever. Through two years of thorough research, I concludedthat insufficiency of spleen is the intrinsic factor of this disease. Itsbasic pathogenesis is the deficiency of spleen Qi and the obstructionof dampness, poison and stasis.
Besides that my experiences in precise tongue diagnosed is alsoincluded in my thesis, through the tongue analysis, it enable me cureproblem differently according to different patients symptoms, whichrange from strengthening the body resistance, invigorating the spleenand warming and inspiring Yang Qi. Also, experiences in selecting thecorrect prescription, etc.
All in all, the main therapeutic principle for advanced gastric canceris benefiting vital energy, nourishing Yin, eliminating sputum andremoving blood stasis. Fu Fang Qi Dong Tang is created particularly tosolve the above problems. Not only this prescription has beenclinically tested effective, it has also been manufactured andcirculated to patients. To support my theory, four typical cases areintroduced in detail, problems are also being highlighted and how theyare being solved clinically.
引文
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