基于人机结合的刘伟胜辨治原发性支气管肺癌用药规律研究
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摘要
目的探讨刘伟胜教授辨治原发性支气管肺癌(简称"肺癌")的用药规律。方法采集刘伟胜教授2009~2014年在广东省中医院诊治的肺癌病案,对其症状、舌象、脉象使用频数统计分析;分别统计手术、放化疗、癌症转移及具体转移部位各自诊次的比例,并分析每个类型的用药频数,比较不同类型用药规律;将所得结果与刘伟胜教授当面访谈交流,并结合相关文献,对结果进行修正补充。结果共纳入408个诊次,其中最常见的症状为咳嗽、眠差、咳痰、气喘等;舌色以暗红、淡红与红色为主;舌苔以薄黄、白腻和黄腻为主;脉象多表现为弦、细、滑。肺癌转移最多的部位是淋巴结、骨和脑。结论刘伟胜教授辨治肺癌的基本病机为本虚标实,手术后患者多用益气养阴药,放化疗患者多用化痰逐瘀散结药。治疗肺癌骨转移时注重补肾培元法的运用,治疗脑转移常用化痰息风、活血祛瘀法。
Objective To explore the medication rules of Professor LIU Weisheng in treating primary bronchogenic carcinoma of lung( "lung cancer" for short). Methods Lung cancer cases treated at Professor LIU′s clinic in Guangdong Provincial Hospital of Chinese Medicine from 2009 to 2014 were collected. The frequency of symptoms, tongue and pulse using in diagnosis were counted. The frequency and respective ratio of surgery, radiotherapy or chemotherapy,cancer metastasis along with the specific metastasis part were calculated and the frequency of treating herbs were counted, and differences of rules among the different treating method were compared and analyzed. The results were revised and supplemented according to special interviews on Professor LIU and pertinent reference literature. Results Totally, 408 cases were included and the most common symptoms were: cough, insomnia, expectoration, asthma, etc.The colors of tongue were mostly dark red, pale and red; most of the tongue moss were thin-yellow, white-greasy and yellow-greasy. The pulses were mainly string, thin, and slippery. The most common parts of cancer metastasis were lymph gland, bone and brain. Conclusion The basic pathogenesis of lung cancer in the cases of Professor LIU is considered asthenia in origin and excess in superficiality. Herbs of supplementing Qi and nourishing Yin are mainly used in the patients after surgery while herbs of resolving phlegm and stasis are commonly used in the patients who have taken radiotherapy or chemotherapy. The method of supplementing kidney is emphasized in the treatment of bone metastasis of lung cancer while the method of resolving phlegm and wind, invigorating the circulation of blood and resolving stasis is often used in brain metastasis.
Objective To explore the medication rules of Professor LIU Weisheng in treating primary bronchogenic carcinoma of lung( "lung cancer" for short). Methods Lung cancer cases treated at Professor LIU′s clinic in Guangdong Provincial Hospital of Chinese Medicine from 2009 to 2014 were collected. The frequency of symptoms, tongue and pulse using in diagnosis were counted. The frequency and respective ratio of surgery, radiotherapy or chemotherapy,cancer metastasis along with the specific metastasis part were calculated and the frequency of treating herbs were counted, and differences of rules among the different treating method were compared and analyzed. The results were revised and supplemented according to special interviews on Professor LIU and pertinent reference literature. Results Totally, 408 cases were included and the most common symptoms were: cough, insomnia, expectoration, asthma, etc.The colors of tongue were mostly dark red, pale and red; most of the tongue moss were thin-yellow, white-greasy and yellow-greasy. The pulses were mainly string, thin, and slippery. The most common parts of cancer metastasis were lymph gland, bone and brain. Conclusion The basic pathogenesis of lung cancer in the cases of Professor LIU is considered asthenia in origin and excess in superficiality. Herbs of supplementing Qi and nourishing Yin are mainly used in the patients after surgery while herbs of resolving phlegm and stasis are commonly used in the patients who have taken radiotherapy or chemotherapy. The method of supplementing kidney is emphasized in the treatment of bone metastasis of lung cancer while the method of resolving phlegm and wind, invigorating the circulation of blood and resolving stasis is often used in brain metastasis.
引文
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[15]郑东旭,任秦有,郑瑾,等.非小细胞肺癌患者失眠与焦虑抑郁症状的研究[C]//中国中西医结合学会基础理论专业委员会.第二届国际抑郁共病暨第十二届中国中西医结合基础理论学术研讨会论文集,2016:1.
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[17]邓屹琪,黄俊珍,江耀广,等.刘伟胜教授论治肺癌经验浅析[J].广州中医药大学学报,2011,28(4):444-445,448.
[18]刘鹏,李柳宁,刘伟胜.刘伟胜“补肾培元”法治疗晚期肺癌的证治探讨[J].江苏中医药,2015,47(9):19-22.
[19]路枝红.刘伟胜教授辨治肺癌经验整理[D].广州:广州中医药大学,2009:28.
[20]谈馨媛,路枝红,吴蕾,等.刘伟胜教授辨治肺癌的经验整理[J].时珍国医国药,2013,24(12):3032-3034.
[2]Chen W,Zheng R,Baade PD,et al.Cancer statistics in China,2015[J].CA Cancer J Clin,2016,66(2):115-132.
[3]Torre LA,Bray F,Siegel RL,et al.Global cancer statistics,2012[J].CA Cancer J Clin,2015,65(2):87-108.
[4]陈记财,李佳,李永锋,等.加味金水六君煎对肺癌围术期患者免疫调节的影响[J].中国医药导报,2016,13(30):138-141.
[5]朱为康,李雁,连强,等.气血双补胶囊对肺癌化疗增效减毒作用的临床观察[J].中国医药导报,2013,10(12):98-99,102.
[6]沈毅,傅萍,孔丽娅.数据挖掘方法在名老中医用药规律研究中的应用[J].中医杂志,2016,57(10):890-893.
[7]于河,王思成,白俊杰,等.基于要素分析的名老中医传承多元方法探索---以孔光一教授名医传承为例[J].世界中医药,2016,11(12):2797-2801.
[8]张华,刘保延,田从豁,等.“人机结合、以人为主”的名老中医经验整理研究方法[J].中医研究,2007,20(2):4-7.
[9]中华人民共和国卫生部医政司.中国常见恶性肿瘤诊治规范[M].北京:北京医科大学、中国协和医科大学联合出版社,1991.
[10]郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002.
[11]中医药学名词审定委员会.中医药学名词2004[M].北京:科学出版社发行部,2005.
[12]黄依莲,岳甜甜.MSCT对不同病理类型中央型肺癌的诊断与鉴别诊断价值[J].现代医用影像学,2015,24(6):936-939.
[13]林嬿钊.刘伟胜教授学术思想与临床经验的整理与研究[D].广州:广州中医药大学,2011:26.
[14]金智慧.刘伟胜教授治疗肺癌的临床经验及用药规律研究[D].广州:广州中医药大学,2013:65.
[15]郑东旭,任秦有,郑瑾,等.非小细胞肺癌患者失眠与焦虑抑郁症状的研究[C]//中国中西医结合学会基础理论专业委员会.第二届国际抑郁共病暨第十二届中国中西医结合基础理论学术研讨会论文集,2016:1.
[16]李柳宁,陈海.刘伟胜教授治疗肺癌的临床经验[J].陕西中医,2007,28(4):464-465.
[17]邓屹琪,黄俊珍,江耀广,等.刘伟胜教授论治肺癌经验浅析[J].广州中医药大学学报,2011,28(4):444-445,448.
[18]刘鹏,李柳宁,刘伟胜.刘伟胜“补肾培元”法治疗晚期肺癌的证治探讨[J].江苏中医药,2015,47(9):19-22.
[19]路枝红.刘伟胜教授辨治肺癌经验整理[D].广州:广州中医药大学,2009:28.
[20]谈馨媛,路枝红,吴蕾,等.刘伟胜教授辨治肺癌的经验整理[J].时珍国医国药,2013,24(12):3032-3034.
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