中医膏方在分化型甲状腺癌术后心悸中的应用
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摘要
[目的]总结笔者运用膏方辨治分化型甲状腺癌术后心悸的临床经验。[方法]通过对分化型甲状腺癌术后出现心悸的病因病机进行分析,总结笔者运用膏方辨治此类心悸的观点、临床经验及独到之处,并通过案例具体说明。[结果]笔者认为分化型甲状腺癌术后心悸的病机为术后脏腑失养、阴阳气血亏虚,复因药物扰心、情志内伤。病性虚实兼杂,虚处常见气血不足、阴阳失衡、心神失养,实者为药毒、血瘀、痰饮。临证时应根据心率,辨清虚实病机。制膏时注意选择道地药材,注重辅料。所举验案一属阳气亏虚、痰湿郁滞,拟温阳化浊膏治疗;验案二属气阴两虚、痰瘀互结,治以益气养阴、化痰行瘀,拟养阴通络膏治疗。同时,两案均配以原剂量左甲状腺素钠片,终获良效。[结论]治疗分化型甲状腺癌术后心悸患者,在三因制宜的基础上,注重中西理念融合,参考患者病机、临床用药特点,自拟膏方用于临床,增效防复。膏方药效稳定,患者依从性更高,具有较强的临床推广价值。
[Objective]To explore the clinical experience of author in treating palpitation of differentiated thyroid cancer after operation with TCM herbal paste. [Methods] Through analyzing the etiology and pathogenesis of palpitation of differentiated thyroid cancer after operation, author's academic thoughts and clinical experience with TCM herbal paste, and specifying typical cases in treatment was summarized. [Results] Zang-fu organs, Qi and blood, Yin and Yang deficiency, compound for drug disturbing, emotional internal injury are the main mechanisms of palpitation of differentiated thyroid cancer after operation. The nature of disease is mixed excessiveness and deficiency, insufficiency of vital energy and blood, imbalance of Yin and Yang, failure of nounrishment of heart and spirit, drug poison, blood stasis, phlegm retention are common. According to the patient 's heart rate, the pathogenesis of deficiency and excess is identified. It is necessary to select genuine medicinal materials for TCM herbal paste prescription, and pay attention to supplementary materials. Case one was differentiated as deficiency of Yang Qi and stagnation of phlegm and dampness, and was treated with Wenyang Huazhuo paste; case two was differentiated as deficiency of Qi and Yin, and phlegm and blood stasis, and was treated with Yangyin Tongluo paste according to therapeutic principles of supplementing Qi and nourishing Yin; eliminating phlegm and removing blood stasis. Both patients achieved good results accompanied with Left Thyroxine Sodium Tablets at original dose. [Conclusion] Author lays emphasis on blending of traditional Chinese and western medicine that combines with three categories of disease cause theory in treating palpitation of differentiated thyroid cancer after operation. In the therapy of self-designed TCM herbal paste, thyroid stimulating hormone inhibition is the basement, pathogenesis and clinical medication characteristics is concerned to keep curative effect. Integrating Chinese and western medicine can increase effect and prevent recurrence. The TCM herbal paste has strong clinical promotion value of popularization for its stable efficacy and good patient's compliance.
[Objective]To explore the clinical experience of author in treating palpitation of differentiated thyroid cancer after operation with TCM herbal paste. [Methods] Through analyzing the etiology and pathogenesis of palpitation of differentiated thyroid cancer after operation, author's academic thoughts and clinical experience with TCM herbal paste, and specifying typical cases in treatment was summarized. [Results] Zang-fu organs, Qi and blood, Yin and Yang deficiency, compound for drug disturbing, emotional internal injury are the main mechanisms of palpitation of differentiated thyroid cancer after operation. The nature of disease is mixed excessiveness and deficiency, insufficiency of vital energy and blood, imbalance of Yin and Yang, failure of nounrishment of heart and spirit, drug poison, blood stasis, phlegm retention are common. According to the patient 's heart rate, the pathogenesis of deficiency and excess is identified. It is necessary to select genuine medicinal materials for TCM herbal paste prescription, and pay attention to supplementary materials. Case one was differentiated as deficiency of Yang Qi and stagnation of phlegm and dampness, and was treated with Wenyang Huazhuo paste; case two was differentiated as deficiency of Qi and Yin, and phlegm and blood stasis, and was treated with Yangyin Tongluo paste according to therapeutic principles of supplementing Qi and nourishing Yin; eliminating phlegm and removing blood stasis. Both patients achieved good results accompanied with Left Thyroxine Sodium Tablets at original dose. [Conclusion] Author lays emphasis on blending of traditional Chinese and western medicine that combines with three categories of disease cause theory in treating palpitation of differentiated thyroid cancer after operation. In the therapy of self-designed TCM herbal paste, thyroid stimulating hormone inhibition is the basement, pathogenesis and clinical medication characteristics is concerned to keep curative effect. Integrating Chinese and western medicine can increase effect and prevent recurrence. The TCM herbal paste has strong clinical promotion value of popularization for its stable efficacy and good patient's compliance.
引文
[1]中华医学会内分泌学分会,中华医学会外科学分会,中国抗癌协会头颈肿瘤专业委员会,等.甲状腺结节和分化型甲状腺癌诊治指南[J].中国肿瘤临床,2012,39(17):1249-1272.Chinese Society of Endocrinology,Chinese Medical Association Surgical Society,Head and Neck Cancer Professional Committee of China Anti-Cancer Association,et al.Guidelines for thyroid nodule and differentiated thyroid cancer[J].Chin J Clin Oncol,2012,39(17):1249-1272.
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[4]刘尚全.中医药对甲状腺癌术后患者症状改善的作用[J].现代肿瘤医学,2003,11(2):112-113.LIU Shangquan.The therapy effect of Chinese medicine to postoperative thyroid carcinoma patients[J].J Mod Oncol,2003,11(2):112-113.
[5]张玉萍.秦伯未膏方集[M].福州:福建科学技术出版社,2007:4.ZHANG Yuping.Traditional Chinese Medicine Paste Collection of QIN Bowei[M].Fuzhou:Fujian Science&Technology Publishing House,2007:4.
[6]王胜南.中医膏方治疗心血管病的临床应用和效果评价规范研究[D].济南:山东中医药大学,2015:48.WANG Shengnan.Research on the clinical application and effect evaluation specification of traditional Chinese medicine paste for treating cardiovascular disease[D].Ji’nan:Shandong University of Traditional Chinese Medicine,2015:48.
[7]孙晓生,谢波.中医三因制宜膏方治未病初探[J].新中医,2012,44(2):99-100.SUN Xiaosheng,XIE Bo.Preliminary study on traditional Chinese medicine paste treating disease before it arises according to three categories of etiological factors system[J].Journal of New Chinese Medicine,2012,44(2):99-100.
[8]叶天士.临证指南医案[M].北京:人民卫生出版社,2006:432.YE Tianshi.A Guide to Clinical Practice with Medical Records[M].Beijing:People's Medical Publishing House,2006:432.
[9]王斌,林兰,倪青,等.中医辅助西医治疗甲状腺癌优势探究[J].北京中医药,2011,30(5):354-356.WANG Bin,LIN Lan,NI Qing,et al.Study on the advantages of treatment for thyroid cancer by traditional Chinese medicine assisting western medicine[J].Beijing JTrad Chin Med,2011,30(5):354-356.
[10]王彬,高雅滨.甲状腺癌术后中医药治疗的优势[J].国际中医中药杂志,2008,30(3):234-235.WANG Bin,GAO Yabin.Advantages of traditional Chinese medicine in the treatment of postoperative thyroid carcinoma[J].Int J Trad Chin Med,2008,30(3):234-235.
[11]李伟,王慧,徐立金,等.甲状腺癌术后中医药康复的优势[J].光明中医,2017,32(14):2066-2068.LI Wei,WANG Hui,XU Lijin,et al.Advantages of traditional Chinese medicine in the rehabilitation of thyroid cancer after surgery[J].Guangming Journal of Chinese Medicine,2017,32(14):2066-2068.
[2]朱丹溪.丹溪心法[M].北京:人民军医出版社,2007:81.ZHU Danxi.Danxi Xinfa[M].Beijing:Military Science Publishing House,2007:81.
[3]吴鞠通.温病条辨[M].北京:人民卫生出版社,2005:175.WU Jutong.Wenbing Tiaobian[M].Beijing:People's Medical Publishing House,2005:175.
[4]刘尚全.中医药对甲状腺癌术后患者症状改善的作用[J].现代肿瘤医学,2003,11(2):112-113.LIU Shangquan.The therapy effect of Chinese medicine to postoperative thyroid carcinoma patients[J].J Mod Oncol,2003,11(2):112-113.
[5]张玉萍.秦伯未膏方集[M].福州:福建科学技术出版社,2007:4.ZHANG Yuping.Traditional Chinese Medicine Paste Collection of QIN Bowei[M].Fuzhou:Fujian Science&Technology Publishing House,2007:4.
[6]王胜南.中医膏方治疗心血管病的临床应用和效果评价规范研究[D].济南:山东中医药大学,2015:48.WANG Shengnan.Research on the clinical application and effect evaluation specification of traditional Chinese medicine paste for treating cardiovascular disease[D].Ji’nan:Shandong University of Traditional Chinese Medicine,2015:48.
[7]孙晓生,谢波.中医三因制宜膏方治未病初探[J].新中医,2012,44(2):99-100.SUN Xiaosheng,XIE Bo.Preliminary study on traditional Chinese medicine paste treating disease before it arises according to three categories of etiological factors system[J].Journal of New Chinese Medicine,2012,44(2):99-100.
[8]叶天士.临证指南医案[M].北京:人民卫生出版社,2006:432.YE Tianshi.A Guide to Clinical Practice with Medical Records[M].Beijing:People's Medical Publishing House,2006:432.
[9]王斌,林兰,倪青,等.中医辅助西医治疗甲状腺癌优势探究[J].北京中医药,2011,30(5):354-356.WANG Bin,LIN Lan,NI Qing,et al.Study on the advantages of treatment for thyroid cancer by traditional Chinese medicine assisting western medicine[J].Beijing JTrad Chin Med,2011,30(5):354-356.
[10]王彬,高雅滨.甲状腺癌术后中医药治疗的优势[J].国际中医中药杂志,2008,30(3):234-235.WANG Bin,GAO Yabin.Advantages of traditional Chinese medicine in the treatment of postoperative thyroid carcinoma[J].Int J Trad Chin Med,2008,30(3):234-235.
[11]李伟,王慧,徐立金,等.甲状腺癌术后中医药康复的优势[J].光明中医,2017,32(14):2066-2068.LI Wei,WANG Hui,XU Lijin,et al.Advantages of traditional Chinese medicine in the rehabilitation of thyroid cancer after surgery[J].Guangming Journal of Chinese Medicine,2017,32(14):2066-2068.