摘要
王晞星教授,博士研究生导师,第四批全国名老中医学术经验传承指导老师,卫生部有突出贡献中青年专家,享受国务院政府特殊津贴。从事中医临床、科研、教学工作30余载,对脾胃病及肿瘤的研究有较深造诣。倡导“和法”治病的观点,对胃肠功能性疾病有独到的治疗方法和研究成果,运用“和法”理念结合现代研究成果治疗肿瘤,走出了一条中医的创新之路。
本论文在探析王晞星教授学术渊源的基础上,较全面地总结了导师“和法”治疗肿瘤的学术思想和临床经验,归纳了晚期胃癌证治规律,探讨了“和法”理念对晚期胃癌的生存影响。论文分为三个部分：
第一部分王晞星教授学术渊源概述。
1、梳理了导师“和法”理念治疗肿瘤的学术思想以及临床经验的形成历程,探求名医的成才之路。
导师偶然的机会踏上从医之路,系统的院校学习与实践锤炼了他扎实的中医功底；熟读《内经》、《伤寒论》、《脾胃论》等中医经典形成了他重视脾胃、善用经方的诊治特点；广泛涉猎中医大师的学术经验开拓了他的临证思路；受中医文化的启迪他逐渐领悟了“和法”治病的实质；师承脾胃病名家萧汉玺使他对“和法”治疗脾胃病有了更深的体会,并在继承的基础上有所创新；对中医事业强烈的使命感使他把研究目标转向恶性肿瘤这一世界难题,又将多年对“和法”的感悟引入到肿瘤的治疗中。王晞星老师认为“抓机遇,读经典,学名家,勤实践,善思考,重创新”是名医的成才之路。
2、通过总结历代中医典籍对“和法”的论述,分析其学术源流关系,以及导师对“和法”治病的继承与发展。
《内经》理论体系贯穿“和法”的思想,奠定了“和法”的理论基础；《伤寒论》将“和法”内涵全面体现于临床实践,对“和法”的形成发展做出了重要贡献；成无已、张介宾、程钟龄、戴天章等后世医家有关“和法”的论述,丰富和完善了中医学“和法”的理论。目前,“和法”广泛应用于治疗消化系统、妇科、儿科、心脑血管疾病等各种病证,但较少涉及治疗肿瘤；肿瘤的治疗多采用扶正或祛邪(化痰、祛瘀、解毒)等法,也较少涉及运用“和法”。王晞星老师独辟蹊径,将“和法”理念贯穿到疑难重病肿瘤的治疗中,形成了独具特色的学术思想和临床经验,可谓对“和法”治病的继承与发展。
第二部分王晞星教授学术思想与临床经验总结。
1、从中国文化价值观对中医理论的影响、“和法”治疗肿瘤的内涵、运用“和法”治疗肿瘤的缘由、“和法”治疗肿瘤的基本原则、“和法”在常见肿瘤论治中的应用、以及常用“和法”方药在肿瘤临床中的应用等六个方面较为系统地总结归纳了导师“和法”治疗肿瘤的学术思想。
①中医理论,体现“和谐”。中医理论体系的两个基本特点浓缩为两个字就是“和谐”。②“和法”之义,涵盖宽广。广义的“和”既是治法,也是目的,同时更是一种理念。③治疗肿瘤,“和法”确当。原因：肿瘤发病,诸般不和；病机复杂,唯“和”能调；中西医学,包容共进；以人为本,带瘤生存。④治疗原则,贯穿“和法”。具体体现：扶正祛邪,标本兼顾；病证合参,相得益彰；内外合治,彰显优势；中西合璧,综合治疗。⑤常见肿瘤,“和法”论治。举例：消化系统肿瘤脾胃不和、肝脾不调、肝胃不和、寒热不调；乳腺肿瘤肝脾不调;泌尿生殖系统肿瘤阴阳失调等等。⑥“和法”方药,灵活运用。常用方药：逍遥散、四逆散、柴胡汤类、滋水清肝饮、半夏泻心汤等等。
2、从病因病机、辨证论治、辨病论治、用药特点等方面系统全面总结了导师对常见消化系统肿瘤及脾胃病的诊疗经验。
六个常见消化系统肿瘤的诊治经验：①胃癌。胃癌本质是脾胃虚弱,治疗首重健脾,顾护胃气。②结直肠癌。结直肠癌亦属脾胃病范畴,治宜通调并举,注重气机通降,调理脾胃。③食管癌。食管癌基本病机为脾虚气滞、胃气上逆,故健脾疏肝、和胃降逆贯穿始终。④肝癌。肝癌多见肝脾不调及肝胆不和,治疗的关键在于疏肝健脾、调畅气机。⑤胆道癌。胆道癌发生的重要机制是肝胆湿热、胆胃不和,治疗重在疏利肝胆、健脾和胃。⑥胰腺癌。胰腺癌的发生与脾虚肝郁、肝胆不和密切相关,多从健脾疏肝、疏肝利胆论治。三个常见脾胃病的诊治经验：①放射性直肠炎。病名“肠澼”,病机毒伤肠络,治疗独重保留灌肠,研制专药肠瑞灌肠剂。②非甾体抗炎药相关性胃病。NSAIDs相关性胃病病因为药毒犯胃,瘀热中阻,胃失和降,治当和胃降逆为主。③功能性消化不良。王老师力倡从肝论治消化系统功能障碍性疾病。功能性消化不良病在胃,因在肝,以理气法为主辨治。
第三部分晚期胃癌证治规律研究及基于“和法”理念治疗晚期胃癌的生存评价
1.采用回顾性临床研究方法,运用频数分析、聚类分析、主成分分析等数理统计和多因素分析方法对王晞星教授辨治晚期胃癌的症—证—法—方—药规律进行了总结研究,为中医辨证论治晚期胃癌提供客观科学的依据。
①王晞星教授辨治晚期胃癌的中医证型主要有五类：肝胃不和证(36.6%)、脾虚气滞证(27.7%)、痰毒瘀结证(22.7%)、寒热错杂证(7.9%)、肝胃阴虚证(4.9%)。
②五个证型的辨证要点：肝胃不和证为胃脘胀痛、痛窜及两胁、脉弦细、嗳气泛酸、呕吐反胃；脾虚气滞证为身疲乏力、腹胀便溏、食少纳呆、呕吐痰涎；痰毒瘀结证为胸闷膈满、胃脘刺痛、大便色黑、心下痞硬、面色晦暗、恶心；寒热错杂证为便溏泻、胃脘痞满、脘腹冷痛、口舌生疮、苔黄；肝胃阴虚证为胃内灼热、嘈杂不舒、食后脘痛、舌质红或有裂纹。
③中医证候要素分布规律：晚期胃癌病位证素主要在脾、胃、肝；病性证素主要有气虚、气滞、血瘀、痰、毒。
④用药规律：王晞星教授治疗晚期胃癌排前10位的常用药物：茯苓、甘草、陈皮、党参、柴胡、黄芪、山慈菇、蛇舌草、白术、八月札。多以平性药为主。
⑤常用方剂：肝胃不和证用四逆散加减；脾虚气滞证用香砂六君子汤加减；痰毒瘀结证用小陷胸汤合温胆汤加减；寒热错杂证用半夏泻心汤加减；肝胃阴虚证用一贯煎合四逆散加减。
王晞星教授认为气虚、气滞、血瘀、痰、毒为晚期胃癌主要的病性因素,病位主要在脾胃,与肝密切相关。基本病机是脾胃肝脏腑功能失调,脾虚贯穿疾病始终。治疗扶正祛邪并举,辨证辨病结合,重视健脾护胃,用药平和精准,善用经方合方,充分体现了“和”的思想。
2、采用前瞻性队列研究方法,观察基于“和法”辨治晚期胃癌患者的生存时间及生活质量,探讨“和法”治疗对晚期胃癌的生存影响。
收集符合晚期胃癌诊断,并具备化疗适应症的病例。中医组单纯服用中药治疗,中西医结合组化疗联合中药治疗,西医组单纯进行化疗。所有中药均由王晞星教授统一辨证处方。应用乘积-极限法(Kaplan-Meier法)计算三组生存率,应用对数秩检验(log-rank)方法进行三组生存率的比较,并绘制生存曲线。分别于治疗前、治疗后三个月时采用EORTC QLQ-C30癌症患者生活质量核心量表及EORTC QLQ-STO22胃癌特异性量表对患者进行问卷调查,应用重复测量的方法对生活质量量表评分进行统计学处理。
中药组(166例)、中西结合治疗组(83例)、西药组(63例)的中位生存期分别为456天(约15个月)、422天(约14个月)、324天(约11个月),三组生存率比较有显著性差异(p<0.01)。EORTC QLQ-C30及EORTC QLQ-STO22评价显示,治疗后三组功能子量表和总健康状况子量表评分,中医组明显高于西医组,中西医结合组居中,三组比较有统计学差异(p<0.01)；三组症状子量表评分均有下降,但中医组分值明显低于西医组,中西医结合组居中,三组比较有统计学差异(p<0.01)。提示中医“和法”治疗晚期胃癌能够改善患者生活质量,延长生存期。中医“和法”治疗晚期肿瘤具有巨大优势,为指导临床选择治疗方案提供了客观依据。
由上述总结研究可以看出：王晞星教授“和法”治疗肿瘤的学术思想内涵丰富,临床经验独到。治疗肿瘤贯穿广义之“和法”思维,具体运用的治则方药体现狭义之“和法”。“和法”治疗晚期胃癌能改善生活质量,延长生存期,对临床治疗晚期肿瘤具有很强的指导意义。
Professor Wang Xixing, doctoral tutor, one of the fourth batch of the old Chinese medicine academic experience teachers, middle-aged expert with outstanding contribution to the Ministry of Public Health, enjoys special government al lowances of the state counci1. He has engaged in traditional Chinese medicine clinical practice, teaching, and research work for more than30years, and specialized in the stomach disease and tumor study. He advocates "harmonizing" curative perspectives and has a unique treatment methods and research achievements on functional gastrointestinal disorders. In addition, He has been applying the idea of tradition Chinese "harmonizing" to the western medicinal research results in treating tumor, which successfully lead an innovative development to traditional Chinese medicine.
On the base of exploring the professor Wang Xixing academic origin, This thesis summarized the academic thoughts and clinical experience of professor Wang's "harmonizing"treatment to tumor, summed up the treatment rule of advanced gastric cancer, discussed "harmonizing" concept to advanced gastric cancer survival impact. The thesis is divided into three parts:
Part one:Professor Wang Xixing academic overview
1、Discussing the formation of professor Wang's academic thought and clinical experience of "harmonizing" in the treatment of tumors, and seeking the paths of well-known specialists.
Tutor Wang became interested in traditional Chinese medicine by chance when he was young, and got further systematic study on traditional Chinese medicine in colleges and practiced a lot clinically. By extensively studying TCM classics, such as the Yellow Emperor's Internal Classic, Treatise on Febrile Diseases, the Theory of Spleen and Stomach, he paid great attention to spleen and stomach, and made the best use of classical prescriptions in the diagnosis and treatment; By reading widely on the clinical experience from masters of TCM, he developed his own academic thoughts especially grasp the essence of "harmonizing"
Professor Wang was learned from famous gastroenterologist Xiao Hanxi, who helped him get deeper understanding and innovative ideas on using "harmonizing" treatment on spleen and stomach diseases. Driven by the strong sense of mission to carryforward TCM, professor Wang set his research target to malignant tumors, a worldwide difficult problem, and brought his long-accumulated "harmonizing" insights into the theory of tumor treatment. Tutor Wang Xixing pointed out that to be a successful doctor, one need to "seize opportunities, read classic books, follow masters, practice more, think much, and focus on innovations"
2、Through the summary of the idea on "harmonizing" in ancient TCM classics, we analyze its academic origin and tutor Wang's inheritance and development on it.
In Yellow Emperor's Internal Classic, the idea of "harmonizing" run all through the book, laying its theoretical basis. The book Treatise on Febrile Diseases reflects the use of "harmonizing" in clinical practice, and make contribution to the formation and development of the "harmonizing" theory. Cheng Wuji, Zhang Jiebin, Cheng Zhongling, Dai Tianzhang and other doctors from late generation's work about "harmonizing" theory enriched and completed the Chinese medicine theory of "harmonizing". Nowadays,"harmonizing" theory has been widely used in the treatment of digestive disease, gynecological disease, pediatric disease, cardiovascular and cerebrovascular diseases, but it hasn't largely involved with the treatment of tumor. The treatment of tumor are commonly guided by the principle of Fuzheng Quxie (or dispersing phlegm, removing stasis, detoxifying). Tutor Wang Xixing innovatively brought "harmonizing" concept to the complicated therapy of tumor, which contributed to his unique academic thoughts and clinical experience. This acted as a great contribution to the inheritance and development of the treatment principle of "harmonizing"
Part Two:Professor Wang Xinxing's academic thoughts and clinical experience.
1、We summarized tutor Wang's academic thoughts of "harmonizing" treatment to tumor in six aspects as follows:impacts of Chinese cultural values had on the theory of traditional Chinese medicine, reasons and basic principles of using "harmonizing" treatment to tumor, application of "harmonizing" in treatment of common tumor, and some commonly used tumor drugs and prescriptions clinical practice.
①The theory of traditional Chinese medicine embodies the concept of "harmony". The basic features of traditional Chinese medicine theoretical system could be condensed into a word-"harmony ".②The concept of "harmonizing" is a multifaceted one. The general meaning refers to not only a kind of method, but also the final purpose to this particular method, at the same time it is also an idea.③The reason behind "harmonizing" treatment on the tumor."The pathogenesis of tumor is very complex and only can be moved by'harmonizing'". Combining traditional Chinese medicine with Western medicine is an people-oriented way to increase the survival of patients with tumor.④The concept of "harmonizing" is presented by therapeutic principles and methods. For example, strengthening heal thy qi to eliminate pathogens, treatment focusing both on alleviating symptoms and cursing the cause to improve the whole therapeutic effects, applying a comprehensive treatment of combining the internal with external and combining traditional Chinese medicine with western medicine, and this has brought great advantage to the efficacy of treatment;⑤"harmonizing" treatment for common tumor, for example:digest ive system tumor with spleen-stomach disharmony, liver-spleen disharmony, disharmony between liver and stomach, or incoordination between cold and heat, breast tumor with spleen-stomach disharmony, and genito-urinary system tumor with Yin-yang disharmony.⑥using "harmonizing " prescription flexibly, such as using ease powder、Sini Powder、Bupleurum fruticosum、ZishuiQinggan Decoction、Banxiaxiexin Decoction.
2、We comprehensively summarize Professor Wang's clinical experience of diagnosis and treatment of digestive tumor and spleen-stomach disease from aspects such as the pathogenesis, treatment based on syndrome differentiation, characteristics of his prescription and others.
The diagnosis and treatment experience of six kinds of commonly seen digestive system tumor.①Gastric cancer. Gastric cancer is caused by weakness of the spleen and stomach. In order to protect stomach qi, spleen should be treated first.②Colorectal cancer. Colorectal cancer also belongs to the spleen-stomach category, it is better to be treated by regulating Qi and protecting spleen and stomach.③Esophagus cancer. The TCM pathology of Esophagus cancer is the stagnation of spleen Qi and the adverse flow of stomach Qi, and the treatment method is smoothing liver, strengthening spleen and regulating Qi movement.⑤Biliary tract cancer. The TCM pathology of biliary tract cancer lies in the damp heat in liver and gall and disharmony between gall and stomach. Its treatment focuses on smoothing liver and on strengthening spleen and stomach,⑥pancreatic cancer. Pancreatic cancer is closely related with spleen deficiency and liver Qi stagnation, and its treatment is soothing liver and gallbladder. The experience of diagnosis and treatment of three commonly seen spleen and stomach diseases.①Radiation proctitis. The TCM name of the disease is" Chang Pi" and TCM pathogenesis is the poison in intestine collateral. Treatment of it lies in retention enema, and special drug called Intestinal Rui is the our research result.②NSAID-related gastropathy. The TCM pathology of NSAIDs-related gastropathy is that the stomach is hurt by the poison of the drug, excessive heat stagnate the middle, causing irregular descending of stamoch Qi. The treatment is regulating stomach qi.③Functional dyspepsia. Tutor Wang advocated to borrow the TCM treatment of liver impairment, and apply them to digestive system diseases. From TCM perspective, funct ional dyspepsia is rooted in the liver, and it should be treated by regulating qi.
Part Three. Professor Wang Xixing's research on syndromes and treatments of advanced gastric cancer and survival evaluation of the "harmonizing" treatment on advanced gastric cancer.
1、We summarized professor Wang Xixing's TCM rule of treatment on advanced gastric cancer based on syndrome differentiation and followed the line of symptoms, syndrome, treatment principle, and prescriptions. By using research methods like frequency analysis, cluster analysis, principal component analysis and multifactor analysis, we provided objective and scientific basis for TCM treatment on advanced gastric cancer.
①Professor Wang Xixing divided advanced gastric cancer into five categories based on the rule of syndrome differentiation:disharmony between the liver and stomach syndrome (36.6%), spleen deficiency and qi stagnation syndrome (27.7%), phlegm stagnation syndrome (22.7%), the cold-heat coexisted syndrome (7.9%), and yin deficiency of liver and stomach syndrome (4.9%).
②The key for syndrome differentiation. Symptoms such as pain in stomach and lateral side of thorax, taut thready pulse, belching, vomiting pantothenic acid would go to disharmony between the liver and stomach syndrome. Lassitude of the body, bloating belly, anorexia, vomiting would be the symptom of the spleen deficiency and qi stagnation syndrome. Symptoms like chest tightness, epigastric pain, black stool, epigastric fullness and rigidity, darkish complexion and nausea would go to phlegm stagnation syndrome. The cold-heat coexisted syndrome would have symptoms like loose stool, stomach fullness, abdomen pain, sore and yellow tongue. Syndrome of yin deficiency of liver and stomach would have symptoms like gastric heartburn, noisy and uncomfortable feeling after eating, stomach pain, and red tongue with crack coat.
③regularity of distribution. TCM pathological factors for advanced gastric cancer mainly lies in the spleen, stomach and liver; syndrome key factors, and is mainly caused by qi stagnation, blood stasis, Qi deficiency, phlegm and poison.
④Rule of using drugs. The top10drugs commonly used by Professor Wang Xixing's prescription of advanced gastric cancer:tuckahoe,liquorice, tangerine peel, dangshen, bupleurum, astragalus root, asarum, diffusa, Rhizoma Atractylodis Macrocephalae, August's. They are mostly of mild flavor.
⑤Commonly used prescriptions:Disharmony between liver and stomach syndrome is treated by modified four inverse powder. Stagnation of Qi due to spleen deficiency syndrome is treated by decoction of six noble drugs. Phlegm stagnation syndrome is treated with Xiao Xianxiong Decoction and Wendan Decoction. The cold-heat coexisted syndrome is treated by Banxia Xiexin Decoction. Liver and stomach yin deficiency is treated with modified Decoction of four inverse powder.
Professor Wang Xixing thought that the primary pathological factors for advanced gastric cancer are qi stagnation, blood stasis, deficiency of Qi, phlegm stasis and poison, and they mainly effect spleen and stomach, and the liver is closely related. The basic pathogenesis is spleen and liver dysfunction, with spleen deficiency run through the whole pathologicalprocess. TCM treatment is based on syndrome differentiation, disease differentiation combined with methods to protect spleen and stomach, using prescription properly and effectively, which fully embodies the "harmonizing" thoughts.
2、By cohort study, a prospective research method, we observed the survival time and living quality of patients with advanced gastric cancer treated by "harmonizing" treatment and discussed the impact of "harmonizing" treatment on patients with advanced gastric cancer.
This research collects diagnosed advanced gastric cancer cases, which are suitable for chemotherapy treatment. Patients in TCM group were only treated tradi t ional Chinese medicine, the experimental group were treated Chinese herbal medicine combined with chemotherapy. The western medicine group was only treated by chemotherapy. All traditional Chinese medicine were prescribed by Professor Wang Xixing. We used product limit method (Kaplan-Meier method) to calculate the survival rate of the three groups, using the logrank test (log-rank) method to compare the survival rate for three groups and drew survival curves. The patients were investigated with a questionnaire designed according to EORTC QLQ-C30and EORTC QLQ-STO22three month before and after the treatment respectively, and repeated measurement was used to process statistics.
The median survival time of traditional Chinese medicine treatment group (166cases), traditional Chinese combined with western medicine treatment group (83cases), western medicine treatment group (63cases) were456days (about15months),422days (about14months),324days (aboutll months) respectively. The difference of survival rate of three groups of was significant (p<0.01). After treatment, scoresof function subscale and total health status subscale in EORTC QLQ-C30and EORTC QLQ-STO22in the traditional Chinese medicine treatment groupwere significantly higher than the western medicine treatment group, traditional Chinese combined with western medicine treatment group in the middle; and scores of symptoms subscale decreased in three groups, but the TCM treatment group were significantly lower than thewestern medicine treatment group, integrative group in the middle, showing a statistically significant difference in three groups (p<0.01).
"Harmonizing" treatment from Chinese tradi t ional medicine can improve life quality of patients with advanced gastric cancer, prolonging the period of survival, indicating a guidance meaning to the clinical treatment of advanced gastric cancer.
引文
[1]王洪图主编.《内经讲义》.第1版.北京：人民卫生出版社,2005.
[2]景浩.《黄帝内经》与儒家“致中和”思想.中医药学刊,2006,24(3)：481-482.
[3]胡永军,孟静岩.《黄帝内经》对和法的奠基作用.中华中医药学刊,2007,25(9)：1940-1941.
[4]孙榕,叶庆莲.《内经》和法的重要特点--自和.江苏中医药,2008,40(10)：14-16.
[5]高飞.“和”与“和而不同”考释.中医药学刊,2005,23(3)：420-428.
[6]梅国强主编.《伤寒论讲义》.第1版.人民卫生出版社,2004.
[7]黄仰模主编.《金匮要略讲义》.第1版.人民卫生出版社,2005.
[8]孔伟,郭鹏.试述《伤寒论》对和法形成和发展的贡献.河南中医,2007,27(2)：1-2.
[9]聂惠民.论《伤寒论))之“和法”.中国医药学报,2002,17(4)：199-202.
[10]何德昭.论“和”是张仲景学术思想的核心.中医药临床杂志,2006,18(1)：6-7.
[11]张大明.仲景学说需要返朴归真、正本清源.上海中医药杂志,2003(7)：7.
[12]林榕,刘永环.《伤寒论》“和法”之研究.实用中医内科杂志,2006,20(2)：137-138.
[13]王淳.从小柴胡汤的证治及配伍谈和法.中国医药学报,2002,17(12)：712-714.
[14]黄菁.《金匮要略》中和法的运用.时珍国医国药,2009,20(2)：495-496.
[15]朱肱.类证活人书.天津：天津科学技术出版社,2003：47.
[16]成无己.《注解伤寒论》.北京：中国医药科技出版社,2011.
[17]成无己.《伤寒明理论》.北京：学苑出版社,2009.
[18]徐春甫.古今医统大全.北京：人民卫生出版社,1991：628-705.
[19]张介宾.景岳全书.上海：上海科学技术出版社,1959：975-976,1021.
[20]戴天章.广瘟疫论.北京：人民卫生出版社,1992：57.
[21]何廉臣.重订广温热论.上海：上海科学技术出版社,145-146.
[22]汪昂.医方集解.上海：上海科学技术出版社,1991：1
[23]程国彭.《医学心悟》.北京：人民卫生出版社,2006.
[24]王子接.《绛雪园古方选注》.中国中医药出版社,2007.
[25]吴谦.《医宗金鉴》.北京：中国医药科技出版社,2011.
[26]费伯雄.《医醇賸义》.北京：中国医药科技出版社,2011.
[27]张秉成.《成方便读》.第1版.北京：学苑出版社,2010.
[28]丹波元简.《药治通义》.北京：人民卫生出版社,1983.
[29]中国中医研究院.《蒲辅周医疗经验》.北京：人民卫生出版社,2005.
[30]秦伯未.《谦斋医学讲稿》.上海：上海科学技术出版社,2009.
[31]任应秋.中医各家学说.上海：上海科学技术出版社,1983：232-233.
[32]许济群主编.方剂学.第1版.上海：上海科学技术出版社,1985.6：45-53.
[33]刘冬梅.傀继武运用和法治疗脾胃病经验撷菁.山东中医杂志,2008,27(3)：201-202.
[34]李启秀,王彭龄.从和法论治肝胃郁热型反流性食管炎临床观察.中国中医药信息杂志,2008,15(10)：71-74.
[35]李云平.和法在慢性萎缩性胃炎治疗中的体现.中西医结合与祖国医学基层医学论坛,2009(增刊)：74-75.
[36]郭玉青.和法治疗功能性消化不良的临床观察.河北中医,2007,29(6)：493-494.
[37]李仁祥,王正华.中医和法治疗肠激惹综合征临床体会.湖北中医杂志,1999,21(3)：124-125.
[38]宋建华.调和法治疗胆系疾病术后综合征验案两则.中国中医急症,2006,1(3)：323.
[39]荣姝妮.妇科和法的妙用.山西职工医学院学报,2008,18(1)：68-69.
[40]周群,刘莹莹,吴丽萍等.和法在妇科癥瘕中的应用.河南中医,2009,29(9)：872-873.
[41]张立娟,刘金星,王康锋.和法在女性围绝经期综合征治疗中的应用.中医药学刊,2006,24(9)：1693-1694.
[42]王晓燕,张秀敏,杨化君.和法在儿科的临床应用与体会.中医儿科杂志,2005,1(2)：36-37.
[43]洪建英.运用和法治疗小儿反复呼吸道感染45例.山东中医杂志,2006,25(6)：387-388.
[44]刘建和,程丑夫,吴亦之.试论和法在治疗冠心病心律失常中的应用.中医药学刊,2006,24(12)：2296-2297.
[45]庞蕾蕾.浅谈“和法”与中风的治疗.现代中西医结合杂志,2006,15(11)：1502-1503.
[46]郑薇.运用仲景“和法”治疗心脑血管疾病.陕西中医,2000,21(2)：93-94.
[47]黄志贤.和法在口疮治疗中的应用.中国医药学报,2003,18(2)：105.
[48]朱平.和法治疗痤疮的体会.上海中医药杂志,2000(7)：41.
[49]陈勇毅.和法在老年病治疗中的运用.浙江中医杂志,2003(8)：352-353.
[50]苏凤哲,张明顺.论和法在血液病发热中的应用.世界中西医结合杂志,2009,4(6)：381-383.
[51]于俊生.和法在慢性肾功能衰竭治疗中的应用.江苏中医药,2007,39(7)：6-7.
[52]周永学.和法的临床运用体会.浙江中医杂志,2003(1)：32-33.
[53]李道睿,崔太荣,昊皓.林洪生辨治肿瘤学术思想初探.中国中医药信息杂志,2008,15(6)：86-87.
[54]孙建立.刘嘉湘治疗恶性肿瘤学术思想探讨.辽宁中医杂志,2002,29(7)：389-390.
[55]袁雪莲,王振家.张代钊教授治疗肿瘤学术思想介绍.新中医,2008,40(1)：16-18.
[56]冯磊,宋军.路志正教授治疗恶性肿瘤经验撷蓄.世界中西医结合杂志,2007,2(4)：193-195.
[57]朱华宇.周岱翰教授治疗恶性肿瘤学术思想拾萃.中医药学刊,2004,22(3)：394-395.
[58]高振华.孙秉严论治肿瘤学术思想刍谈.中医研究,2009,22(1)：53-55.
[59]曹利平,苗文红,王向阳,等.谢远明学术思想述要.陕西中医,2007,28(7)：868-870.
[60]周红光,陈海彬,吴勉华.周仲瑛教授从瘀热辨治恶性肿瘤的学术思想探讨.疑难病杂志,2010,9(5)：381-384.
[61]何立丽.孙桂芝关于恶性肿瘤病因病机“二本”学说.中国中医药信息杂志,2010,17(1)：88-89.
[62]倪克锋,林胜友,沈敏鹤.吴良村教授“一消二扶三平衡法”论治肿瘤学术思想探析.实用中医内科杂志,2008,22(8)：13-14.
[63]阮善明.沈敏鹤运用升降理论治疗肿瘤的学术思想.中华中医药学刊,2007,25(12)：2456-2457.
[64]徐振晔,郑展.试论中医阴阳平衡法治疗恶性肿瘤.上海中医药杂志,2007,41(4)：37-39.
[65]王新杰.郑玉玲教授“和”法诊治恶性肿瘤经验摭拾.河南中医,2004,24(2)：21-23.
[66]任华萍.试论和法及其在肿瘤病洽疗中的应用.上海中医药杂志,2008,42(5)：26-28.
[67]宁云峰.试论“和法”在中医肿瘤临床上的应用ITAC国际2007中医药肿瘤学术大会：96-97.
[1]董襄国,阮善明.论中医的核心内容——和.浙江中医药大学学报,2009,33(5)：642-643.
[2]孙榕,叶庆莲.《内经》和法的重要特点——自和.江苏中医药,2008,40(10)：14-16.
[3]陈丽云,严世芸.“和”的追求：传统哲学视域中的中医学理.华东师范大学学报(哲学社会科学版),2011(2)：29-36.
[4]董少萍,罗曼.“中和”观对中医学的影响.浙江中医学院学报,1997,21(5)：7-8.
[5]张苇航,何新慧.哲学之“和”与中医之“和”.医古文知识,2005(4)：4-7.
[6]时乐,吴晓琦,李云.浅论和法的内涵与外延.新疆中医药,2003,21(1)：1-2.
[7]王晞星,李源增.《医苑英华》.北京：中国中医药出版社,2007.10
[8]赵爱光,杨金坤,赵海磊,等.四君子汤诱导裸小鼠移植性人胃癌细胞凋亡的初步研究.癌症,2001,20(2)：163-167.
[9]李宜放,郝淑兰.王晞星教授治疗胃癌经验.中国民间疗法,2011,19(2)：15-17.
[10]郭光业.四逆散加味治疗反流性食管炎45例.河北中医药学报,2005,20(1)：19-20.
[11]张辉,方肇勤.健脾理气法应用于肝癌的临床进展.河南中医,2007,27(7)：78-81.
[12]李翔,叶利洪,李继承.冬凌草甲素抗肿瘤活性及其机制.细胞生物学杂志,2009,31(3)：313-318.
[13]清·王清任.医林改错.1995年第一版.中国中医药出版社,13-14.
[14]吕玉萍,吕玉红,王文萍.胰腺的中医归属.环球中医药,2008(4)：11-13.
[15]李宜放,王晞星,刘丽坤,等.肠瑞灌肠剂对放射性直肠炎大鼠IL-1p及NF-κB表达的影响肿瘤研究与临床,2008,20(10)：665-668.
[16]赵剑锋,孟动玲.王晞星教授治疗NSAIDs相关性胃肠病经验.中华现代中医学杂志,2006,2(8)：719-720.
[1]陈灏珠.实用内科学.第12版.北京：人民卫生出版社,2005：109.
[2]周阿高,李琰,洪声,等.中医药联合化疗治疗胃癌疗效的Meta分析.世界中西医结合杂志,2010,5(5)：376-381.
[3]邱佳信.健脾法为主治疗晚期胃癌的探讨.中医杂志,1992.33(8)：23.
[4]查雪良.中西医结合治疗晚期胃癌34例.山东中医药大学学报,1997.21(5)：376-377.
[5]钱心兰等.攻补兼施治疗胃癌113例.上海中医药杂志,1996(2)：7-9.
[6]王生祥,陈红兵,王吉胜,等.晚期胃癌160例治疗体会.甘肃医药,2011,30(5)：287-288.
[7]龙华,李忠.中晚期胃癌中医证候学特征的研究.北京中医药大学中医学专业硕士学位论文,2010：21.
[8]陈曦.扶正消瘤汤治疗中晚期胃癌46例临床观察.航空航天医药,2008,19(2)：99.
[9]陈强松,陈奕,裴润琼,等.健脾抑瘤汤对晚期胃癌患者生存质量的影响.中国中医药现代远程教育,2012,10(12)：129-130.
[10]杨振斌,方晓华,高鹏,等.磨积散联合化疗治疗中晚期胃癌临床观察.现代肿瘤医学,2008,16(8)：1405-1407.
[11]吕东来,魏品康.消痰散结方治疗中晚期胃癌15例.中国中西医结合消化杂志,2007,15(6)：401.
[12]施仲义,黄兆明.中药健脾扶正为主联合化疗治疗晚期胃癌28例疗效观察.新中医,2006,38(6)：44-45.
[13]张武,郑维锷.艾迪注射液联合顺铂治疗癌性胸腹水疗效观察.现代中西医结合杂志,2007,16(10)：1345.
[14]刘昕,花宝金.中医药治疗对进展期胃癌患者生活质量和生存期的影响.中国中西医结合消化杂志,2008,28(2)：105-107.
[1]Van Cutsem E. Thetreatment of advanced gastric cancer:new findings on the activity of the taxanes. The Oncologist,2004,9(12):9.
[2]FERLAY J, SHIN HR, BRAY F, et al. GLOBOCAN 2008, Cancer incidence and mortality worldwide: IARC CancerBase No.10 [EB/OL]. Lyon, France:International Agency for Research on Cancer; 2010. [2011-07-01]. http://globocan. iarc. fr.
[3]黄家驷,吴阶平.外科学.北京：人民卫生出版社,1999：601
[4]陈峻青.要重视晚期胃肠癌的治疗.中国实用外科杂志,2000,20(10)：579.
[5]孙燕,周际昌.临床肿瘤内科手册.北京：人民卫生出版社,2009：481,336-348.
[6]WAGNER AD, GROTHE W, HAERTING J, et al. Chemothera-py in advanced gastric cancer:A systematic review and meta-analysis based on aggregate data. J Clin Oncol,2006,24(18):2903-2909.
[7]周岱翰.临床中医肿瘤学.北京：人民卫生出版社,2003：159-166.
[8]中国抗癌协会.新编常见恶性肿瘤诊治规范.中国协和医科大学出版社,1999：7,14.
[9]国家中医药管理局医政司主编.中华人民共和国中医药行业标准-中医病证诊断疗效标准(ZY/T001.1-94).南京大学出版社,1994.
[10]国家药品监督管理局.中药新药临床研究指导原则.中国医药科技出版社,2002.
[11]李乾构,周学文,单兆伟.中华中医药学会脾胃病分会组织编写.中医消化病诊疗指南.中国中医药出版社,2006
[12]国家技术监督局.中医临床诊疗术语证候部分(GB/T16751.2-1997).中国质检出版社,1997
[13]朱文锋.创立以证素为核心的辨证新体系.湖南中医学院学报,2004,24(6)：38-39.
[14]朱文锋.证素辨证学.北京：人民卫生出版社,2008：88-159
[15]李赞华,万霞,刘建平.队列研究与随机对照试验的方法学比较.北京中医药大学学报(中医临床版),2008,15(5)：11-14.
[16]王建彬,杨宇飞,于河,等.中医药多中心前瞻性队列研究的监查.世界科学技术—中医药现代化,2009,11(2)：304-307.
[17]邱彩锋,赵继军QLQ-C30的应用及计分方法.国外医学护理分册,2005,24(11)：701-703.
[18]徐瑞华,滕开原.晚期胃癌化疗进展.癌症,2009,28(10)：1108-1113.
[19]李朝燕,赵爱光,曹妮达,等.中医药治疗晚期胃癌文献的质量评价及疗效分析.中华中医药学刊,2011,29(5)：1098-1101.
[20]慕晓艳,赵爱光,郑培永.中西医评价恶性肿瘤生命质量的异同及对策.时珍国医国药,2009,20(1)：22-23,25.
[21]Demierre MF, Kim YH, Zackheim HS.Prognosis,clinical outcomes and quality of life issues in cutaneous T-cell lymphoma. Hematol Oncol Clin North Am,2003,17(6):1485-1507.
[22]罗健,孙燕.癌症患者生活质量研究.中国肿瘤,2001,10(2)：76-78.
[23]FDA.Guidance for Industry:Clinical Trial Endpoints for the Approval ofCancer Drugs and Biologics,2007,May.
[24]Johnson JR, Temp le R. Food and drug administration requirements forapproval of new anti-cancer drugs. Cancer Treat. Rep,1985,69:1155-1157.
[25]郑君,郑坚,郑培永.生存质量量表在胃癌疗效评价中的应用进展.中西医结合学报,2008,6(3)：304-310.
[26]孟琼,万崇华,罗家洪.癌症患者生命质量测定量表EORTC QLQ2C30的应用.中国行为医学科学,2005,14(3)：273-274.
[27]姜宝法,徐涛,刘春晓,等.胃癌患者生活质量问卷(QLQ-ST022)中文版的制定.中国心理卫生杂志,2005,19(5)：310-312.
[28]刘春晓,姜宝法,徐敏,等.胃癌患者的生活质量调查.中国临床康复,2006,10(18)：20-22.
[29]孟琼,万崇华,罗家洪.胃癌患者生命质量测定量表的研制(摘要).昆明医学院学报,2008,29(4)：177.