张代钊教授诊治老年中晚期癌症思路探讨
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摘要
癌症已成为危害全人类生命健康的一大类疾病,全世界每年约有700多万人发生癌症,每年约有500多万人因患癌症而死亡。目前,我国每年约有200-300多万人新患癌症,每年约有160-200多万人因患癌症而夺去了生命,我国现癌症患者常年保持在250万至300万人以上。
癌症也是我国中老年人中最为常见的疾病之一,在城市中占各种疾病死亡的第一位,农村居第二位。近20-30年来,我国肺癌,肝癌,胃癌,乳腺癌,子宫颈癌,卵巢癌等癌症发病率继续在上升。
我国现有13亿多人口,60岁以上的人口已达1.44亿,在癌症病人中60岁以上的老年人约占60%以上。由于多数病人未能达到早期发现、早期诊断和早期治疗,所以我国中晚期癌症病人多,这主要是由于就诊晚、误诊多和误治多。据临床多年来的统计约有80%以上的病人在就诊时病情已属中晚期。这些病人因年龄较高,体质较弱,病情晚,症状多,痛苦大,合并症较多,故其生存质量差,生存期也较短,一般多在一年左右死亡。
据统计我国每年用于癌症病人的医药费用已达数千亿元人民币,(以每个病人花费10万元人民币计算,200-300万癌症病人即花掉医药费2000-3000亿元人民币)这的确是我们医务工作者需要思考和解决的问题。
四十余年来,我国运用中医药及中西医结合的方法诊治癌瘤,越来越被广大医务工作者和患者所接受。通过大量的临床观察和实验研究,也证明了中医药对提高癌症病人的免疫力和抗癌能力,减轻放化疗毒副反应、稳定病情、提高生活质量和生存期都起到了很好的治疗作用。
本题探讨目的：在跟师临床学习中,观察到导师在对老年的中晚期癌症病人减少痛苦、减轻症状、提高生存质量、延长生存期和降低死亡率等这些方面有丰富的临证治验,为此特选本题探讨。
老年人为什么容易患癌瘤：
1癌瘤的发生是经过一个十分漫长的病理变化过程,一般正常细胞演变、分化成癌细胞大约需要10—15年,甚或20—30年以上,所以,癌症的发生多在50—60岁以上。
2由于人到老年后各个脏器的生理功能下降,内分泌系统失调,免疫功能减退,《内经》：老年人肾气虚衰则五脏六腑俱衰；《灵枢,天年》：六十岁,心气始衰·····七十岁；脾气虚；八十岁,肺气虚·····九十岁肾气衰······百岁,五脏皆虚·····。因此,癌的发生也随之上升。
3有些老年人由于长期受到精神上的创伤,疾病干扰,居住或工作环境的污染,饮食不洁,长期吸烟,大量饮酒等等。不良生活饮食习惯也可以加速癌症的发生和发展。
老年人易患的癌瘤：主要有食管癌(噎嗝),胃癌(反胃),肺癌(肺积),结肠及直肠癌(积聚),肝癌(肝积),子宫颈癌(崩漏),乳腺癌(乳岩),前列腺癌等恶性肿瘤。
1导师诊治老年中晚期癌瘤思路探讨
1.1“体虚邪实”是老年中晚期癌瘤症候的特点
老年多有气血不足,脏腑虚损之证“正气内存,邪不可干,邪之所凑,其气必虚”。
“邪实”是指中晚期癌症病人“病情严重”,肿瘤多有复发,增大或远处转移,症候急,病情重,精神紧张,性情急躁,精神抑郁……。
1.2以扶正培本为主,抗癌解毒为辅是导师治疗老年中晚期癌瘤的主要治疗原则
扶正培本是祖国医学中主要治疗法则之一,也是以中医学的整体观、天人合一及阴阳平衡等理论为依据而形成的治疗原则。由于老年中晚期癌瘤是一个“虚症”。《医宗必读》：积之成也,正气不足,而后邪气踞之。《外科医案》：气血虚则成岩。从祖国医学的论述中充分说明了癌症的发生、发展与正气虚损有着密切的关系。因此对扶正培本治则的探索和深入研究已成为防治癌瘤的重要途径；这也是我国防治癌瘤的创举。
扶正培本：其主要治则为益气养血,健脾和胃,和滋补肝肾等为主。
抗癌解毒之主要治则：为理气和血,通经活络,化痰利湿,软坚散结和解毒止痛。
1.3减轻症状,减少痛苦,提高生存质量和生存期是治疗老年中晚期癌瘤的主要目的
导师多年来的临床经验证明,对这类病人的治疗目的应先以解除病人当前最大痛苦和提高生存质量为主要目的。应在尽量不增加病人的痛苦和损伤病人免疫力的前提下,进行病人能够承受得了的中西医治疗。
近20多年来,国内外肿瘤医学家对癌瘤的认识发生了根本的变化,认为癌症是一种慢性疾病,不一定要根治癌瘤,只要病人能够无痛苦的生活下来,就是一个显著成果。
1.4合理的中西医结合治疗是提高治疗效果的主要途径
数十年来,全国肿瘤科研单位合理的中西医结合治疗对老年肺癌,胃癌,肠癌,肝癌,鼻咽癌,乳腺癌及子宫颈癌等都取得了比单用中医或西医更好的疗效。其远期生存率(1、3、5年)都有一定提高。
1.5康复治疗
是治疗老年中晚期癌症病人的重要组成部分,主要目的是要使病人增强战胜癌症的必胜信心,使病人了解患了癌症不等于死亡。
结语：关于如何才能降低我国癌症病人的发病率,死亡率和提高病人的生存率导师提出应在积极的以预防为主,防治结合和中西医结合思想的指导下进行：
1.5.1正确掌握祖国医学的辩证与西医的辨病相结合
1.5.2局部治疗与整体相结合
1.5.3临床治疗与基础研究相结合
1.5.4实施合理的、有计划的、对病人体质及经济能力都承受得了的综合治疗
以上原则是以期达到对老年中晚期癌瘤患者减轻症状和痛苦,提高生存质量和生存期,进一步降低死亡率。
Cancer ranks among the most common and most lethal malignancies worldwide and approximately7million of new cases and5million of death attributes to it annually. In China, approximately2-3million new cancer cases are diagnosed,1.6-2million of deaths relates to cancer and the annual maintainance cancer patients keeps about2.5-3millions. Cancer is also one of the most common diseases in the elderly population in China. It presets the highest incidence in metropolis and the second in rural area. The incidence of cancers, including lung, GI tract, breast, cervical, ovary, et al. is rising rapidly.
The population is about1.3billion in our nation, among which144million are over the age of60. As for no able to be detected, diagnosed and treated in time or in early time, the patients in milled and advanced stages are commonly-seen in clinic or more than80%of initial diagnosed patients defined to middle or late stages according to statistic.
Apart from limited technology, late clinic consultation, mis-diagnosis and mis-management are also fundamental obstacles to improving cancer outcoms. Due to the factors like highly aged, poor body constitution, advanced stage, multi-symptoms, multi-complications and in severe grave, they bear poor quality of life, short life-span, and passing away within one year in general.
Statistically, the cost of medic and medicare exceeds more than RMB100billion Yan annually (RMB100thousand per cancer patient, so RMB200-300billion Yan out of2-3million cancer patients). We medical staffs have to think about and solve the tough in front of us.
Over the past40years, the principles and practices of cancer by TCM and integrative medicine is more and more acceptable by both medical stuffs and patients.
Through accumulative clinical trial and laboratory experiments, it has been approved that TCM takes it active and promising effects for cancer patients in terms of immune system, anticancer ability, side effects relating to chemo and/or radiation, disease stabilization, quality of life and life span.
The Object of the Study
In the process of the study of "master and apprentice", the rich experience of master's on management of advanced cancer patients in the aspects of reliving the painful, the side effects, improving QOL, prolonging TTP and life span gave me deep impression, that is why I choose the topic.
The reasons why the elderly is susceptible to cancer stricken:
1The generation of cancer, in fact, is a long-term pathological process, which may last10-15years even20-30years from a biological cell to a cancer cell, so the onset time commonly presents over50-60years.
2As to deteriorating biological function, disordering endocrine system, descending immune function of the aged as 《Internal Meridian》 states:"The deficiency and impairment of the kidney function of the elderly lead to that of all the other organs",《Ling Shu》:"of the sixtieth, the heart Qi begin weakening; of the seventieth, spleen Qi begin in deficiency, of the eightieth, deficiency; of ninetieth, failure, of the hundredth, all the organs lose their biological functions at all." so the incidence of cancer rises due to the reasons.
3The causations like the mental distress for a long time, comorbidities, the environmental pollution of working's and reside's, contaminated food, heavy smoking, high-dose alcoholic consumption, unhealthy life habit, could also accelerate the generation and development of cancers.
The aged population is more prone to esophageal cancer, gastric cancer, lung cancer, CRC, HCC, cervical, breast, prostate cancer, et al. The study of esoteric academic thought of muster's
A."weakening body constitution and excess of evil elements" is the specific pathology in the elderly cancer patients with advanced stage. For the elderly, the deficiency of both blood and Qi and impairment of visceral organs turns to be in clinic manifestation as 《Internal Meridian》 noted:"The pathogenesis could not attack the body if the immune defence is strong enough in it, otherwise, the defence power would be weakened if the exterior evil factors enclose or exist around the body for a little bit longer." The excess of evil elements refer to those patients in advanced stages with severe disease, disease relapse, metastasis, tumor size in progression, symptoms in emergency, mental tension and distress, sharp temper, et al.
B. Strengthening the body resistance and consolidating the constitution (SBRCC) as first; anti-cancer and detoxication (ACD)as adjuvant are the primary management for the elderly in advanced stages.
SBRCC is one of the primary multiple disciplinaries of TCM which is embodied on the other primary theory of TCM like wholeness, haven and human being in harmony and the balance of Yin and Yang. The pathogenetic nature of the elderly in advanced stages refers to deficiency as the classic medical work 《Yi Zong Bi Du》 noted:"Where that tumor formed emerges deficiency of defence power and at where exterior oncogene attack",《Wai Ke Yi An》:"Cancers are formed upon deficiency of blood and Qi" that strongly back to the regulation of close relationship between the developing cancers and the impairment of body resistance. So the practice in clinic and study of SBRCC have turned to be the leading way in terms of prevention and treatment of cancers by TCM as well as a creation in the nation.
SBRCC includes replenishing Qi and blood, invigorating the spleen and regulating the stomach, nourishing the liver and kidney.
ACD encloses regulating the flow of Qi and blood, promoting the blood flow to remove the obstruction in collaterals, dispelling phlegm and removing dampness, softening hardness and dispelling nodulars, detoxicating evil elements and reliving the pain.
C. Limiting symptoms, reliving the painfulness promoting QOL and prolonging life span are the major targets of management for the elderly in advanced stages.
From the rich clinical experience of my teacher's, it has proved that the major disciplinary management for this kind of patients should high-light on promoting the QOL and reliving the most sufferings presented on clinic and conduct the treating approaches with TCM that patients could be able to afford in expense and to stand physically under the premise of less painfulness to patients and less impairment of immune system.
Over the past two decades, the acknowledgement of cancer has been radically taken place from the view of oncologists worldwide, which believe that cancer is a sort of chronic disease and not be rooted out in necessary only no pain or less pain is good enough for cancer patient to keep alive.
D. Acceptable approaches of Integrative Medicine is the primary way of boosting treating efficiency. In the past more than ten years, the cancer institutes nationwide treated the elderly, by Integrative Medicine, with lung, stomach, breast, cervical cancer as well as CRC, HCC, NPC, et al and gained a better results comparing with each single approach TCM or Western medicine. The survival rates of1y,3y and5y wre all improved in a certain degree.
E. Rehabilitation
Rehabilitation is also one of the primary parts of management of elderly cancer patients, which increase confidence of patients'to win the war to cancer evil and get rid of the awareness that cancer means death.
Conclusion
Through the esoteric individual academic study of Professor Zhang's results in the following regulations conductiog clinic practice:
a Integrating the treatment based on differenciation of symptoms and signs of TCM and differenciation of diseases of western medicine.
b Integrating the local practices and the systemic ones.
c Integrating clinic practice and laboratory study.
d Applying the comprehensive disciplines which are acceptable, systemic, being able to stand physically and afford from pocket, in order to limit symptoms and relieve the sufferings for the elderly cancer patients in advanced stages, promoting QOL prolong the life span and improve the death rate.
癌症也是我国中老年人中最为常见的疾病之一,在城市中占各种疾病死亡的第一位,农村居第二位。近20-30年来,我国肺癌,肝癌,胃癌,乳腺癌,子宫颈癌,卵巢癌等癌症发病率继续在上升。
我国现有13亿多人口,60岁以上的人口已达1.44亿,在癌症病人中60岁以上的老年人约占60%以上。由于多数病人未能达到早期发现、早期诊断和早期治疗,所以我国中晚期癌症病人多,这主要是由于就诊晚、误诊多和误治多。据临床多年来的统计约有80%以上的病人在就诊时病情已属中晚期。这些病人因年龄较高,体质较弱,病情晚,症状多,痛苦大,合并症较多,故其生存质量差,生存期也较短,一般多在一年左右死亡。
据统计我国每年用于癌症病人的医药费用已达数千亿元人民币,(以每个病人花费10万元人民币计算,200-300万癌症病人即花掉医药费2000-3000亿元人民币)这的确是我们医务工作者需要思考和解决的问题。
四十余年来,我国运用中医药及中西医结合的方法诊治癌瘤,越来越被广大医务工作者和患者所接受。通过大量的临床观察和实验研究,也证明了中医药对提高癌症病人的免疫力和抗癌能力,减轻放化疗毒副反应、稳定病情、提高生活质量和生存期都起到了很好的治疗作用。
本题探讨目的：在跟师临床学习中,观察到导师在对老年的中晚期癌症病人减少痛苦、减轻症状、提高生存质量、延长生存期和降低死亡率等这些方面有丰富的临证治验,为此特选本题探讨。
老年人为什么容易患癌瘤：
1癌瘤的发生是经过一个十分漫长的病理变化过程,一般正常细胞演变、分化成癌细胞大约需要10—15年,甚或20—30年以上,所以,癌症的发生多在50—60岁以上。
2由于人到老年后各个脏器的生理功能下降,内分泌系统失调,免疫功能减退,《内经》：老年人肾气虚衰则五脏六腑俱衰；《灵枢,天年》：六十岁,心气始衰·····七十岁；脾气虚；八十岁,肺气虚·····九十岁肾气衰······百岁,五脏皆虚·····。因此,癌的发生也随之上升。
3有些老年人由于长期受到精神上的创伤,疾病干扰,居住或工作环境的污染,饮食不洁,长期吸烟,大量饮酒等等。不良生活饮食习惯也可以加速癌症的发生和发展。
老年人易患的癌瘤：主要有食管癌(噎嗝),胃癌(反胃),肺癌(肺积),结肠及直肠癌(积聚),肝癌(肝积),子宫颈癌(崩漏),乳腺癌(乳岩),前列腺癌等恶性肿瘤。
1导师诊治老年中晚期癌瘤思路探讨
1.1“体虚邪实”是老年中晚期癌瘤症候的特点
老年多有气血不足,脏腑虚损之证“正气内存,邪不可干,邪之所凑,其气必虚”。
“邪实”是指中晚期癌症病人“病情严重”,肿瘤多有复发,增大或远处转移,症候急,病情重,精神紧张,性情急躁,精神抑郁……。
1.2以扶正培本为主,抗癌解毒为辅是导师治疗老年中晚期癌瘤的主要治疗原则
扶正培本是祖国医学中主要治疗法则之一,也是以中医学的整体观、天人合一及阴阳平衡等理论为依据而形成的治疗原则。由于老年中晚期癌瘤是一个“虚症”。《医宗必读》：积之成也,正气不足,而后邪气踞之。《外科医案》：气血虚则成岩。从祖国医学的论述中充分说明了癌症的发生、发展与正气虚损有着密切的关系。因此对扶正培本治则的探索和深入研究已成为防治癌瘤的重要途径；这也是我国防治癌瘤的创举。
扶正培本：其主要治则为益气养血,健脾和胃,和滋补肝肾等为主。
抗癌解毒之主要治则：为理气和血,通经活络,化痰利湿,软坚散结和解毒止痛。
1.3减轻症状,减少痛苦,提高生存质量和生存期是治疗老年中晚期癌瘤的主要目的
导师多年来的临床经验证明,对这类病人的治疗目的应先以解除病人当前最大痛苦和提高生存质量为主要目的。应在尽量不增加病人的痛苦和损伤病人免疫力的前提下,进行病人能够承受得了的中西医治疗。
近20多年来,国内外肿瘤医学家对癌瘤的认识发生了根本的变化,认为癌症是一种慢性疾病,不一定要根治癌瘤,只要病人能够无痛苦的生活下来,就是一个显著成果。
1.4合理的中西医结合治疗是提高治疗效果的主要途径
数十年来,全国肿瘤科研单位合理的中西医结合治疗对老年肺癌,胃癌,肠癌,肝癌,鼻咽癌,乳腺癌及子宫颈癌等都取得了比单用中医或西医更好的疗效。其远期生存率(1、3、5年)都有一定提高。
1.5康复治疗
是治疗老年中晚期癌症病人的重要组成部分,主要目的是要使病人增强战胜癌症的必胜信心,使病人了解患了癌症不等于死亡。
结语：关于如何才能降低我国癌症病人的发病率,死亡率和提高病人的生存率导师提出应在积极的以预防为主,防治结合和中西医结合思想的指导下进行：
1.5.1正确掌握祖国医学的辩证与西医的辨病相结合
1.5.2局部治疗与整体相结合
1.5.3临床治疗与基础研究相结合
1.5.4实施合理的、有计划的、对病人体质及经济能力都承受得了的综合治疗
以上原则是以期达到对老年中晚期癌瘤患者减轻症状和痛苦,提高生存质量和生存期,进一步降低死亡率。
Cancer ranks among the most common and most lethal malignancies worldwide and approximately7million of new cases and5million of death attributes to it annually. In China, approximately2-3million new cancer cases are diagnosed,1.6-2million of deaths relates to cancer and the annual maintainance cancer patients keeps about2.5-3millions. Cancer is also one of the most common diseases in the elderly population in China. It presets the highest incidence in metropolis and the second in rural area. The incidence of cancers, including lung, GI tract, breast, cervical, ovary, et al. is rising rapidly.
The population is about1.3billion in our nation, among which144million are over the age of60. As for no able to be detected, diagnosed and treated in time or in early time, the patients in milled and advanced stages are commonly-seen in clinic or more than80%of initial diagnosed patients defined to middle or late stages according to statistic.
Apart from limited technology, late clinic consultation, mis-diagnosis and mis-management are also fundamental obstacles to improving cancer outcoms. Due to the factors like highly aged, poor body constitution, advanced stage, multi-symptoms, multi-complications and in severe grave, they bear poor quality of life, short life-span, and passing away within one year in general.
Statistically, the cost of medic and medicare exceeds more than RMB100billion Yan annually (RMB100thousand per cancer patient, so RMB200-300billion Yan out of2-3million cancer patients). We medical staffs have to think about and solve the tough in front of us.
Over the past40years, the principles and practices of cancer by TCM and integrative medicine is more and more acceptable by both medical stuffs and patients.
Through accumulative clinical trial and laboratory experiments, it has been approved that TCM takes it active and promising effects for cancer patients in terms of immune system, anticancer ability, side effects relating to chemo and/or radiation, disease stabilization, quality of life and life span.
The Object of the Study
In the process of the study of "master and apprentice", the rich experience of master's on management of advanced cancer patients in the aspects of reliving the painful, the side effects, improving QOL, prolonging TTP and life span gave me deep impression, that is why I choose the topic.
The reasons why the elderly is susceptible to cancer stricken:
1The generation of cancer, in fact, is a long-term pathological process, which may last10-15years even20-30years from a biological cell to a cancer cell, so the onset time commonly presents over50-60years.
2As to deteriorating biological function, disordering endocrine system, descending immune function of the aged as 《Internal Meridian》 states:"The deficiency and impairment of the kidney function of the elderly lead to that of all the other organs",《Ling Shu》:"of the sixtieth, the heart Qi begin weakening; of the seventieth, spleen Qi begin in deficiency, of the eightieth, deficiency; of ninetieth, failure, of the hundredth, all the organs lose their biological functions at all." so the incidence of cancer rises due to the reasons.
3The causations like the mental distress for a long time, comorbidities, the environmental pollution of working's and reside's, contaminated food, heavy smoking, high-dose alcoholic consumption, unhealthy life habit, could also accelerate the generation and development of cancers.
The aged population is more prone to esophageal cancer, gastric cancer, lung cancer, CRC, HCC, cervical, breast, prostate cancer, et al. The study of esoteric academic thought of muster's
A."weakening body constitution and excess of evil elements" is the specific pathology in the elderly cancer patients with advanced stage. For the elderly, the deficiency of both blood and Qi and impairment of visceral organs turns to be in clinic manifestation as 《Internal Meridian》 noted:"The pathogenesis could not attack the body if the immune defence is strong enough in it, otherwise, the defence power would be weakened if the exterior evil factors enclose or exist around the body for a little bit longer." The excess of evil elements refer to those patients in advanced stages with severe disease, disease relapse, metastasis, tumor size in progression, symptoms in emergency, mental tension and distress, sharp temper, et al.
B. Strengthening the body resistance and consolidating the constitution (SBRCC) as first; anti-cancer and detoxication (ACD)as adjuvant are the primary management for the elderly in advanced stages.
SBRCC is one of the primary multiple disciplinaries of TCM which is embodied on the other primary theory of TCM like wholeness, haven and human being in harmony and the balance of Yin and Yang. The pathogenetic nature of the elderly in advanced stages refers to deficiency as the classic medical work 《Yi Zong Bi Du》 noted:"Where that tumor formed emerges deficiency of defence power and at where exterior oncogene attack",《Wai Ke Yi An》:"Cancers are formed upon deficiency of blood and Qi" that strongly back to the regulation of close relationship between the developing cancers and the impairment of body resistance. So the practice in clinic and study of SBRCC have turned to be the leading way in terms of prevention and treatment of cancers by TCM as well as a creation in the nation.
SBRCC includes replenishing Qi and blood, invigorating the spleen and regulating the stomach, nourishing the liver and kidney.
ACD encloses regulating the flow of Qi and blood, promoting the blood flow to remove the obstruction in collaterals, dispelling phlegm and removing dampness, softening hardness and dispelling nodulars, detoxicating evil elements and reliving the pain.
C. Limiting symptoms, reliving the painfulness promoting QOL and prolonging life span are the major targets of management for the elderly in advanced stages.
From the rich clinical experience of my teacher's, it has proved that the major disciplinary management for this kind of patients should high-light on promoting the QOL and reliving the most sufferings presented on clinic and conduct the treating approaches with TCM that patients could be able to afford in expense and to stand physically under the premise of less painfulness to patients and less impairment of immune system.
Over the past two decades, the acknowledgement of cancer has been radically taken place from the view of oncologists worldwide, which believe that cancer is a sort of chronic disease and not be rooted out in necessary only no pain or less pain is good enough for cancer patient to keep alive.
D. Acceptable approaches of Integrative Medicine is the primary way of boosting treating efficiency. In the past more than ten years, the cancer institutes nationwide treated the elderly, by Integrative Medicine, with lung, stomach, breast, cervical cancer as well as CRC, HCC, NPC, et al and gained a better results comparing with each single approach TCM or Western medicine. The survival rates of1y,3y and5y wre all improved in a certain degree.
E. Rehabilitation
Rehabilitation is also one of the primary parts of management of elderly cancer patients, which increase confidence of patients'to win the war to cancer evil and get rid of the awareness that cancer means death.
Conclusion
Through the esoteric individual academic study of Professor Zhang's results in the following regulations conductiog clinic practice:
a Integrating the treatment based on differenciation of symptoms and signs of TCM and differenciation of diseases of western medicine.
b Integrating the local practices and the systemic ones.
c Integrating clinic practice and laboratory study.
d Applying the comprehensive disciplines which are acceptable, systemic, being able to stand physically and afford from pocket, in order to limit symptoms and relieve the sufferings for the elderly cancer patients in advanced stages, promoting QOL prolong the life span and improve the death rate.
引文
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