高荣林调理脾胃经验总结及用治前列腺癌验证
|
摘要
高荣林教授,中国中医科学院广安门医院名老中医研究室主任医师、博士生导师,享受国务院政府特殊津贴,兼任国家食品药品监督管理局新药评审专家,中央保健会诊专家,中华中医药学会内科疑难病专业委员会副主任委员,世界中医药联合会睡眠医学专业委员会会长,北京中医药大学兼职教授,全国第四批名老中医药专家学术经验继承指导老师。本文从高荣林教授调理脾胃学术思想渊源、高荣林教授调理脾胃学术思想和临床应用2个方面进行了较全面、系统的整理和总结。在继承高师调理脾胃学术思想的基础上,从调脾胃的角度出发治疗晚期前列腺癌,提出补脾可以代替补肾的新观点,开展了调理脾胃法治疗晚期前列腺癌的临床研究,为中医治疗晚期前列腺癌提供新的思路。
一、高荣林教授学术思想渊源概述
高荣林教授1969年毕业于北京中医学院(现北京中医药大学),1979年考取中国中医研究院(现中国中医科学院)研究生班,获医学硕士学位。高师师承路志正董德懋二老,熟谙《黄帝内经》、《伤寒杂病论》、《脾胃论》等多部医学经典,崇尚仲景学说,重视人整体的协调统一,辨证注重脏腑关系,临床讲求权变调理,临床实践中注重对脾胃的调理,认为调理脾胃法不仅可以用于脾胃疾病的治疗,还可广泛运用于其它系统疾病的防治当中。主编《董德懋内科经验集》、《中医内科临床手册》、《中医睡眠医学》、《中国中医研究院广安门医院专家医案精选》、《路志正医林集腋》5部著作。从高师的学习、工作经历研究方向及工作40余年来取得的成绩来看,高师当属当代脾胃学派名老中医药专家。
二、高荣林教授调理脾胃的学术思想概述和临床应用
1.调理脾胃的理论基础
高师在临床实践中注重对脾胃虚实和气机升降的调理,应用调理脾胃之法,可谓得心应手。脾与胃同居中焦,以膜相连,足太阴经属脾络胃,足阳明经属胃络脾,两者构成表里配合关系。脾胃同为气血生化之源、后天之本,在饮食物的受纳、消化及水谷精微的吸收、转输等生理过程中起主要作用。脾与胃的功能特性,通过纳和化、升和降、燥与湿三个方面来体现。
2.高荣林教授调理脾胃理论观点
(1)化生精微,荣养脏腑
脾胃为后天之本,气血生化之源。人以水谷为本,水谷精微是人体生命活动的源动力。通过调理脾胃,益其生化之源,有助于机体功能的恢复。
(2)升清降浊,脾胃为枢
脾胃同居中焦,脾胃为气机升降之枢纽,贵健通和畅。高师临床重视调整全身之气机,以脾胃为枢纽,或以调理气机以和脏腑,或以和脏腑以调气机。高师临床常告诫笔者：调节气机的升降,不能顾此失彼,切莫着眼于单一证候,务必要着眼于整个气机的运动。
(3)重视气化,五脏相关
五脏气机在人体中不是孤立的,而是有机联系的。五脏在维持气机升降过程中,各司其职,方使表里出入有常,上下升降有序。然脾胃为升降出入之枢纽,“脾为之使,胃为之市”,调理气机,首当脾胃。
(4)四季脾旺,御邪延寿
脾居中州,灌溉四傍,四季脾旺不受邪。强调顾护脾胃的方法,突出其在治病延年中的核心地位。
3.基于临床,提出脾胃病证大纲
高师在多年临床的基础上,提出脾胃病证大纲。按照虚实分类,虚证包括：脾胃虚弱证、脾气虚陷证、脾胃虚寒证、脾胃阴虚证等；实证包括脾胃湿热证、胃气上逆证、胃热证等,临床中还多见虚实夹杂证。对各证的临床表现、治则治法和方药进行了概括。
4.高荣林教授调理脾胃临证要点临床治法
高师在师承路志正、董德懋二老学术思想的基础上,在临床中强调调理脾胃。其临证要点包括：(1)注重升降,调理气机；(2)注重纳化,补脾开胃；(3)津气兼顾,润燥适宜；(4)三因制宜,辨证调护。并在临床中提出调理脾胃正法、变法,调理脾胃正法包括：健脾益气法、升举中气法、温中散寒法、理气法、养阴法、祛湿法、消导法、清热法等；调理脾胃常用变法包括：健脾疏肝法、健脾益肺法、健脾宁心法、健脾温肾法等。
5.调理脾胃以治五脏
《素问.玉机真脏论篇》：“脾脉者土也,孤脏以灌四傍者也”,“五脏者,皆禀气于胃,胃者五脏之本也。”倘脾胃健旺,气血旺盛、气化正常,则五脏六腑四肢百骸皆得所养,脾胃健而五脏安；同样可以通过调其他脏腑来补脾胃不足,安五脏即所以调脾胃。高师在临床中从脾胃和五脏的关系出发,提出调理脾胃治心、调理脾胃治肝、调理脾胃治肺、调理脾胃治肾、调理脾胃治胃的理论。就上述理论,结合随师临床所得,本文对心悸、胸痹、失眠、咳嗽、水肿、胃痛、嗳气、泄泻、关格等疾病病案进行了分析,临床求证了调理脾胃以治五脏的客观性。
三、调理脾胃法治疗晚期前列腺癌的临床研究
基于中医治疗晚期前列腺癌应该“慎用补肾”的临床实际,在继承高师调理脾胃学术思想的基础上,提出治疗难治性前列腺癌“补脾可以代替补肾”、“扶正即是祛邪”的理论,同时开展了调理脾胃法治疗晚期前列腺癌的临床研究。
临床研究目的：客观评价调理脾胃法(以六君子汤为基本方)治疗晚期前列腺癌的临床疗效。方法：采用随机、对照的方法,选择符合难治性前列腺癌的患者67例。治疗组采用调理脾胃法基本方六君子汤联合西医治疗方案(中西医结合治疗),对照组采用西医治疗方案。治疗周期6个月。分别在治疗前、治疗第1、3、6月采集Karnofsky评分、EORTC QOL C-30853评分、中医临床症状评分、外周血白细胞数(WBC)、血红蛋白(Hb)。结果：治疗组剔除4例,对照组剔除3例,最终有效病例60例,治疗组和对照组各30例。①调理脾胃法能显著改善激素难治性前列腺癌患者的生活质量,提高卡式评分、能降低EORTC QOL C-30853评分中体力状况评分、排尿症状评分、疼痛症状评分和躯体功能评分。②调理脾胃法能明显改善前列腺癌患者纳呆、乏力、排尿困难、尿痛等症状。③调理脾胃法能延缓PSA增长速度。④调理脾胃法能提高患者外周血WBC、Hb。结论：①调理脾胃法能提高难治性前列腺癌患者的生活质量；②调理脾胃法可能成为中医治疗晚期前列腺癌的常用方法之一。
四、创新点
1.理论创新：在充分继承高荣林教授调理脾胃学术思想的基础上,结合晚期前列腺癌病因、病机、治疗特点,提出调理脾胃--扶正祛邪可以作为治疗晚期前列腺癌的基本治法之一,为中医治疗晚期前列腺癌提供新的思路。
2.思路创新：晚期前列腺癌西医治疗——手术切除睾丸或药物去势,要求睾酮达到去势水平,这往往引起中医肾虚症状。传统补肾方法因补肾中草药可能存在类雄激素样作用,可能会提升睾酮水平,而加重病情,违背西医标准治疗原则。本研究受高荣林教授“擅调脾胃者,可以治五脏”学术思想影响,针对晚期前列腺癌的疾病特点,从调脾胃的角度出发,提出补脾可以代替补肾,丰富了晚期前列腺癌的治疗思路。
3.临床创新：基于上述观点,开展随机、对照临床研究,通过以六君子汤为基本方联合西医标准方案治疗晚期前列腺癌,证实调理脾胃法能明显改善患者乏力、纳呆等临床症状,提高生活质量。
Professor Gao Ronglin, a chief physician and doctoral tutor of Research Office of Famous Senior Practitioners, Guang'an Men Hospital, China Academy of Chinese Medical Sciences, receiving the government special allowance distributed by Department of State, being an expert of new drug evaluation of State Food and Drug Administration, an expert of the central health care consultation, vice chairman of Internal Difficult Disease Committee of China Association, president of the Professional Committee of Sleep Medicine of World Federation of Chinese Medicine, an adjunct professor at Beijing University of Chinese Medicine, and a tutor of the fourth installment of the Inheritance Program of Famous Senior Practitioners'Experiences.
The origin of Professor Gao Ronglin's academic thought of spleen and stomach regulation, the content of the thought, and clinical practices over the thought were systematically organized and summarized in this paper. Based on the inheritance of Professor Gao Ronglin's opinion, a new hyothese comes up that tonifying spleen is as good as supplementing kidney in the clinical practice for the advanced stage prostate cancer. Thus, we performed a randomized clinical trial to test this new hypothess method for the advanced stage prostate cancer.
Ⅰ. The origin of Professor Gao Ronglin's academic thought
Graduated from Beijing College of Chinese Medicine in1969(now Beijing University of Chinese Medicine), Professor Gao Ronglin obtained master degree from postgraduate class of China Academy of Chinese Medicine in1979(now China Academy of Chinese Medical Sciences). Being one of the students of two maters of TCM, Lu Zhizheng and Dong Demao, he is very accomplished on medical classics, such as Yellow Emperor, Febrile Diseases, Stomach Theory, etc. and Zhang Zhongjing Theories; in clinic, he is emphasizing the theory of harmony between human beings and the nature, and focusing on syndrome differentiation by the relationships between the Five-Zang and Six-Fu organs. One of his academic ideas is that the method of regulation on spleen and stomach is not only for the treatment of stomach diseases, but also widely used in prevention and treatment of other diseases. And he is the chief editor of five books, Experiences and Sparkles on Medical Road of Lu Zhizheng, Dong Demao's Experience of Internal Medicine, Traditional Chinese Medicine Clinical Handbook, Sleep Medicine in Traditional Chinese Medicine, and Experts'Medical Cases Selected of Guang'an Men Hospital, China Academy of Traditional Chinese Medicine. Viewing from his education, working and researching experience, and his accomplishments over40years, Professor Gao Ronglin is an experts of TCM who hold the opinion of regulation on spleen and stomach.
Ⅱ. The academic thoughts of regulation on spleen and stomach of Professor Gao Ronglin and its clinical application
1. The theoretical basis of regulation on spleen and stomach
Professor Gao Ronglin is handy in regulation on spleen and stomach, which is based on conditioning of the asthenia and sthenia of spleen and stomach, and of the movement of qi. Being located in middle jiao and connected by membranes as well as Foot Taiyin Meridian of Spleen and Foot Yangming Meridian of Stomach, spleen and stomach are combined as interior and exterior organs. As the source of qi and blood and the foundation of acquired constitution, spleen and stomach take important roles in many physiological processes, such as receiving materials in the diet, digestion and absorption of the food, and transfusion of the nutritional elements. Functional properties of the spleen and stomach can be summarized as receiving and transforming, regulating up and down, and dryness and wetness.
2. The academic thoughts of regulation on spleen and stomach of Professor Gao Ronglin
(1) Transforming the essence and nourishing the organs
The spleen is the physical earth center which is the source of both the body's qi and blood. Both of these vital substances are considered to be transformations of food essence. The stomach is therefore called the "sea of grain and water". After "grinding and fermenting" the incoming materials part of the essence distilled from food is passed on to the spleen, while the rest is passed on downwards to the small intestine. If the stomach fails to receive and ferment properly, the supply of postnatal qi to the other organ networks will be disturbed. Master Hua's Classic of the Central Viscera states:"If the stomach qi is strong, all of the five zang and the six fu networks will be strong."
(2) Raising the clear and descending the turbid
The crucial transporting function of the spleen is entirely based on its action of "raising the pure (essence)." If the spleen qi rises, a "transporting" affect will ensue. On the other hand, the equally important action of passing on of the dregs-and the continued differentiation of pure and turbid fluids-are a result of the stomach's downward momentum, generally referred to as "descending the turbid." Fluid differentiation and absorption is achieved cooperatively by the small intestine, the triple warmer, and the bladder, but these aspects of fluid metabolism are often attributed, simply, to the descending function of the stomach.
(3) Qi movement relating to five-zang organs
Spleen/stomach plays a pivotal role in qi movement as drawing a Taiji (yin-yang symbol) of bodily waxing and waning:"The heart and the lung are yang; as they follow the downward impulse of stomach qi and descend on the right, they transform into yin. The liver and the kidney are yin; as they follow the upward impulse of spleen qi and ascend on the left, they transform into yang." air five organs in the body is not isolated, but is an organic link. Five internal organs in the maintenance of air-lifting process, their roles, there are often parties to an access table, lift up and down the order. However, the spleen and stomach to lift out of the hub, air-conditioning, the first when the stomach.
(4) Strong spleen helping to keep away from the external evils and to enjoy a healthy life
The Classic states:"When the spleen is healthy it can generate all living things. If it becomes depleted, it can bring about the hundred diseases", which emphasizes the central position in healing sickness that method of nursing spleen and stomach stands. When treating spleen/stomach disorders, the system's relationship to other organ networks needs to be taken into consideration. Particularly the liver's overbearing influence needs to be corrected if it is the original cause for the spleen's distress. Spleen tonics are therefore often accompanied by herbs that smooth and emolliate the liver.
3. The TCM syndromes of spleen and stomach
Practicing in clinic over years, Professor Gao Ronglin proposed the outline of spleen and stomach syndromes, which are classified as asthenia and sthenia syndromes, including SPLEEN/STOMACH WEAKNESS, DOWNWARD COLLAPSE OF SPLEEN QI, SPLEEN/STOMACH COLD AND WEAKNESS, SPLEEN/STOMACH YIN DEFICIENCY; DAMP HEAT IMPLICATING THE SPLEEN, STOMACH QI REVERSING UPWARDS, and STOMACH HEAT, as well as syndromes mixing asthenia and sthenia. The clinical manifestations, principle of treatment and prescriptions were summarized.
4. Professor Gao Ronglin's principle of treatment on regulating Spleen and Stomach
Basing on inheritance of the experiences of the two famous senior practitioners, Lu Zhisheng and Dong Demao, Professor Gao Ronglin emphasizes on regulation of the spleen and stomach in clinic. The clinical highlights include:(1) qi movement conditioning;(2) tonifying the spleen opening appetite;(3) appropriate drying and moistening;(4) treatment basing on Three Reasons. The principle of treatment include:strenthening the spleen and replenishing Qi, raising central yang and lifting collapse, warming the middle and expelling coldness, harmonizing the center and regulating qi, nourishing yin, drying dampness, consumer-mediated, clearing heat, soothing the liver and tonifying spleen, tonifying spleen and benefiting lung, tonifying spleen and calming down the heart, and tonifying spleen and wanning heart.
5. Regulating spleen and stomach to heal other organs
Su Wen· the real Zang organs chapter said:"the spleen is belonging to the earth which nourishes the other four organs.""Five internal organs get essence qi from the stomach, which is the foundation of the five zang organs." Just as the earth assumes the position of centeredness, balance, and harmony in nature, the spleen/stomach network is the body's center of balance. All up and down movements pivot around it, and both damp and dry qualities come together here to form a physiologically beneficial alliance. As the main text of the fever school, Wenbing Tiaobian, points out:"The spleen should be treated like the beam of a scale:if it is not in horizontal balance, it will not be at peace." Treating the spleen/stomach also requires the use of substances that are harmoniously balanced. Foods and herbs that are overly hot or cold or dry or moistening should be avoided. By regulating spleen and stomach, disorders of the other four zang organs, the heart, the lung, the liver and the kidney can be treated. On the basement of the above theories, combining with the clinical learning income, many cases of Professor Gao were selected and analyzed, such as palpitation, chest bi, insomnia, cough, edema, stomach pain, belching, diarrhea, intestinal obstruction, etc, which are the evidence of the objectivity that treating internal organs by using the methods of regulating spleen and stomach.
Ⅲ. The clinical study on the treatment of advanced prostate cancer by regulating spleen and stomach
Based on TCM treating principle summarized from clinical practice of advanced prostate cancer "cautions on tonifying kidney", as well as inheriting Professor Gao's academic thought about regulating spleen and stomach, the theories of "strengthening spleen means to tonify kidney" and "strengthening body resistance means to dispel evils" were proposed in the treatment of advanced prostate cancer, while carrying out the clinical study on the treatment of advanced prostate cancer by regulating spleen and stomach.
OBJECTIVE:to evaluate the clinical effect of treating advanced prostate cancer with the method of regulating spleen and stomach (Four Major Herbs Combination (Si Junzi Tang, SJZT) as the main formula). METHODS:67patients with advanced prostate cancer which are hard to be clinically controlled were recruited in the randomized, controlled trail. Patients were divided into two groups: SJZT+western medicine group and western medicine group, with6-month treating period. Karnofsky score, EORTC QOL C-30853score, TCM clinical symptom score, peripheral white blood cell count (WBC), and hemoglobin (Hb) were collected before treatment,1st,3rd, and6th months of the treatment.
RESULT:Excluding4cases in SJZT+western medicine group, and3cases in western medicine group,60cases were included in final statistics,30in each group.①The method of regulating spleen and stomach can significantly improve the life quality of patients with hormone-refractory prostate cancer and the Karnofsky score; And can reduce the physical status score, urinary symptom score, pain score and physical function score in EORTC QOL C-30853score.②The method of regulating spleen and stomach significantly improved symptoms of patients with prostate cancer, such as poor appetite, fatigue, urinating difficulty, painful urination, etc..③The method of regulating spleen and stomach can delay the PSA growth rate.④The method of regulating spleen and stomach induced peripheral blood WBC and Hb. CONCLUSION:①The method of regulating spleen and stomach can significantly improve the life quality of patients with hormone-refractory prostate cancer.②The method of regulating spleen and stomach can become a commonly used TCM method in the treatment of advanced prostate cancer.
Ⅳ Innovation
1. Theoretical Innovation:Basing on inheritance of Professor Gao Ronglin's academic thought of spleen and stomach regulation, combined with the etiology, pathogenesis, and disease characteristics of advanced prostate cancer, the basic TCM treating principle was proposed:to regulate spleen and stomach, est. to promote the body resistance and to eliminate pathogenic factors, which provides new ideas in TCM treatment of advanced prostate cancer.
2. Idea innovative:As standard treatment, surgical removal of the testicles or medical castration requiring testosterone to castration levels, often causes to TCM kidney deficiency symptoms. While traditional methods for tonifying kidney with herbs may raise testosterone levels and worse the illness, contrary to principles of standards treatment. With the inspire of Professor Gao Ronglin's academic thought of "the practitioner who is good at regulating spleen and stomach can heal other internal organs", from the perspective of spleen/stomach, the idea of benefiting spleen/stomach equals to tonifying kidney was proposed, which can enrich the idea of TCM treatment of advanced prostate cancer.
3. Clinical Innovation:Basing on those points of view, a randomized, controlled clinical trail was carried out with the integration treatment of SJZT and western standard for advanced prostate cancer. It is confirmed that the method of regulating Spleen and Stomach can significantly make the symptoms better, such as fatigue, poor appetite etc., and can improve the quality of life.
一、高荣林教授学术思想渊源概述
高荣林教授1969年毕业于北京中医学院(现北京中医药大学),1979年考取中国中医研究院(现中国中医科学院)研究生班,获医学硕士学位。高师师承路志正董德懋二老,熟谙《黄帝内经》、《伤寒杂病论》、《脾胃论》等多部医学经典,崇尚仲景学说,重视人整体的协调统一,辨证注重脏腑关系,临床讲求权变调理,临床实践中注重对脾胃的调理,认为调理脾胃法不仅可以用于脾胃疾病的治疗,还可广泛运用于其它系统疾病的防治当中。主编《董德懋内科经验集》、《中医内科临床手册》、《中医睡眠医学》、《中国中医研究院广安门医院专家医案精选》、《路志正医林集腋》5部著作。从高师的学习、工作经历研究方向及工作40余年来取得的成绩来看,高师当属当代脾胃学派名老中医药专家。
二、高荣林教授调理脾胃的学术思想概述和临床应用
1.调理脾胃的理论基础
高师在临床实践中注重对脾胃虚实和气机升降的调理,应用调理脾胃之法,可谓得心应手。脾与胃同居中焦,以膜相连,足太阴经属脾络胃,足阳明经属胃络脾,两者构成表里配合关系。脾胃同为气血生化之源、后天之本,在饮食物的受纳、消化及水谷精微的吸收、转输等生理过程中起主要作用。脾与胃的功能特性,通过纳和化、升和降、燥与湿三个方面来体现。
2.高荣林教授调理脾胃理论观点
(1)化生精微,荣养脏腑
脾胃为后天之本,气血生化之源。人以水谷为本,水谷精微是人体生命活动的源动力。通过调理脾胃,益其生化之源,有助于机体功能的恢复。
(2)升清降浊,脾胃为枢
脾胃同居中焦,脾胃为气机升降之枢纽,贵健通和畅。高师临床重视调整全身之气机,以脾胃为枢纽,或以调理气机以和脏腑,或以和脏腑以调气机。高师临床常告诫笔者：调节气机的升降,不能顾此失彼,切莫着眼于单一证候,务必要着眼于整个气机的运动。
(3)重视气化,五脏相关
五脏气机在人体中不是孤立的,而是有机联系的。五脏在维持气机升降过程中,各司其职,方使表里出入有常,上下升降有序。然脾胃为升降出入之枢纽,“脾为之使,胃为之市”,调理气机,首当脾胃。
(4)四季脾旺,御邪延寿
脾居中州,灌溉四傍,四季脾旺不受邪。强调顾护脾胃的方法,突出其在治病延年中的核心地位。
3.基于临床,提出脾胃病证大纲
高师在多年临床的基础上,提出脾胃病证大纲。按照虚实分类,虚证包括：脾胃虚弱证、脾气虚陷证、脾胃虚寒证、脾胃阴虚证等；实证包括脾胃湿热证、胃气上逆证、胃热证等,临床中还多见虚实夹杂证。对各证的临床表现、治则治法和方药进行了概括。
4.高荣林教授调理脾胃临证要点临床治法
高师在师承路志正、董德懋二老学术思想的基础上,在临床中强调调理脾胃。其临证要点包括：(1)注重升降,调理气机；(2)注重纳化,补脾开胃；(3)津气兼顾,润燥适宜；(4)三因制宜,辨证调护。并在临床中提出调理脾胃正法、变法,调理脾胃正法包括：健脾益气法、升举中气法、温中散寒法、理气法、养阴法、祛湿法、消导法、清热法等；调理脾胃常用变法包括：健脾疏肝法、健脾益肺法、健脾宁心法、健脾温肾法等。
5.调理脾胃以治五脏
《素问.玉机真脏论篇》：“脾脉者土也,孤脏以灌四傍者也”,“五脏者,皆禀气于胃,胃者五脏之本也。”倘脾胃健旺,气血旺盛、气化正常,则五脏六腑四肢百骸皆得所养,脾胃健而五脏安；同样可以通过调其他脏腑来补脾胃不足,安五脏即所以调脾胃。高师在临床中从脾胃和五脏的关系出发,提出调理脾胃治心、调理脾胃治肝、调理脾胃治肺、调理脾胃治肾、调理脾胃治胃的理论。就上述理论,结合随师临床所得,本文对心悸、胸痹、失眠、咳嗽、水肿、胃痛、嗳气、泄泻、关格等疾病病案进行了分析,临床求证了调理脾胃以治五脏的客观性。
三、调理脾胃法治疗晚期前列腺癌的临床研究
基于中医治疗晚期前列腺癌应该“慎用补肾”的临床实际,在继承高师调理脾胃学术思想的基础上,提出治疗难治性前列腺癌“补脾可以代替补肾”、“扶正即是祛邪”的理论,同时开展了调理脾胃法治疗晚期前列腺癌的临床研究。
临床研究目的：客观评价调理脾胃法(以六君子汤为基本方)治疗晚期前列腺癌的临床疗效。方法：采用随机、对照的方法,选择符合难治性前列腺癌的患者67例。治疗组采用调理脾胃法基本方六君子汤联合西医治疗方案(中西医结合治疗),对照组采用西医治疗方案。治疗周期6个月。分别在治疗前、治疗第1、3、6月采集Karnofsky评分、EORTC QOL C-30853评分、中医临床症状评分、外周血白细胞数(WBC)、血红蛋白(Hb)。结果：治疗组剔除4例,对照组剔除3例,最终有效病例60例,治疗组和对照组各30例。①调理脾胃法能显著改善激素难治性前列腺癌患者的生活质量,提高卡式评分、能降低EORTC QOL C-30853评分中体力状况评分、排尿症状评分、疼痛症状评分和躯体功能评分。②调理脾胃法能明显改善前列腺癌患者纳呆、乏力、排尿困难、尿痛等症状。③调理脾胃法能延缓PSA增长速度。④调理脾胃法能提高患者外周血WBC、Hb。结论：①调理脾胃法能提高难治性前列腺癌患者的生活质量；②调理脾胃法可能成为中医治疗晚期前列腺癌的常用方法之一。
四、创新点
1.理论创新：在充分继承高荣林教授调理脾胃学术思想的基础上,结合晚期前列腺癌病因、病机、治疗特点,提出调理脾胃--扶正祛邪可以作为治疗晚期前列腺癌的基本治法之一,为中医治疗晚期前列腺癌提供新的思路。
2.思路创新：晚期前列腺癌西医治疗——手术切除睾丸或药物去势,要求睾酮达到去势水平,这往往引起中医肾虚症状。传统补肾方法因补肾中草药可能存在类雄激素样作用,可能会提升睾酮水平,而加重病情,违背西医标准治疗原则。本研究受高荣林教授“擅调脾胃者,可以治五脏”学术思想影响,针对晚期前列腺癌的疾病特点,从调脾胃的角度出发,提出补脾可以代替补肾,丰富了晚期前列腺癌的治疗思路。
3.临床创新：基于上述观点,开展随机、对照临床研究,通过以六君子汤为基本方联合西医标准方案治疗晚期前列腺癌,证实调理脾胃法能明显改善患者乏力、纳呆等临床症状,提高生活质量。
Professor Gao Ronglin, a chief physician and doctoral tutor of Research Office of Famous Senior Practitioners, Guang'an Men Hospital, China Academy of Chinese Medical Sciences, receiving the government special allowance distributed by Department of State, being an expert of new drug evaluation of State Food and Drug Administration, an expert of the central health care consultation, vice chairman of Internal Difficult Disease Committee of China Association, president of the Professional Committee of Sleep Medicine of World Federation of Chinese Medicine, an adjunct professor at Beijing University of Chinese Medicine, and a tutor of the fourth installment of the Inheritance Program of Famous Senior Practitioners'Experiences.
The origin of Professor Gao Ronglin's academic thought of spleen and stomach regulation, the content of the thought, and clinical practices over the thought were systematically organized and summarized in this paper. Based on the inheritance of Professor Gao Ronglin's opinion, a new hyothese comes up that tonifying spleen is as good as supplementing kidney in the clinical practice for the advanced stage prostate cancer. Thus, we performed a randomized clinical trial to test this new hypothess method for the advanced stage prostate cancer.
Ⅰ. The origin of Professor Gao Ronglin's academic thought
Graduated from Beijing College of Chinese Medicine in1969(now Beijing University of Chinese Medicine), Professor Gao Ronglin obtained master degree from postgraduate class of China Academy of Chinese Medicine in1979(now China Academy of Chinese Medical Sciences). Being one of the students of two maters of TCM, Lu Zhizheng and Dong Demao, he is very accomplished on medical classics, such as Yellow Emperor, Febrile Diseases, Stomach Theory, etc. and Zhang Zhongjing Theories; in clinic, he is emphasizing the theory of harmony between human beings and the nature, and focusing on syndrome differentiation by the relationships between the Five-Zang and Six-Fu organs. One of his academic ideas is that the method of regulation on spleen and stomach is not only for the treatment of stomach diseases, but also widely used in prevention and treatment of other diseases. And he is the chief editor of five books, Experiences and Sparkles on Medical Road of Lu Zhizheng, Dong Demao's Experience of Internal Medicine, Traditional Chinese Medicine Clinical Handbook, Sleep Medicine in Traditional Chinese Medicine, and Experts'Medical Cases Selected of Guang'an Men Hospital, China Academy of Traditional Chinese Medicine. Viewing from his education, working and researching experience, and his accomplishments over40years, Professor Gao Ronglin is an experts of TCM who hold the opinion of regulation on spleen and stomach.
Ⅱ. The academic thoughts of regulation on spleen and stomach of Professor Gao Ronglin and its clinical application
1. The theoretical basis of regulation on spleen and stomach
Professor Gao Ronglin is handy in regulation on spleen and stomach, which is based on conditioning of the asthenia and sthenia of spleen and stomach, and of the movement of qi. Being located in middle jiao and connected by membranes as well as Foot Taiyin Meridian of Spleen and Foot Yangming Meridian of Stomach, spleen and stomach are combined as interior and exterior organs. As the source of qi and blood and the foundation of acquired constitution, spleen and stomach take important roles in many physiological processes, such as receiving materials in the diet, digestion and absorption of the food, and transfusion of the nutritional elements. Functional properties of the spleen and stomach can be summarized as receiving and transforming, regulating up and down, and dryness and wetness.
2. The academic thoughts of regulation on spleen and stomach of Professor Gao Ronglin
(1) Transforming the essence and nourishing the organs
The spleen is the physical earth center which is the source of both the body's qi and blood. Both of these vital substances are considered to be transformations of food essence. The stomach is therefore called the "sea of grain and water". After "grinding and fermenting" the incoming materials part of the essence distilled from food is passed on to the spleen, while the rest is passed on downwards to the small intestine. If the stomach fails to receive and ferment properly, the supply of postnatal qi to the other organ networks will be disturbed. Master Hua's Classic of the Central Viscera states:"If the stomach qi is strong, all of the five zang and the six fu networks will be strong."
(2) Raising the clear and descending the turbid
The crucial transporting function of the spleen is entirely based on its action of "raising the pure (essence)." If the spleen qi rises, a "transporting" affect will ensue. On the other hand, the equally important action of passing on of the dregs-and the continued differentiation of pure and turbid fluids-are a result of the stomach's downward momentum, generally referred to as "descending the turbid." Fluid differentiation and absorption is achieved cooperatively by the small intestine, the triple warmer, and the bladder, but these aspects of fluid metabolism are often attributed, simply, to the descending function of the stomach.
(3) Qi movement relating to five-zang organs
Spleen/stomach plays a pivotal role in qi movement as drawing a Taiji (yin-yang symbol) of bodily waxing and waning:"The heart and the lung are yang; as they follow the downward impulse of stomach qi and descend on the right, they transform into yin. The liver and the kidney are yin; as they follow the upward impulse of spleen qi and ascend on the left, they transform into yang." air five organs in the body is not isolated, but is an organic link. Five internal organs in the maintenance of air-lifting process, their roles, there are often parties to an access table, lift up and down the order. However, the spleen and stomach to lift out of the hub, air-conditioning, the first when the stomach.
(4) Strong spleen helping to keep away from the external evils and to enjoy a healthy life
The Classic states:"When the spleen is healthy it can generate all living things. If it becomes depleted, it can bring about the hundred diseases", which emphasizes the central position in healing sickness that method of nursing spleen and stomach stands. When treating spleen/stomach disorders, the system's relationship to other organ networks needs to be taken into consideration. Particularly the liver's overbearing influence needs to be corrected if it is the original cause for the spleen's distress. Spleen tonics are therefore often accompanied by herbs that smooth and emolliate the liver.
3. The TCM syndromes of spleen and stomach
Practicing in clinic over years, Professor Gao Ronglin proposed the outline of spleen and stomach syndromes, which are classified as asthenia and sthenia syndromes, including SPLEEN/STOMACH WEAKNESS, DOWNWARD COLLAPSE OF SPLEEN QI, SPLEEN/STOMACH COLD AND WEAKNESS, SPLEEN/STOMACH YIN DEFICIENCY; DAMP HEAT IMPLICATING THE SPLEEN, STOMACH QI REVERSING UPWARDS, and STOMACH HEAT, as well as syndromes mixing asthenia and sthenia. The clinical manifestations, principle of treatment and prescriptions were summarized.
4. Professor Gao Ronglin's principle of treatment on regulating Spleen and Stomach
Basing on inheritance of the experiences of the two famous senior practitioners, Lu Zhisheng and Dong Demao, Professor Gao Ronglin emphasizes on regulation of the spleen and stomach in clinic. The clinical highlights include:(1) qi movement conditioning;(2) tonifying the spleen opening appetite;(3) appropriate drying and moistening;(4) treatment basing on Three Reasons. The principle of treatment include:strenthening the spleen and replenishing Qi, raising central yang and lifting collapse, warming the middle and expelling coldness, harmonizing the center and regulating qi, nourishing yin, drying dampness, consumer-mediated, clearing heat, soothing the liver and tonifying spleen, tonifying spleen and benefiting lung, tonifying spleen and calming down the heart, and tonifying spleen and wanning heart.
5. Regulating spleen and stomach to heal other organs
Su Wen· the real Zang organs chapter said:"the spleen is belonging to the earth which nourishes the other four organs.""Five internal organs get essence qi from the stomach, which is the foundation of the five zang organs." Just as the earth assumes the position of centeredness, balance, and harmony in nature, the spleen/stomach network is the body's center of balance. All up and down movements pivot around it, and both damp and dry qualities come together here to form a physiologically beneficial alliance. As the main text of the fever school, Wenbing Tiaobian, points out:"The spleen should be treated like the beam of a scale:if it is not in horizontal balance, it will not be at peace." Treating the spleen/stomach also requires the use of substances that are harmoniously balanced. Foods and herbs that are overly hot or cold or dry or moistening should be avoided. By regulating spleen and stomach, disorders of the other four zang organs, the heart, the lung, the liver and the kidney can be treated. On the basement of the above theories, combining with the clinical learning income, many cases of Professor Gao were selected and analyzed, such as palpitation, chest bi, insomnia, cough, edema, stomach pain, belching, diarrhea, intestinal obstruction, etc, which are the evidence of the objectivity that treating internal organs by using the methods of regulating spleen and stomach.
Ⅲ. The clinical study on the treatment of advanced prostate cancer by regulating spleen and stomach
Based on TCM treating principle summarized from clinical practice of advanced prostate cancer "cautions on tonifying kidney", as well as inheriting Professor Gao's academic thought about regulating spleen and stomach, the theories of "strengthening spleen means to tonify kidney" and "strengthening body resistance means to dispel evils" were proposed in the treatment of advanced prostate cancer, while carrying out the clinical study on the treatment of advanced prostate cancer by regulating spleen and stomach.
OBJECTIVE:to evaluate the clinical effect of treating advanced prostate cancer with the method of regulating spleen and stomach (Four Major Herbs Combination (Si Junzi Tang, SJZT) as the main formula). METHODS:67patients with advanced prostate cancer which are hard to be clinically controlled were recruited in the randomized, controlled trail. Patients were divided into two groups: SJZT+western medicine group and western medicine group, with6-month treating period. Karnofsky score, EORTC QOL C-30853score, TCM clinical symptom score, peripheral white blood cell count (WBC), and hemoglobin (Hb) were collected before treatment,1st,3rd, and6th months of the treatment.
RESULT:Excluding4cases in SJZT+western medicine group, and3cases in western medicine group,60cases were included in final statistics,30in each group.①The method of regulating spleen and stomach can significantly improve the life quality of patients with hormone-refractory prostate cancer and the Karnofsky score; And can reduce the physical status score, urinary symptom score, pain score and physical function score in EORTC QOL C-30853score.②The method of regulating spleen and stomach significantly improved symptoms of patients with prostate cancer, such as poor appetite, fatigue, urinating difficulty, painful urination, etc..③The method of regulating spleen and stomach can delay the PSA growth rate.④The method of regulating spleen and stomach induced peripheral blood WBC and Hb. CONCLUSION:①The method of regulating spleen and stomach can significantly improve the life quality of patients with hormone-refractory prostate cancer.②The method of regulating spleen and stomach can become a commonly used TCM method in the treatment of advanced prostate cancer.
Ⅳ Innovation
1. Theoretical Innovation:Basing on inheritance of Professor Gao Ronglin's academic thought of spleen and stomach regulation, combined with the etiology, pathogenesis, and disease characteristics of advanced prostate cancer, the basic TCM treating principle was proposed:to regulate spleen and stomach, est. to promote the body resistance and to eliminate pathogenic factors, which provides new ideas in TCM treatment of advanced prostate cancer.
2. Idea innovative:As standard treatment, surgical removal of the testicles or medical castration requiring testosterone to castration levels, often causes to TCM kidney deficiency symptoms. While traditional methods for tonifying kidney with herbs may raise testosterone levels and worse the illness, contrary to principles of standards treatment. With the inspire of Professor Gao Ronglin's academic thought of "the practitioner who is good at regulating spleen and stomach can heal other internal organs", from the perspective of spleen/stomach, the idea of benefiting spleen/stomach equals to tonifying kidney was proposed, which can enrich the idea of TCM treatment of advanced prostate cancer.
3. Clinical Innovation:Basing on those points of view, a randomized, controlled clinical trail was carried out with the integration treatment of SJZT and western standard for advanced prostate cancer. It is confirmed that the method of regulating Spleen and Stomach can significantly make the symptoms better, such as fatigue, poor appetite etc., and can improve the quality of life.
引文
[1]Siegel R, Ward E, Brawley O, et al. Cancer statistics,2011:The impact of eliminating socioeconomic and racial disparities on premature cancer deaths[J]. CA Cancer J Clin,2011,61:212-36.
[2]那彦群.中国泌尿外科疾病诊断治疗指南[M].北京：人民卫生出版社,2007：7-87.
[3]Osoba D, Tannock IF, Ernst DS, et al. Health-related quality of life in men with metastatic prostate cancer treated with prednisone alone or mitoxantrone and prednisone[J]. J Clin Oncol,1999,17:1654-63.
[4]Tannock IF, Osoba D, Stockler MR, et al. Chemotherapy with mitoxantrone plus prednisone or prednisone alone for symptomatic hormone-resistant prostate cancer:A Canadian randomized trial with palliative end points[J]. J Clin Oncol, 1996,14:1756-64.
[5]吕立国,占炽明,王昭辉,等.陈志强教授对晚期前列腺癌中医病因病机的探讨[J].新中医,2007,39(2)：81.
[6]宋竖旗,李灿.张亚强教授对前列腺癌中医病因病机的认识[J].中国中医基础医学杂志,2008,14(2)：131.
[7]吕立国,代睿欣,王昭辉,等.陈志强教授扶正抑瘤法治疗晚期前列腺癌临床经验[J].新中医,2007,39(5)：91.
[8]张亚强,林飞.前列消癓汤治疗前列腺癌的临床观察[J].中国中西医结合外科杂志,2006,12(2)：83.
[9]黄智峰,赖海标,曾晔,等.肿节风注射液对中晚期前列腺癌26例PSA、F-PSA的影响[J].中医研究,2006,19(11)：25.
[10]厉将斌,那彦群,郭应禄,等.前列腺癌中医药治疗的经验与思路[J].中国中西医结合杂志,2002,22(6)：425.
[11]张亚强,林飞.前列消瘤汤对前列腺癌C57小鼠移植瘤的抑制作用[J].中国中西医结合外科杂志,2005,11(6)：505.
[12]张亚强,林飞.前列消癓汤对前列腺癌裸鼠移植瘤的抑制作用[J].中国中医药信息杂志2005,12(11)：20.
[13]张辉,吕家驹,丁森泰,等.吴茱萸碱诱导前列腺癌PC-3细胞凋亡机制的实验研究[J].中国老年医学杂志,2007,27(7)：1230.
[14]张蜀武,张培海,常德贵.人参胡核汤对人前列腺癌PC-3细胞增殖的抑制作用[J].中国男科学杂志,2007,21(6)：7.
[15]沈映君.中药药理学[M].北京：人民卫生出版社,2002：900-915.
[16]彭煜,彭培初.泉安方治疗晚期前列腺癌骨转移痛初探[J].中国男科学杂志,2004, 18(4)：46.
[17]郭凤,于广久,康健.人参皂甙Rh2诱导肿瘤细胞凋亡的研究进展[J].锦州医学院学报,2006,27(5)：52-54.
[18]王强,赵玲辉,杨慧科.人参皂甙Rh-2对细胞间连接黏附分子在小鼠移植瘤淋巴管表达的影响[J].解剖学研究,2007,29(1)：29-32.
[19]Xie X, Eberding A, Madera C, Fazli L, Jia W, Goldenberg L, et al. Rh2 Synergistically Enhances Paclitaxel or Mitoxantrone in Prostate Cancer Models[J]. J Urol,2006; 175:1926-31
[20]LIU W K, XU S X, CHE C T. Anti-proliferative effect of ginseng saponins on human prostate cancer cell line[J].Life Sci,2000,67(11):1297-1306.
[21]Kim SW, Kwon HY, Chi DW, et at. Reversal of P-glycoprotein-mediated multidrug resistance by ginsenoside Rg3.Biochem Pharmacol,2003,65(1):75-82.
[22]Rhim H, Kim H, Lee DY, et al. Ginseng and ginsenoside Rg3, a newly identified active ingredient of ginseng, modulate Ca2+ channel currents in rat sensory neurons. Eur J Pharmacoll, 2002,436(3):151-158.
[23]刘昳,叶峰,邱根全,等.白术内酯Ⅰ对肿瘤恶病质患者细胞因子和肿瘤代谢因子的影响[J].第一军医大学学报,2005,25(10)：1308-1311.
[24]孙文平,李发胜,侯殿东,等.当归、白术、制白附子多糖对小鼠免疫调节作用的影响[J].中国中医药信息杂志,2008,15(7)：37-38.
[25]许津,吕丁,钟启平,等.茯苓素对小鼠L1210细胞的抑制作用[J].中国医学科学院学报,1988,10(1)：45-49.
[26]张文女,黄金龙.茯苓多糖的抗肿瘤作用[J].中草药,1999,30(7)：561-562.
[27]梁喜爱.中药猪苓、茯苓治疗肿瘤的药理功能新探[J].铁道医学,1992,20(4)：235.
[28]张秀明.茯苓药理作用研究概况[J].中药材,2001,24(6)：446-449.
[29]陈定南.茯苓多糖抗肿瘤及其有关药理作用[J].中药通报,1987,12(9)：553.
[30]潘明继,李永辉,陈连舫,等.羧甲基茯苓多糖的临床试用及抗癌实验研究[J].福建医药杂志,1983(5)：230-231.
[31]吴洁,孙桂芝.孙桂芝教授防治肿瘤转移复发临床常用中药及现代药理研究[J].中华中医药学刊,2007,25(1)：66.
[32]李洛恩,王冬毅.茯苓的药理及临床新用[J].基层中药杂志,1997,11(3)：55.
[33]田守生,李世忠.甘草及炙甘草汤的药理与与应用[J].中国药业,1999,8(8)：48.
[34]王忱,谢广茹,史玉荣,等.甘草多糖的体内抑瘤作用及其机制的研究[J].临床肿瘤学杂志,2003,8(2)：85-87.
[35]王岳五,史玉荣,张海波,等.甘草残渣中多糖GPS抗肿瘤作用的研究[J].南开大学学报,2000,33(4)：46-48.
[36]Tanaka T, Makita H, Kawabata K, et al. Chemoprevention of azoxymethane-induced rat colon carcinogenesis by the naturally occurring flavonoids, diosmin and hesperidin[J].Carcinogenesis,1997,18(5):957-965.
[37]Zheng Q, Hirose Y, Yoshimi N, et al. Further investigation of the modifying effect of various chemopreventive agents on apoptosis and cell proliferation in human colon cancer cells[J].J Cancer ResClin Oncol,2002,128(10):539-546.
[38]Kim MJ, Park H J, Hong M S, et al. Citrus Reticulata Blanco induces apoptosis in human gastric cancer cells SNU-668[J].Nutr Cancer,2005,51(1):78-82.
[39]Kang SA, Park H J, Kim M J, etal. CitriReticulatae Viride Peri-carpium extract induced apoptosis in SNU-C4, human colon cancer cells[J].J Ethnophannacol,2005,97(2):231-235.
[40]钱十辉,王佾先,杨念云.陈皮提取物体内抗肿瘤作同及其对癌细胞增殖周期的影响[J].中国中药杂志,2003,28(12)：1167-1170.
[41]李兰英,彭蕴汝.陈皮多甲氧基黄酮类成分对人肝癌SMMC-7721、HepG2细胞株增殖的影响[J].中药材,2007,30(3)：324-326.
[42]管晓琳,罗刚,朱玲,等.川陈皮素诱导非小细胞肺癌A549细胞凋亡的研究[J]中国医科大学学报,2006,37(5)：443-446.
[43]李丽,王慧娟,盖成万.半夏的药理和临床研究进展[J].中医药信息,2006,23(5)：38-40.
[44]黄必胜.、半夏蛋白对肝癌细胞Bet-7402生长抑制作用的研究[J].湖北中医杂志,2006,28(12)；11-12.
[45]赵永娟,王蕾,侯琳,等.半夏多糖抗肿瘤作用研究[J].中国药理学通报,2006,22(3)：368-371.
[46]周金黄.中药药理学[M].上海：上海科技出版社,1986：125-126.
[47]森川罄.半夏中所见的多形核白细胞活性抗肿瘤作用[J].国外医学·中医中药分册,1988,10(1)：44.
[48]代龙,杨培民,魏永利.中药白花蛇舌草研究进展[J].现代中药研究与实践,2009,23(4)：75-78.
[49]陈秀珍,朱大诚,王艳辉,等.白花蛇舌草药理作用及临床应用研究新进展[J].中药材,2009,32(1)：157-161.
[50]赵阳白花蛇舌草抗肿瘤作用研究进展[J].山东中医杂志,2009,28(7)：517-519.
[51]张炜.白花蛇舌草对肿瘤细胞信号传导通路的抑制[J].食品与生物技术学报,2006,25(1)：50-51.
[52]赵善黎,张肖晗.白花蛇舌草注射液联合化疗治疗恶性肿瘤[J].医药论坛杂志,2007,28(10)：74-75.
[53]钱韵旭,赵浩如,高展,等.白花蛇舌草提取物的体外抗肿瘤活性[J].江苏药学与临床研 究,2004,12(4)：36-38.
[54]高超,刘颖,蔡晓敏,等.白花蛇舌草对U14宫颈癌抗肿瘤作用的实验研究[J].适用癌症杂志,2007,22(6)：557-559.
[55]李洁.白花蛇舌草对S180荷瘤小鼠抑瘤作用的实验研究[J].中医研究,2008,21(5)：11-13.
[56]李丽秋,张德慧,马淑霞,等.中草药白花蛇舌草等对实验性大肠癌作同机制的研究[J].中国微生态学杂志,2008,20(3)：224-225.
[57]Li Rui, ZhaoHaoru, Lin Yinin. Anti-tumor Effect and Protective Effect on Chemotherapeutic Damage of Water Soluble Extracts from Hedyotis diffus[J]. J Chin Pharm Sci,2002,11 (2): 54-58.
[58]张明智,张可杰,王庆端,等.夏枯草对淋巴瘤细胞增殖的影响[J].医药论坛杂志,2007,28(1)：54-55.
[59]张可杰,张明智,王庆端,等.夏枯草对Raji细胞生长和凋亡相关[J].基因蛋白表达的影响[J].中药材,2006,29(11)：1207-1210.
[60]刘新奎,王琳,张明智.夏枯草对人淋巴瘤细胞增殖的影响[J].山东医药,2008,48(46)：30-31.
[61]付晓瑞,张明智,刘宏民,等.夏枯草提取物对Jurkat细胞凋亡的影响[J].郑州大学学报(医学版),2008,43(5)：964-967.
[62]王琨,董惠芳,章晓鹰,等.夏枯草对SGC-7901细胞的影响[J].上海医学检验杂志,2000,15(5)：305-306.
[63]张海波,蔡安和,周荣耀,等.夏枯草及抗炎1号注射液经肝动脉联合灌注治疗大鼠晚期肝癌的实验研究[J].实用中西医结合临床,2003,3(4)：1-3.
[64]张海波,周荣耀,章晓鹰,等.夏枯草及抗炎一号注射液经肝动脉联合灌注治疗大鼠肝癌作同机制的初步探讨[J].现代肿瘤医学,2006,14(6)：646-648.
[65]朱娜.夏枯草提取液与顺铂协同抗肿瘤作用的体内研究[J].中国民族民间医药,2009,18(24)：25-26.
[66]陈长英,伍钢,张明智.夏枯草提取物体内外对小鼠T淋巴瘤EL4细胞生长的影响[J].郑州大学学报(医学版),2009,44(2)：380-383.
[2]那彦群.中国泌尿外科疾病诊断治疗指南[M].北京：人民卫生出版社,2007：7-87.
[3]Osoba D, Tannock IF, Ernst DS, et al. Health-related quality of life in men with metastatic prostate cancer treated with prednisone alone or mitoxantrone and prednisone[J]. J Clin Oncol,1999,17:1654-63.
[4]Tannock IF, Osoba D, Stockler MR, et al. Chemotherapy with mitoxantrone plus prednisone or prednisone alone for symptomatic hormone-resistant prostate cancer:A Canadian randomized trial with palliative end points[J]. J Clin Oncol, 1996,14:1756-64.
[5]吕立国,占炽明,王昭辉,等.陈志强教授对晚期前列腺癌中医病因病机的探讨[J].新中医,2007,39(2)：81.
[6]宋竖旗,李灿.张亚强教授对前列腺癌中医病因病机的认识[J].中国中医基础医学杂志,2008,14(2)：131.
[7]吕立国,代睿欣,王昭辉,等.陈志强教授扶正抑瘤法治疗晚期前列腺癌临床经验[J].新中医,2007,39(5)：91.
[8]张亚强,林飞.前列消癓汤治疗前列腺癌的临床观察[J].中国中西医结合外科杂志,2006,12(2)：83.
[9]黄智峰,赖海标,曾晔,等.肿节风注射液对中晚期前列腺癌26例PSA、F-PSA的影响[J].中医研究,2006,19(11)：25.
[10]厉将斌,那彦群,郭应禄,等.前列腺癌中医药治疗的经验与思路[J].中国中西医结合杂志,2002,22(6)：425.
[11]张亚强,林飞.前列消瘤汤对前列腺癌C57小鼠移植瘤的抑制作用[J].中国中西医结合外科杂志,2005,11(6)：505.
[12]张亚强,林飞.前列消癓汤对前列腺癌裸鼠移植瘤的抑制作用[J].中国中医药信息杂志2005,12(11)：20.
[13]张辉,吕家驹,丁森泰,等.吴茱萸碱诱导前列腺癌PC-3细胞凋亡机制的实验研究[J].中国老年医学杂志,2007,27(7)：1230.
[14]张蜀武,张培海,常德贵.人参胡核汤对人前列腺癌PC-3细胞增殖的抑制作用[J].中国男科学杂志,2007,21(6)：7.
[15]沈映君.中药药理学[M].北京：人民卫生出版社,2002：900-915.
[16]彭煜,彭培初.泉安方治疗晚期前列腺癌骨转移痛初探[J].中国男科学杂志,2004, 18(4)：46.
[17]郭凤,于广久,康健.人参皂甙Rh2诱导肿瘤细胞凋亡的研究进展[J].锦州医学院学报,2006,27(5)：52-54.
[18]王强,赵玲辉,杨慧科.人参皂甙Rh-2对细胞间连接黏附分子在小鼠移植瘤淋巴管表达的影响[J].解剖学研究,2007,29(1)：29-32.
[19]Xie X, Eberding A, Madera C, Fazli L, Jia W, Goldenberg L, et al. Rh2 Synergistically Enhances Paclitaxel or Mitoxantrone in Prostate Cancer Models[J]. J Urol,2006; 175:1926-31
[20]LIU W K, XU S X, CHE C T. Anti-proliferative effect of ginseng saponins on human prostate cancer cell line[J].Life Sci,2000,67(11):1297-1306.
[21]Kim SW, Kwon HY, Chi DW, et at. Reversal of P-glycoprotein-mediated multidrug resistance by ginsenoside Rg3.Biochem Pharmacol,2003,65(1):75-82.
[22]Rhim H, Kim H, Lee DY, et al. Ginseng and ginsenoside Rg3, a newly identified active ingredient of ginseng, modulate Ca2+ channel currents in rat sensory neurons. Eur J Pharmacoll, 2002,436(3):151-158.
[23]刘昳,叶峰,邱根全,等.白术内酯Ⅰ对肿瘤恶病质患者细胞因子和肿瘤代谢因子的影响[J].第一军医大学学报,2005,25(10)：1308-1311.
[24]孙文平,李发胜,侯殿东,等.当归、白术、制白附子多糖对小鼠免疫调节作用的影响[J].中国中医药信息杂志,2008,15(7)：37-38.
[25]许津,吕丁,钟启平,等.茯苓素对小鼠L1210细胞的抑制作用[J].中国医学科学院学报,1988,10(1)：45-49.
[26]张文女,黄金龙.茯苓多糖的抗肿瘤作用[J].中草药,1999,30(7)：561-562.
[27]梁喜爱.中药猪苓、茯苓治疗肿瘤的药理功能新探[J].铁道医学,1992,20(4)：235.
[28]张秀明.茯苓药理作用研究概况[J].中药材,2001,24(6)：446-449.
[29]陈定南.茯苓多糖抗肿瘤及其有关药理作用[J].中药通报,1987,12(9)：553.
[30]潘明继,李永辉,陈连舫,等.羧甲基茯苓多糖的临床试用及抗癌实验研究[J].福建医药杂志,1983(5)：230-231.
[31]吴洁,孙桂芝.孙桂芝教授防治肿瘤转移复发临床常用中药及现代药理研究[J].中华中医药学刊,2007,25(1)：66.
[32]李洛恩,王冬毅.茯苓的药理及临床新用[J].基层中药杂志,1997,11(3)：55.
[33]田守生,李世忠.甘草及炙甘草汤的药理与与应用[J].中国药业,1999,8(8)：48.
[34]王忱,谢广茹,史玉荣,等.甘草多糖的体内抑瘤作用及其机制的研究[J].临床肿瘤学杂志,2003,8(2)：85-87.
[35]王岳五,史玉荣,张海波,等.甘草残渣中多糖GPS抗肿瘤作用的研究[J].南开大学学报,2000,33(4)：46-48.
[36]Tanaka T, Makita H, Kawabata K, et al. Chemoprevention of azoxymethane-induced rat colon carcinogenesis by the naturally occurring flavonoids, diosmin and hesperidin[J].Carcinogenesis,1997,18(5):957-965.
[37]Zheng Q, Hirose Y, Yoshimi N, et al. Further investigation of the modifying effect of various chemopreventive agents on apoptosis and cell proliferation in human colon cancer cells[J].J Cancer ResClin Oncol,2002,128(10):539-546.
[38]Kim MJ, Park H J, Hong M S, et al. Citrus Reticulata Blanco induces apoptosis in human gastric cancer cells SNU-668[J].Nutr Cancer,2005,51(1):78-82.
[39]Kang SA, Park H J, Kim M J, etal. CitriReticulatae Viride Peri-carpium extract induced apoptosis in SNU-C4, human colon cancer cells[J].J Ethnophannacol,2005,97(2):231-235.
[40]钱十辉,王佾先,杨念云.陈皮提取物体内抗肿瘤作同及其对癌细胞增殖周期的影响[J].中国中药杂志,2003,28(12)：1167-1170.
[41]李兰英,彭蕴汝.陈皮多甲氧基黄酮类成分对人肝癌SMMC-7721、HepG2细胞株增殖的影响[J].中药材,2007,30(3)：324-326.
[42]管晓琳,罗刚,朱玲,等.川陈皮素诱导非小细胞肺癌A549细胞凋亡的研究[J]中国医科大学学报,2006,37(5)：443-446.
[43]李丽,王慧娟,盖成万.半夏的药理和临床研究进展[J].中医药信息,2006,23(5)：38-40.
[44]黄必胜.、半夏蛋白对肝癌细胞Bet-7402生长抑制作用的研究[J].湖北中医杂志,2006,28(12)；11-12.
[45]赵永娟,王蕾,侯琳,等.半夏多糖抗肿瘤作用研究[J].中国药理学通报,2006,22(3)：368-371.
[46]周金黄.中药药理学[M].上海：上海科技出版社,1986：125-126.
[47]森川罄.半夏中所见的多形核白细胞活性抗肿瘤作用[J].国外医学·中医中药分册,1988,10(1)：44.
[48]代龙,杨培民,魏永利.中药白花蛇舌草研究进展[J].现代中药研究与实践,2009,23(4)：75-78.
[49]陈秀珍,朱大诚,王艳辉,等.白花蛇舌草药理作用及临床应用研究新进展[J].中药材,2009,32(1)：157-161.
[50]赵阳白花蛇舌草抗肿瘤作用研究进展[J].山东中医杂志,2009,28(7)：517-519.
[51]张炜.白花蛇舌草对肿瘤细胞信号传导通路的抑制[J].食品与生物技术学报,2006,25(1)：50-51.
[52]赵善黎,张肖晗.白花蛇舌草注射液联合化疗治疗恶性肿瘤[J].医药论坛杂志,2007,28(10)：74-75.
[53]钱韵旭,赵浩如,高展,等.白花蛇舌草提取物的体外抗肿瘤活性[J].江苏药学与临床研 究,2004,12(4)：36-38.
[54]高超,刘颖,蔡晓敏,等.白花蛇舌草对U14宫颈癌抗肿瘤作用的实验研究[J].适用癌症杂志,2007,22(6)：557-559.
[55]李洁.白花蛇舌草对S180荷瘤小鼠抑瘤作用的实验研究[J].中医研究,2008,21(5)：11-13.
[56]李丽秋,张德慧,马淑霞,等.中草药白花蛇舌草等对实验性大肠癌作同机制的研究[J].中国微生态学杂志,2008,20(3)：224-225.
[57]Li Rui, ZhaoHaoru, Lin Yinin. Anti-tumor Effect and Protective Effect on Chemotherapeutic Damage of Water Soluble Extracts from Hedyotis diffus[J]. J Chin Pharm Sci,2002,11 (2): 54-58.
[58]张明智,张可杰,王庆端,等.夏枯草对淋巴瘤细胞增殖的影响[J].医药论坛杂志,2007,28(1)：54-55.
[59]张可杰,张明智,王庆端,等.夏枯草对Raji细胞生长和凋亡相关[J].基因蛋白表达的影响[J].中药材,2006,29(11)：1207-1210.
[60]刘新奎,王琳,张明智.夏枯草对人淋巴瘤细胞增殖的影响[J].山东医药,2008,48(46)：30-31.
[61]付晓瑞,张明智,刘宏民,等.夏枯草提取物对Jurkat细胞凋亡的影响[J].郑州大学学报(医学版),2008,43(5)：964-967.
[62]王琨,董惠芳,章晓鹰,等.夏枯草对SGC-7901细胞的影响[J].上海医学检验杂志,2000,15(5)：305-306.
[63]张海波,蔡安和,周荣耀,等.夏枯草及抗炎1号注射液经肝动脉联合灌注治疗大鼠晚期肝癌的实验研究[J].实用中西医结合临床,2003,3(4)：1-3.
[64]张海波,周荣耀,章晓鹰,等.夏枯草及抗炎一号注射液经肝动脉联合灌注治疗大鼠肝癌作同机制的初步探讨[J].现代肿瘤医学,2006,14(6)：646-648.
[65]朱娜.夏枯草提取液与顺铂协同抗肿瘤作用的体内研究[J].中国民族民间医药,2009,18(24)：25-26.
[66]陈长英,伍钢,张明智.夏枯草提取物体内外对小鼠T淋巴瘤EL4细胞生长的影响[J].郑州大学学报(医学版),2009,44(2)：380-383.