摘要
论文以中医学理论为指导，基于导师周仲瑛教授研究诊治疑难杂病的学术思想及对原发性肝癌的认识，以“癌毒”为主线，探索中医药对肝癌的因、理、证、治的认识，探讨抗癌扶正法在治疗肝癌中的具体运用。通过对临床治疗的观察，总结疗效，确立多因并治的抗癌扶正方。并结合现代医学生物学手段，通过体内外实验，研究抗癌扶正方抗肝癌的作用机理。
论文的第一部分理论研究，着眼于肝之生理、病理及其与它脏的关系，从理论上系统探讨原发性肝癌的病因、病机及治法。提出肝癌的病因复杂，内外合邪产生多种病理因素，如气滞、血瘀、痰凝、湿浊、湿热、火郁热毒错综加杂，则癌毒内生。癌毒是肝癌致病的病理关键。作为特定的病理因素，癌毒具有复杂性、隐匿性、复发性、扩散性、猛烈性、凶险性、循环往复性等诸多特点。在发病及病理演变过程中，癌毒炽盛贯穿始终，即便是在病程后期，正虚邪亦盛。肝癌病理性质可概括为本虚标实，虚实夹杂。癌毒为标，气阴两虚、气血亏虚为本。肝癌病位在肝胆，与脾、肾密切相关。临床辨证当注意辨病期早中晚，辨癌毒性质，辨正虚类别，辨病变脏腑，辨危急险症。在治则治法方面，应遵循“祛邪扶正”和“急治其标，缓则治本”的原则，在“抗癌解毒”的基础上，针对性使用清热解毒、疏理气机、活血化瘀、祛湿化痰、清热利湿、软坚散结、益气养血、养阴生津、滋阴补肾、健脾助运等治法。在临证运用时，需要处理好局部与整体、辨证与辨病、祛邪与扶正、治标与治本、单治与复治、解毒与攻毒、治气与治血、肝肾与脾肾、生理与心理等关系。
论文的第二部分临床研究，通过对52例原发性肝癌的临床资料进行分析与归纳，总结原发性肝癌的相关病史、症状表现、癌毒类型、证候分类特征，从而得出肝癌具有症状错综、病理因素多样、癌毒炽盛、多证重叠等特性。对26例原发性肝癌的临床疗
效分析，采用临床症状、肝功能、瘤体大小变化、生存期、卡氏生活质量评分等指标。结果显示：中医药治疗肝癌在减轻症状、保护肝功能、稳定瘤体、提高生活质量等方面有较好疗效。并列举验案说明导师的辨治特色。
根据原发性肝癌癌毒病理因素的复杂性，抗癌扶正、复法并用成为治疗的必然。总结临床有效治法，设立“抗癌扶正方”。论文的第三部分，利用医学生物学技术，在基础实验层面研究此方抗肝癌的作用机理。具体采用细胞培养技术、MTT法观察细胞增殖、荧光染色、流式细胞仪分析细胞周期及检测基因表达、药物血清温育液的制备等项技术，分别从动物体内及体外细胞实验的角度，测定本方对小鼠移殖性肝癌及人肝癌细胞SMMC-7721的作用。动物体内实验结果显示：抗癌扶正方各剂量组对小鼠移殖性肝癌的抑瘤率皆达26%以上，此方具有促进肿瘤细胞坏死、升高白细胞、升高脾指数、提高免疫力的功能。体外细胞实验结果显示：本方具有抑制肿瘤细胞增殖、调低抑制凋亡癌基因—突变型P53及Bcl-2的表达、诱发细胞凋亡的作用。从而肯定了解毒抗癌、行气活血、祛瘀化痰、软坚散结及补益气血、扶助正气多法合用在治疗肝癌中的积极作用。为此方的进一步深入研究、临床实验、临床推广奠定了基础。
本文的第四部分附篇—中西参鉴，就现代中、西医学对原发性肝癌的临床及实验研究作了总结与综述，以扩大知识面、了解最新动态、阐发所存在的问题、展望新的研究思路，强调进一步深入探索的重要性与必要性。
Guided by theory of traditional Chinese medicine, based on the academic ideas and treatment experiences on obstinate disease and primary liver cancer of professor Zhou Zhongying, through the clue of cancer toxin, this paper probes the etiology、pathogenesis、syndrome pattern and treatment methods of primary liver cancer, discusses the clinical application of treatment principle by anticancer and strengthening vital energy. Through clinical oberservation and curative effect conclusion, establishing the prescription of anticancer and strengthening vital energy for various pathologic factors. Combined by modern medicine biological means, through the animal and cell experiment, the paper researches mechanism of the prescription for antiliver cancer.
In the first part of this paper about theory study, focusing on physiology 、pathology of liver and the relationship with other organs, the article discusses the etiology 、pathogenesis and treatment methods. The article puts forward that primary liver cancer results from cancer toxin, which is due to various complex pathological factors, such as qi stagnation、blood stasis、phlegm stagnation、damp-turbid、damp-heat、smolder heat and heat-toxin. Cancer toxin ,a kind of special toxin, has compound character of complexity、secretiveness、diffusivity、rabidity、danger、recurrence and repetition .From beginning to development of primary liver
cancer, the cancer toxin exists in the whole process. The pathologic property of primary liver cancer could be concluded as excess of Biao and deficiency of Ben、complex of excess and deficiency.As cancer toxin being Biao, on the contrary ,deficiency of qi and blood or vacuity of qi and yin is Ben. Primary liver cancer is located in the liver and gallbladder, connected with spleen and kidney. It is important ot pay attention to distinguish the course of disease、the property of cancer toxin 、the deficiency type、the diseased organs and the dangerous symptoms during clinical differentiation. For treatment principle and methods, obeying the basic principle of "relieving Biao in acute cases, aiming at Ben in chronic disease", focusing on anticancer and detoxification, the paper expatiates on detail treatment methods such as eliminating heat and detoxification、regulating qi 、promoting blood circulation and relieving blood stasis、eliminating damp and resolving phlegm、softening mass and relieving lump、tonifying qi and nourishing blood、tonifying yin and invigorating fluid、nourishing yin and tonifying kidney 、strengthening spleen and promoting stomach. When applicating these methods in the clinic, the article emphasize such relations as whole and local 、syndrome differentiation and disease discrimination、dispelling repletion and supplementing vacuity 、treat Biao and treat Ben、single method treatment and compound treatment 、detoxification and attacking toxin、treat qi and cure blood、liver and kidney or spleen and kidney、 physiology and psychology etc.
In the second part of this paper about clinic study, analyzing and concluding the 52 cases of primary liver cancer, the article summarizes the related history 、manifestated symptoms、type of cancer toxin、the property of syndrome-patterns of primary liver
cancer. It is shown that primary liver cancer has characters of comprehensive symptoms 、multiple pathogenic factors、ferocious toxin 、compound syndrome-patterns .Summing up curative effect of 26 cases, adopting targets of clinical manifestation、liver function、size of cancer lump、survival period、Karnofsky scores, the researches show traditional Chinese medicine have good effect on relieving clinical symptoms、protecting liver cancer、keeping cancer lump stable and raising life quality .The paper also cites fives cases in order to express distinguising and treatment feature.
Because of the complexity of liver cancer toxin, it is necessary to cure the disease with anticancer and strengthening vital energy by compound methods. Basing on the clinical research results, we establish the prescriptio
引文
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