当代乳腺癌中医专家治疗乳腺癌术后并发症经验分析
Experience Analysis of Contemporary TCM Breast Cancer Experts in Treating Complications due to Breast Cancer Surgery
-
摘要: 目的 归纳统计当代乳腺癌中医专家治疗乳腺癌术后及放、化疗并发症的医案,分析总结他们辨治乳腺癌术后及放、化疗并发症的用药规律。方法 检索中国知网、万方及维普等数据库,结合相关著作,查找符合纳入标准的相关案例,提取信息并汇总分析处方用药、辨证分型、功效等信息。结果 乳腺癌术后并发症整体属虚、局部属实,以扶正祛邪、攻补兼施为治则。用药特点以补益为主,辅以化瘀、养阴。以气血瘀滞为主证的上肢肿胀,多治以活血化瘀通络,如桃红四物汤等,若伴湿热瘀结,治以清热活血,方用四妙勇安汤加减;证属气阴两虚的放射性肺炎,治以养阴清肺润燥,方用增液汤、养阴清肺汤等;以胃虚痰气逆阻为主证的消化道反应,治以和胃降逆,方用橘皮竹茹汤或旋覆代赭汤;以气血亏虚为主证的骨髓抑制,多治以益气养血,如人参养荣汤及补中益气汤等;证属肝肾阴虚的内分泌紊乱者,大多以六味地黄丸滋补肝肾,若伴心神失养等症,则可加用甘麦大枣汤、清骨散以养心安神;若伴肿瘤转移者,治以祛邪攻毒,方用仙方活命饮及阳和汤等。结论 乳腺癌术后及放、化疗并发症证候复杂多变,掌握其证候演变规律及方药特点对发挥中医药在该领域的治疗优势具有重要意义。Abstract: OBJECTIVE To summarize and count the medical records of contemporary breast cancer experts in traditional Chinese medicine (TCM) treating complications due to breast cancer surgery, radiotherapy or chemotherapy, as well as analyze their medication rules. METHODS Through searching Traditional Chinese Medicine Oncology and other professional works on CNKI, Wanfang and VIP, the relevant cases that meet the inclusion criteria were found to extract information and analyze prescription drugs, syndrome differentiation, efficacy and other information. RESULTS Complications due to breast cancer surgery is deficiency in general and partly excess. Thus, the therapeutic principle was reinforcing healthy qi and dispelling pathogen, along with reinforcing healthy qi and eliminating pathogenic factors. The more frequently prescribed drugs were characterized by tonics supplemented with dissolving stasis and nourishing yin. As for the upper limbs swollen with qi and blood stasis as the main syndrome, it was often treated with activating blood, remove blood stasis and dredging collaterals, such as prescribing Taohong Siwu Decoction. If accompanied by dampness-heat stasis, heat-clearing and blood-activating would be the therapeutic methods, and modified Simiao Yongan decoction could be given. As to the radiation pneumonia with qi and yin deficiency, the patients would treated with nourishing yin, clearing the lungs, and moisturizing dryness, and prescriptions like Zengye decoction, or Nourishing Yin and Clearing Lung decoction were given. With regards to the digestive tract reactions with gastric deficiency and phlegm-qi adversity as the main syndrome, the therapeutic methods were regulating stomach and ascending qi, the prescription was Jupi Zhuru decoction or Xuanfu Daizhe decoction. When it came to myelosuppression with qi and blood deficiency as the main syndrome, the common treatments were to replenish qi and nourish blood with Renshen Yangrong decoction or Buzhong Yiqi decoction. For endocrine disorders with liver and kidney yin deficiency, the treatment was Liuwei Dihuang pills to nourish liver and kidney. If it was accompanied by mental dystrophy, Ganmai Dazao decoction and Qinggu powder were prescribed to nourish the heart and calm the mind. If it was accompanied by tumor metastasis, the prescription was Xianfang Huxing drink and Yanghe decoction to eliminate pathogenic factors and attack toxic substances. CONCLUSION The symptoms of complications due to breast cancer surgery, radiotherapy, or chemotherapy are complex and changeable. It is of great significance to grasp the evolution of symptoms and characteristics of prescriptions to take advantage of TCM treatment in this field.