Professor ZHENG Yu-ling believes that patients with advanced esophageal cancer are deficiency in healthy qi and extremely excessive in pathogenic qi. The deficiency of liver,spleen,stomach,and kidney,in particular the spleen and kidney yang deficiency,causes stubborn phlegm and blood stasis accumulating in the sophagus,and then results into the cancer. Spleen and kidney yang deficiency,and stubborn phlegm and blood stasis contribute to the core pathogenesis of advanced esophageal cancer,and deficiency,phlegm and blood stasis are the primary pathogenic factors. By following the principles of warming and tonifying spleen and kidney,eliminating phlegm and removing blood stasis, Professor ZHENG Yu-ling established the Fu Gui Guanshitong Formula for the treatment of advanced esophageal cancer, and satisfactory efficacy has been achieved. In this article, the experience of Professor ZHENG Yu-ling in treating advanced esophageal cancer was summarized,and a proven case was presented.
甲状腺癌术后的并发症是影响患者术后生活的重要问题,如何有效治疗术后并发症亟待解决.中医药作为甲状腺癌术后综合治疗的重要组成部分,在改善术后不适感、提高术后生活质量等方面大有裨益.本文参考近年相关文献,整理总结各医家对于甲状腺术后并发症的中医治疗方法并展开论述,以期为临床治疗提供参考.
肿瘤相关性抑郁是由于癌症确诊、治疗及各种并发症导致患者产生情绪障碍的病理反应,属于中医学的"郁证"范畴.它的发生是由于癌毒产生的痰饮、水湿、瘀血等病理产物阻滞气机,导致气机升降失常.升降理论是中医学理论之一,本文从肝左升肺右降、脾升胃降及心肾相交三方面探讨肿瘤相关性抑郁的辨治.
本文介绍1例经化疗、靶向治疗、区域热疗、手术治疗后复发的外阴上皮样肉瘤进展并肺转移患者的临床资料,通过中医药联合动脉灌注化疗栓塞术及安罗替尼靶向治疗两个疗程后复查胸部+盆腔CT,进行两次前后对比分析及疗效评价,结果表明外阴上皮样肉瘤的病灶及肺部转移瘤的病灶范围较前明显缩小并未再增长,随访3个月后复查CT疗效评价为部分缓解,随访6个月后复查CT疗效评价为疾病稳定.本案例中该患者曾采用多种治疗方案后均复发,最终进展并肺转移,而中医药联合动脉灌注化疗栓塞术及靶向药治疗后延长患者的生存期,降低局部复发率,减少化疗、靶向治疗药物的毒副作用,改善患者的临床症状,为外阴上皮样肉瘤的治疗提供参考.
食管癌在祖国医学多属"噎膈""噎"的范畴,病机是热邪伤阴、热毒烧灼食管,正如《素问·阴阳别论》谓:"三阳结,谓之膈",张子和解释曰:"三阳者,谓大肠、小肠、膀胱也.结为热结也.小肠热结则血脉燥,大肠热结则便秘,膀胱热结则津液涸.三阳既结,便秘不通,火反上行,所以噎食不下."热毒之邪灼伤津液致阴枯热结,阴血枯竭,虚火自生,脾不健运,蕴湿生痰,遂致"痰则塞而不通,气则上而不下."痰气交阻亦为重要病机,《订补明医指掌》谓:"噎膈多起于忧郁,忧郁则气结于胸,臆而生痰,久者痰结成块.胶于上焦,道路狭窄,不能宽畅,饮或可下,食则难入,而病已成矣.好酒之徒,患此者必是顽痰".且痰气互结,久则成瘀,阴枯热结,每有蓄毒,故本病常见瘀毒.
肿瘤是严重威胁人类健康的疾病,在中医学中属于"癥瘕"、"积聚"和"岩"等范畴.证候分型是中医诊断和治疗肿瘤的基础,实验研究是中医探索肿瘤证候分型规律的重要手段.本文从中医肿瘤病证结合动物模型、类器官模型和细胞模型三方面,综述了中医肿瘤基础实验模型研究进展.
目的 采用中医传承计算平台挖掘中药复方改善肝动脉栓塞综合征的用药规律,通过网络药理学研究其初步作用机制并运用分子对接进行验证.方法 以"中医""中药""TACE术后""肝动脉栓塞术后""化疗栓塞综合征"为主题词,检索相关临床研究文献,筛选出其中的中药复方,应用中医传承计算平台3.0版本对复方数据进行频次统计、药物聚类及关联规则分析,并对通过聚类分析挖掘出的中药组合进行网络药理学分析,运用分子对接进行验证.结果 共检索筛选出目标文献105篇,药物功效以补虚类、清热类为主,中药四气分布主要在寒、温、平性,五味以苦、甘居多;归经以脾、肺、肝为主.通过网络药理学分析并筛选出药物主要活性成分为山奈酚、槲皮素、β-谷甾醇、黄芩素,主要通过AKT1、IL6、TNF、IL1B靶点作用于IL-17、肿瘤坏死因子、HIF-1信号通路等,分子对接显示关键活性成分靶点结合活性良好.结论 治疗原发性肝癌肝动脉栓塞综合征的复方药物以扶正补脾为主要功效,用药及配伍以疏肝理气、清热化痰、活血化瘀、补气养阴,并通过多成分、多靶点、多通路发挥改善肝动脉栓塞综合征的作用.
本文介绍潘敏求教授基于"瘀、毒、虚"理论治疗食管癌的经验.潘敏求教授认为,外感邪毒、情志不遂、饮食不节、房劳过度、素体虚弱是食管癌发病的基础,在"瘀、毒、虚"的病机观点上提出分期论治,将食管癌分为早、中、晚三期,分别采用开郁化痰、解毒化瘀、益气补血的治法.同时潘敏求教授提倡中西医结合治疗食管癌,即根据患者所接受手术、放疗、化疗等方式的不同,采用健脾益血、补气养阴、温补脾肾的治法,灵活使用蛇虎汤、金石清解方、脾肾方等加减,在改善食管癌的症状、延长生存期、提高生活质量等方面都获得了较好疗效.
目的 研究慢性萎缩性胃炎(chronic atrophic gastritis,CAG)OLGA/OLGIM分期及其中医证型与结直肠腺瘤性息肉(colorectal adenoma,CRA)发生风险的关系.方法 选取2020年1月至2022年8月于佛山市中医院行胃肠镜检查的45741例患者的资料,按病理结果分为慢性非萎缩性胃炎和CAG,非结直肠腺瘤和CRA,其中CAG分为肝胃不和证、脾胃湿热证、脾胃虚弱证、胃阴不足证、胃络瘀阻证,应用SPSS对收集的一般资料、Hp感染情况、CAG及其中医证型、CRA的数据进行组间卡方检验,探讨慢性萎缩性胃炎与结直肠腺瘤的相关性,进一步使用logistic二元回归分析性别、年龄、CAG及其胃炎评价系统(operative link on gastritis assessment,OLGA)和基于肠化生的胃炎评价系统(operative link on gastritis assessment based on intestinal metaplasia,OLGIM)风险分期与结直肠腺瘤的相关性.结果 纳入统计的结直肠腺瘤患者共1305例,检出率为15.85％.Logistic回归显示慢性萎缩性胃炎是结直肠腺瘤发生的独立危险因素(OR=1.495,95％CI:1.206～1.854),OLGA及OLGIM分期为Ⅲ期～Ⅳ期时危险程度显著升高:OLGA-Ⅲ期(OR=4.854,95％CI:1.997～11.797),OLGA-Ⅳ期(OR=6.192,95％CI:1.408～27.225);OLGIM-Ⅲ期(OR=2.446,95％CI:1.125～5.320),OLGIM-Ⅳ期(OR=5.238,95％CI:1.858～14.766).慢性萎缩性胃炎胃络瘀阻证结直肠腺瘤发生率最高,其次为脾胃湿热证、肝胃不和证、脾胃虚弱证、胃阴不足证.结论 慢性萎缩性胃炎为结直肠腺瘤发生的独立危险因素,CRA发生风险与CAG严重程度呈正相关.CAG胃络瘀阻证发生CRA风险最高.
目的 利用Meta分析研究益气活血法对化疗非小细胞肺癌淋巴细胞亚群的影响.方法 检索PubMed、Embase、Cochrane图书馆、中国知网(CNKI)、维普期刊资源整合服务平台(VIP)、中国生物医学数据库(CBM)、万方数据知识服务平台(Wanfang)数据库.筛选出对照组为常规静脉化疗,实验组为常规化疗加上益气活血方药治疗非小细胞肺癌的随机对照试验,通过对研究进行筛选和资料提取,应用Revman5.3软件对外周血淋巴细胞亚群CD3+、CD4+、CD8+、CD4+/CD8+和NK等结局指标进行Meta分析.结果 共纳入11项RCT,纳入患者940例,其中试验组共472例,对照组468例,系统评价结果显示,对比常规静脉化疗,益气活血方药联合化疗治疗能显著改善非小细胞肺癌患者CD3+[MD=5.42,95％CI(0.85,10.00),P<0.05]、CD4+[MD=7.07,95％CI(5.88,8.72),P<0.05]以及CD4+/CD8+水平[MD=0.35,95％CI(0.29,0.41),P<0.05],对CD8+和NK水平的影响差异无统计学意义(P>0.05).结论 益气活血法能够改善化疗非小细胞肺癌患者的免疫功能,但是本研究具有一定的局限性,需要临床上进行更多的多中心、大样本的随机对照试验.
目的 本研究通过观察半夏泻心汤加减联合紫杉醇+顺铂方案(TP方案)化疗对晚期食管鳞癌临床疗效、毒副反应、营养状况的影响,评价其有效性及安全性.方法 本研究纳入遂宁市中心医院符合纳排标准的食管鳞癌患者142例,随机分为试验组和对照组,试验组71例,对照组71例.试验组使用半夏泻心汤加减联合TP方案化疗,每3周调整处方1次,连续中药治疗,对照组仅给予TP方案化疗.两组化疗均以3周为一个给药周期,最多治疗6个周期.观察两组患者近期疗效、无进展生存期(progression-free survival,PFS)、毒副反应及营养状况.结果 试验组客观缓解率(objective response rate,ORR)为45.46％,对照组ORR为38.57％,两组对比,差异不具有统计学意义(χ2=0.661,P=0.416).试验组疾病控制率(disease control rate,DCR)为72.73％,对照组DCR为51.43％,两组对比,试验组优于对照组,差异具有统计学意义(χ2=6.525,P=0.011).试验组中位无进展生存期(progression-free survival,PFS)为5.9个月,对照组中位PFS为4.5个月,两组对比,试验组优于对照组,差异具有统计学意义(χ2=31.597,P=0.000).恶心呕吐程度,试验组明显优于对照组,差异具有统计学意义(P=0.001).两组PG-SGA评分对比,试验组优于对照组,差异具有统计学意义(χ2=19.799,P=0.000).结论 本研究提示半夏泻心汤加减干预提高了晚期食管鳞癌化疗的近期临床疗效、PFS,减轻了化疗毒副反应,改善了患者营养状况,具有临床应用价值.
目的 从门诊跟诊、资料收集到统计学研究,得出吴万垠教授辨治大肠癌临床经验中组方选药规律,并予以剖析,进一步总结梳理吴万垠教授辨治大肠癌的经验.方法 收集2021年1月至2022年10月到广东省中医院肿瘤科吴万垠教授门诊求治的大肠癌患者资料,将收集到的处方录入数据库,用SPSS Statistics、SPSS Modeler软件进行统计学分析研究.结果 所收集的患者病机为脾虚、湿瘀结聚,把处方中选药次数由高到低排列为炙甘草、薄盖灵芝、薏苡仁、白术、红芪、茅莓根、蛇舌草、延胡索、黄精、枸杞子、夏天无、补骨脂、石见穿、橘红、重楼、北沙参、红豆杉等.本研究纳入85例结直肠癌患者,共300诊次.包括51例男性患者(60％)和34例女性患者(40％).年龄区间为27至90岁,主要的年龄段是50至70岁.药物的频次频率结果提示甘草、薄盖灵芝和薏苡仁的应用频率均超过80％,是最为常用的3种中药.关联分析结果提示炙甘草和薄盖灵芝联合应用的次数最多(支持度87.33％,置信度98.86％).常用的药物组合结果提示白术多配合薏苡仁和炙甘草应用(支持度80％,置信度92.917％),薄盖灵芝多与薏苡仁、炙甘草组合(支持度80％,置信度90.417％).结论 吴万垠教授治疗大肠癌辨证强调辨证与辨病、辨症相结合,立足于脾虚、湿瘀结聚的关键病机,治疗以健脾益气、扶正抑瘤、化瘀散结为大法,以资临床借鉴.
目的 从文献角度出发,"以毒攻毒"为科学假说,探索毒性药物治疗癥瘕积聚的用药规律.方法 整理《中医方剂大辞典》中收载的治疗癥瘕积聚的方剂,建立方剂数据库,统计分析对癥瘕积聚有治疗作用的总体药物和毒性药物频次、单首方中毒性药物频次、毒性药物功效、药性、药味、归经分布以及中药特征的多因素分析;以Apriori关联规则进行建模分析,Cytoscape 3.9.1软件构建中药核心复杂网络,IBM SPSS Statistics26对核心网络中的药物进行系统聚类分析.结果 对筛选出的607首方剂、485味中药进行分析:含毒性药物方剂460首,占比75.78％;使用频次≥50次的高频药物34味,毒性药物11味,占比32.35％;约4/5的方剂中含有毒性药物,约1/5单方组成含≥50％的毒性药物.毒性药物类别以泻下药、温里药、活血化瘀药、化痰药和攻毒杀虫收湿止痒药为主;性味以辛、温为主,归经以肝、脾、肺经为主.采用逐步Logistic回归分析筛选主要影响因素,结果显示归心、肺、肾、心包经以及活血化瘀药、化痰止咳药、补虚药、收涩药均是对癥瘕积聚有治疗作用的重要影响因素(回归系数>0,且P<0.01).常用毒性药物药对有巴豆-硇砂、巴豆-乌头、巴豆-芫花;网络聚类高频毒性中药共得到8个新的中药组合:甘遂、京大戟、芫花、巴豆;硇砂、干漆、轻粉;斑蝥、芫青;全蝎、蜈蚣、朱砂、雄黄;半夏、苦杏仁;乌头、细辛、吴茱萸、皂荚;狼毒、莽草、藜芦、附子;硫黄;网络聚类高频药物共得到6个新的中药组合:三棱、莪术、青皮、陈皮、木香、槟榔、丁香、枳壳、牵牛子、神曲;当归、川芎、桃仁、香附;大黄、鳖甲;茯苓、人参、白术、厚朴、甘草、皂荚、乌头、肉桂、干姜、附子、吴茱萸;半夏;麝香、朱砂、硇砂、干漆、巴豆、芫花.结论 毒性药物在癥瘕积聚治疗中占比巨大,主要治法为泻下消积软坚、健脾温阳、利痰散结,并以活血/破血消癥贯穿其中.
目的 基于多种方式筛选量表条目,研制肝内胆管癌中医证候调查量表(ICC-TCMsss).方法 建立ICC-TCMsss理论模型,基于文献调查和扎根访谈结果,设计ICC-TCMsss问卷,开展两轮德尔菲专家咨询,使用界值法筛选条目.结果 基于ICC相关书籍18部、文献8篇,扎根访谈20名患者及家属,10名中医肿瘤科医务人员反馈结果,初筛ICC-TCMsss包括7个维度共30个条目.两轮共35人次Delphi法调查显示,两轮问卷专家积极系数、回收率均为100％,W分别为0.52(χ2=256.376,P<0.001)和0.557(χ2=240.686,P<0.001),Cr分别是0.826、0.831,说明专家代表性强,参与度、重视度和协调程度高,结果可靠性强.界值法筛选,经标准化和专家研讨形成ICC-TCMsss 7个维度共28个条目.结论 基于多种方式,初步完成ICC-TCMsss条目筛选及研制,有待临床实践考评和优化.
随着医学模式的转变,肿瘤临床疗效评价的观念逐渐发生改变,传统的以瘤体大小变化为核心的疗效评价标准不断受到挑战,新检查手段及新疗法的临床应用对实体瘤临床疗效评价标准直接产生了影响,亟须建立全面的、准确的、规范的恶性实体瘤综合疗效评价体系.直接反映患者主观感受的症状群的评价越来越得到重视,丰富和完善了肿瘤疗效评价体系中的"软指标"评价.从整体观念出发,实施个体化的辨证论治,注重改善患者的各类临床症状是中医治疗的传统特色与优势,建立反映中医药疗效特色以及以免疫治疗、分子靶向治疗为代表的新兴治疗手段疗效特点的综合性疗效评价体系具有现实意义,也是未来发展的趋势.
Cancer-related depression,as a common pathological depression during the diagnosis and treatment of malignant tumors,is one of the important factors affecting the progression and treatment of tumor diseases.At present,the treatment of cancer-related depression is mainly based on simple antidepressants,and there are no specific antidepressants for tumor patients.The patients had poor compliance to the drug,and long-term use of antidepressants is prone to cause drug-resistance and adverse reaction,which result into unsatisfactory efficacy.Traditional Chinese medicine（TCM）characteristic therapies（acupuncture,acupoint application,five-element music therapy,emotional therapy,traditional health-care exercises,massage and scraping therapy,etc.）belong to the non-drug treatment under the guidance of the TCM theory,which have the advantages of good curative effect,low cost,high safety and high patients’compliance,and can play an important role in the treatment of cancer-related depression.The purpose of this paper is to summarize the progress of the application of characteristic TCM therapy in the treatment of cancer-related depression,and to provide some reference for its clinical treatment and research.
Objective To observe the clinical effects of Tuhuanglian lotion wet compress on acute radiation dermatitis of breast cancer patients. Methods By using the method of clinical randomized controlled study,70cases of breast cancer patients meeting the inclusion criteria and planning to perform postoperative radiotherapy were randomly divided into two groups. The trial group was assigned 36 cases and the control group was assigned 34cases. The control group was given routine nursing and health training. On the basis of the treatment for the control group,the trial group was given wet compress of Tuhuanglian lotion on the skin of the radiation area. The RTOG grade, incidence of acute radiation dermatitis, visual analog scale（VAS） scores of skin pain and itching,erythema degree,and the incidence of adverse reactions were compared between the control group and the trial group within 3 weeks after the initiation of RT. Results Eventually,a total of 36 cases in the trial group and 31cases in the control group completed the trial. On the 14th and 21st day of radiotherapy,the RTOG grade of the trial group was lower than that of the control group,and the difference was statistically significant（P＜0.05）. The incidence of radiation dermatitis in the trial group was lower than that of the control group,and the difference was statistically significant（P＜0.05）. At each time points of observation,the degree of erythema in the skin of the radiation area,VAS scores of skin pain and itching of the trial group was lower than that of the control group,and the difference was statistically significant（P＜0.05）. There were no related adverse reactions occurring in both groups. Conclusion The application of Tuhuanglian lotion during radiotherapy for breast cancer patients can reduce the incidence and the severity of acute radiation dermatitis, and relieve erythema, pain and pruritus effectively. No adverse reactions occur during the treatment.
Primary liver cancer is one of the common malignant tumors in China,which seriously affects people’s life and health.Traditional Chinese medicine has its unique advantages in the treatment of primary liver cancer.This article introduced the experience of Professor LIN Li-zhu in treating a case of postoperative recurrence and metastasis of medium-term and advanced primary liver cancer with integrated traditional Chinese and western medicine.The patient was an elderly male who visited the doctor by the chief complication of “repeated upper abdominal pain and discomfort for more than 2 years” In April of 2003,the patient was diagnosed as liver tumor and then underwent surgical resection.The case was confirmed as the well-differentiated hepatocellular carcinoma.After surgery,the patient received oral use of tegafur and levamisole.Half a year later,liver cancer recurred,and then the patient took hepatic arterial chemoembolization and received Chinese medicine treatment following the therapeutic principle of soothing liver and removing blood stasis,clearing liver and detoxification.The patient experienced the progression-free survival period of 72 months.And then the patient suffered recurrence and metastasis,but the illness was controlled and the quality of life was good by the integrated traditional Chinese and western medicine therapy.Till March 2022,the overall survival period of the patient was more than 19 years.
Based on inheriting the theory of depression syndrome from the medical practitioner of past dynasties and by combining the long-term clinical practice,Chinese Medicine Master LIN Yi puts forward the theory of“treating breast diseases from Liuyu（six types of stagnancy）”. Chinese Medicine Master LIN Yi believes that breast diseases develop from Liuyu and should be treated from Liuyu, and the clinical practice of Liuyu runs through the treatment of breast cancer. Master LIN proposed the four-grade prevention and treatment strategy for breast cancer based on the idea of TCM preventive treatment of disease,which plays the outline function to the breast cancer treatment,becomes the backbone of her academic thought context,and has the unique academic value and the clinical guiding significance.
Since the outbreak of the COVID-19 and to respond the policy of the Ministry of Education of “classes suspended but learning continuing”,the Oncology Teaching and Research Office of the First Clinical Medical School of Guangzhou University of Chinese Medicine has made diverse attempts and studies in the teaching of Chinese Medicine Oncology.During the trial,some advances had achieved,but many challenges and deficiencies still remain.In order to provide initial guidance to the direction of teaching reform in Chinese Medicine Oncology,we conducted a systematic investigation included curriculum setting,curriculum depth,content distribution,class hour arrangement,and case teaching in the students of Chinese medicine oncology orientation class,and then analyzed the advantages and shortcomings of various teaching methods,which leads to the final conclusions.
