原发性肝癌的治疗早期主要以手术为主,中晚期肝癌也可选择肝动脉化疗栓塞术(Transcatheter Arterial Chemoembolization,TACE),局部消融治疗,靶向免疫治疗,局部姑息性放疗,但对于年纪较大、不能手术或拒绝有创性治疗的患者,中医中药作为一种治疗手段,也突显了良好的疗效.在此医案中,安徽静安中西医结合医院单纯应用中医中药治疗,患者生活质量得到了明显改善,而且治疗1年多后,肿瘤甚至完全消失,疗效显著.现对其治疗经验做一总结.

目的:总结近10年以来原发性肝癌采用中西医结合疗法的研究进展情况,从中总结学习有价值的治疗经验及理论,进一步指导临床.方法:在中国知网和万方数据库中查阅学习有关原发性肝癌的中西医结合治疗文献,主要从肝癌的病因病机、辨证治疗、中西结合治疗原发性肝癌方面的研究进展和存在问题方面进行综述,从中提取并归纳总结.结果:原发性肝癌采用中西医结合疗法具有显著优势,既能减少西医治疗的不良反应,又能控制肝癌复发、转移,部分中晚期肝癌的单独治疗方法可以采用纯中医治疗.结论:原发性肝癌中西医治疗方法较多,各有特色,各有利弊,而采用中西医结合综合疗法更能体现其优势,不仅能缓解患者的痛苦,更能提高治疗效果,是目前原发性肝癌的一个重要治疗手段.近些年中医药在预防和治疗肝癌的研究进展迅速,尤其对于晚期肝癌的研究越来越多,众多临床与实验研究及中心揭示很多中草药的抗肿瘤作用机理,临床证实其抗癌作用有效性,开辟肝癌治疗新天地.中医药治疗肝癌的最大困惑就是缺乏疗效评估对应客观指标,没有统一的辨证分型和治疗方法,无法得到广泛推广.

Objective:To observe the clinical efficacy of Ganzaoning granules on the patients with nonalcoholic steatohepatitis (NASH).Methods:Totally,395 patients with NASH who sought medical care in Changhai Hospital,Second Military Medical University and Hefei Branch of Changhai Hospital from 2013 to 2016 were enrolled for the study.The patients were given Ganzaoning granules at a dosage of 15 g,twice a day,for a succession of 6 months.Close observations were made on the general conditions,laboratory indicators,single symptom of traditional Chinese medicine(TCM),as well as ultrasonographic detection results for the evaluation of treatment efficacy.Results:There were no significant differences in body mass index (BMI) before and after treatment (P＞0.05),while there was statistical significance in abdominal circumference (P＜0.05).The main single symptoms of TCM were obviously improved,with an overall effective rate of 83.29 ％.The levels of TC,TG,and LDL-C were all reduced after the treatment,while there were no significant changes in the level of HDL C,when comparisons were made between pre-treatment and post treatment.Before treatment,the patients were assessed as moderate NASH by uhrasonography,with a total of 252 cases,accounting for 63.80％.However,after treatment,they were mainly diagnosed as mild NASH,with a total of 311 cases,accounting for 78.73 ％.Conclusion:Ganzaoning granules could produce obvious effects on NASH.

Objective:To investigate the anti-tumor effects of Jiedu Granule preparation on H22 tumor-bearing mice.Methods:Mice were inoculated with H22 hepatoma cells to establish ascites H22 transplanted tumor model and then were randomly divided into 4 groups:low dose of Jiedu Granule preparation treatment group(JL),high dose of Jiedu Granule preparation treatment group(JH),Sorafenib treatment group(SF) and negative control group(NA).All drugs were administrated separately for 14 days,the tumor volume was monitored.After treatment for 15 days,6 mice in each group were killed to identify the weight pathological changes of tumors,and the effects of treatment on livers and kidneys.Results:After treatment,compared with NA,the tumor volumes of SF and JD groups were significantly decreased (P ＜ 0.01).Compared with those in NA group,the tumorous cellular density,atypia and mitotic counts in tumors of JH group and SF group were significantly decreased and the tumor necrosis was increased (P ＜0.01).The effect of JH group was better than that of JL group in the tumorous cellular density and atypia(P ＜ 0.01).Conclusion:These findings indicate that Jiedu Granule preparation has antitumor activity in the H22 tumor-bearing mice,and seems to be a safe and effective supplementary agent for the treatment of hepatocellular carcinoma (HCC).

Objective To investigate the efficacy and safety of Ganzaoning granules in the treatment of patients with nonalcoholic fatty liver. Methods 300 patients with nonalcoholic fatty liver were recruited in our hospital between October 2015 and October 2016,and they were randomly divided into two groups,with 150 case in each group. All patients were given a regular diet and exercise therapy,and 150 patients were treated with Ganzaoning granules at the base of diet and exercise therapy. TCM syndrome scores,blood biochemical parameter, clinical efficacy and adverse reactions were observed. Results At the end of 3 month treatment,the total effective rate in the Ganzaoning granule-treated group was 93.3%,significantly higher than 61.3% in the control group (P<0.01);TCM syndrome score was(9.3±2.1),significantly lower than [(12.8±3.6),P<0.01] in the control group;serum ALT,AST,TC and TG levels were(38.1±12.4)U/L,(36.4±9.6)U/L,(2.1±0.4)mmol/L and(5.2±1.4) mmol/L,significantly lower than [(54.2±9.3)U/L,(50±11.2)U/L,(2.7±0.4)mmol/L and(6.5±1.2)mmol/L in the control,respectively,P<0.01]. Conclusion Ganzaoning granule treatment at the base of diet and exercise therapy in patients with nonalcoholic fatty liver has a good clinical efficacy and safety.

目的:探讨健脾疏肝、利湿化浊法对脂肪肝患者临床症状及肝功能的影响.方法:研究对象选自我院2015年10月~2016年10月收治的95例非酒精性脂肪肝患者,对所有患者均给予甘枣宁颗粒治疗,疗程结束后对患者进行疗效评估,同时比较治疗前后患者的临床症状体征缓解情况以及肝功能变化情况.结果:95例患者中治疗总有效率为92.63%;常见临床症状中,肝区胀痛改善82.11%,食欲减退改善89.36%,疲乏改善73.26%,上腹闷痛改善79.76%,易怒改善84.42%;95例患者治疗后ALT、AST、GGT水平均较治疗前显著下降(P<0.01).结论:健脾疏肝、利湿化浊法治疗非酒精性脂肪肝能有效缓解临床症状,改善患者的肝功能,疗效确切.

Objective To investigate the clinical effect and safety of hepatic arterial infusion of cinobufotalin injection combined with lipiodol chemoembolization (TACE) in the treatment of Barcelona Clinic Liver Cancer (BCLC) stage C primary liver cancer.Methods A retrospective analysis was performed for the clinical data of 82 patients with BCLC stage C primary liver cancer who were admitted to Department of TCM Oncology in Changhai Hospital from December 2010 to October 2014.According to intraoperative medication,the patients were divided into two groups.The 40 patients in the cinobufotalin group were treated with hepatic arterial infusion with cinobufotalin combined with lipiodol embolism,and the 42 patients in the control group underwent TACE with epirubicin.The objective response rate,time to progression,median survival time,and acute adverse events were compared between the two groups after a single treatment.The t-test was used for comparison of continuous data between groups,the chi-square test was used for comparison of categorical data between groups,and the Kaplan-Meier method was used for the analysis of cumulative survival rate.Results At 1.5 months after surgery,the cinobufotalin group had a significantly higher objective response rate than the control group (27.5 ％ vs 9.52％,x2 =4.429,P =0.035).The time to progression was 2.4 months (95％ CI:1.978-2.822) in the cinobufotalin group and 3.0 months (95％ CI:2.260-3.740) in the control group,and there was no significant difference between the two groups (P =0.344).The median survival time was 6.6 months (95％ CI:4.131-9.069) in the cinobufotalin group and 10.3 months (95％ CI:0.089-20.511) in the control group,and there was no significant difference between the two groups (P =0.132).At 5 days after surgery,the cinobufotalin group had significantly lower incidence rates of abnormal alanine aminotransferase level,white blood cell count,and platelet count,as well as adverse events including hepatalgia,abdominal distension,and nausea/vomiting than the control group (x2 =6.193,5.311,6.096,5.909,4.761,and4.173,all P＜0.05).Conclusion As for patients with BCLC stage C primary liver cancer,hepatic arterial infusion of cinobufotalin injection combined with lipiodol chemoembolization has a better short-term therapeutic effect,milder adverse effects,and a similar long-term therapeutic effect compared with TACE with conventional chemotherapeutic agents.

目的:评估华蟾素注射液肝动脉给药联合碘油栓塞对中晚期原发性肝癌患者中医证候特点的影响.方法:80例中晚期原发性肝癌患者随机分为华蟾素组和表阿霉素组.于介入治疗前及治疗后第6周,采用"中医肝病证候调查表"对两组患者的中医证候进行调查,并观察其单一症状出现频次及程度.结果:治疗前,两组气虚证、血瘀证、气滞证等评分及中医乏力、胁痛、大便干及小便黄等症状比较均无统计学差异.治疗后第6周,与表阿霉素组比较,华蟾素组气虚证、血瘀证、气滞证评分及乏力、胁痛、大便干、小便黄等显著变化(P＜0.05,P＜0.01).结论:华蟾素注射液肝动脉给药联合碘油栓塞治疗方案可改善中晚期原发性肝癌患者中医单证证候.

目的：观察合并肝硬化的肝癌患者行经导管肝动脉化疗栓塞（TACE）治疗后的疗效。方法将120例临床诊断为原发性肝癌患者经B超和CT检查分成肝癌合并肝硬化（A）组和无肝硬化（B）组，均给予TACE治疗，在治疗结束后3月观察近期疗效，随访观察生存率。结果在治疗后3月，B组完全缓解率为38.3%，显著高于A组的18.3%（P<0.05）；B组血清白蛋白为（36.8±4.2） g/L，显著高于A组的（33.2±3.5） g/L（P<0.05）；随访3年，B组中位生存时间为43.5（11.3，55.3）月，显著长于A组的18.58（9.1，26.8）月（P<0.05），3 a生存率为33.3%，显著高于A组的13.3%（P<0.05）。结论对于不可手术切除的肝癌患者行TACE治疗前，了解是否存在肝硬化是很有必要的。对存在肝硬化患者需要加强保肝，预防肝衰竭的发生。

目的:初步评估华蟾素注射液肝动脉给药联合碘油栓塞治疗中晚期肝癌的安全性.方法:将住院治疗的中晚期原发性肝癌患者80例分为华蟾素组和表阿霉素组.两组患者均予肝动脉栓塞术(HAE)治疗,华蟾素组患者同时给予华蟾素注射液肝动脉注射,表阿霉素组给予表阿霉素肝动脉注射.分别于纳入时及3个月时进行介入,治疗方案结束后第6周进行疗效评价.检测患者血常规、肝肾功能、凝血功能指标并观察患者介入术后不良反应等,评价华蟾素治疗的安全性.结果:治疗前两组患者的血常规、肝肾功能、凝血指标等差异均无统计学差异(P＞0.05).介入术后两组患者均出现骨髓抑制现象,WBC、PLT和HGB下降,但华蟾素组轻于表阿霉素组.两组患者血TB、ALT、AST水平均显著升高(P＜0.05,P＜0.01),第6天开始恢复,在治疗后第6周华蟾素组TB、ALT、AST、ALP、γ-GGT值低于表阿霉素组(P＜0.05).两种治疗方法对肾功能及凝血指标无明显影响.华蟾素组患者出现厌食、恶心呕吐、发热、疼痛等症状的程度及例数明显低于表阿霉素组.结论:华蟾素注射液肝动脉栓塞治疗方案较表阿霉素肝动脉栓塞治疗方案具有较高的安全性.

笔者在临床中应用加味四黄汤治疗各种难愈性皮肤溃疡,每有获效,报道如下:加味四黄汤组成:生大黄、黄连、黄柏、黄芩、蛇床子、紫草、千里光各50g、花椒15g,久煎浓缩,先熏洗后浸泡或浸透无菌纱布湿敷. 1 临床资料 例1:姚某,男性,65岁,患右下肢静脉曲张30余年,右下肢外侧皮肤溃烂1年余,于2010年就诊我院.

Primary liver cancer (PLC) is one of the most common malignant tumors because of its high incidence and high mortality. Traditional Chinese medicine (TCM) plays an active role in the treatment of PLC. As the most important part in the TCM system, syndrome differentiation based on the clinical manifestations from traditional four diagnostic methods has met great challenges and questions with the lack of statistical validation support. In this study, we provided evidences for TCM syndrome differentiation of PLC using the method of analysis of latent structural model from clinic data, thus providing basis for establishing TCM syndrome criteria. And also we obtain the common syndromes of PLC as well as their typical clinical manifestations, respectively.

朱德增教授认为感冒后咳嗽以感受风邪为主，不同发病季节，患者体质差异，可兼夹寒、热、燥、湿之邪为病，治疗以疏风宣散为主，兼以清热解毒、辛温散寒、生津润燥、化湿祛痰之法，升降并用，宣敛并施，以恢复肺洁净之性，宣降之功。

目前原发性肝癌占我国恶性肿瘤发病率第4位，占死亡率第2位[1]。原发性肝癌（PLC）以肝细胞癌（HCC）为主，胆管细胞型肝癌（ICC）占PLC的5%~25%。ICC是由肝内胆管被覆上皮发生的一种原发性肝癌，起源于二级以上的肝内胆管上皮恶性肿瘤[2]。本病症状隐匿，早期难以发现，根治性切除机会较少，进展快，预后差，本文试对其诊治的研究进展作一概述。

目的:探讨自拟中药止痛散外敷治疗晚期癌疼痛的疗效.方法:将122例患者随机分为对照组58例,治疗组64例,作疗效对比观察.对照组采用甘草粉加内科治疗;治疗组在内科常规保守治疗的基础上加用自拟止痛散外敷疼痛区,外敷4～6h/次,隔日1次,5次为1个疗程.结果:2组疗效对比,治疗组加用自拟中药止痛散,在缓解癌痛方面明显优于对照组.两者差异显著(P＜0.01).结论:中药止痛散采用“内病外治”,除在镇痛方面具有较好疗效外,也避免了内服药物造成的胃肠道反应.

Objective To evaluate the effect of transhepatic arterial embolization(TAE)with Cinobufotalin Injection on the quality of life(QOL)in patients with advanced primary liver cancer.Methods Eighty patients with advanced primary liver cancer were randomly divided into treatment group(n=40)and control group(n=40).The treatment group received TAE with Cinobufotalin Injection,while the control group received TAE with Epirubicin Injection.Before and 6weeks after TAE,the QOL was evaluated by Zubrod-ECOG-WHO(ZPS)score and Functional Assessment of Cancer Therapy-Hepatobiliary(FACTHep)questionnaire(Chinese version).Results Before treatment,there were no significant differences in ZPS score,FACT-Hep subscale scores,and total FACT-Hep score between the two groups(P0.05).At 6days after TAE,the treatment group showed a significant improvement in ZPS score(P0.01).At 6weeks after TAE,the treatment group had significantly higher FACT-Hep subscale scores and total FACT-Hep score than the control group(P0.05or P0.01).Conclusion Administration of Cinobufotalin Injection via the hepatic artery combined with lipiodol embolization can improve the QOL in patients with advanced primary liver cancer.