吕培文治疗乳腺癌术后类围绝经期综合征经验  

Lyu Peiwen’s experience in treating perimenopausal-like syndrome following breast cancer surgery

作　　者：于加乐 张子辰 陈雯 张董晓[1] 吕培文(指导)[1] YU Jiale;ZHANG Zichen;CHEN Wen;ZHANG Dongxiao;LYU Peiwen(Beijing Hospital of Traditional Chinese Medicine,Capital Medical University,Beijing 100010;Beijing University of Chinese Medicine)

机构地区：[1]首都医科大学附属北京中医医院,北京100010 [2]北京中医药大学

出　　处：《现代中医临床》2023年第2期64-68,共5页Modern Chinese Clinical Medicine

基　　金：北京市自然科学基金资助项目(No.7202064);北京市中医药科技发展资金项目(No.JJ-2020-64)。

摘　　要：乳腺癌是我国最常见的女性恶性肿瘤,激素受体阳性的浸润性乳腺癌患者,皆应接受术后辅助内分泌治疗,内分泌治疗常用的他莫昔芬和芳香化酶抑制剂均是通过抑制或降低体内雌激素水平达到抑制癌细胞生长或增值的目的,体内激素水平被动下降会引发子宫内膜增厚、月经失调、潮热、阴道不适、乏力、失眠、肌肉关节痛等,这一系列不良反应与围绝经期综合征相似,将其称为类围绝经期综合征,属中医“绝经前后诸症”的范畴。吕培文教授认为乳腺癌术后类围绝经期综合征的表现与气血失和、肝肾亏虚密切相关,在治疗时以调和气血、调补肝肾为主要治法,在遣药组方时,以“四藤二红”及五子衍宗丸为基础加减运用。从审证求因、本于气血,诸症丛生、责之肝肾,兼顾情志、气畅血调几方面探讨从调和气血、调补肝肾论治的理论依据。从治病求本、调和气血,调补肝肾、精血同调,调畅情志、疏肝理气几方面分析从调和气血、调补肝肾论治的遣药组方。结合临床验案对吕教授治疗乳腺癌术后类围绝经期综合征的诊疗思路及用药经验进行介绍。Breast cancer is the most common female malignant tumor in China.Invasive breast cancer patients with positive hormone receptors are supposed to receive the adjuvant endocrine therapy after surgery.Tamoxifen and aromatase inhibitors,which are commonly used in the endocrine therapy,both inhibit the growth of cancer cells by suppressing or lowering estrogen levels in the body.A passive decrease in hormone levels can lead to some adverse reactions,such as thickened endometrium,menstrual disorder,hot flashes,vaginal discomfort,fatigue,insomnia,muscle and joint pains,and so on.Such adverse reactions,which are similar to perimenopausal syndrome,are termed perimenopausallike syndrome,and it belongs to the category of“pre-and past-menopausal syndromes”in traditional Chinese medicine.Professor Lyu Peiwen believes that the manifestations of perimenopausal-like syndrome following the breast cancer surgery are closely related to disharmony between Qi and blood,and the deficiency of the liver and kidney.The main treatment method is to harmonize the Qi and blood and tonify the liver and kidney.The formula is based on“Siteng Er Hong”and Wuzi Yanzong Pill.This paper discusses the theoretical basis of harmonizing Qi and blood,tonifying the liver and kidney from such perspectives as determination of etiologic factors based on differentiation,elucidating etiology based on Qi and blood;multiple symptoms modulated from the liver and kidney;giving consideration to emotion,harmonizing Qi and blood flow.This paper analyzes the prescription of harmonizing Qi and blood,nourishing and modulating the liver and kidney from several aspects:searching for the primary cause of disease in treatment,harmonizing Qi and blood,nourishing and modulating the liver and kidney,modulating essence and blood together,regulating emotions,and soothing the liver and Qi.

关 键 词：类围绝经期综合征 调和气血 调补肝肾 五子衍宗丸 名医经验 吕培文 

分 类 号：R273[医药卫生—中西医结合]