基于郑钦安“阳主阴从观”探讨晚期肺癌恶性胸腔积液的中医辨治  

Discussion on the Treatment of Malignant Pleural Effusion in Advanced Lung Cancer Based on ZHENG Qin'an's“Yang Dominates and Yin Follows”Viewpoint

作　　者：尹悦 陈滨海 YIN Yue;CHEN Binhai(The Second Clinical Medical School of Zhejiang Chinese Medical University,Hangzhou 310053,China;The Second Affiliated Hospital of Zhejiang Chinese Medical University)

机构地区：[1]浙江中医药大学第二临床医学院,杭州310053 [2]浙江中医药大学附属第二医院

出　　处：《浙江中医药大学学报》2023年第10期1209-1212,共4页Journal of Zhejiang Chinese Medical University

基　　金：浙江省中医药科技计划(2022ZB148)。

摘　　要：[目的]运用郑钦安“阳主阴从观”辨析晚期肺癌恶性胸腔积液的病因病机,并在此基础上探讨其中医治疗思路。[方法]基于郑氏独特的阴阳观及其阴阳辨证思想,联系患者的临床表现,对晚期肺癌患者恶性胸腔积液之成因进行剖析,并结合“火神派”用药特点,具体论述治则及方药选用,最后列举临床案例加以验证。[结果]郑氏精简的“阴阳辨证”,化繁为简,勘破了晚期肺癌患者恶性胸腔积液分证论治诸家众说纷纭的困局。以“护火复燃”“补土伏火”为中心的治则,以“姜桂附”为核心的遣方用药,确实能够很好地贴合疾病发生发展的特点。所举验案辨治均以郑氏思想为指导,治以四逆汤合苓桂术甘汤加减方,患者症状得到显著改善。[结论]基于郑氏“阳主阴从观”辨治晚期肺癌患者恶性胸腔积液切实且效彰,打破了其临床治疗手段匮乏的窘境,对改善症状、延长患者生存期多有启迪。[Objective] To explore the etiology and pathogenesis of malignant pleural effusion(MPE) in advanced lung cancer based on ZHENG Qin'an's“Yang dominates and Yin follows”viewpoint,and to explore its traditional Chinese medicine(TCM) treatment ideas.[Methods] This paper analyses the causes of MPE in advanced lung cancer according to the clinical manifestations of patients based on ZHENG's concept of Yin and Yang and his unique thought of Yin and Yang differentiation. Meanwhile,this paper also discusses the specific treatment principles and prescription selection of MPE under the guidance of the school of Warming Yang's theories on the selection of Chinese-herb drugs. Finally,it cites a clinical case to verify the conclusions. [Results] ZHENG's simplified theory of syndrome differentiation has settled the debate among physicians about the treatment of MPE in advanced lung cancer. The therapeutic principles center on“fire protection and reignition”and“replenishing soil and suppressing fire”and the extensive use of ginger,monkshood and liquorice have been confirmed that they adapt well to the characteristics of MPE occurrence and development in advanced lung cancer. The diagnosis and treatment of the reported case which guided by ZHENG's theory can truly abate symptoms which are caused by MPE through using the formulas of Sini Decoction and Linggui Zhugan Decoction. [Conclusion] The differentiation and treatments of MPE in advanced lung cancer patients which are under the guidance of ZHENG Qin'an's“Yang dominates and Yin follows”viewpoint are truly right,which also expand the treatment methods of MPE and provide new inspiration in clinical practice.

关 键 词：胸腔积液 郑钦安 阳主阴从观 真阳学说 补土伏火 晚期肺癌 辨证论治 

分 类 号：R273[医药卫生—中西医结合]