从卫气的生成与输布探讨化疗后白细胞减少症的中医治疗策略  

Treatment Strategy of Leukopenia After Chemotherapy with Traditional Chinese Medicine from the Generation and Transmission of Defense Qi

作　　者：毕盛 吴胤文 李丽玲 张伟娜 黄金昶 BI Sheng;WU Yinwen;LI Liling;ZHANG Weina;HUANG Jinchang(Beijing University of Chinese Medicine Third Affiliated Hospital,Beijing,100029)

机构地区：[1]北京中医大学附属第三医院,北京市100029

出　　处：《中医杂志》2024年第1期113-118,共6页Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金(82074545)。

摘　　要：通过分析卫气与白细胞在功能、发挥作用部位、昼夜节律方面的相似性,提出白细胞减少症的中医病机为卫气不足。基于对历代经典中卫气生成输布相关论述的梳理,认为下焦元气为卫气之源,中焦水谷之气充实卫气,上焦输布卫气至周身。故而临床中医治疗化疗后白细胞减少症可以龟鹿二仙胶、右归丸等补肾填精,结合艾灸关元、气海等穴位,补下焦元气以实卫气之源;以归脾汤、补中益气汤、参苓白术散、四君子汤等健脾益气,结合艾灸中脘、足三里等穴位,运中焦脾胃以充实卫气;以桂枝汤加减调和营卫,结合艾灸大椎、肺俞等穴位或刮痧,通上焦腠理以促进卫气输布。从卫气生成输布的全过程考虑,灵活选择内治法与外治法相结合,以期为肿瘤患者白细胞减少症的治疗提供思路。By analysing the similarity between defense qi and leukocytes in terms of function,site of action,and circadian rhythm,it is proposed that in traditional Chinese medicine(TCM),the pathogenesis of leukopenia is defense qi deficiency.By analyzing the relevant discussions on the generation and transmission of defense qi in TCM classics,it is believed that the original qi in lower jiao(焦)is the source of defense qi,while the water and grain qi in middle jiao enriches defense qi,and the upper jiao transmits and distributes defense qi to the whole body.Therefore,when treating leukopenia after chemotherapy with TCM,Guilu Erxian Gelatin(龟鹿二仙胶)and Yougui Pill(右归丸)are often used to tonify the kidney and supplement essence,and moxibustion at Guanyuan(CV 4)and Qihai(CV 6)is usually accompanied to replenish the original qi in lower jiao and enrich the source of defense qi.Guipi Decoction(归脾汤),Buzhong Yiqi Decoction(补中益气汤),Shenling Baizhu Powder(参苓白术散),and Sijunzi Decoction(四君子汤)are often suggested to strengthen spleen and replenish qi,in combination with moxibustion at Zhongwan(CV 12)and Zusanli(ST 36)to transport the spleen and stomach in the middle jiao to enrich the defense qi.Modified Guizhi Decoction(桂枝汤)to harmonize nutrient and defensive aspects is often used,and moxibustion at Dazhui(GV 14)and Feishu(BL 13)or scraping is added to dredge the striae and interstice in the upper jiao and promote transmission and dissemination of the defense qi.Considering the whole process of generation and distribution of defense qi,it is suggested to choose the most appropriate treatment modality flexibly,and combine internal treatment with external treatment,in order to provide ideas for the treatment of leukopenia in tumour patients.

关 键 词：白细胞减少症 卫气 化疗 恶性肿瘤 

分 类 号：R259[医药卫生—中西医结合]