基于“诸湿肿满,皆属于脾”辨治癌性腹水  

Syndrome Differentiation and Treatment of Cancer Abdominal Effusion Based on“All dampness and Swelling-Fullness Belonging to Spleen”

作　　者：贺忠宁 程孟祺 石伯伦 花宝金[1] HE Zhongning;CHENG Mengqi;SHI Bolun;HUA Baojin(Guang'anmen Hospital,China Academy of Chinese Medical Science,Beijing 100053,China)

机构地区：[1]中国中医科学院广安门医院,北京100053

出　　处：《辽宁中医杂志》2024年第4期22-25,共4页Liaoning Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金面上项目(82174465)。

摘　　要：癌性腹水患者预后差、生活质量低、病死率高,目前临床治疗疗效差,不良反应明显,且易反复发作。中医中药治疗癌性腹水有一定的临床疗效,不良反应低,值得进一步探讨。文章基于《素问·至真要大论篇》“诸湿肿满,皆属于脾”的理论基础,总结癌性腹水的发病机制及临床治疗思路,以期为癌性腹水的临床诊疗提供依据。生理功能上脾主运化,是维持机体正常水液代谢的关键枢纽,病理上,若脾脏功能失常,则水湿、水谷不能正常运化,内停于腹则成鼓胀,日久阻滞气机,脉络受损,正虚邪恋而成积聚,可见脾失健运在癌性腹水的形成过程中起到了重要的作用,脾脏功能失常是癌性腹水发生的关键,因此临床治疗上应以益气健脾,芳香化湿为基本治则,并根据临床辨证,结合温补脾肾阳气,活血化瘀利水等治法,在调理脾胃的基础上,根据患者的证候灵活配伍,调节五脏平衡,以达到更好的疗效。The patients with cancerous ascites have poor prognosis,low quality of life and high mortality rate.Currently,the clinical treatment has poor efficacy,obvious side effects,and is prone to recurrent attacks.In this paper,based on the theoretical basis of“all dampness and swelling-fullness belonging to spleen”in Suwen,the pathogenesis and clinical treatment of cancerous ascites were summarized,in order to provide a basis for the clinical diagnosis and treatment of cancerous ascites.Physiologically,spleen is responsible for transportation and transformation,and the physiological function is the key to maintain the body's normal water metabolism.Pathologically,if spleen function disorder will cause water dampness,and the water and food can not normally transport and transform.If it stops in the abdomen,it will cause meteorism,block Qi flow over time,damage the veins and accumulate positive and negative evils.It can be seen that spleen dysfunction plays an important role in the formation of cancerous ascites,and spleen dysfunction is the key to the occurrence of cancerous ascites.Therefore,in clinical treatment,the basic treatment principles should be based on nourishing Qi and strengthening spleen,removing dampness by means of aromatics,and according to clinical syndrome differentiation,combined with methods such as warming and tonifying spleen and kidney Yangqi,promoting blood circulation,removing blood stasis and promoting diuresis.On the basis of regulating spleen and stomach,flexible combinations should be made according to the patients'syndrome to regulate the balance of the five organs,in order to achieve better therapeutic effects.

关 键 词：癌性腹水 诸湿肿满 皆属于脾 鼓胀 从脾论治 

分 类 号：R442.5[医药卫生—诊断学]