基于“脾主肌肉”论健脾法在肿瘤恶病质肌肉萎缩中的应用  

Application of Spleen-Strengthening Therapy in Muscle Atrophy of Tumor Cachexia Based on Theory of“Spleen Governing Muscle”

作　　者：张艳 王栋 李玉 李清波 唐林[1] 孟静岩[1] ZHANG Yan;WANG Dong;LI Yu;LI Qingbo;TANG Lin;MENG Jingyan(College of Traditional Chinese Medicine,Tianjin University of Traditional Chinese Medicine,Tianjin 301617,China)

机构地区：[1]天津中医药大学中医学院,天津301617

出　　处：《中华中医药学刊》2024年第5期89-93,共5页Chinese Archives of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(82274396,82204961);天津市研究生科研创新项目(2022BKY191);天津中医药大学研究生科研创新项目(YJSKC-20221014)。

摘　　要：肌肉萎缩是肿瘤恶病质晚期患者中最易出现的症状,也是肿瘤患者预后不良的一个危险征兆,临床常用食欲刺激药、营养神经肌肉药物等手段并不能逆转肿瘤恶病质肌肉萎缩。肿瘤恶病质肌肉萎缩的临床特征与中医“虚劳”相似,其发生的病因病机多为脾摄乏源、运动减少、忧思伤脾、毒邪结聚、气血暗耗、脏腑虚衰等,最终导致脉络阻塞、气血亏空,从而肌肉失于濡养出现肌肉萎缩。肿瘤恶病质肌肉萎缩的发生究其根本是中焦脾土运化失司,水谷精微化生不足,气血乏源难以充养肌肉出现肌肉萎缩。中医药在治疗肿瘤恶病质肌肉萎缩方面也越来越凸显出巨大优势,综合近数十年关于肿瘤恶病质肌肉萎缩的研究发现,中医治则大多从健脾和胃、健脾益肾、健脾解毒、健脾疏肝入手,健脾法始终贯穿着其治疗的根本核心。脾主运化与气血的生成、肌肉的充实密切相关,脾失健运导致肌肉萎缩的提法最早可见于《黄帝内经》,因此基于“脾主肌肉”理论,结合中医整体观来探讨健脾法治疗肿瘤恶病质肌肉萎缩的中医机理,以期为临床治疗提供新的诊疗思路。Muscle atrophy is the most common symptom among late-stage cancer cachexia patients,and it is also a danger⁃ous sign of poor prognosis in cancer patients.The common methods such as drugs that stimulate appetite,and nourish nerves and muscles in clinical practice cannot reverse muscle atrophy in cancer cachexia.The clinical characteristics of cancer cachexia muscle atrophy are similar to traditional Chinese medicine“consumptive disease”,the etiology and pathogenesis of cancer cachex⁃ia muscle atrophy are mostly due to spleen deficiency,reduced exercise,worry and anxiety impairing spleen,accumulation of toxin and evil,Qi and blood depletion,and deficiency of Zang-Fu organs,which eventually lead to vascular obstruction,deficiency of Qi and blood,and muscle loss of nutrition leading to muscle atrophy.The occurrence of muscle atrophy in cancer cachexia is fun⁃damentally due to the disorder of spleen transportation and transformation in the middle energizer,insufficient metaplasia of re⁃fined nutrients such as water and grains,and the lack of Qi and blood to nourish muscles.Traditional Chinese medicine in the treatment of cancer cachexia muscle atrophy has become more and more prominent advantages.The comprehensive research on cancer cachexia muscle atrophy in recent decades has found that the treatment of traditional Chinese medicine is mostly from in⁃vigorating spleen and stomach,strengthening spleen and nourishing kidney,strengthening spleen and detoxifying,strengthening spleen and soothing liver,and the strengthening spleen method has always been the fundamental core of its treatment.The spleen governing transportation and transformation is closely related to the generation of Qi and blood and the enrichment of muscles,the concept of spleen dysfunction leading to muscle atrophy was first seen in Huangdi Neijing.Therefore,based on the theory of“spleen governing muscles”and combined with the holistic view of traditional Chinese medicine,this study explored the mecha⁃nism of spleen strengthening th

关 键 词：肿瘤恶病质 肌肉萎缩 健脾法 脾主肌肉 

分 类 号：R273[医药卫生—中西医结合]