基于“阳化气,阴成形”论治癌性腹水临床经验探讨  

The clinical experience in the differentiation and treatment of malignant ascites based on the theory of Yang transforms Qi,while Yin produces the shape

作　　者：张文静[1] 郭立中[1] 朱颖[1] 徐敏[1] 陈利[1] 贺佳文 ZHANG Wenjing

机构地区：[1]南京中医药大学,江苏南京210029

出　　处：《中医临床研究》2024年第13期41-44,共4页Clinical Journal Of Chinese Medicine

基　　金：中国中医科学院学部委员周仲瑛国医大师学术思想与临证经验传承研究(CI2022E028XB);江苏省(社会发展)重点研发计划(BE2019723)。

摘　　要：癌性腹水作为中晚期肿瘤的常见并发症之一,临床以腹部胀满和呼吸窘迫为主要症状,多见于晚期卵巢、胰腺和胃肠道恶性肿瘤等腹腔脏器恶性肿瘤患者。其发展速度快,病情进行性加重,一旦出现癌性腹水,患者的中位生存期将缩短至数月甚至数周,严重影响肿瘤患者的后续治疗及生活质量。癌性腹水的治疗至今仍是临床一大难题。“阳化气,阴成形”是《黄帝内经》中关于阴阳生理病理状态的重要论述,阳主“动”而流散以化气,阴主“静”而凝聚以成形,二者调和一致则为平人,若平衡被打破则百病由生。郭立中教授立足临床,结合古医籍和临床经验,提出“阳化气”不及、“阴成形”太过与癌性腹水的发生、发展密切相关。其中,“阳化气”不及是发病之本,“阴成形”太过是发病之标。肺、脾、肾阳虚化气不足,水液运化失常,水湿结聚,水为寒邪,寒性收引凝滞,易致血脉凝结,血凝又加重水湿留而不行,水湿、血瘀停聚腹腔形成癌性腹水。阳虚、水湿、血瘀是关键病因,病性为本虚标实,导师以扶阳消阴为治疗总则,重视扶肺、脾、肾阳气以固其本,消水湿瘀血以治其标,并根据疾病不同时期的病机特点在治疗上讲求次第,灵活变通,并配合外治法,临床收效显著。Malignant ascites,as one of the common complications of middle and advanced tumors,is mainly characterized by abdominal distension and respiratory distress.It is more common in advanced ovarian,pancreatic and gastrointestinal malignant tumors and other abdominal organs malignant tumors patients.It develops rapidly,and aggravates progressively.Once malignant ascites occurs,the median survival period of patients will be shortened to several months or even weeks,which seriously affects the follow-up treatment and survival quality of tumor patients.The treatment of malignant ascites is still a major clinical problem.That Yang(阳)transforms into Qi,while Yin(阴)produces the shape is an important exposition on the physiological and pathological states of Yin and Yang in Huangdi Neijing(《黄帝内经》).Yang administers movement and dispersion to transform Qi(气),while Yin administers stillness and cohesion to produce the shape.When the two are in harmony,the human body is normal.If the balance of the two is broken,many diseases are occur.Based on clinical practice,combined with ancient medical books and clinical experience,Prof.GUO Lizhong proposes that insufficient Qi from Yang transformation and excessive shape from Yin formation are closely related to the occurrence and development of malignant ascites.Among them,insufficient Qi from Yang transformation is the root of the disease,and excessive shape from Yin formation is the symptoms of the disease.Yang deficiency in the lungs,spleen and kidneys results in insufficient Qi from Yang transformation,which leads to abnormal transportation of water and fluid,and accumulation of water-dampness.Water is a cold pathogenic factor,and the attribute of cold is contraction and stagnation,which is easy to lead to blood coagulation.Blood coagulation aggravates water-dampness to stay and not work.Eventually water-dampness and blood stasis accumulate in the abdominal cavity to form maglinant ascites.Yang deficiency,water-dampness,and blood stasis are the key causes of the dis

关 键 词：阳化气 阴成形 癌性腹水 扶阳消阴 

分 类 号：R273[医药卫生—中西医结合]