应用健脾益气摄血法论治肿瘤治疗相关性血小板减少症的临证探讨  

Clinical discussion on the application of invigorating spleen and benefiting qi and controlling blood method for the treatment of cancer therapyrelated thrombopenia

作　　者：严香 罗美 于佳卉 张雅月[1] 田劭丹[1] 陈信义[1] 兰梦好 YAN Xiang;LUO Mei;YU Jiahui;ZHANG Yayue;TIAN Shaodan;CHEN Xinyi;LAN Menghao(Department of Oncology and Hematology,Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China)

机构地区：[1]北京中医药大学东直门医院血液肿瘤科,北京100700

出　　处：《北京中医药大学学报》2024年第6期808-812,共5页Journal of Beijing University of Traditional Chinese Medicine

基　　金：国家自然科学基金青年科学基金项目(No.81703903);国家中医药管理局高水平中医药重点学科建设项目——中医血液病学(No.zyyzdxk-2023268);北京中医药大学东直门医院临床研究和成果转化能力提升试点项目(No.DZMG-ZJXY-23014)。

摘　　要：肿瘤治疗相关性血小板减少症中医病名为“药毒紫癜病”,是肿瘤治疗过程中常见的血液学不良反应,因肿瘤治疗手段存在差异,其发病机制复杂,致血小板减少程度不同,治疗难度大。基于“脾主统血”理论,本文认为“药毒紫癜病”主因药毒直接损伤气血,导致气血亏虚;又攻伐脾胃,致脾气虚弱,后天之本气血化生无源。后天之本不足,精微物质不足以滋养先天,肾精亏虚,骨髓失养,化生血液功能减退,终成“药毒紫癜病”。“调平与平调”理论是本团队治疗恶性血液肿瘤疾病的重要学术思想,本文通过相关文献整理,系统阐述了肿瘤治疗相关性血小板减少症脾虚证的病因病机及治法治则,认为以健脾益气摄血法拟定的组方治疗肿瘤治疗相关性血小板减少症脾虚证符合中医方证、药证对应原则,理论可行,具有较高的临床应用价值。Cancer therapy-related thrombopenia,which is called"medicinal poison purpura"in traditional Chinese medicine,is a common hematologic adverse reaction during oncology treatment that is difficult to treat due to the differences in oncology treatments and the complexity of the pathogenesis,resulting in various degrees of thrombocytopenia.Based on the theory that"spleen controlling blood",this paper believes that"medicinal poison purpura"is mainly caused by direct damage to the blood and qi by medicinal poison,leading to qi and blood deficiency;it also attacks the spleen and stomach,resulting in the deficiency of spleen qi and no source of qi and blood production.Due to the spleen deficiency,there is no essence to nourish kidney and bone marrow;their function of generating blood decreases,eventually it becomes"medicinal poison purpura".The theory of"regulating balance and flat regulation"is an important academic idea of our team in the treatment of malignant hematological tumors.In this paper,we have systematically elaborated on the etiology,pathogenesis,and therapeutic principles of the treatment of cancer therapy-related thrombopenia with spleen deficiency pattern through the collation of relevant literature.We believe that the prescription formulated according to the method of invigorating spleen and benefiting qi and controlling blood for the treatment of cancer therapy-associated thrombocytopenia with spleen deficiency pattern is in line with the principle of correspondence between prescription and syndrome,and correspondence between drugs and syndrome in traditional Chinese medicine,which is theoretically feasible and has a high clinical application value.

关 键 词：肿瘤治疗相关性血小板减少症 药毒紫癜病 健脾益气摄血法 脾主统血 

分 类 号：R273[医药卫生—中西医结合]