从正虚邪实论治恶性胸膜间皮瘤伴急性呼吸困难思路探析  

Discussion on the Treatment of Malignant Pleural Mesothelioma with Acute Dyspnea from Healthy Qi Deficiency and Pathogen Excessiveness

作　　者：程权 石占利[2] 傅华洲[1] Cheng Quan;Shi Zhanli;Fu Huazhou(Hangzhou First People′s Hospital,Zhejiang,Hangzhou 310006,China)

机构地区：[1]浙江省杭州市第一人民医院,浙江杭州310006 [2]浙江省中西医结合医院,浙江杭州310006

出　　处：《中国中医急症》2024年第10期1750-1755,共6页Journal of Emergency in Traditional Chinese Medicine

基　　金：国家中医药管理局第七批全国老中医药专家学术经验继承工作室建设项目(国中医药人教函[2022]76号);浙江省名老中医专家传承工作室建设项目(GZS2020029);浙江省医药卫生科技计划项目(2024KY1323)。

摘　　要：恶性胸膜间皮瘤是肿瘤内科恶性程度较高的癌种之一,近年国内外指南中的治疗方案有限且疗效欠佳,同时伴随药物毒副反应较大,致使该类患者较其他癌种的预后更差。恶性胸膜间皮瘤常常侵犯胸膜及纵隔,伴随呼吸困难、胸痛咳嗽等一系列不适症状,严重影响了患者的生活质量及后续的规范治疗。中医学认为恶性胸膜间皮瘤多因长期邪毒侵袭以及素体内虚所致,属于中医学“胸痹”范畴。本病病因病机以脾肾亏虚为主,气滞血瘀及痰瘀互结贯穿疾病全程。恶性胸膜间皮瘤伴急性呼吸困难的治疗应注意从正虚邪实论治,运用健脾化痰止咳、清热解毒平喘、活血散瘀利水三联疗法,在此基础上灵活运用对药和角药辨证辨病施治,获效显著。Malignant pleural mesothelioma is one of the most malignant cancers in medical oncology.In recent years,the treatment regimens in the guidelines at home and abroad are limited and the efficacy is not good,accom-panied by drug adverse reactions,resulting in a worse prognosis than other cancers.The progression of malignant pleural mesothelioma often involves the pleura and mediastinum,along with a series of uncomfortable symptoms such as dyspnea,chest pain and cough,which seriously affects the quality of life of patients and subsequent stan-dardized treatment.According to traditional Chinese medicine(TCM),malignant pleural mesothelioma is mainly caused by long-term pathogen invasion and deficiency of elements,which belongs to the category of“chest obstruc-tion”in TCM.The pathogenesis is mainly characterized by deficiency of the spleen and kidney,with qi stagnation,blood stasis,and phlegm accumulation present throughout the course of the disease.For the treatment of malignant pleural mesotheliom accompanied by acute respiratory distress,attention should be given to treating both healthy qi deficiency and pathogen excessiveness conditions.Therapies should focus on strengthening the spleen and trans-forming phlegm to stop coughing,clearing heat and detoxifying to relieve asthma,and activating blood circulation to dissipate stasis and promote diuresis.On this basis,flexible application of specific herbal combinations and indi-vidual herbs should be employed according to syndrome differentiation and disease characteristics,which can yield significant results.

关 键 词：恶性胸膜间皮瘤 正虚邪实 呼吸困难 思路探析 

分 类 号：R734.3[医药卫生—肿瘤]