刘沈林运用“择药任势”思维辨治胃癌经验  

LIU Shenlin's Experience in Treating Gastric Cancer with the Thinking of"Prescription According to Tendency"

作　　者：孙庆敏 张粲粲 郑晓霞 卢雨佳 张翔 郑姗姗 吴坚 刘沈林(指导) SUN Qingmin;ZHANG Cancan;ZHENG Xiaoxia;LU Yujia;ZHANG Xiang;ZHENG Shanshan;WU Jian(Affiliated Hospital of Nanjing University of Chinese Medicine/Jiangsu Province Hospital of Chinese Medicine,Nanjing,210029;The First Clinical Medical College,Nanjing University of Chinese Medicine)

机构地区：[1]南京中医药大学附属医院/江苏省中医院,江苏省南京市210029 [2]南京中医药大学第一临床医学院

出　　处：《中医杂志》2024年第20期2075-2080,共6页Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金(82174197);江苏省基础研究计划(BK20211392);江苏省中医药管理局中医药科技发展计划(ZD202307)。

摘　　要：总结刘沈林教授运用“择药任势”思维辨证施治胃癌的临床经验。将胃癌诊治思维方法、用药技巧凝练总结为权势、能势、时势、形势4个维度,即辨证强调气的“权势”地位,认为胃癌的发生主要始于脏腑气机失调,强调疏调肝脾之气截断病势;指出湿痰瘀毒是导致“能势”代谢失衡的重要环节,擅长运用破血逐瘀和清热解毒之法阻断能量失衡所致的病理连锁反应,恢复机体稳态;在治疗过程中,根据胃癌分期、时序演化的特点,探讨“时势”背景下正邪交争的盛衰变化,根据不同病程调整攻补药物的剂量以求衡复中;将“形势”与胃癌晚期虚劳状态相接轨,善用大剂量黄芪,配伍灵活,补诸虚不足,旺气生血,通调血脉。This paper summarized the clinical experience of Professor LIU Shenlin in diagnosing and treating gas⁃tric cancer with the thinking of"prescription according to tendency".In this paper,the thinking of diagnosis and treat⁃ment for gastric cancer and medication skills were summarized into four dimensions:power,energy,chronology and situation.The diagnosis emphasizes the tendency of qi power,considering that the onset of gastric cancer primarily stems from the disorder of qi movement in zang-fu organs,and emphasizing the importance of regulating the liver and spleen qi to intercept the tendency of disease.It points out that dampness-phlegm-stasis-toxin is a crucial link leading to the metabolic imbalance of body energy,and Professor LIU adepts at using methods such as breaking up blood and expelling stasis,and clearing heat and resolving toxins to block the pathological chain reaction caused by energy imbalance and to restore the homeostasis of the organism.In the treatment process,according to the characteristics of gastric cancer staging and chronological evolution,we will explore the changes of the exuberance and weakness of healthy qi and pathogenic qi in the context of the chronologic tendency,and adjust the dosage of attacking and tonic medicines in different stages of the disease in order to balance and restore the body.The"situation"is in line with the state of consumptive disease in advanced gastric cancer,Professor LIU skillfully uses large doses of Huangqi(Astragalus mongholicus)with flexible combination of medicinals to replenish deficiencies,invigorate qi,and regulate blood vessels.

关 键 词：胃癌 择药任势 气 势 名医经验 刘沈林 

分 类 号：R249[医药卫生—中医临床基础] R273[医药卫生—中医学]