基于“肝肾同源”理论防治乳腺癌内分泌治疗相关性骨质疏松症的思路探讨  

Discussion on the Prevention and Treatment of Endocrine Therapy Associated Osteoporosis in Breast Cancer Based on the Theory of“Liver and Kidney Sharing the Common Source”

作　　者：刘梓燊 郑瑛瑛 袁梦琪 张甘霖[1] 杨国旺[1] LIU Zishen;ZHENG Yingying;YUAN Mengqi;ZHANG Ganlin;YANG Guowang(Beijing Hospital of Traditional Chinese Medicine,Capital Medical University,Beijing 100010,China)

机构地区：[1]首都医科大学附属北京中医医院,北京100010

出　　处：《广州中医药大学学报》2025年第2期293-297,共5页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(编号:82174454)。

摘　　要：乳腺癌内分泌治疗主要用于乳腺癌患者的术前新辅助治疗、术后辅助治疗和晚期乳腺癌的解救治疗。骨质疏松症是乳腺癌内分泌治疗的常见不良反应,严重影响患者的生活质量。肝肾同源与骨质疏松症的病因病机及治则密切相关。乳腺癌内分泌治疗相关性骨质疏松症的发病与肝肾的关系最为密切,其病机特点为本虚标实,本虚为肝肾不足,标实为瘀血阻络。补益肝肾的中医药干预可用于乳腺癌患者的不同内分泌治疗阶段。在术前新辅助治疗阶段,中医药干预应重在攻癌,与新辅助治疗协同发挥抗癌功效,辅以扶正,减少不良反应的发生率,可选用六味地黄丸加减治疗。在术后辅助治疗阶段,中医药干预应重在扶正,帮助患者恢复身体机能,预防骨质疏松症,可选用独活寄生汤、左归丸等加减治疗。在晚期解救治疗阶段,治疗以扶正为主要方向,用药除选用补益肝肾、强筋壮骨、行气活血止痛等方药外,还可增加血肉有情之品,以增强补益肝肾之效果。Endocrine therapy is mainly used as preoperative neoadjuvant therapy and postoperative adjuvant therapy for breast cancer patients and as salvage therapy for advanced breast cancer patients.Osteoporosis is the common adverse reaction of endocrine therapy for breast cancer,which seriously affects the quality of life of the patients.The theory of“liver and kidney sharing the common source”is closely related to the etiology,pathogenesis and therapeutic principle of osteoporosis.It is believed that the pathogenesis of endocrine therapy associated osteoporosis in breast cancer is most closely related to liver and kidney,and is characterized by deficiency in origin and excess in superficiality.Deficiency in origin manifests as deficiency of liver and kidney,and excess in superficiality manifests as blood stasis blocking collaterals.Chinese herbal medicine with the actions of nourishing liver and kidney can be used for interventions of various stages of endocrine therapy for breast cancer.In the stage of preoperative neoadjuvant therapy,Chinese herbal medicine intervention focuses on inhibiting cancer,so as to achieve synergistic anticancer actions with neoadjuvant therapy;the intervention can also be supplemented by medicine for supporting healthy qi with modified Liuwei Dihuang Pills,thus to reduce the incidence of adverse reactions.In the stage of postoperative adjuvant therapy,Chinese herbal medicine intervention focuses on supporting healthyqi,so as to promote the recovery of body functions and prevent the occurrence of osteoporosis,and modified treatment withDuhuo Jisheng Decoction orZuogui Pills can be chosen.In the advanced stage of salvage treatment,Chinese herbal medicine intervention focuses on supporting healthyqi,and medicines for nourishing liver and kidney,strengthening muscles and bones,and activatingqi and blood circulation to relieve pain can be chosen;in addition,medicinals with affinity to flesh and blood can be added to enhance the actions of nourishing liver and kidney.

关 键 词：肝肾同源 乳腺癌 内分泌治疗 骨质疏松症 补益肝肾 六味地黄丸 独活寄生汤 左归丸 

分 类 号：R273[医药卫生—中西医结合]