基于“年长则求之于府”探讨老年肿瘤患者治疗相关不良反应的辨治思路  

Differentiation and treatment strategies for therapy-related adverse reactions in elderly tumor patients based on"seeking treatment from the Fu organs for old age"

作　　者：胡家宾 王新苗 HU Jiabin;WANG Xinmiao(Health Care Department of the Security Bureau of the Joint Staff Department of the Central Military Commission,Beijing 100017,China;Oncology Department,Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053)

机构地区：[1]中央军委联合参谋部警卫局卫生保健处,北京100017 [2]中国中医科学院广安门医院肿瘤科,北京100053

出　　处：《北京中医药》2025年第4期531-534,共4页Beijing Journal of Traditional Chinese Medicine

摘　　要：老年肿瘤治疗相关不良反应(如恶心呕吐、便秘、皮疹等)是抗肿瘤治疗难以正常开展的重要原因,严重影响老年患者的生活质量和生存获益。本文基于《黄帝内经》“年长则求之于府”理论,综合老年“脏虚腑实”之病理特点,即脏虚由自然衰老所致,一时难以从根本上进行纠正;腑实即腑气易滞失畅,可当即通,提出从府论治老年肿瘤治疗相关不良反应。在病机上,提出毒留胃腑,浊阴难降,发为恶心呕吐;毒停肠腑,传导失畅,发为便秘;毒滞玄府,开阖失司,发为皮疹。在治法上,提倡以通字立法,对于毒留胃腑之恶心呕吐,当通降胃气,降中有升;对于毒停肠腑之便秘,当通肠腑泄浊,攻中兼守;对于毒滞玄府之皮疹,宣肺畅玄,开中合阖,如此府气得通,药毒得解,可助抗肿瘤治疗继续开展。Adverse reactions related to tumor treatment in elderly patients(such as nausea,vomiting,constipation,and rashes)are major obstacles to the normal progression of anti-tumor treatment,significantly affecting the quality of life and survival benefits of elderly patients.Based on the theory of"seeking treatment from the Fu organs for old age"in Huangdi Neijing,and integrating the pathological characteristics of"Zang organ deficiency and Fu organ excess"in the elderly(where Zang organ deficiency results from natural aging and is difficult to correct fundamentally in the short term,while Fu organ excess is due to stagnation and obstruction of Fu qi,which can be promptly addressed),this article proposes a treatment approach from the perspective of the Fu organ to manage tumor treatment-related adverse reactions in elderly patients.In terms of pathogenesis,it is suggested that toxins remain in the stomach,making it difficult to lower turbid yin,resulting in nausea and vomiting.Toxins stagnate in the intestines,causing poor transit and leading to constipation.Toxins stagnate in the sweat pore,leading to the failure of opening and closing,which causes rashes.Regarding treatment,the dredging method is advocated.For nausea and vomiting caused by toxins in the stomach,the goal should be to dredge and lower the stomach qi,with a combination of descending and ascending methods.For constipation caused by toxin stagnation in the intestines,the approach should focus on dredging the intestines,expelling turbidity,and balancing attack and defense.For rashes caused by toxin stagnation in the sweat pore,ventilating lung,dredging sweat pore,and restoring the balance of opening and closing.In this way,qi in the Fu organs can freely flow,drug toxicity can be relieved.The therapy can enable the continuation of effective anti-tumor treatment.

关 键 词：年长则求之于府 老年人 肿瘤 不良反应 

分 类 号：R273[医药卫生—中西医结合]