基于病理分型与中医证型相参的孙桂芝教授诊治肺癌经验探讨

Discussion of Prof.Sun Gui-zhi's Experiences in the Diagnosis and Treatment of Lung Cancer based on the Pathological Subtypes and Pattern/Syndrome Differentiation of Chinese Medicine

目的对孙桂芝教授收治的中晚期肺癌患者组织病理分型与中医证型和常用处方间相关性进行分析,分析和挖掘研究其诊治肝癌的临床思维模式、诊疗规律和用药经验。方法收集60例中晚期原发性周围型肺癌(以下简称肺癌)患者组织病理学类型及中医临床证型资料,按照中医辨证分为气血瘀滞、痰湿蕴肺、阴虚痰热、气阴两虚4种证型,探讨病理分型与中医证型和常用处方间的相关性。结果四种证型中,以气血瘀滞最为多见(31.67%)。不同中医证型的病理类型具有统计学意义,其中鳞癌占气血瘀滞型的63.64%(14/22),大细胞肺癌占阴虚痰热型的40.00%(8/20),未分化小细胞肺癌占痰湿蕴肺型的44.44%(8/18),腺癌多表现为阴虚为本,兼有气虚或痰热,占阴虚证型总计的19.05%(8/42)。针对不同的病理分型,常用方剂也不同。结论原发性周围型肺癌病理分型与中医证型和常用处方之间存在着一定的内在关系。

Objective To analyze the correlation of the histopathologic subtypes with pattern/syndrome differentiation of Chinese medicine and common herbal formulas for lung cancer at middle and later stages treated by Prof.Sun Gui-zhi and study and explore the clinical thinking mode,the rule of diagnosis and treatment and medication experiences in the treatment of lung cancer.Methods The data of the histopathologic subtypes and the clinical patterns/syndromes of Chinese medicine of 60 cases of primary peripheral lung cancer at the middle and later stages（lung cancer）were collected.According to the pattern/syndrome differentiation in Chinese medicine,4 patterns/syndromes were divided,named qi and blood stagnation,blockage by phlegm and damp in the lung,yin deficiency and phlegm heat,and qi and yin deficiency.The correlation of the pathological subtypes was discussed with the patterns/syndromes of Chinese medicine and the common herbal formulas concerned.Results Of the four patterns/syndromes,qi and blood stagnation pattern/syndrome was the most common（31.67%）.The statistical significance presented in the pathological subtypes among different patterns/syndromes of Chinese medicine,of which,squamous carcinoma accounted for 63.64% of qi and stagnation pattern/syndrome（14/22）,large cell carcinoma for 40.00% of yin deficiency and phlegm heat pattern/syndrome（8/20）,undifferentiated small cell carcinoma for 44.44% of blockage by phlegm damp in the lung（8/18）;adenocarcinoma was mostly manifested as yin deficiency of the root cause,combined with qi deficiency or phlegm heat,accounting for 19.05% totally of yin deficiency pattern/syndrome（8/42）.The different common herbal formulas were prescribed in terms of the different pathological subtypes.Conclusion The pathological subtypes of primary peripheral lung cancer have a certain internal relationship with the patterns/syndromes of Chinese medicine and common herbal formulas.