晚期结直肠癌中药用药规律分析

Laws of Medicinal Herbs Application in Traditional Chinese Medicine Treatment of Advanced Colorectal Cancer

分析2005年1月—2012年8月上海市中医医院、普陀区中心医院的住院和门诊收治的463例晚期结直肠癌患者的病例资料,运用频数统计法对所用方剂中药物的使用频次、功效归类、性味归经等规律进行统计。结果发现:1中药类别分析:从284例服用中药汤剂的研究病例中共出现中药334种,药物使用频次共5 574次。按其功效将归为20类,主要是清热药(66种)、补虚药(38种)、活血化瘀药(31种)、化痰止咳平喘药(29种)、利水渗湿药(27种),共占57.2%;按频次比例占1%以上的中药共23味,按频次依次为:白术202次、茯苓188次、谷芽168次、黄芪162次、麦芽158次、薏苡仁155次、陈皮141次、山楂127次、神曲118次、党参105次、半夏100次、甘草100次、白花蛇舌草89次、山药88次、八月札81次、白芍80次、生地黄77次、枸杞子71次、当归70次、藤梨根63次、枳壳62次、木香57次、野葡萄藤56次;2中药性味分析:所有药物的药性按出现频次依次为温(2 071次)、寒(1 575次)、平(1 553次)、凉(358次)、热(18次),其中温、寒、平类药物共用5 199次,占用药次数的93.2%;所有药物涉及药味,依次为甘(3 346次)、苦(2 459次)、辛(1 714次)、酸(543次)、淡(427次)、涩(289次)、咸(222次),前3位的甘、苦、辛,共占83.5%;3中药归经分析:药物归经使用频次共计14 512次,从高到低以脾经、胃经、肺经、肝经为多,共占72.7%;4临床疗效分析:按是否服用中药将463例病例分为两组。对照组179例,其中死亡155例,生存时间为(14.674±1.083)个月,1 a生存率为42.8%、2 a生存率为21.3%、3 a生存率为8.4%、4 a生存率为4.2%、5 a生存率为0.0%。中药组284例,其中死亡220例,生存时间为(34.018±4.558)个月,1 a生存率为69.4%、2 a生存率为41.4%、3 a生存率为23.5%、4 a生存率为18.3%、5 a生存率为13.8%。可见,晚期结直肠癌的药物归经分析显示,归脾、胃两经药物超过40%。该病患者多以脾肾亏虚、气血不足为主要表现,发病的关键是人体内环境失衡,脏腑、经络等功能失调,即"内虚",而在各种"内虚"中,脾胃虚弱又是最重要、最关键的病理基础。因此,治疗晚期结直肠癌需重用入脾经、胃经类药物,补益脾胃,充脾胃之气,固后天之本,继而渐缓得效。

Objective： To discuss laws of compound medicine application of traditional Chinese medicine in treatment of advanced colorectal cancer. Methods： Clinic data of 463 patients with advanced colorectal cancer from January 2005 to August 2012 were an-alyzed with retrospective study. The efficacy,character,taste and channel-tropism of TCM medicinal herbs being used were summarized by frequency method. Results： There were 334 kinds of Chinese herbs used in 284 treating cases. These herbal medicines were used mainly for heat-clearing,nourishing,blood circulation promoting and blood stasis relieving,phlegm resolving and cough and asthma relieving,damp clearing and diuresis promoting. There were 23 kinds of commonly used TCM medicinal herbs,with the top 10 being Atractylodes macrocephala,Poria cocos,Setaria italica,Astragalus membranaceus,Hordeum vulgare,Coix lacryma-jobi,Citrus reticulata,Crataegu pinnatifida,Medicated Leaven,and Codonopsis pilosula. Most of these medicinal herbs used in these cases were warm or cold in character or with peaceful property,while most of the medicinal herbs used in these cases were sweet,bitter or pungent in taste. In channel-tropism,the main channels related were Spleen meridian,Stomach meridian,Lung meridian,and Liver meridian,with 76. 2% among the all medicinal herbs. Conclusion： The characters,tastes and the channel-tropism of TCM medicinal herbs used in treatment of advanced colorectal cancer were closely related to the efficacy based on the etiological factors and the pathogenesis of advanced colorectal cancer.