恶性肿瘤并发出血的中医辨证施治

Malignant Tumor Complicated with Hemorrhage of Evidence-based Medicine in TCM

凡肿瘤患者血液不循常道引起的体表出血和内脏出血如咯血、吐血、便血、尿血等,均称为并发出血。临床表现以齿衄、鼻衄、呕血、黑便等常见。临床分型主要为阴虚火旺、热络伤脉、脾虚气弱、肝郁气逆、脾胃虚寒等。临床治疗为阴虚火旺治以滋阴退热、凉血止血,用知柏地黄丸合百合知母汤;热络伤脉治以清热泻火、凉血止血,用泻心汤合玉女煎;脾虚气弱治以益气健脾、养血止血,用黄芪建中汤;肝郁气逆治以清肝泻肺、凉血止血,用大柴胡汤;脾胃虚寒治以温中健脾、养血止血,用黄土汤。

Surface bleeding and visceral hemorrhage caused by blood circulating away from normal passage in cancer patients,such as hemoptysis,vomiting blood,stool,bloody urine,etc.,are called concurrent hemorrhage. The common clinical manifestations are gum bleeding epistaxis,hematemesis,melena,etc. Clinical classification is mainly fire excess from yin deficiency,warm vein injury,deficiency of the spleen causing weakness of QI,liver depression reversed flow of spleen and stomach cold and so on. The clinical treatment was based on syndrome differentiation. Fire excess from yin deficiency is treated by nourishing Yin to relieve fever,and cooling blood and hemostasis with Zhibai Dihuang pill and Lily and Anemarrhena Decoction. Warm vein injury is treated by clearing heat-fire and cooling blood and hemostasis with Xiexin Decoction and Jade Maiden Decoction. Deficiency of the spleen causing weakness of QI is treated by replenishing Qi to invigorate the spleen and nourishing the blood and hemoslasis with Huangqi Jianzhong Decoction. Inverse gas caused by liver depression is treated by clearing liver-fire and purging lung,and cooling blood and hemostasis with daisaikoto. Insufficiency of spleen-YANG,deficiency cold of the spleen is treated by warming the middle and invigorating the spleen,and nourishing the blood and hemoslasis with Terrae Flavae Decoction. The efficacy of Chinese medicine in the prevention and treatment of bleeding complicated with malignant tumor is satisfactory.