淋巴瘤相关性贫血患者中医证型及用药规律分析

Analysis of TCM Syndromes and Rules of Drug Usage in Patients with Lymphoma Anemia

目的:调查分析淋巴瘤相关性贫血患者的中医证候、证型特点及中药应用规律。方法:收集近6年在南京中医药大学附属医院住院的淋巴瘤相关性贫血且接受中药治疗的580例患者的临床资料,应用SPSS 17.0统计软件对患者的四诊信息、证型、中药药物应用频次、频率进行分析。结果:淋巴瘤相关性贫血患者主要证候有乏力、浅表淋巴结肿大、咳嗽、纳差、贫血貌、发热、舌质淡或淡红、苔白腻或薄白、脉细或弦细等。涉及的脏腑主要是脾胃和肾,与心、肝、肺相关。证候要素主要包括气虚、血虚,也可表现为阴虚、毒、痰、瘀、热等。中医证型依次为气血亏虚证、癌毒内蕴证、气阴两虚证、痰瘀互结证、痰热互结证、气虚血瘀证等。补虚药和清热药是应用最广泛的两类,其他依次为化痰平喘药、利水渗湿药、活血化瘀药、消食药、解表药、理气药等。补虚药中主要是补气药,其次是补阴药、补血药和补阳药。清热药以清热解毒为主,其次是清热凉血药、清热燥湿药、清热泻火药及清虚热药。甘草、白术、黄芪、当归、白芍药等10味药占补虚药总数的75.32%。白花蛇舌草、玄参、金银花、山慈菇、半枝莲、蒲公英、连翘等10味药占清热解毒药总数的77.11%。结论:淋巴瘤相关性贫血患者的证候表现复杂,病机以虚为主,夹杂痰瘀、热毒等病理因素,健脾益肾、祛瘀解毒为主要治法,药物选择应立足辨证论治,同时可选择常用的补益药和解毒抗癌药。

Objective： To investigate the TCM symptom and syndrome characters of patients with anemia of lymphoma and the application rule of traditional Chinese medicine. Methods： The clinical data of 580 patients with lymphoma anemia treated in TCM hospital of Jiangsu Province were collected in the past 6 years. SPSS 17. 0 statistical software was used to analyze the diagnosis information,syndromes,and drug frequency in TCM medication. Results： The major symptoms of Lymphoma anemia patients are weakness,superficial lymph nodes,cough,poor appetite,anemia,fever,pale or pink tongue,greasy or thin white fur as well as thin or thin wiry pulse. The organs involved are Spleen,Stomach and Kidney and the disease is also related to the functions of Heart,Liver and Lung. The syndromes include Qi deficiency,Blood deficiency,or Yin Deficiency,Toxin,Sputum,Blood Stasis,Heat and so on.The TCM syndromes are Qi and Blood Deficiency,Cancer Toxin Implication,Qi and Yin Deficiency,Phlegm and Blood Stasis,as well as Qi Deficiency and Blood Stasis and so on. Tonic and heat clearing medicine are the most widely used drugs. Others aredrugs which can dispel Phlegm,asthma and Dampness,activate blood circulation,help digestion,relieve exterior syndrome as well as regulate Qi and so on. Tonic medicine includes drugs that tonify Qi,Yin,Blood and Yang of patients. Heat-clearing medicine includes drugs that clear Heat in detoxification,clear Heat and cool Blood,clear Heat to dispel Dampness,clear Heat to purge Fire and clear deficiency Heat. Ten kinds of drugs that can tonify deficiency like Licorice,Atractylodes,Astragalus,Angelica and White peony accounted for 75. 32% of the total number of drugs. Ten kinds of drugs that can clear Heart in detoxification like Hedyotis diffusa,Scrophulariaceae,Honeysuckle,Mountain arrowheads,Scutellaria barbata,Dandelion,Forsythia accounted for 77. 11% of the total number of drugs. Conclusion： The syndromes of patients with lymphoma anemia are complicated and the main pathogenesis is deficiency with Phlegm,Stasis,Heat,Toxin and other pathological factors. The main medication methods are tonifying Spleen and Kidney as well as dispelling Stasis and detoxification. Drug selection is mainly based on syndrome differentiation in treatment,and drugs that are tonic and function in detoxification and anticancer can be selected.