原发性肝癌的中医三级治则

Treating primary liver cancer by three levels of TCM treatment principle

中医重视整体调节、个体化诊治,不良反应轻,费用低廉,具有独特优势,是肝癌综合治疗中不可或缺的组成部分。治则是中医药诊疗肝癌的必备环节,对临床立法、处方用药具有指导作用。在精气分化过程中,肝脏若受到致癌剂的长期刺激,出现异常分化,同时正气不足,修复能力下降,从而产生恶性的肝脏癌邪。癌邪在水谷精微的滋养下,不断增殖生长,形成影像学检查可探测到的肿块,即临床期肝癌。癌块进一步增大和发展,产生气滞、血瘀、痰、湿、热等病理产物,损害脏腑功能。根据肝脏癌邪理论与病因病机,制定一级治则:针对致癌因素进行治疗、扶持正气、中药抗癌、治疗癌肿所致病理产物。根据西医不同治疗方式制定中医的二级治则。根治切除后治则为"预防癌邪复发"。TACE后治则为"护肝、改善症状和人体环境、抗癌"。根治性消融后治则为"预防癌邪复发";姑息减瘤消融后治则为"抗癌、改善人体环境"。放疗期间治则为"减轻放疗不良反应、保障放疗顺利进行"。放疗后治则转为"护肝护胃、适度抗癌"。三级治则比二级治则更加具体,直接指导立法和用药,主要内容有:扶正与祛邪并举、急则治标缓则治本、"癌邪种子"与"人体土壤"兼顾、全程不间断个体化治疗。

TCM medicine was pay more attention on overall regulation, individualized diagnosis and treatment, with mild adverse reactions and low cost, and has unique advantages. It is an integral part of comprehensive treatment of liver cancer. The principle of treatment is the necessary link in the treatment of liver cancer with TCM. It plays a guiding role in clinical legislation and prescription medication. In the process of Qi differentiation, the liver with the long-term stimulation of carcinogens, abnormal differentiation, lack of righteousness were found, and repair capacity were decreased, resulting in malignant liver cancer evil. Under the fine nourishment of water and grain, the cancer evil becomes a mass of cancer. Mass of cancer can also transfer growth and form Qi stagnation、blood stasis、phlegm、damp、hot and other pathological conditions. According to the cancer evil theory and etiology and pathogenesis of liver cancer, the first grade rule of treatment is established. According to the different methods of western medicine, the second-grade rule of treatment are formulated. The third-grade treatment is more specific than the second level treatment, which directly guides the legislation and the medication.