药对“土贝母-浙贝母”应用于乳腺癌的用药经验

Experience of Couplet Medicinals “Bolbostemma Paniculatum-Peimine” on Breast Cancer

目的：选用导师治疗乳腺癌常用药对之一＂土贝母-浙贝母＂进行总结,分析其在处方中的应用特点。方法：查阅2013年1月—2014年12月间东方医院门诊病案室建档的现存病案,根据纳入、排除标准,选取肿瘤科门诊初诊建档的女性乳腺癌患者,筛选病历中包含药对＂土贝母-浙贝母＂的首拟方,回顾性分析组方特点及应用规律,总结配伍使用＂土贝母-浙贝母＂治疗乳腺癌的临床经验。结果：处方中含有药对＂土贝母-浙贝母＂的病例占乳腺癌处方比例的26.0%。患者临床表现以＂未诉明显不适＂为主,其余伴随症状包括咳嗽、少量黄痰、咽痛、口干、口苦、潮热、食欲不振、眠差、便干等。舌质以红、黯红为主,少量可见瘀斑。舌苔以薄白为主,少量患者苔少,或微腻。脉象以细脉为主,其中以细滑、沉细、弦细多见。土贝母-浙贝母配伍剂量常用为土贝母6 g,浙贝母15 g。处方药味在16~31味之间,均为大方。配伍的其他药物出现亦有集中特点,其中26味中药在处方中出现频率在1/3以上。药性以寒为主,药味以甘、苦、辛味多见,归经以脾、胃、肝经为主。结论：含有药对＂土贝母-浙贝母＂乳腺癌处方,适用于微热内伏、痰毒交结的证候,且体内处于邪气不盛、正气尚虚的治疗阶段。

Objective： To summary the experience and prescription features of Bolbostemma Paniculatum-Peimine,and explore the rules of Chinese medicine compatibility for breast cancer in Professor Hu Kaiwen＇s prescription. Methods： Check out outpatient records in Dongfang Hospital between Jan. 2013 and Dec. 2014; according to inclusion and exclusion criteria,select breast cancer cases who established the outpatient records first in oncology department and for a long-term visit,and then choose the first prescription which contained ＂Bolbostemma Paniculatum-Peimine＂,retrospective analysis and summarize the experience and rules. Results： 26. 0% of the total were found out. Most of the indications were no obvious discomfort,while other associated symptoms were coughing,a small amount of yellow sputum,sore throat,dry mouth,bitter taste,hot flashes,anorexia,poor sleep,dry stool,and so on. The tongue was mainly red or dark red,seldom with blood stasis. The thin white coating seems to predominate,meanwhile less coating or slightly greasy were in a minority. The pulse was thin,including deep thin,floating thin,and wiry thin. The usual dose of Bolbostemma Paniculatum is 6 g,and Peimine is 15 g. The prescriptions were large,containing 16 ~ 31 kinds of medicines.Except＂Bolbostemma Paniculatum-Peimine＂,other compete medicines centralized distribution,frequency of 26 medicines were more than 1/3. The nature of medicine was cold. The taste concluded sweet,bitter and pungent. Meridian dominated by spleen,stomach and liver. Conclusion： Bolbostemma Paniculatum and Peimine can be suitable for slight heat,phlegm and toxin together,in the treatment stage of deficiency zheng qi and slightly exuberance pathogen qi.