吴煜运用乌梅丸治疗放射性肠炎经验

Wu Yu's experiences in the treatment of radiation enteritis with wumei pills

放射性肠炎(RE)作为腹盆腔放疗中最常见的不良反应,其发病率呈逐年上升趋势。临床多表现为腹泻、腹痛、里急后重、体重下降等症状,可累及小肠、结肠、直肠,现代医学主要以对症支持治疗为主,但目前尚无标准的、规范化的治疗措施。中医药治疗RE具有较好的疗效优势,且治疗相关不良反应较少。吴煜教授认为RE虽表现出类似"湿热痢疾"的症状,但需结合疾病本质为恶性肿瘤,为正气亏虚,癌毒与放射线热毒结聚,故病机仍然属于本虚标实,故不可一味清热解毒利湿。乌梅丸方寒热并调、补泻兼施并兼顾标本,临床应用范围颇广。临证过程中吴煜教授运用乌梅丸方化裁治疗直肠癌相关的RE,证属正气虚损的寒热错杂型,取得一定疗效,有望进一步研究和探讨,以提供更多高质量的治疗证据。

Radiation enteritis is the most common adverse reaction of abdominal pelvic radiotherapy and its incidence rate is increasing by years.The disease is manifested as diarrhea,abdominal pain,tenesmus and weight loss,with small intestine,colon and rectum involved.The symptomatic supportive treatment is dominant in the modern medicine and it is lack of the standardized measures at present.TCM presents the advantages in the treatment of this disease,with few adverse reactions.Professor Wu Yu believes that radiation enteritis is seemed to be similar to diarrhea of damp heat type,but malignant tumor is the essence of it,meaning the deficiency of antipathogenic qi and the mixture of cancer toxin and heat toxin of radiative rays.Hence,radiation enteritis is the deficiency in the root cause and the excess in the symptoms and it cannot be simply treated by clearing heat,detoxification and eliminating damp.Wumei pills act on the mutual regulation of cold and heat,the tonifying and the reducing as well as the mutual treatment of the root cause and the symptoms.This formula has a wide range of indication.In clinical practice,Professor Wu Yu has applied the modified wumei pills to radiation enteritis of rectal cancer that is differentiated as the mixture of cold and heat and the damage of antipathogenic qi.The satisfactory therapeutic effects have been achieved.A further exploration is anticipated to provide the high-quality evidence for the treatment.