半夏复方治疗恶性肿瘤方证规律及安全性临床分析

Clinical Analysis of the Prescription and Safety of Pinellia Ternata Compound in the Treatment of Malignant Tumors

目的研究辽宁中医药大学附属医院肿瘤科殷东风教授临床应用半夏复方(半夏均为法半夏,以下简称半夏)治疗恶性肿瘤的方证规律及安全性临床分析。方法采用回顾性分析,统计总结门诊患者处方中使用半夏复方的方证运用情况及不良事件发生情况;对住院患者服用半夏复方治疗前后肝、肾功能、血常规等指标进行比较,评估其安全性。结果98例门诊患者半夏用量范围为6~15 g,门诊患者辨证分型以气滞痰阻居多,约占20.4%,均予柴胡龙骨牡蛎汤加减治疗;其次为痰瘀互结,约占19.4%,均予柴胡龙骨牡蛎汤加莪术、延胡索等活血药治疗,不良事件发生率为6.12%;病房患者服用半夏复方剂数最多为359剂,应用半夏总量最大者为3590 g,最小者为370 g,治疗前后肝、肾功及血常规无明显变化(P>0.05)。结论殷东风教授认为半夏在治疗恶性肿瘤中的病机靶点主要为痰阻、气逆,且痰阻、气逆两个基本病机可与气滞、瘀血、湿阻、实热、脾虚、阴虚相参杂。其中最常见的证候为气滞痰阻,基本处方为柴胡龙骨牡蛎汤,其次为痰瘀互结,基本处方为柴胡龙骨牡蛎汤加莪术、延胡索等。半夏在治疗恶性肿瘤中当根据体重、体力状况、年龄、证型综合决定用量大小。在剂量合理、配伍正确的前提下较长时间服用半夏复方(≥30 d),不良反应的发生率较低,且对血常规及肝、肾功无明显毒性作用。

Objective:This paper mainly studies the prescription law and clinical safety of Pinellia ternata compound in the treatment of malignant tumors by Professor Yin Dongfeng from the Department of Oncology,The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine.Methods:Retrospective analysis was used to statistically summarize the use of Pinellia ternata compound prescriptions and the occurrence of adverse events in outpatient.The liver,kidney function and blood routine of the inpatients were compared before and after treatment to evaluate its security.Results:The dose of Pinellia ternata in 98 outpatients ranged from 6 to 15g.The syndrome differentiation of the outpatients was mostly qi stagnation and phlegm obstruction,accounting for 20.4%.Both syndrome types of the patients were treated with modified Bupleurum keel oyster decoction.Secondly,the patients with stasis-phlegm type,accounting for about 19.4%,were treated with bupleurum keel oyster decoction plus curcuma zedoaria and corydalis tuber,and the incidence of adverse events was 6.12%.The maximum number of Pinellia ternata compound that the patients took was 359 doses,and the maximum application of Pinellia ternata was 3590g and the minimum was 370g,and there was no significant changes in liver,kidney function and blood routine before and after treatment(P>0.05).Conclusion:Professor Yin Dongfeng believes that the pathogenesis of Pinellia ternata in the treatment of malignant tumors is mainly phlegm stagnation and qi reversed flow,and the two basic pathogeneses can be mixed with qi stagnation,blood stasis,phlegm obstruction,excess heat,spleen deficiency and yin deficiency.The most common syndrome is qi stagnation and phlegm obstruction.The basic prescription is Bupleurum keel oyster decoction,followed by phlegm and blood stasis type and the basic prescription is Bupleurum keel oyster decoction plus curcuma zedoaria and corydalis tuber.In the treatment of malignant tumors,the dose of Pinellia ternata is determined according to body weight,physical condition,age,and syndrome type.Under the premise of reasonable dose and correct compatibility,the patients taking Pinellia ternata compound(≥30 days)for a long time and the incidence of adverse reactions is low,and there is no obvious toxic effect on blood routine and liver and kidney function.