中医药治疗肿瘤放化疗后骨髓抑制研究进展

Research Progress in the Treatment of Arrest of Bone Marrow After Radiotherapy and Chemotherapy with TCM

中医药治疗肿瘤放化疗后骨髓抑制的基本原则是扶正祛邪。治则以补气养血、活血化瘀、健脾养肝、补肾生髓等为主,方如四君子汤、四物汤、八珍汤、归脾汤、当归补血汤、六味地黄汤、血府逐瘀汤、左归丸、右归丸等。常用药物以补血药、补气药、补肾药、补脾药为主,药性偏甘温,多归属于肾、脾、肝三经。补血药多用阿胶、鸡血藤、熟地黄、当归等,补气药多用黄芪、人参等,补肾药多用淫羊藿、巴戟天、益智仁、制何首乌、补骨脂、锁阳、鹿茸、桑葚、枸杞子、杜仲、女贞子等,补脾药多用白术、山药、茯苓、党参、白术等。其作用机制尚不明确,针对性的固定方剂缺乏,大多是各家临床经验方,无统一性、特异性,并且中药在机体肿瘤环境下的活性及诸药的协同作用还有待进一步研究。

The basic principle of TCM in the treatment of arrest of bone marrow after radiotherapy and chemotherapy is to strengthen healthy qi and remove pathogenic factors.The major treatment principle is to nourish qi and blood,promote blood circulation and remove blood stasis,strengthen spleen and liver,nourish kidney and generate marrow.The commonly-used prescriptions include Four Gentlemen Decoction,Four Substances Decoction,Eight-Gem Decoction,Chinese Angelica Spleen-Supplementing Decoction,Spleen-Restoring Decoction,Six-Ingredient Rehmannia Decoction,Blood Mansion Stasis-Expelling Decoction,Left-Restoring Pill,Right-Restoring Pill,etc.The commonly-used medicinals mainly include blood-tonifying medicinals,qi-tonifying medicinals,kidney-tonifying medicinals and spleen-tonifying medicinals,which are sweet and warm in nature,and mostly belong to the three meridians of kidney,spleen and liver.Blood-tonifying medicinals usually choose Ejiao(Colla Corii Asini),Jixueteng(Caulis Spatholobi),Shudihuang(Radix Rehmanniae Praeparata),Danggui(Radix Angelicae Sinensis),etc.;Qi-tonifying medicinals usually choose Huangqi(Radix Astragali),Renshen(Radix Ginseng),etc.;Kidney-tonifying medicinals usually choose Yinyanghuo(Herba Epimedii),Bajitian(Radix Morindae Officinalis),Yizhiren(Fructus Alpiniae Oxyphyllae),Zhiheshouwu(Radix Polygoni Multiflori Praeparata cum Succo Glycines Sotae),Buguzhi(Fructus Psoraleae),Suoyang(Herba Cynomorii),Lurong(Cornu Cervi Pantotrichum),Sangshen(Fructus Mori),Gouqizi(Fructus Lycii),Duzhong(Cortex Eucommiae),Nvzhenzi(Fructus Ligustri Lucidi),etc.;Spleen-tonifying medicinals usually choose Baizhu(Rhizoma Atractylodis Macrocephalae),Shanyao(Rhizoma Dioscoreae),Fuling(Poria),Dangshen(Radix Codonopsis),etc.The mechanism of action is not clear,the targeted fixed prescriptions are lacked;most of them are clinical experience prescriptions,without unity and specificity,and the activity of TCM in the body tumor environment and the synergistic effect of various drugs need further study.