张德忠运用旋覆代赭汤加减治疗上消化道肿瘤经验

Experience of ZHANG De-zhong in Treating Tumors of Upper Digestive Tract with Xuanfu Daizhe Decoction

旋覆代赭汤出自《伤寒论》,主治胃虚痰阻所致诸证。张德忠认为该方畅脾胃之升降气机,标本兼治,虚实互调,切合上消化道肿瘤病机。临证常以旋覆代赭汤加减治疗上消化道肿瘤,随证化裁,如兼脾肾阳衰者,辅以温补脾肾,合右归丸加减;兼脾气不足者,辅以健脾益气,合四君子汤加减,并加大代赭石剂量以加强重镇降逆之功;兼肝胃不和者,治以疏肝解郁,合半夏厚朴汤加减等。本文分析总结张德忠运用旋覆代赭汤加减治疗上消化道肿瘤经验,并附验案两例,以期为开拓经方在上消化道肿瘤的临床应用提供思路。

Xuanfu Daizhe Decoction is a classic recipe from Treatise on Exogenous Febrile Diseases,which is indicated for the syndrome of stomach deficiency with the blockage of phlegm.Professor ZHANG De-zhong suggests that Xuanfu Daizhe Decoction has the actions of regulating the Qi movement of spleen and stomach,and can realize the function of simultaneous treatment of the branch and the root,and simultaneous relief of deficiency and excess,which accords with the pathogenesis of tumors of upper digestive tract.During the treatment of upper gastrointestinal tumors with the modified Xuanfu Daizhe Decoction,the medication should be adapted to the syndromes.For the patients complicated with kidney yang deficiency,the treatment should be assisted by warming and tonifying spleen and kidney with the modified Yougui Pills.For the patients complicated with spleen Qi deficiency,the treatment should be assisted by invigorating spleen and supplementing Qi with the modified Sijunzi Decoction together with the enlarged dosage of Haematitum for strengthening the actions of checking upward adverse flow of qi with heavy herbs.For the patients complicated with disharmony of liver and stomach,the treatment should be assisted by soothing liver and relieving depression with the modified Banxia Houpu Decoction.Two proved cases were listed for supplying thoughts for the clinical application of the classic recipe in the treatment of tumors of upper digestive tract.