辛凯旋教授治疗原发性肝癌经验撷英

Professor XIN Kaixuan’s Experience in the Treatment of Primary Hepatic Carcinoma

[目的]总结辛凯旋教授治疗原发性肝癌的诊治思路和治疗经验。[方法]通过跟师学习及整理医案,从病因病机、辨治方法、剂型特色方面总结辛老治疗原发性肝癌的经验,并附验案一则以佐证。[结果]辛老认为肝癌本虚标实,正气不足是其发病基础,气滞、湿热、瘀毒为主要病理因素,邪毒内侵导致肝脾肾三脏功能失调,"阳化气"不足、"阴成形"太过是肝癌形成的关键。治疗方面,辛老强调以扶正祛邪为总则,确立了健运脾胃、补益肝肾,理气解郁、活血化瘀,清利湿热、畅利三焦,清热解毒、以毒攻毒的四大治法。同时,辛老擅长以丸剂治疗慢病,丸剂配合汤剂贯穿始终。验案所举为肝癌晚期患者,辨病为肝积,病机为肝郁脾虚、湿热中阻,治以疏肝健脾、清利湿热,以香砂六君子汤及六味地黄汤为基础方健脾补肾以扶助正气,辅以利湿清热、行气化瘀解毒之品以消散癌毒,治疗10个月余复查癌肿明显缩小,目前患者病情稳定。[结论]辛凯旋教授在中医辨证论治肝癌方面,遵循扶正祛邪的治则,采用汤剂加丸剂联合治疗,取得较好的疗效,值得临床研究和推广。

[Objective]To summarize Professor XIN Kaixuan’s thinking and experience in diagnosis and treatment of primary hepatic carcinoma(PHC).[Methods]Through learning from teachers and sorting out medical records,this paper summarized Professon XIN’s experience in treating PHC from the aspects of etiology,pathogenesis,differentiation and treatment methods,and dosage form characteristics,and provided a case as evidence.[Results]It is considered that PHC is the disease of deficient root and excess superficislity.Deficiency of vital Qi is the basis of its pathogenesis,and Qi stagnation,heat and dampness,and stasis and toxin are the main pathological factors.The invasion of pathogenic toxin causes the dysfunction of the three organs of liver,spleen and kidney.Insufficient"Yang transforming Qi"as well as"Yin shaping"too much are the key of the formation of PHC.Professor XIN emphasizes that the general principle of treatment is to strengthen the body resistance to eliminate pathogenic factors,and establishes four treatment methods:Invigorating the spleen and stomach,nourishing the liver and kidney;regulating Qi and relieving depression,promoting blood circulation and removing blood stasis;clearing away dampness and heat,smoothing and benefiting tri-Jiao;clearing heat and detoxification,fighting poison with poison.At the same time,Professor XIN is good at using pills to treat chronic diseases,using pills and decoction throughout the process.The case was of advanced liver cancer,and differentiated as liver accumulation,with the pathogenesis of liver stagnation and spleen deficiency,dampness and heat obstruction in the middle-Jiao.According to the therapeutic principles of soothing the liver and strengthening the spleen,clearing dampness and heat,the patient was treated based on Xiangsha Liujunzi Decoction and Liuwei Dihuang Decoction,to strengthen the spleen and tonify the kidney to support the healthy Qi,supplemented with the drugs of removing dampness and heat,promoting Qi to remove blood stasis and detoxify to dissipate cancer toxin.After treatment for more than 10 months,the cancer was significantly reduced,and the patient’s condition is stable at present.[Conclusion]Professor XIN Kaixuan has rich experience in the treatment of liver cancer by combining decoction with pill and following the general principles of invigorating and dispelling pathogenic factors,and has achieved good efficacy,which is worthy of clinical study and application.