恶性肿瘤中医药维持治疗临床价值与述评

Comment on the clinical value of traditional Chinese medicine in the maintenance treatment of tumor

鉴于中西医之间的知识体系差异以及恶性肿瘤维持治疗概念,从中医视角出发,对恶性肿瘤维持治疗概念、中医维持治疗特征以及中医维持治疗现状与对策三方面进行了评述。阐明中医维持治疗的内涵定义、思维模式与治疗方法。重点强调中医维持治疗要在"道法自然"核心理论指导下,把"以人为本、致力中和""坚守内功、修护元气"以及"调畅情志、天人合一"等理念贯穿维持治疗全过程,并通过最高境界的"养心"法则保持恶性肿瘤患者身心处于最佳状态,重视"辨证施治""整体观念""平衡状态""固本清源""靶向归经""治未病"等理论的灵活运用。提出恶性肿瘤的中医药维持治疗是集疾病维持治疗、肿瘤相关症状维持治疗、肿瘤相关并发病症维持治疗三位一体的多维度系统概念。将治疗目标定位在将证候(症状)控制与提高患者生存质量上升到与无进展生存期和总生存期相等位置,让更多的恶性肿瘤患者在维持治疗中获益。

In view of the differences in the knowledge systems between Chinese and Western medicine and the concept of maintenance treatment of malignant tumors, this paper reviews the concept of maintenance treatment of malignant tumors, the characteristics of maintenance treatment in traditional Chinese medicine(TCM), and the existing problems and coping strategies of TCM maintenance treatment. Firstly, the definition, ways of thinking and treatment methods of TCM maintenance treatment are clarified. It is emphasized that the maintenance treatment in TCM should be guided by the core theory of "Tao conforms to the nature", and the concepts of people-orientedness, commitment to the golden mean, adherence to internal energy, restoration and protection of the original qi, regulation of the emotions and correspondence between human beings and nature throughout the whole process of maintenance treatment. In addition, patients with malignant tumors should be placed in the best state of mind and body by adhering to the highest principle of "nourishing the heart". Such concepts and theories should be applied with flexibility as pattern differentiation and treatment, holistic concept, balanced state, consolidating the basis and clearing the source, targeted meridian tropism and preventive treatment.It is proposed that the maintenance treatment of malignant tumors in TCM is a multi-dimensional system that integrates maintenance treatment of diseases, of tumor-related symptoms, and of tumor-related complications. The goal of the treatment should be control of patterns(symptoms) and improvement in the quality of life of patients as well as longer progression-free survival(FPS) and overall survival(OS), so that more patients with malignant tumors can benefit from maintenance treatment.