基于经络热度感测法探讨癌因性疲乏的中医病机

Discussion on Traditional Chinese Medicine Pathogenesis of Cancer-related Fatigue Based on the Heat Measurement of Meridians

目的从经络辨识及中医证候角度探讨中重度癌因性疲乏(Cancer-Related Fatigue,CRF)患者的中医病机。方法采用经络热度感测法对CRF患者进行经络诊察,并使用《癌因性疲乏中医证候调查表》、TCM-I量表进行综合评估以分析CRF的中医病机。结果共调查145例中晚期恶性肿瘤合并中重度CRF患者。(1)经络热度感测结果:脾经作为虚证经络出现频率最高(51.7%),其次是肺经(45.5%);实证经络出现频率最高的属小肠经(32.4%),其次为胃经(29.0%)。(2)中医四诊信息:癌因性疲乏患者舌象特点以舌胖大、舌边齿痕、裂纹舌、舌苔厚腻为主,脉象以滑、细最多见,症状则多见夜尿增多、纳差、渴喜热饮、睡而易醒等。(3)合并症状:最常见的症状是口渴、食欲减退、失眠,重度以上则以失眠、食欲减退、疼痛多见。结论癌因性疲乏患者经络特点多表现为足太阴脾经、手太阴肺经虚,手太阳小肠经、足阳明胃经实为主;而中医病机总体表现为虚实夹杂,以虚为主,虚在肺脾,脾虚尤甚;实在胃肠,痰湿为患。

Objective To explore the traditional Chinese medicine(TCM)pathogenesis of patients with moderate to severe cancer-related fatigue(CRF)from the perspective of meridian identification and TCM syndrome. Methods Using the method of heat measurement of meridians,we made the meridian diagnosis for patients with CRF,and then analyzed the TCM pathogenesis of CRF by using Questionnaire on TCM Syndromes of CRF and TCM-I Scale for comprehensive evaluation. Results A total of 145 advanced malignant tumors patients complicated with moderate to severe CRF were investigated. The results of heat measurement of meridians showed that the spleen meridian(51.7%)had the highest frequency in deficiency meridian syndrome differentiation,and followed by lung meridian(45.5%). The intestine meridian(32.4%) had the highest frequency in excess meridian syndrome differentiation, and then came stomach meridian(29.0%). The examination of the information of four TCM diagnostic methods showed that the tongue features of patients with CRF were characterized by enlarged tongue,tooth-marked tongue,cracked tongue,thick and greasy tongue coating. Pulses were mostly slippery and thready.Symptoms were shown as frequent nocturia,poor appetite,thirst for hot drink,festless sleep. The complicated symptoms of the moderate to severe CRF patients were commonly manifested as thirst, loss of appetite,insomnia,and complicated symptoms of the severe CRF patients were show as insomnia,loss of appetite,and pain. Conclusion The patients with CRF are characterized by deficiency of foot Taiyin spleen meridian and hand Taiyin lung meridian, and by excess of hand Taiyang small intestine meridian and foot Yangming stomach meridian. And the TCM pathogenesis of CRF is manifested by the mixture of deficiency and excess, and the deficiency is predominated. The deficiency syndrome type mainly showed deficiency of spleen and lung, especially spleen deficiency,and the excess syndrome type mainly showed in stomach and intestine,especially manifested as phlegm dampness.