食管癌辨治学术思想及经验撷英

Academic thought and experience essence in treating esophageal cancer

文章总结撷摘了郑玉玲教授诊疗食管癌学术思想和经验之精要。郑教授认为外邪直中、食管反复损伤是导致食管癌的直接病因,高龄和情志抑郁是促进食管癌形成因素。随着正邪交争,脏腑失调,其证候不断发生变化。早期以邪实为主,病机为肝胃不和,痰气交阻于食管;中期以邪实正虚为主,病机为肝、脾、胃失调,痰瘀互结于食管;晚期以正衰邪盛为主,病机为肝脾胃肾虚衰。临证重视脏腑辨证,把气血津液辨证和脏腑辨证紧密结合。西医手段干预后证候发生变化,应根据手术、放疗、化疗等对机体的不同影响,采取不同的施治方案。在整体辨证治疗的同时,重视局部病灶的用药。治疗时应注意顾护正气贯彻始终,常补益药物和化痰祛瘀、解毒散结药物同时应用。文章以典型病例相佐证。郑玉玲教授辨治食管癌的学术思想对临床有较强的指导意义。

This paper summarizes professor ZHENG Yu-ling’s academic thought and experience in diagnosis and treatment of esophageal cancer. Professor ZHENG Yu-ling thinks that in the etiology of esophageal cancer, the direct cause of esophageal cancer is the repeated injury of the esophagus in the external evil, and the factors promoting the formation of esophageal cancer are advanced-age and emotional depression. The syndromes constantly change with the conflict between healthy qi and evil, the viscera disorders in different stages. In the early stage, the pathogenesis is liver-stomach disharmony, phlegm and qi are blocked in the esophagus, which is dominated by evil and excess. In the middle stage, the pathogen excess and positive deficiency were the main factors, the pathogenesis is liver, spleen, stomach imbalance, phlegm and blood stasis in the esophagus.In the late stage, the main pathogenesis is liver, spleen, stomach and kidney deficiency. In the term of syndrome differentiation,it is proposed to pay attention to the syndrome differentiation of viscera, and put forward that the syndrome differentiation of qi,blood, body fluid and viscera should be combined closely. In terms of syndrome changes after intervention by western medicine,it is suggested that different treatment schemes should be adopted according to the different effects of surgery, radiotherapy and chemotherapy on the body. It is proposed to pay attention to the use of local lesions while treating the whole syndrome differentiation, and take care of the healthy qi, implement it all the time. The tonifying drugs and resolving phlegm and blood stasis, detoxification and dissipating drugs were often used for eliminating pathogenic factors and strengthening the foundation at the same time. Finally, the typical cases were used to prove the above ideas. ZHENG Yu-ling’s academic thoughts on esophageal cancer differentiation and treatment have a strong guiding significance for clinical practice.