裴正学教授对放射性口腔黏膜炎的辨治经验

Clinical experience of PEI Zhengxue on dialectical treatment of radiotherapyinduced oralmucositis

通过分析探讨裴正学教授对放射性口腔黏膜炎病因病机的认识,总结裴正学教授辨治放射性口腔黏膜炎的临床经验。裴正学教授认为放射线为放射性口腔黏膜炎的主要病因,属于中医火热毒邪,具备火热邪气“其性炎上、火易耗气伤津、火易生风动血、火易致肿疡”的一般特性和致病特点,但又不完全符合中医“外感六淫”致病的一般特点。首先,其致病形式不同于其他外感六淫之邪的“六经传变”“卫气营血”等传变过程,而是直中脏腑,损伤肺胃。其次,其致病力极强,放疗初期便导致机体津伤气耗,并且鸱张不解,机体并未出现邪正相争之高热、恶寒等表现,而是很快出现气阴亏虚之证,成为放射性口腔黏膜炎本虚(气阴亏虚)的根本病机。第三,其对机体的损伤,在未合并感染时,属于无菌性炎症,主要是放射线所致的微血管闭塞及纤维化,导致口腔黏膜炎的发生发展,患者出现疼痛、溃疡不易愈合等临床表现,以上病理机制符合中医“火热毒邪灼伤络脉”之病机,放射治疗初期便会出现,并贯穿放射治疗之始终。由此,裴正学教授总结出放射性口腔黏膜炎的病因病机具有三大特点:火热毒邪直中脏腑肺胃、伤津耗气为首发主要表现、络脉损伤贯穿全程。因此,裴正学教授在防治放射性口腔黏膜炎临床实践中以益气养阴生津治其本、清热泻火解毒治其标、全程配合活血化瘀止痛之法,并总结出行之有效的方剂和药物,临床效果良好。

This article summarizes the clinical experience of Professor PEI Zhengxue through analyzing and discussing his viewpoints on pathogenesis and treatment of radiotherapy-induced oralmucositis(RTOM).With years of clinical practice,Professor Pei believes that the etiology and pathogenesis of radiotherapy-induced oralmucositis is a fire-toxins resulting in excessive heat-toxins in body,which impairs the fluids and Qi(气)of body and the collateral channels.First of all,its pathogenic form is different from other exogenous six evils’"six channels transmission","Wei(卫),Qi,Ying(营)and blood"transmission process,but is straight in the viscera,which causes lung and stomach damage.Secondly,its pathogenicity is very strong,at the early stage of radiotherapy,it will cause the body to injure Qi,high fever and aversion to cold does not appear,but soon the syndrome of deficiency of Qi and Yin(阴)appears,which is the fundamental pathogenesis of radiotherapy-induced oralmucositis.Thirdly,its damage to the body,without co-infection,belongs to the aseptic inflammation,is mainly of microvascular occlusion and fibrosis caused by radiation,which can lead to the development of oralmucositis,patients suffer from clinical manifestations such as pain,ulcer healing,the above pathological mechanism conforms to the Chinese medicine"heat and toxin burn collaterals"pathogenesis,which runs throughout the course of radiotherapy.The manifestations of excesses of heat-toxins,deficiency of both Qi and Yin,collaterals and blood stasis are the main causes and pathogenesis of RTOM.Therefore,he concludes the effective prescriptions and herbs based on the main principles for the treatment of RTOM,including clearing away heat and purging fire,detoxifying,nourishing Qi,nourishing Yin,replenishing blood,promoting blood circulation,eliminating the congestion and relieving pain,of which the clinical effect is significant.