倪海雯基于癌毒-态靶理论探讨多发性骨髓瘤的临证思维模式

Clinical Thinking Mode of NI Haiwen in Diagnosing and Treating Multiple Myeloma Based on Cancer Toxin-State Target Theory

“态靶理论”是仝小林院士提出的现代中医临床辨治新策略,将传统中医的辨证与现代医学的疾病认识相结合,将中医的宏观调态与现代医学的微观打靶相结合,针对疾病、症状、临床指标选取靶方靶药,建立整体观和精准化相融合的中西医整合新模式。导师倪海雯基于癌毒病机及态靶理论指导多发性骨髓瘤的临床诊疗,认为该病以肾虚癌毒为核心病机,夹杂“痰、热、瘀、虚”,多因复合;以补肾解毒、宣痹通络为治则,贯穿始终,创立验方宣痹消瘤方作为疾病之“靶方”;辨析“痰、热、瘀、虚”之夹杂病机,分别投以化痰、清热、消瘀、补虚以调态;针对骨痛、肾损等并发症分别施以对症之靶药;针对高黏滞血症、单克隆球蛋白增高结合施以标靶药物。探索“癌毒-态靶理论”指导下的中西医结合创新模式契合多发性骨髓瘤新药时代的诊疗实践。

The'state target theory'is a new TCM strategy of clinical differentiation and treatment proposed by TONG Xiaolin,which combines the syndrome differentiation of TCM with the disease understanding of modern medicine,combines the macro-modulation of TCM with the micro-targeting of modern medicine,and selects target drugs and prescriptions according to diseases,symptoms and clinical indicators to establish a new mode of integration between Chinese medicine and West medicine that integrates holism and precision.Based on cancer toxin pathogenesis and state target theory,mentor NI Haiwen guides the clinical diagnosis and treatment of multiple myeloma(MM)and believes that the disease is caused by Kidney deficiency and cancer toxin,which is the core pathogenesis,mixed with‘phlegm,heat,blood stasis and deficiency’complex pathogenesis.With the treatment principle of tonifying Kidney and detoxifying,diffusing impediment and dredging collaterals,TONG established Xuanbi Xiaoliu Formula as the‘target prescription’,identified the mixed pathogenesis of‘phlegm,heat,blood stasis,and deficiency’,and regulated the state by resolving phlegm,clearing heat,removing blood stasis,and tonifying deficiency respectively.Symptomatic target drugs were used for complications,such as bone pain and renal damage respectively.Target drugs were applied according to assay indexes such as hyperviscosity and increased monoclonal globulin.Innovative diagnosis and treatment mode of integrated Chinese and Western medicine were explored under the guidance of‘cancer toxin-state target theory’to fit the clinical diagnosis and treatment of MM.