基于“从化”理论探讨放射性损伤的中医辨治

Discussion on the treatment of radiation injury with traditional Chinese medicine based on“conghua”theory

放射治疗(简称“放疗”)在肿瘤综合治疗中占据重要地位,而放射性损伤是制约其发展的重要瓶颈。“从化”理论源于《黄帝内经》,高度概括了病机变化的特征规律,是中医病机学的重要理论之一。放射线快速、高能、杀伤力强的特点,符合中医学毒邪的特性。毒邪具有明显的“从化性”,放疗毒邪侵袭人体后,根据人体体质差异和侵犯部位的阴阳属性,分别从化为阳毒或阴毒以致病,这可能是放射性损伤演进的关键环节。放疗毒邪侵犯阴虚、燥热体质或阳腑、表位,易从阳化为“热毒”“燥毒”“风毒”,若侵犯阳虚、寒湿体质或阴脏、里位,易从阴化为“痰毒”“瘀毒”。因此,在治疗放射性损伤时,应分清体质阴阳偏颇、脏腑表里部位、病程缓急阶段,辨明各类毒邪导致的病理状态,谨守病机,辨证施治。本文基于“从化”理论的内涵,结合放疗毒邪的致病特点,探讨放射性损伤的病机演变和病证变化规律,以期为放射性损伤的临证辨治提供思路。

Radiotherapy occupies an important position in comprehensive cancer treatment,and radiation injury is an important bottleneck that limits its development.“Conghua”theory,which originated from Huangdi Neijing,is an important theory of pathogenesis that summarizes the characteristic law of pathological change.Radiation has the characteristics of high speed,high energy,and high lethality,which accords with the category of“toxic pathogen”in traditional Chinese medicine.Toxic pathogen has the obvious characteristic of“conghua”.After the radiation toxin damages the body,according to the yin and yang attributes of the physical difference and invaded site,it transforms into a yang toxin or yin toxin,respectively,which may be a key link in the evolution of radiation injury.The radiation toxin invades the yin⁃deficient and dry⁃heat constitutions,or yang fu⁃organs and exterior sites,which are easy to change from yang to“heat⁃toxin”,“dryness⁃toxin”,and“wind⁃toxin”;and it invades the yang⁃deficient and cold⁃dampness constitutions,or yin zang⁃organs and interior sites,which are easy to change from yin to“phlegm⁃toxin”and“stasis⁃toxin”.Therefore,in the treatment of radiation injury,it is necessary to distinguish the yin and yang bias of the constitution,the internal and external parts of the Journal of Beijing University of Traditional Chinese Medicine viscera,and the slow and urgent stages of the disease to identify the pathological state caused by various kinds of toxic pathogens,examine pathogenesis,and provide treatment according to syndrome differentiation.Based on the connotation of“conghua”theory and the pathogenic characteristics of radiation,this paper discusses the laws of pathological evolution and syndrome change in radiation injury,in order to provide new directions for the clinical treatment of radiation injury.