基于“甘以缓之”思想治疗肝癌疼痛初探

A preliminary study on treating hepatocellular carcinoma pain based on the idea of using sweet TCM medicine to relieve contraction

原发性肝细胞癌(简称肝癌)是临床常见的消化系统肿瘤,患者经常出现肝区疼痛的症状,严重影响患者的生活质量。西医治疗肝癌疼痛不良反应多且易成瘾,中医药以辨证论治为基础,在本病的诊治中有一定优势。中医认为肝体拘紧不适则疼痛发生。对于肝癌患者肝区疼痛的治疗,文章基于“甘以缓之”的内涵,结合清代名家马培之的学术思想,总结出以甘以柔肝、甘以补肾、甘以健脾为主组方的用药规律:肝气升动太过或肝血濡养脏体不及导致的肝急疼痛,可以甘温之当归补血行血,直入肝脏以调经止痛,且补中有动,行中有补,扶正补虚兼能活血散结,尤适用于本虚标实之肝癌疼痛的论治;又有精血同源,子病及母,肝血不足而致疼痛者,可通过补肾以缓肝止痛,甘温之熟地黄功善补血养阴,填精益髓,且入肝肾两经,起到精血同补,肝肾同治的作用;脾胃为水谷之海,气血生化之源,脾胃虚弱则肝血亦亏,进而发生疼痛,此为“土虚木乘”,此时可通过扶土以抑木,甘温之白术、大枣之属健脾和胃,补中益气,脾胃健运则气血充盛,土虚木乘之势得以转变,肝脏挛缩状态得以舒缓。以此甘味中药缓肝急之法验之临床,疗效颇著。

Primary hepatocellular carcinoma,or liver cancer for short,is a common tumor of digestive system in clinical practice.Patients with liver cancer often have liver pain symptoms in liver region,which seriously affect the quality of life of patients.The treatment of liver cancer pain in Western medicine has many adverse reactions,and is easy to make patients addicted to medicines.P TCM treatment is based on syndrome differentiation,and has certain advantages in the diagnosis and treatment of this disease.TCM proposes that pain occurs when the liver are convulsive discomfort.In terms of the treatment of this disease,based on the connotation of using sweet TCM medicine to relieve contraction,combined with the academic thought of MA Peizhi,a TCM master in the Qing Dynasty,the author summarized the medication rule of TCM on the disease according to the treatment principles of using sweet TCM medicine to soften the liver,using sweet TCM medicine to nourish kidney,and using sweet TCM medicine to strengthen spleen.The sweet and warm medicine such as Danggui(Radix Angelicae Sinensis)can be used to replenish blood,regulate menstruation and relieve pain in order to treat liver cancer pain caused by excessive liver-Qi(肝气)or insufficient ability of liver blood to nourish the organs.It can not only strengthen the body,but also promote blood circulation and disperse knots.It is especially suitable for the treatment of liver cancer pain caused by deficiency and excess.The pain caused by insufficient liver and blood can be alleviated by tonifying kidney method.Shu Dihuang(Radix Rehmanniae Preparata)is sweet and warm,and has the effects of tonifying blood and Yin(阴),and supplementing essence,and its active ingredients mainly flows into liver and kidney meridians,which can play the role of nourishing both essence and blood,and treating liver and kidney simultaneously.For patients with weak spleen and stomach,the pain is caused by the deficiency of liver and blood.Sweet and warm medicines such as Baizhu(Rhizoma Atractylodis macrocephalae)and Dazao(Fructus Jujubae)can be used to strengthen the spleen and stomach,and replenish Zhongqi(中气).When the spleen and stomach are healthy,Qi and blood will be sufficient,which can relieve the state of liver contracture.This method of using sweet TCM medicine to relieve contraction has been used in clinical practice,and the effect is remarkable.