国医大师熊继柏辨治无功能性垂体微腺瘤经验

Experience of Chinese Medical Master XIONG Ji-Bai in Differentiating and Treating Non-functional Pituitary Microadenomas

垂体腺瘤是常见的颅内肿瘤之一,近年来发病率增高。其中,无功能性垂体微腺瘤也有恶变或体积增大引起占位病变等风险,但针对该病目前尚缺乏规范的诊疗指南。国医大师熊继柏认为,阴虚内燥为无功能性垂体微腺瘤的基本病机。若患者不具备垂体危象或垂体卒中等急症,且无明显垂体占位改变,但以反复多饮多尿、口渴等对患者生活质量有长远影响的症状为主时,属本虚标缓之类,应首先抓主症、固其本,可按“消渴”辨证论治;以益肾固元、养阴生津为法,方选二冬汤合菟丝子丸加味;结合“固本以正元”“祛邪以遏症”“察常以达变”的三层辨证思维,以稳定瘤体大小,降低恶化概率,提高患者生活质量。其诊疗思路可为完善或补充无手术指征的垂体腺瘤的治疗方案提供参考。

Pituitary adenoma is one of the most common intracranial tumors with increasing incidence in recent years.And non-functional pituitary adenoma has the risk of malignant transformation or developing into occupying lesions for the increasing size.However,standardized diagnosis and treatment guideline for non-functional pituitary microadenomas is still absent.Chinese medical master XIONG Ji-Bai believes that internal dryness due to yin deficiency contributes to the basic pathogenesis of non-functional pituitary adenoma.For the patients without pituitary crisis or pituitary stroke and without obvious pituitary occupying lesions,while having the symptoms of recurrent polydipsia and polyuria,thirst and other symptoms that have a long-term impact on the patient’s quality of life,their manifestations can be classified into the syndrome of deficiency in the origin while the symptoms being not urgent,and the treatment should follow the principle of syndrome differentiation and treatment of diabetes through grasping the primary symptoms and consolidating the origin.And the therapy of nourishing kidney to consolidate the essence and nourishing yin to produce body fluid can be chosen,and the formula of Erdong Decoction plus modified Tusizi Pills can be adopted.The three-layered syndrome-differentiation way of“consolidating vital base to support healthy qi”,“eliminating pathogens to relieve the symptoms”,and“making modified treatment according to the symptoms and based on the routine pattern”can be used for stabilizing the size of the tumor,reducing the probability of deterioration,and improving the quality of life of patients.The diagnostic and therapeutic thoughts of Chinese medical master XIONG Ji-Bai will provide reference for improving or supplementing the regimen for pituitary adenomas without surgical indications.