宋宗良教授基于气机升降理论治疗甲状腺癌术后疲劳综合征经验探析

Professor SONG Zongliang’s experience in treating postoperative fatigue syndrome of thyroid carcinoma based on the theory of Qi movement ascending and descending

甲状腺癌术后疲劳综合征是甲状腺癌术后常见的临床综合征,现代医学对于本病的认识仍处于探索阶段,尚未明确其发病机制,治疗具有一定的局限性,疗效不甚显著。中医学对于本病的治疗有着独特的见解,较现代医学而言更为安全有效,具有一定的优势。中医学认为脏腑以气化为用,气化主要的运动形式为升降出入。气机调畅,气升降出入如常,机体的物质与能量得以转化,气化方能正常运行。反之,气机失畅,气化亦会失司。宋宗良教授基于气机升降理论治疗本病,认为本病的发生与肝脾气机升降失调密切相关,手术创伤,失血失液,阴血亏耗,破血夺气,中焦气机紊乱,加之术后情志郁结,肝之气机不畅,进一步影响中焦气机升降,气血运化乏源,津液输布失畅,易于疲劳。治疗法则以调畅气机为主,以加味逍遥散、柴胡疏肝散、四逆散为基础方,使肝脾气机升降转输如常,协调平衡,脏腑各司其职,诸证自除。现代药理研究亦证实加味逍遥散中的诸多中药成分具有抗肿瘤、免疫调节等诸多药理作用。此方用于临床,疗效显著,值得学习借鉴,希翼能够为甲状腺术后疲劳综合征的治疗提供一种新的治疗方案,为今后的临床研究带来一些新的灵感。笔者有幸侍诊左右,现通过总结宋教授经验对本病进行探析。

Fatigue syndrome after thyroid cancer surgery is a common clinical syndrome after thyroid cancer surgery.The understanding of this disease in modern medicine is still in the exploratory stage.The pathogenesis of the disease is not yet clear,and the treatment has certain limitations,with not very significant effects.TCM has unique insights into the treatment of this disease,which is safer and more effective than modern medicine,and has certain advantages.TCM believes that Zang-fu organs(脏腑)are used by gasification,and the main movement form of gasification is ascending,descending,entering and outing.When Qi(气)movement is adjusted smoothly,that is,when the rise and fall of Qi are normal,the material and energy of the body can be transformed,and the gasification can operate normally.Conversely,if Qi movement is not smooth,the gasification will also be unbalanced.Professor SONG Zongliang treats the disease based on the theory of Qi movement ascending and descending,and believes that the occurrence of the disease is closely related to the dysregulation of Qi movement ascending and descending of liver and spleen.Surgical trauma lead to blood loss and fluid loss,which causes the loss of Yin(阴)and blood,and then leads to the disorder of Qi movement in middle energizer.In addition,because of postoperative emotional depression,Qi movement of liver is not smooth,further affecting the ascending and descending of Qi movement in middle energizer.When the source of Qi and blood is depleted and the distribution of body fluid is not smooth,fatigue is easy to appear.The treatment principle is mainly to regulate Qi movement,with Jiawei Xiaoyao San(加味逍遥散),Chaihu Shugan San(柴胡疏肝散)and Sini San(四逆散)as the basic prescriptions,so as to make the ascending and descending of Qi movement in the liver and spleen as usual.When Zang-fu organs perform their duties,the symptoms are all eliminated.Modern pharmacological studies have also confirmed that many components of TCM materials in Jiawei Xiaoyao San have many pharmacological effects such as anti-tumor and immune regulation.This prescription has a significant clinical effect and is worth learning.It is hoped that it can provide a new treatment plan for the treatment of fatigue syndrome after thyroid surgery and bring some new inspiration for future clinical research.The author has the privilege to learn from Professor SONG Zongliang clinically,and now analyzes the disease by summarizing the experience of Professor SONG Zongliang in treating the disease.