王祥麒教授从“阳虚失血”论治肺癌咯血经验

Experience of Professor WANG Xiangqi in the treatment of hemoptysis of lung cancer from the aspect of“Yang deficiency and blood loss”

咯血是肺癌常见并发症之一,不仅严重危害患者的身体健康,也会使患者产生恐惧感和沉重的心理负担,不利于患者积极配合治疗和康复。文章总结导师王祥麒教授从“阳虚失血”治疗肺癌咯血的临证经验。导师博览古代医家著述并结合个人临床观察,认为肺癌咯血的出现并非皆是火邪灼络、气虚不摄、瘀血阻滞所致,阳虚失血亦是常见病机之一。阳虚阴寒体质者脏腑功能衰退、气血运行不畅、痰湿不得温化而易形成癥瘕积聚,甚则发展为癌瘤,而癌毒久羁人体,更加损阳耗气,所以肿瘤患者更易出现阳气虚衰的病机。导师临证时重视整体观念与辨证论治相结合,四诊合参,治病求本,本于阴阳,善于调和阴阳而使机体恢复平衡状态,选方用药灵活变通。在温补阳气的同时,导师辅以补气、理气、活血化瘀、引火归原等法以增强止血作用,分别从“阳虚气易虚,气虚血不摄”“阳虚阴必走,阴走血不留”“阳虚则寒凝,寒凝血易瘀”“火不归原,虚火灼肺伤络”四个方面对阳虚型肺癌咯血的产生机制进行详细阐述。中医药治疗肺癌咯血具有独特优势,不仅可以有效改善咯血症状,也有利于全身功能的恢复,预防肿瘤的复发转移,延缓病情进展,提高患者的生活质量,延长患者的生存时间。

Hemoptysis is one of the common complications of lung cancer,which not only seriously harms the physical health of patients,but also causes patients’sense of fear and heavy psychological burden,which is not conducive to patients’active cooperation in treatment and rehabilitation.This article summarizes the clinical experience of Professor WANG Xiangqi in the treatment of hemoptysis of lung cancer from the aspect of“Yang deficiency and blood loss”.Through reviewing the writings of ancient doctors and combining with the personal clinical observation,Mentor WANG believes that hemoptysis of lung cancer is not fully caused by the fire burning of the collaterals,the deficiency of Qi(气),and the stasis of blood.Yang(阳)deficiency and blood loss is also one of the common pathogenesis.In the case of Yang deficiency and Yin(阴)cold constitution,the function of the viscera declines,the movement of Qi and blood is not smooth,and the phlegm and dampness can not be heated,which is easy to form a lump accumulation,and even develops into cancer.In addition,the long-term detention of cancer toxins in the human body,further damages the Yang and deplets the Qi,therefore,patients with cancer are more prone to the pathogenesis of Yang and Qi deficiency.In clinical practice,we should attach importance to the combination of holistic concept and syndrome differentiation and treatment,the four diagnostic methods are integrated,the treatment is based on Yin and Yang,and we should be good at reconciling Yin and Yang to restore the balance of the body,and be flexible in selecting prescription and medication.At the same time of warming and tonifying Yang,the treatment is supplemented by invigorating Qi,regulating Qi,activating blood stasis,and inducing fire to return to the original source to enhance the hemostatic effect.The mechanism of hemoptysis in lung cancer of Yang deficiency type is elaborated from four aspects respectively:“Yang deficiency is easy to cause deficiency of Qi,and Qi deficiency leads to blood loss”,“Yang deficiency will inevitably lead to Yin deficiency,which finally leads to blood loss”,“Yang deficiency causes cold accumulation,which in turn causes blood stasis”,and“If fire does not return to the original source,deficiency fire will burn the lung and damage collaterals”.Traditional Chinese medicine has unique advantages in the treatment of lung cancer hemoptysis,which can not only effectively relieve the symptoms of hemoptysis,but also contribute to the recovery of systemic function,prevent tumor recurrence and metastasis,delay the progression of the disease,improve the quality of life of patients,and extend the survival time of patients.