健脾温肾法治疗前列腺癌放射疗法术后尿失禁医案一则

One case of invigorating spleen and warming kidney therapy in the treatment of urinary incontinence after radiotherapy for prostate cancer

前列腺癌是老年男性泌尿系统常见恶性肿瘤之一,其发病率随年龄增长而升高,我国前列腺癌的发病率呈现逐年上升的趋势。尿失禁为前列腺癌治疗后的常见并发症之一,严重影响患者生活质量及心理健康。其发生机制较复杂,可能与局部神经、肌肉损伤相关,现代医学针对尿失禁的治疗方式多种多样,以保守治疗、药物及手术治疗为主。中医将尿失禁归属于“遗尿”“遗溺”“小便不禁”等疾病范畴,主要由脏腑功能失调所致,以脾、肾两脏为主,两脏功能失调、相互影响导致水液代谢异常,发为遗尿。近年中医药治疗尿失禁取得一定的进展,且治疗方法多样,根据个体辨证施治,临床多采用多样治疗方式联合治疗。针刺作为传统中医药疗法的重要组成部分,在临床上广泛应用,其通过针刺相应穴位达到刺激排尿神经及局部肌肉收缩以改善排尿功能的目的。针刺结合中药内服治疗在改善尿失禁患者控制排尿及憋尿时间方面具有较好的临床疗效。中医治疗本病较安全、无不良反应,患者易接受。笔者在门诊跟师过程中,老师以健脾温肾法为治疗原则,以针刺结合中药内服治疗前列腺癌放射疗法术后尿失禁患者,其临床疗效显著,现将该患者诊疗过程整理成临床验案,为临床治疗该病提供诊疗思路。

Prostate cancer is one of the common urinary system malignant tumors of the elderly male,and its incidence rate increases with age.The incidence rate of prostate cancer in China is increasing year by year.Urinary incontinence is one of the common complications after prostate cancer treatment,which seriously affects the quality of life and mental health of patients.The mechanism of its occurrence is complex and may be related to local nerve and muscle damage.Modern medicine has various treatment methods for urinary incontinence,which mainly include conservative treatment,medication,and surgical treatment.Traditional Chinese medicine categorizes urinary incontinence as diseases such as“enuresis”,“drowning”,and“urinary incontinence”.The main cause of the disease is dysfunction of the viscera,which mainly involves the spleen and kidney.The dysfunction and mutual influence of the two organs lead to abnormal water and liquid metabolism,resulting in enuresis.In recent years,there have been some progresses in the treatment of urinary incontinence in traditional Chinese medicine,and there are various treatment methods.According to individual differential treatment,multiple treatment methods are often used in clinical practice.Acupuncture,as an important part of traditional Chinese medicine therapy,is widely used in clinical practice.The goal of stimulating the urinating nerve and local muscle contraction to improve the urinating function is achieved by acupuncture at corresponding points.Acupuncture plus oral administration of traditional Chinese medicial materials has a good clinical effect in improving the control of urination and the duration of holding urine in patients with urinary incontinence.Traditional Chinese medicine has the advantages of more safety and no adverse effects in treating this disease,making it easy for patients to accept.In the process of the author’s following the teacher in the outpatient consultation,the teacher applies the method of invigorating the spleen and warming the kidney as the treatment principle,and uses acupuncture plus Chinese medicial materials oral administration to treat urinary incontinence after radiotherapy for prostate cancer.Its clinical effect is remarkable.Now,the diagnosis and treatment process of this patient is sorted into clinical cases as follows,providing diagnostic and therapeutic ideas for the clinical treatment of this disease.