基于“随变而调气”探讨恶性肿瘤的中医辨治

Exploring Traditional Chinese Medicine Pattern Identification and Treatment of Malignant Tumors Based on"Regulating Qi with Changes"

认为气的变化贯穿恶性肿瘤疾病及治疗全程。早期气郁诱发肿瘤形成,肿瘤术后以气陷为核心病机,化疗阶段气逆为恶心、呕吐相关症状的重要病机,复发转移阶段以气虚为主。提出将《灵枢·卫气失常》所论之“随变而调气”作为治则,贯彻在恶性肿瘤的中医辨治中,因变而随治,以调气之法治之:气郁则疏,以理气开郁法消除肿瘤,可予经验方疏肝健脾方;气陷则升,用益气升陷法以升提术后脏器,予《医学衷中参西录》之升陷汤;气逆则降,用行气降逆法以散积聚之药毒,药毒阻滞中焦气机、胃气上逆者予《伤寒论》旋覆代赭汤,中阳不足、浊阴不降者予《伤寒论》之吴茱萸汤;气虚则补,用益气解毒法以防癌毒之鸱张,予经验方扶正解毒方。

It is believed that qi changes throughout the whole process of malignant tumors.Tumour formation is induced by qi constraint in the early stage,qi sinking is the core disease mechanism after tumour surgery,qi counter⁃flow is an important disease mechanism for nausea and vomiting related symptoms in chemotherapy stage,and qi defi⁃ciency is the main pathology in recurrence and metastasis stage.It is proposed that the therapeutic principle of"regu⁃lating qi with changes"discussed in Miraculous Pivot:Wei Qi Disorder(《灵枢·卫气失常》)should be implemented in traditional Chinese medicine(TCM)pattern identification and treatment of malignant tumours,modifying the treat⁃ment with changes,and regulating qi with corresponding methods:for qi constraint,it should soothe to eliminate the tumour by the method of rectifying qi to resolve constraint,with treatment as Shugan Jianpi Formula(疏肝健脾方);for qi sinking,it should raise to lift up postoperative viscera by the method of boosting qi to raise sinking,with treat⁃ment as Shengxian Decoction(升陷汤)from Records of Chinese Medicine with Reference to Western Medicine(《医学衷中参西录》);for qi counterflow,the method of moving qi and direct counterflow downward will be used to dissipate the accumulated medicinal toxicity,and patients with retention of medicinal toxicity in the middle jiao and ascending counterflow of stomach qi treated by Xuanfu Daizhe Decoction(旋覆代赭汤)from Treatise on Febrile Diseases(《伤寒论》),patients with middle yang deficiency and turbid yin failing to descend treated by Wuzhuyu Decoction(吴茱萸汤)from Treatise on Febrile Diseases;for qi deficiency,it should tonify to prevent the tumor toxin from spreading by the method of boosting qi to resolve toxins,treated by Fuzheng Jiedu Formula(扶正解毒方).