基于“建中”理论探讨肿瘤营养不良病机及治法

Exploring the pathogenesis and treatment of cancer related malnutrition based on“Jianzhong”theory

肿瘤营养不良是恶性肿瘤最常见的并发症之一,以食欲减退、消化道营养影响症状、体重减轻为主要临床表现。中医认为其属虚劳类病。追其源头,多因肿瘤瘀毒结聚、抗肿瘤治疗损伤导致中焦虚寒、肠失传化,引起五脏精气不足,渐至于机体气血阴阳虚衰。从“建中”理论出发可以认为该病的基本病机为中焦虚寒、肠失传化。在治疗上,应以温补中焦助运化为主要治法,方剂用大建中汤与参苓白术散温胃散寒、益气健脾。又因肿瘤患者病情复杂,往往还存在痰湿困脾、瘀血阻滞,所以还需开胃醒脾增摄入、化瘀散寒强功效,强调芳香化湿药物与活血化瘀药物的使用,从而达到改善患者胃肠蠕动排空功能与调整肠道紊乱菌群的目的。临床应注重胃肠道消化功能的提高,增加营养物质摄入、消化及吸收,最终实现改善患者营养状态、降低营养风险的目的。

Cancer related malnutrition is a common complication of malignant tumors,characterized by decreased appetite,gastrointestinal symptoms,and weight loss.Traditional Chinese medicine believes that it belongs to the consumptive disease.Tracing its source,it often occurs due to the accumulation of tumor stasis and toxins,as well as damage caused by antitumor treatment,resulting in the deficiency cold of the middle jiao and the loss of intestinal transport and digestion,causing insufficient jing and qi in the five internal organs,gradually leading to the deficiency of qi,blood,yin and yang in the body.Starting from the“Jianzhong”theory,it can be considered that the basic pathogenesis of this disease is the deficiency cold of the middle jiao and the loss of intestinal transport and digestion.In terms of treatment,the main treatment method is to warm and tonify the middle jiao to assist in transportation and digestion,and the prescription uses Dajianzhong Tang and Shenling Baizhu San to warm the stomach,dispel cold,and nourish qi and invigorate the spleen.Due to the complex condition of tumor patients,there is often phlegm dampness trapped in the spleen and blood stasis obstruction.Therefore,it is necessary to appetizing and invigorating the spleen to increase intake,dispelling cold and resolving blood stasis to increase therapeutic effect,and emphasize the use of aromatic dampness removing drugs and blood activating and stasis removing drugs.Thus achieving the goal of improving the patient’s gastrointestinal peristalsis and emptying function,as well as adjusting the dysbiosis of the gut microbiota.Further improve the digestive function of the gastrointestinal tract,increase nutrient intake,digestion,and absorption,ultimately achieving the goal of improving patient nutritional status and reducing nutritional risks.