徐力教授防治高危肺结节“结癌转化”思路探析及验案举隅

Professor XU Li’s thoughts on the prevention and treatment of high-risk lung nodules“nodal cancer transformation”and case examples

随着胸部高分辨率CT的普及,高危肺结节检出率大大提升,其往往提示人体肺结节有恶变趋势,西医除手术外尚无可靠的治疗办法,但部分患者存在外科手术禁忌证,且手术往往费用昂贵且不能治本。中医药治疗肺结节具有独特优势。南京中医药大学徐力教授具有丰富的治疗高危肺结节的临证经验,认为高危肺结节的基本病机为肺气虚馁,以气化失常、阴形聚集为本,痰瘀胶结、顽固难解、癌毒渐生为标,属本虚标实。人体肺气虚弱,津液输布失常,邪气入侵,阴阳失衡,内外相引,精微物质变生痰、瘀等病理产物胶结于肺络,则生结节。结节日久,肺气愈损,痰瘀固结不解,出现豹变之势而内生癌毒,癌毒附着于痰、瘀之邪上,胶结于肺络则生窠囊,发为高危结节。治疗需先证而治,预截潜证,以通补肺气、抑阴扶阳为总纲领,以补肺汤为底方拟“截阻结癌转化”方,并将着眼点立于“肺络”理论,多法复方并举,以“清解热毒,宣肺清络”“消痰祛瘀,行气和络”“攻毒散结,畅通肺络”为要确立分治则。徐教授在临证中成功扭转多例患者的“结癌转化”进程,现兹举两案并作浅析,以飨同道。

High-risk lung nodules often suggest that human lung nodules have a tendency of malignant transformation,for which there is no reliable treatment in western medicine except for surgery.Prof.XU Li believes that the basic pathomechanism of high-risk lung nodules is the deficiency of lung Qi(气),and dysfunction of Qi,gathering of Yin(阴)as the root cause,phlegm and blood stasis are cemented,stubborn and difficult to resolve,and cancer toxicity is gradually generated as the surface symptom,which belongs to the deficient root and excessive symptoms.Treatment should be based on the first evidence,pre-intercepting the latent evidence,taking tonifying the lung Qi,suppressing Yin and supporting Yang(阳)as the general program,focusing on the“lung collaterals”,using multiple methods and compound prescriptions,and taking clearing collaterals,harmonizing collaterals and clearing collaterals as the main points to set up sub-treatment rules.Prof.XU has successfully slowed down the process of“transformation of cancer”in many patients in clinical practice.Two cases are now cited and analyzed for the benefit of colleagues.