黄芪建中汤治疗急性白血病化疗后骨髓抑制伴发热的经验分享

Experience of Treating Myelosuppression with Fever after Chemotherapy for Acute Leukemia with Huangqi Jianzhong Decoction

急性白血病化疗后骨髓抑制伴发热是急性白血病最严重的化疗并发症之一,西医治疗存在治疗时间长、费用高、药物副作用多等不足。该病与古文记载的“急劳”“热劳”等病的临床表现相似,该病患者经历化疗后体内的毒邪大多得到控制,但攻伐太过,加上化疗药物本来就有影响人体气血津液的生成等毒副作用,其药毒进入机体,正气奋起抵抗,正邪交争于中焦,扰乱中焦气机,损伤脾胃,脾虚则气血生化乏源,日久及肾,肾主骨生髓,而白血病患者骨髓本受疾病抑制,现肾虚髓伤,气血化生更加不足,阴血亏虚日久,必累及阳气,如此则成气血阴阳皆虚之象,脾虚不能布散津液,则心失所养、肺失濡润、肝失所藏,进而发展为以中焦脾胃虚弱为基础的五脏气血阴阳虚损之候。黄芪建中汤可健运中焦、滋阴和阳,恢复中焦脾胃功能,化生气血,改善该类患者虚损状态,而且可以快速补充人体正气,加上其解肌退热、调和营卫之功效,外证亦除,治疗急性白血病在化疗后骨髓抑制伴发热临床疗效颇佳。文章通过文献复习、理论分析,并结合临床案例及个人处方用药经验,以期为临床治疗本病提供参考。

Myelosuppression with fever after chemotherapy is one of the most serious complications of acute leukemia,and Western medical therapies have shortcomings such as long treatment time,high costs,and side effects.The clinical manifestations of this condition are similar to those of acute consumptive diseases and heat consumptive diseases recorded in ancient work of traditional Chinese medicine.Most of the toxic pathogens in the body of patients with this disease after undergoing chemotherapy are controlled.However,too excessive attack,combined with the toxic side effects of chemotherapy drugs on the production of qi,blood,and body fluid in the human body,leads to the invasion of drug toxins into the body and the response of healthy qi.The combating between healthy and pathogenic qi disturbs the qi movement in the middle energizer and causes damage to the spleen and stomach.Spleen deficiency leads to lack of source for the transformation and generation of qi and blood,which will involve the kidney as time goes by.The kidney governs the bone and marrow generation.The bone marrow is inhibited in leukemia patients,which,together with kidney deficiency and marrow consumption,will aggravate the lack of source for the transformation and generation of qi and blood.The long-term deficiency of yin and blood will involve yang qi,thus resulting in the deficiency of qi,blood,yin,and yang.Spleen deficiency impairs the transportation and distribution of body fluid,which then involves the heart,lung,and liver.Later,the deficiency of the middle energizer,spleen,and stomach results in the deficiency and consumption of five zangorgans,qi,blood,yin,and yang.Huangqi Jianzhong Decoction can promote the transportation in the middle energizer,nourishing yin and yang,restore the functions of spleen and stomach in the middle energizer,and transform qi for blood generation,thus ameliorating the deficiency state of such patients and quickly reinforcing the healthy qi.In addition,with the effects of releasing flesh,abating fever,and harmonizing nutrient-defense,the decoction can alleviate the external symptoms,demonstrating remarkable effect in the treatment of myelosuppression with fever after chemotherapy for acute leukemia.Through literature review,theoretical analysis,clinical case illustration,and prescribing experience summary,the paper aims to provide reference for clinical practice.