王昌俊教授“分期论治、通利二便”治疗脑胶质母细胞瘤的经验撷萃

Professor WANG Changjun’s experience in treating glioblastoma by stages,diuresis and defecation

脑胶质母细胞瘤(Glioblastoma,GBM)是成人中枢神经系统中最常见的原发性恶性肿瘤,目前以手术治疗为主,其他还有放疗、化疗、电场治疗、靶向治疗和免疫治疗等。由于本病独特的生物学特性、血脑屏障的存在及治疗时需尽量避免脑功能受损等因素的影响,治疗效果不佳、治疗费用高、复发率极高、生存期短,给患者及其家庭、医院、社会造成了很大负担。王昌俊教授认为GBM为本虚邪实之病。本虚以肝脾肾亏虚、髓海不足为主,邪实以痰、瘀、风、癌毒为主。其病位在脑,与肝、脾、肾密切相关。正虚为本,痰、瘀、风、癌毒齐扰清窍而发为本病。治疗上,第一,强调分期论治,根据患者在不同阶段所接受的西医治疗手段对“本虚”“邪实”影响的不同,调整扶正和祛邪的力度。第二,全程注重通利二便,使痰、瘀、毒等邪有出路。第三,重视引药上行。临床多选用对脑肿瘤有效的药物和对药、引经药,以引药上行、引药到达脑窍,从而提高疗效。第四,扶正以健脾和胃为先,兼顾补益肝肾。此疗法在提高患者生活质量、延长生存时间等方面取得了良好疗效。

Glioblastoma is the most common primary malignant tumor in the adult central nervous system.At present,its main treatment method is surgery,and others include radiotherapy,chemotherapy,electric field therapy,targeted therapy,and immunotherapy.However,due to the unique biological characteristics of this disease,the existence of the blood-brain barrier,and the need to avoid brain function damage during treatment,the treatment effect is poor,the treatment cost is high,the recurrence rate is extremely high,and the survival period is short,which has caused a great burden to patients,families,hospitals,and society.Professor WANG Changjun believes that glioblastoma is a disease of original deficiency and pathogen excess.This original deficiency is mainly characterized by deficiency of the liver,spleen,and kidney,as well as deficiency of Sui Hai(髓海).The pathogen excessive factors are phlegm,blood stasis,wind,and cancer toxin.Its location is in the brain and is closely related to the liver,spleen,and kidneys.This disease is caused by the disturbance of phlegm,blood stasis,wind,and cancer toxins that disturb the clearing of the orifices.In terms of the treatment Firstly,Professor WANG emphasizes staging treatment in the treatment.According to the different effects of the comprehensive treatment methods adopted by patients at different stages on the“deficiency”and“excess”of this disease,the strength of supporting healthy energy and eliminating pathogen is adjusted.Secondly,the professor emphasizes that the whole process should pay attention to promoting diuresis and defecation,so that phlegm,blood stasis and toxin can be rapidly discharged from the body.Thirdly,the professor emphasizes that we need to pay attention to guiding drugs to the brain to exert their effects.In clinical practice,drugs that are effective for brain tumors are often selected,such as drug pairs and meridian inducing drugs,so as to lead drugs upward and reach the brain orifices,and improve the curative effect.Fourthly,the professor emphasizes that strengthening the spleen and stomach is the top priority for strengthening the body,while also nourishing the liver and kidneys.This therapy has achieved good therapeutic effects in improving patient quality of life and prolonging survival time.