【作者】 施俊；

【导师】 魏品康；

【作者基本信息】 中国人民解放军军医进修学院 ， 中医师承制， 2012， 博士

【摘要】 目的：对魏品康教授消痰和胃法防治化疗呕吐学术思想进行系统的整理与研究。方法：分为理论渊源、用药规律、临床观察和实验验四部分。理论渊源：逐层阐述魏品康教授消痰扣胃法的理论基础。用药规律：检索1989-2010年中国期刊全文数据库中医防治化疗呕吐临床文献并描进分析,总结化疗呕吐一般用药规律,再以“化疗”、“呕吐”为关健词,从魏品康病例数据库中筛取2006年1月-2010年10月防治化疗呕吐病例与处方,按中药功能、药性、药味、归经及药对进行频数和聚类分析。临床观察：采用自身交叉对照设计,纳入恶性肿瘤首次化疗患者48例,随机分为两组,按照不同顺序先后采用单纯格拉司琼、地塞米松静滴与联合消痰和胃方口服,观察每天呕吐次数,采用MDASI(M.D.Anderson Symptom Inventory.M.D安德森症状调查量表)与KPS评分(Karnofsky Performance Status Scale,卡氏评分)评价症状变化与生存质量。实验验证：观察大鼠腹腔注射顺铂后24h和72h大鼠高岭土异食癖摄食量、糖精水消耗量和正常饮食摄食量,并采用ELISA法检两个时间点大鼠小肠、血清、脑千5-HT(5-hydroxytryptamine,5-羟色胺)、5-HIAA (5-hydroxyindoleacetie acid,5-羟吲哚乙酸)和DA(Dopamine,多巴胺)含量,探讨消痰和胃方防治化疗呕吐的相关机制。结果：文献尤重补益,以理气剂、补益剂、祛痰剂为主,药物以补虚药、化痰止咳平喘药、理气药为高,药性多温、平,药味多甘、辛、苦,多入脾、胃、肺经。魏品康教授处方用药则常见理气药、化痰药、补气药、消食药等,常见药物有甘草、半夏、鸡内金、天南星、白芍、大黄等31味。药味多温,药性多辛,其次为苦、甘,以入脾、胃、肝、肺经为主,常见药对有枳壳与枳实、丁香与柿蒂、半夏与天南星等。临床观察表明联合运用消痰和胃方化疗呕吐次数明显减少,化疗第3天(d3)存在统计学差异,P=0.0172。MDASI症状调查量表疲乏、恶心、睡眠不安、苦恼、气短、胃口差、昏昏欲睡、口干、悲伤、呕吐、麻木、一般生活、情绪等多项多日存在统计学差异,P<0.05,各项评分明显降低。实验研究证实消痰和胃方可明显抑制顺铂诱导的大鼠高岭土摄食量,提高糖精水的消耗量和正常饲料的摄食量,降低顺铂诱导后24h和72h脑千5-HT、5-HIAA和DA含量,降低24h血清DA含量,降低72h血清5-HT和DA含量,增高24h小肠DA含量。结论：魏品康教授认为痰阻与滞留为化疗呕吐两大病理因素,防治重在消痰与通降并举,以消痰和胃为基本治则。消痰和胃方有效抑制化疗呕吐,减轻化疗毒副反应提高生存质量。消痰和胃方对化疗诱导急性与延迟性呕吐的防治作用可能与调节脑千、小肠与血清5-HT、5-HIAA、DA水平有关。更多还原

【Abstract】 Objective:To explore experience and academic thought from Professor Wei Pin-kang about therapy of resolving phlegm and regulating stomach (RPRS) in treatment of chemotherapy-induced vomiting (CIV).Methods:4parts were included:theoretical source, analysis of herbal medication, clinical trial and experimental testing. Theoretical source:Theoretical foundation about therapy of RPRS was expounded gradually Analysis of herbal medication:TCM clinical literature in CNKI (1989-2010) involving CIV was retrieved and analyzed to explore the rule of Cliinese medicine in treating CIV Subsequently herbs and prescriptions of cases concerning CIV were collected from Wei Pin-kang case-database (keywords: chemotherapy and vomiting,2006.1-2010.10). The herbs, category nature, flavor, meridian distribution and couple herbs were summarized by frequency method or hierarchical cluster analysis. Clinical trial:A randomized, crossover trial of two periods was performed on48patients received chemotherapy first time. They were randomly divided into two groups who received administration of granisetron hydrochloride and dexamethasone injection combined or not combined with RPRS decoction according to adverse order. The frequencies of vomiting daily in each group were recorded. MDASI and KPS were used to evaluate status of patients. Experimental testing:Wistar rats were injected intraperitoneally with cisplatin to induce pica and conditioned taste avoidance. The RPRS decoction was administered with granisetron hydrochloride administered as control drug. Kaolin, saccharin solution intake and common feed consumption were recorded in the following24h and72h. The content of5-HT,5-HIAA and DA in brain stem, small intestine and senun were detemiiiied in ELISA.Results: Qi regulating, restorative, phlegm resolving decoctions and restorative, phlegm resolving, qi regulating herbs were used frequently in literature. Warm and flat were main medicinal properties. Sweet, pungent, bitter herbs and meridian tropisms to spleen, stomach and lung were given priority to others. However, qi regulating, resolving phlegm, invigorating qi, relieving food retention herbs and etc were used frequently in prescriptions from Professor Wei Pin-kang. The most frequently used herbs had31species including Radix Ghxyrrhizae, Rhizonui PiiieJh’ae*EndotheUum Corneum Gigeriae Galh\RhizomaArisaewatis, Radix Paeoniae Alba, Radix et Rhizoma Rhei and etc. Warm nature and pungent, bitter, sw:eet herbs were most frequently used. These herbs mostly attributed to spleen, stomach, liver and lung meridians. The couple-herbs used most frequently includedRhizor}m PineJIiae and R]}izoma Arisaematis, Fnictus Aurantii Inmiantnts and Stdmmtttre Bitter Orange, Flos Caiyophyfli and Calyx Kaki and etc. Clinical trial proved that vomiting frequency ond3CP=0.0172) and scales of multi-items in several days (P-0.05), including fatigue, nausea, sleep, distress, dyspnea, loss of appetite, drowsiness, dry mouth, sadness, vomiting, numbness, general activity and mood in MDASI, of patients combined with RPRS decoction had statistical differences. Experimental testing showed that RPRS decoction inhibited pica significantly, improved saccharin solution intake and anorexia induced by cisplatin in rats. RPRS decoction reduced higher content of5-HT,5-HIAA and DA in brain stem at24h and72h, DA in serum at24h,5-HT and DA in senun at72h and increased content of DA in small intestine at24h after cisplatin administration.Conclusion: Professor Wei emphasizes dissolving phlegm and descending stagnation because phlegm and stagnation are two important etiological factors of CIV. He suggests therapy of RPRS to treat CIV RPRS decoction can inlribit effectually CIV (acute and delay), relieve adverse reaction of chemotherapy and improve quality of life on the base of regulating content of5-HT,5-HIAA and DA in brain stem, small intestine and senun.更多还原