【作者】 李思运；

【导师】 龚婕宁；

【作者基本信息】 南京中医药大学 ， 温病学， 2013， 博士

【摘要】 目的：通过研究中医补益法在肺癌化疗不良反应治疗中的运用,探讨肺癌化疗中如何正确使用补益法扶助机体正气,在明确应用原则和基本要点的基础上,初步揭示其运用的一般规律,以期达到减少不良反应、提高治疗效果、改善患者生活质量的目的,并为临床中西医结合治疗肺癌提供有益的理论指导。方法：本课题采用文献研究和临床回顾性病例分析的方法,从中西医对肺癌及化疗不良反应的认识、临床补益法如何辨证使用、常用治法及用药等三方面进行研究。论文内容分为三部分：第一部分,通过检索大量最新的国内外文献,探讨肺癌的中西医概念、病因病机、临床表现、诊断治疗及化疗不良反应的中医辨治概况；第二部分,对202例江苏省中医院肿瘤科收取的肺癌化疗中患者病历资料进行研究,以统计学处理为手段,探讨中医辨证分型的基本规律,并通过药物使用频次分析,总结其用药特点。第三部分,在文献和临床研究的基础上,阐明肺癌化疗中中医补益法运用的原则及要点。结果：中医学认为肺癌大都存在正气亏损、阴阳两虚的基础,加之化疗药物进一步损伤脾胃,脾胃虚衰以致气血生化乏源,更使正气亏虚、气血瘀滞,病症经久不愈。化疗药物损伤机体的机理可归纳为以下几点：①直接损伤机体正气,耗伤气血,损及阴阳,败坏精血,致使正气亏虚；②中伤脾胃,影响脾胃运化功能,导致气血生化乏源；同时,也可因脾失运化,而使痰湿内生；③损及肾脏,影响骨髓,致使肾精不足,骨髓空虚,影响气血精髓之生化；也可导致水液代谢紊乱,产生痰湿之证；④损伤肝脏致使肝阴不足,疏泄失调,导致肝郁气滞,血瘀内阻。本文研究结果表明,从统计数据显示肺癌化疗时中医治疗以补虚为方向,酌情辅以清热化痰、止咳平喘、活血化瘀、软坚散结等干预手段。因而提示：对肺癌化疗中的患者,中医总体的治疗原则为“扶正祛邪”。依据202例收纳病例的统计资料,大致辨证分为12个证型,其治疗方法以“益气养阴、补肺健脾”为基础,再根据患者证型的不同,予以清热、化痰、祛湿、活血化瘀、软坚散结等治法,合理配伍,多法联用,以达到增强化疗疗效、减轻化疗不良反应、提高生存质量、延长生存期等作用。临床运用补益法的原则是辨证施补、灵活变化、补而不滞,并应注意健脾助运、养阴生津、补肺益肾、养中寓调、缓补消积等要点。结论：中医补益法是肺癌化疗中的重要治法,在辨证基础上灵活选用恰当的补法,对肺癌化疗患者具有重要意义。临床以益气养阴、补肺健脾法最为常用,可酌情配合清热、化痰、祛湿、软坚等治法共同使用。更多还原

【Abstract】 Objective:To study the application of Chinese Herbal Medicine for the side effects of lung cancer chemotherapy and discuss the effects of Chinese Herbal Medicine in reducing the side effects in order to achieve detoxing, maximizing the benefits of the chemotherapy and improving patients’quality of life.Method:The discussion consists of three parts. First:Researched and discussed the latest literatures that touched on the concept of Chinese and western medicine, causes of lung cancer, symptoms of lung cancer, diagnosis and treatment. Second:Studied202medical records of the patient with lung cancer at Jiangsu Province Hospital of TCM. Analyzed the data and found patterns on herbal treatment. Third:Based on the literature and clinical research, clarify the principles and main points of Chinese Herbal Medicine on lung cancer chemotherapy.Results:Chinese Medicine states that lung cancer is based on the decline of Qi and the weakness of both Ying and Yang. When treating with chemotherapy, it hurts spleen and stomach in addition to the Qi. Thus causing a vicious circle that will prolong the illness. The mechanism of chemotherapy will distress the body in the following ways:1. direct harm on Qi2. injure spleen and stomach which affects the digestive systems3. damage kidney which affects marrows and metabolism4. damage liver. The result of analysis points out the direction for treating lung cancer patients with chemotherapy:provide supplement on the weakness of Qi. In addition, the treatments should include clearing heat, the reduction on phlegm and coughing and invigorate the circulation of blood. This concludes the general guideline for treating lung cancer patients with chemotherapy. The study further categorized12types of patients from the research of medical records. With the different types of patient, the Chinese Herbal Medicine should be applied according to the symptoms. This way, it ensures that the benefit of chemotherapy is maximized, side effects of chemotherapy are reduced, and quality of life is improved. Through this study, a general guideline for treating lung cancer patients with chemotherapy can be found and be referenced in the future for other lung cancer studies.Conclusion:The application of Chinese medicine supplements is an important method in lung cancer chemotherapy. Selection of appropriate tonifying method based on syndrome differentiation, plays an important role in lung cancer patients undergoing chemotherapy. The method of supplementing qi, nourishing yin and strengthening spleen and supplementing lung can be combined with nourishing yin and clearing heat, phlegm, dampness, soft hard treatment.更多还原