【作者】 杨玉兴；

【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， 2009， 博士

【摘要】 我的师承博士导师魏品康教授提出从痰辨识癌症并发抑郁症(CCD)。本课题研究了魏教授对CCD中医病名、病因、病机等理论认识,总结了消痰解郁法治疗CCD的临床经验,观察了魏教授研制的固定制剂一消痰解郁方治疗消化系癌症(DC)并发抑郁症的临床疗效并进行疗效机制探讨,归纳了魏品康教授治疗CCD的学术思想体系,使之得以传承和发扬。课题分为理论研究和临床研究两部分。理论研究部分:在系统整理癌症、抑郁症与中医痰证相关文献的基础上,通过跟师出诊、导师授课、收集医案等,结合回顾导师的从医经历、学术成就,总结导师对CCD的中医病名、病因病机、治法方药和饮食情志调护等认识,归纳魏教授治疗CCD的学术思想和临证经验。结果:(1)CCD属于中医广义郁证范畴;(2)提出CCD为“恶痰内阻,痰气火三邪相杂,脏腑功能失调,痰邪上扰,神志失常”的病因病机理论;(3)创立“消痰解郁法”为治疗CCD的治则,并配合饮食、情志等综合调护措施;(4)研制出治疗CCD的固定制剂一“消痰解郁方”,临床有效,已进行了初步的实验药理学研究。临床研究部分:确诊141例DC合并抑郁症患者,对其临床现象学和中医证候特征进行了初步观察和分析总结;将其中120例患者,按照前瞻、随机、对照等方法,分为治疗组(消痰解郁方,n=60)、中药对照组(逍遥丸,n=30)和西药对照组(盐酸氟西汀,n=30),治疗6周,观察各组患者治疗前后抑郁症状、卡氏评分(KPS)、抑郁量表(包括SDS自评量表和HAMD他评量表)评分、中医症状及血清T细胞亚群及NK细胞水平等变化情况,并进行疗效机制分析。结果:(1)被调查的DC患者普遍存在抑郁情绪,抑郁症发生率为44.76%,以轻、中度抑郁为最常见,肿瘤部位不同发生率不同,是否发病与文化程度、肿瘤TNM分期有关,患者家属中亦普遍存在抑郁情绪;(2)DC并发抑郁患者常见中医症状为:情志抑郁、倦怠乏力、面色无华、精神疲惫、嗜卧少动、静而少动、情绪低沉、运动迟缓、悲观厌世、善叹息、少寐、体重减轻、纳差、腰膝酸软、多愁善感、性欲减退等,常见的舌色为红、淡红和淡白,舌苔为白腻、薄白、黄腻,常见的脉象为弦滑、细滑、弦细、弦等;(3)消痰解郁方可以改善DC并发抑郁症患者的临床症状、降低抑郁量表评分,总有效率为82.46%,好于中、西药对照组(P＜0.05～0.01);(4)消痰解郁方可提高患者的KPS;(5)消痰解郁方可升高患者血清CD3、NK、CD4/CD8值,降低CD8值;(6)临床使用消痰解郁方安全有效、未发现明显毒副作用。通过以上研究,总结出魏品康教授消痰解郁方治疗CCD学术思想体系如下:(1)CCD病名为广义郁证,病因为恶痰内阻,病机为痰气火三邪相杂,病位可累及五脏六腑,致痰邪上扰,神志失常所致;(2)消痰解郁法为治疗CCD的基本法则;(3)消痰解郁方可以改善DC并发抑郁患者的临床症状和免疫功能,提高生存质量,降低抑郁量表评分,临床使用安全有效。更多还原

【Abstract】 1.ObjectiveMy tutor Professor Wei Pinkang put forward the theory of Identifing Cancer Concurrent Depression(CCD) based on Phlegm Syndrom of Traditional Chinese Medicine(TCM).In this study,we researched the name of disease,etiology and pathogenesis of CCD based on phlegm syndrom of TCM,summarized the clinical experience of treating CCD by the way of eliminating phlegm and relieving stagnation,observed the clinical efficacy and mechanism of Xiao-tan-jie-yu Prescription(XTJYP) invented by Professor Wei Pinkang on digestive cancer (DC) concurrent cepression.Above all contents belong to Professor Wei Pinkang’s academic thought on CCD,we should inherit and develop it.2.MethodsThe study is made up of two parts:theoretical study part and clinical research part.In theoretical study part,we reviewed literatures about cancer,depression and phlegm syndrome of TCM,visited and learned with Professor Wei Pinkang, collected his TCM cases,recalled his medical experience and achievements, summarized his views on the name of diseases,etiology,pathogenesis,treatment, dietary and emotional nursing,induced his academic thought and clinical experience on CCD.In clinical research part,we diagnosed 141 patients with DC concurrent depression,observed and analyzed their symptoms and clinical characteristics of TCM.120 of 141 patients were chosen and divided into 3 groups according to prospective,randomized,and controlled ways.The 3 groups were treatment group(treatment with XTJYP,n=60),TCM controlled group (treatment with Xiao-yao-wan Pill,n=30) and Western medicine controlled group (treatment with Fluoxetine Collocystis,n=30).Before and after 6 weeks’ treatment,the depressive symptoms,Karnofsky performance status (KPS),Self-Rating Depression Scale(SDS),Hamilton Rating Scale for Depression(HAMD,24) and TCM symptoms of patients were assessed,the level of serum T cell subsets and NK cells were also detected.3.Results3.1 Theoretical studies’ results:(1)CCD belongs to generalized depression of TCM.(2)The etiological factor and pathogenesis of CCD include following:①internal malignant phlegm pathogen;②phlegm pathogen,qi pathogen and fire pathogen;③zang-fu organs’ dysfunction;④phlegm pathogen destroying brain.(3)The basic therapeutic method treating CCD is eliminating phlegm and relieving stagnation,auxiliary dietary and emotional nursing.(4)As a patent Chinese medicine,XTJYP is effective,some preliminary pharmacological experiments of it had been done.3.2 Clinical researches’ results:(1)Generally,patients with DC all have depressive emotions,the incidence of depression is 44.76%,and low to medium grade depression are the most common.The kind of cancer is different,the incidence of CCD is different. Whether or not to fall ill is related on education level and TNM stage of tumor. The families of patients with DC also commonly have depression emotions.(2)The common symptoms of TCM in patients with DC concurrent depression are:depression,fatigue,pale,neurolysis,like to lie down,static rather than dynamic,low mood,bradykinesia,pessimistic,sigh,insomnia,weight loss, loss of appetite,pain in waist and knee,sentimental,loss of libido,and so on.The common colors of tongue are red,carmoisine and light white.The common tongue coating are white and greasy coating,white and thin coating,yellow and greasy coating.The common pulses are thready and slippery pulse,slender pulse, thready pulse,thready and slender pulse,thready pulse.(3)XTJYP can improve clinical symptoms of patients with DC concurrent depression,reduce SDS and HAMD’ scores,the total effective rate was 82.46%, better than in the controlled groups of TCM and western medicine(P＜0.05～0.01).(4)XTJYP can improve KPS of patients with DC concurrent depression.(5)XTJYP can elevate patients’ CD3,NK and CD4/CD8 values,lower values of CD8. (6)XTJYP is safe and effective,has no obvious side effects and toxicities. 4.ConclusionsProfessor Wei Pinkang’s academic thoughts of treating CCD include following:(1)CCD belongs to generalized depression of TCM,its basic etiological factor is inner malignant phlegm pathogen,which interferes zang-fu organs’ function and destroies brain with qi pathogen and fire pathogen;(2)The basic therapeutic principle of treating CCD is eliminating phlegm and relieving stagnation;(3)XTJYP can improve the clinical symptoms and immune function of the patients with DC concurrent depression,improve the quality of life and reduce depression scales’ score,it’s safe and effective.更多还原