【作者】 王泰渊；

【导师】 叶丽红；

【作者基本信息】 南京中医药大学 ， 中医内科学， 2012， 硕士

【摘要】 目的：系统检索2005-2012年中国学术文献网络出版总库(CNKI)公开发表的有关中医药治疗乳腺癌临床研究文献为对象,采用文献计量学方法,探索乳腺癌中医证治用药分布规律,为临床和科研组方用药及专病专证治疗提供了客观依据及理论基础,并探究乳腺癌其防治基本思路,提供临床参考依据。方法：本研究通过大量文献及肿瘤科专家医案临床病例报导,有系统建立数据库,运用频数分析,研究乳腺癌相关中医药治疗的文献。总结乳腺癌常见证型、治则治法及用药规律基本方,拟定中医药治疗乳腺癌标准规范。结果：一、乳腺癌中医辨证分型规律研究,主要包括：(1)术前：中医证型分布频率由高到低为肝郁型(100%)、痰瘀毒热型(100%)频次最高,其次为气血两虚型(56.92%)、冲任失调型(44.62%)、脾虚痰湿型(29.23%)、肝肾阴虚型(21.54%)、气阴两虚型(10.77%)、正虚邪实(16.92%)、肺肾两虚型(1.54%)、脾肾阳虚(1.54%)。(2)术后：中医证型分布频率由高到低为气血两虚型(30.46%)、其次为冲任失调型(27.86%)、气阴两虚型(24.41%)、气血双亏型(15.04%)、肝气郁结型(11.09%)、脾虚痰湿型(10.6%)、瘀毒内阻型(4.93%)。二、乳腺癌治则治法研究,主要包括：益气健脾法总频次367,其次为补血养阴法总频次349、清热解毒法总频次319、理气解郁法总频次247,四种治法共占所有治法出现总频次数的68.96%(1282/1859),其中益气健脾法提及次数最多,占所有治法总频次数的(19.74%),其次为补血法、清热法、理气法等。三、乳腺癌经方研究,主要包括：补中益气汤占总频次25,(占5.06%)、逍遥散占总频次24,(占4.86%)、知柏地黄汤占总频次23,(占4.66%)、黄连解毒汤占总频次22,(占4.45%)。四、乳腺癌中医用药规律研究,主要包括：(1)常用扶正药：健脾补气药黄耆(总频次287)、茯苓(总频次227)、补血养阴药当归(总频次252),三种药物共占用药总频次(3853次)的19.88%。(2)常用祛邪药：疏肝解郁药、活血化瘀药、清热解毒药、化痰软坚药。五、乳腺癌中西医结合治疗研究：主要包括：放/化疗联合中药、介入治疗配合中药、综合疗法、术后配合中药等治疗。结论：一、乳腺癌治疗阶段分为：术前、术后证型。术前肝郁型为主；术后气血两虚型为多。其中两证相兼冲任失调型、气阴两虚型2类证型出现频率占总的证候频次的52%。说明乳腺癌术后患者证情较复杂,常常多证相兼。二、乳腺癌治则治法方面：按较高的频次前四种治法有：益气健脾法、补血养阴法清热解毒法、理气解郁法等。可见各医家对乳腺癌治疗的认识采用益气健脾法、补血养阴法治疗乳腺癌有较多的共识。三、乳腺癌经方研究：按较高的频次前四种治法有：补中益气汤、逍遥散、知柏地黄汤、黄连解毒汤。其中经方、名方336频次,(占总数的68.02%)、自拟方158频次,(占总数的31.98%),可见经方、名方在乳腺癌的治疗中仍占主导地位。四、乳腺癌中医用药规律分为：扶正药、祛邪药。(1)常用扶正药：健脾补气药黄耆总频次287,茯苓总频次227,补血养阴药当归总频次252,三种药物共占用药总频次(3853次)的19.88%。(2)常用祛邪药：疏肝解郁药、活血化瘀药、清热解毒药、化痰软坚药,上述中药说明了乳腺癌治疗中的标本兼治的原则。五、乳腺癌中西医结合治疗研究：频率由高到低：放/化疗联合中药治疗为主、其次以介入治疗配合中药、综合疗法及术后配合中药等治疗,体现了乳腺癌术后配合中药科学地配置治疗特点。虽然各医家用药异同,辨证思路大致相同,均能达到良好治疗效果并为乳腺癌开发新药及临床应用指导原则提供参考依据。更多还原

【Abstract】 Purpose:Does the system search It was the things that relevant traditional Chinese medicine published in academic total storehouse (CNKI) of online publishing of document of China treated the clinical research document of the breast cancer in2005to2012, adopt the metrology method of documents, explore that the Chinese medicine card of the breast cancer manages and uses medicine and is distributed the law, have offered the objective basis and theoretical foundation for the thing that clinic and scientific research group side use medicine and the special special card of disease is treated, and probe into the breast cancer it prevents and cures basic thinking, offer the clinical basis of consulting.Method:This research passes a large number of documents and clinical case reports of department’s expert’s medicine case of tumour, there is the system that sets up the database, use and analyse frequently, study documents that the relevant traditional Chinese medicine of the breast cancer treated. Summarize often witnessing type of breast cancer, manage and manage the law and use medicine in the basic side of law, draft that traditional Chinese medicine treats the standard norm of the breast cancer.Result:First, the dialectical dividing type law of Chinese medicine of breast cancer is studied, include mainly:(1) Before the skill:It is a strongly fragrant type of liver (100%) from high to low that the Chinese medicine card type is distributed frequency, the poisonous hot type of phlegm silt (100%) have the highest frequency, secondly it is two empty types of qi and blood (56.92%), wash lacking proper care type once (44.62%), empty wet type of phlegm of spleen (29.23%), deficiency of Yin type of liver kidney (21.54%), angry and two overcast empty types (10.77%), empty and evil and real (16.92%), two empty types of lung kidney (1.54%), deficiency of yang of spleen kidney (1.54%).(2) After the skill:It is two empty types of qi and blood from high to low that the Chinese medicine card type is distributed frequency (30.46%), lacking proper care type that secondly let in order to wash (27.86%), two overcast empty types that angry (24.41%), qi and blood pair losing type (15.04%), diseases with such symptoms as costal pain.etc. forming type (11.09%), the spleen phlegm type (10.6%), the silt hindering type inside not malicious not wet not timid not strongly fragrant (4.93%).Second, the breast cancer manages and manages France to study, include mainly:Replenish qi to invigorate the spleen law total367frequency, secondly for is it raise overcast law total349frequency, is it detoxify law total319frequency, is it solve strongly fragrant law total247frequency to regulate the flow of vital energy to clear away heat to enrich the blood, four manage law account for all manage law appear total68.96%of number of times frequently altogether (1282/1859), replenish qi to invigorate the spleen law most large to mention number of times among them, account for all manage law total the number of times frequently(19.74%), secondly in order to enrich the blood in France, clearing away heat in France, regulating the flow of vital energy in France,etc..Third, the breast cancer includes mainly through square research:In not mending benefit angry account for soup by frequency25not total,(take by5.06), the carefree to it is account for frequency24not total to break up,(take by4.86), know cypress account for frequency23not total the digitalis soups,(take4.66), the rhizome of Chinese goldthread detoxify soup account for total22frequency,(take4.45).Fourth, breast cancer Chinese medicine uses medicine the law is studied, include mainly:(1) Support the straight medicine dailily:Good for the spleen and mend angry yellow Die (total frequency is287) of medicine, Indian bread (total frequency is227), enriching the blood to raise the overcast medicine Chinese angelica (total frequency is252), three kinds of medicines take up19.88%of the total frequency (3853times) of medicine altogether.(2) Whether daily to eliminate the pathogenic factor the medicine. Is it solve strongly fragrant medicine, silt medicine of invigorating blood circulation etc., clear away heat antidote, reduce phlegm the soft hard medicine to soothe the liver.Fifth, the therapy of combining traditional Chinese and Western medicine of breast cancer is studied:Include mainly:Put/chemotherapy unite traditional Chinese medicine, is it is it cooperate with traditional Chinese medicine, composite treatment, cooperate with traditional Chinese medicine,etc. treat behind the skill to treat to get involved.Conclusion:First, the breast cancer treats stage and is divided into:Before the skill, card type after the skill. The strongly fragrant type of liver is a main fact before the skill; Two empty types of qi and blood are many after the skill. Two card looks is it let person who lack proper care to wash, angry overcast two timid type2card type appear frequency account for total card wait52of frequency among them. The skills it prove breast cancer future trouble the cards the getting more complicated relatively in feeling often card looks not many and concurrently.Second, the breast cancer manages and manages the law:Manage the law according to higher the first four kinds of frequency and have:Replenish qi to invigorate the spleen law. is it raise overcast law clear away heat law of detoxifying. is it solve strongly fragrant law.etc. to regulate the flow of vital energy to enrich the blood. It is obvious and have more common understandings to treat the breast cancer to raise the overcast law to respectively cure understanding that the breast cancer is treated of house law by replenishing qi to invigorate the spleen, enrich the blood.Third, the breast cancer passes square research:Manage the law according to higher the first four kinds of frequency and have:Benefit angry soup, carefree to come loose, know cypress digitalis soup, the rhizome of Chinese goldthread detoxify the soup in mending. Among them through square, square frequency336of name,(take68.02of the total amount), draft square frequency158by oneself,(take31.98of the total amount), it is obvious through being square, the name still occupies an leading position squarly in the treatment of the breast cancer.Fourth, breast cancer Chinese medicine uses medicine the law is divided into:Support straight medicine, eliminate the pathogenic factor the medicine.(1) Support the straight medicine dailily:Good for the spleen and mend287angry yellow Die’s total frequencies of medicine, the total frequency of Indian bread is227, enrich the blood and raise the overcast medicine as sum up252frequencies, three kinds of medicines take up19.88%of the total frequency (3853times) of medicine altogether.(2) Whether daily to eliminate the pathogenic factor the medicine. Is it solve strongly fragrant medicine, silt medicine of invigorating blood circulation etc., clear away heat antidote, reduce phlegm the soft hard medicine to soothe the liver, principle of treating both principal and secondary aspect of disease that above-mentioned traditional Chinese medicine have stated the breast cancer while treating.Fifth, the therapy of combining traditional Chinese and Western medicine of breast cancer is studied:Frequency is from high to low:Put/chemotherapy unite traditional Chinese medicine treat for main fact, secondly with is it is it cooperate with traditional Chinese medicine, composite treatment and cooperate with traditional Chinese medicine,etc. treat behind the skill to treat to get involved, cooperate with the traditional Chinese medicine to dispose the characteristic of treating scientifically after reflecting the breast cancer skill Though each cure the similarities and differences of using medicine of the family, the dialectical thinking is roughly the same, can reach the good result of treatment and offer the reference basis for the thing that develop the new medicine and clinical practice guideline in breast cancer.更多还原