【作者】 冯政果；

【导师】 李柳宁；

【作者基本信息】 广州中医药大学 ， 中西医结合临床， 2010， 硕士

【摘要】 目的研究在“培土生金”法指导下组成的科室肺癌协定1号方治疗ⅢB／Ⅳ期非小细胞肺癌患者证型的变化,并揭示证型变化的实质,为临床辨证论治及优化治疗方案提供一定依据。方法本研究采用前瞻性的研究方法。研究对象为2009年3月至2010年3月期间广东省中医院门诊及住院部病人,将符合入选条件的60例患者辨证给予我科肺癌协定1号方,采用病例观察表,观察治疗前及治疗后病人的证型变化,观察期为2月。全部数据结果采用SPSS 13.0统计软件进行分析,计量资料采用t检验,计数资料采用卡方检验,等级资料采用秩和检验等方法进行分析,以P＜0.05为有显著性差异。结果1.通过对主要症候因子的分析,经过卡方检验,治疗前后P＜0.05,有显著性差异的证候主要有倦怠乏力,呼吸气短,口干、干咳少痰、自汗盗汗、咳嗽咯白痰。2.分析单一证型(气虚证、阴虚证、血瘀证、痰湿证、热毒证)共138例次(因观察病例采取单证,故中医证型相加之和超过60例),治疗前按证候发生率排列由多至少为气虚证48例(80%)>阴虚证30例(50%)>痰湿证28例(46.7%)>血瘀证24例(40%)>热毒证8例(13.3%)；治疗后按证候发生率排列由多至少为气虚证35例(58.3%)>血瘀证30例(50%)>痰湿证23例(38.3%)>阴虚证19例(31.7%)>热毒证6例(10%)。3.ⅢB／Ⅳ期非小细胞肺癌患者在舌象方面的研究：舌色分淡红、红、淡暗、暗红、淡白5种,治疗前按比例多少排列：暗红舌(38.3%)>淡暗舌(30%)>红舌(13.3%)>淡白舌(11.7%)>淡红舌(6.7%)；治疗后按比例多少排列淡暗舌(41.7%)>暗红舌(21.7%)>淡白舌(13.3%)>淡红舌(11.7%)=红舌(11.7%),比较治疗前后舌色的变化,P＜0.05,前后舌色具有显著性差异。舌苔治疗前按比例多少排列：白腻苔(55%)>薄黄苔(25%)>薄白苔(11.7%)>剥少(6.7%)>黄腻苔(1.7%)；治疗后按比例多少排列：白腻苔(45%)>薄白苔(31.7%)>薄黄苔(11.7%)>剥少(10%)>黄腻苔(1.7%),比较舌苔治疗前后变化,P＜0.05,前后舌苔有居显著性差异。4.在面色方面,治疗前面色比例由多至少排列为白(68.3%)>黑(20%)>红(8.3%)>黄(3.3%)；治疗后面色比例由多至少排列为白(53.3%)>黑(25%)>红(11.7%)>黄(10%),治疗前后面色比较,P<0.05,治疗前后面色有显著性差异。5.在脉象方面,治疗前按比例多少排列：细脉(45%)>沉脉(13%)>滑脉(16.7%)>数脉(10%)>弦脉(6.7%)；治疗后按比例多少排列细脉(31.7%)>滑脉(26.7%)>沉脉(20%)>数脉(11.7%)>弦脉(10%)。P>0.05,治疗前后对比无明显差异。结论1.肺癌1号方治疗晚期非小细胞肺癌患者,治疗前后舌质、舌苔、面色均有明显变化,症状明显改善的有倦怠乏力、呼吸气短、口干舌燥、干咳少痰、潮热盗汗、咳嗽咯白痰；证型方面,总的来说虚证(气虚证、阴虚证)较实证(痰湿证、血瘀证、热毒证)为多；治疗前后变化明显的为气虚证、阴虚证,治疗前后无明显变化的为痰湿证、血瘀证、热毒证。2.“培土生金”法指导下组成的肺癌1号方治疗晚期非小细胞肺癌患者能明显改善气虚证及阴虚证,揭示了晚期非小细胞肺癌患者气虚证及阴虚证的本质正是由于脾胃功能虚弱,而变生诸症,提示在临床上顾护脾胃的重要性。该法对于实证(痰湿证、血瘀证、热毒证)的改善未能显示出明显的效果,有待进一步的研究,建议可在此方的基础上,适当增加驱邪药物。更多还原

【Abstract】 ObjectivesTo analyze the syndrome changes for the patients of the stage IIIB/IV non-small lung cancer who received the therapy of NO.1 Prescription of lung cancer which was composed by the rule "Strengthen earth to generate metal" Provided evidence for the different clinical treatment and optimization treatment.MethodsThe forward-looking methods was used in the study, from March 2009 to March 2010 period,60 patients who was confirmed diagnosis of stage III/IV NSCLC were enrolled. The patients received NO.1 Prescription of lung cancer by different treatment. The changes of syndrome were observated in two months with Case observation table. All data results were analyzed by SPSS 13.0 statistical software. Measurement data using t test, chi-square test with count data, grade data methods such as Wilcoxon test was used to analyze, by P< 0.05 with Significance mean.Result1.The symptom was analyzed by Chi-square test, significant differences of syndrome before and after the treatment were Lassitude, shortness of breath, dry mouth, dry cough with scanty sputum, spontaneous sweating, coughing slightly white sputum.2.138 single syndromes (Qi deficiency, Yin deficiency, blood stasis, phlegm, fever and toxic syndrome) were analyzed, The single syndrome was used for the observation, so the sum of syndromes was more than 60 cases. Before the treatment, before the treatment, the incidence of the syndrome was arranged with at least by the more:Qi Deficiency 48 cases (80%)> Yin deficiency 30 cases (50%)> phlegm in 28 cases (46.7%)> blood stasis in 24 patients (40%)> heat-toxin syndrome in 8 cases (13.3%); after the treatment, the incidence of the syndrome was arranged with at least by the more:qi deficiency (58.3%)> blood stasis of 30 patients (50%)> 23 cases of phlegm (38.3%)> Yin deficiency in 19 cases (31.7%)> Heat toxic syndrome in 6 cases (10%).3. The tongue color of 60 patients of stageⅢB/Ⅳnon-small cell lung cancer were classified into 5 Category:Pink, red, light dark, dark red, pale. before the treatment, the incidence of the syndrome was arranged with at least by the more:dark red tongue (38.3%)> short dark tongue (30%)> red tongue (13.3%)> pale tongue (11.7%)> pink tongue (6.7%); after the treatment, the incidence of the syndrome was arranged with at least by the more:light dark tongue (41.7%)> dark red tongue (21.7%)> pale tongue (13.3%)> pink tongue (11.7%) = Red tongue (11.7%) compared the change of tongue color before and after treatment, P<0.05, The changes was a significant with different color. Coating on the tongue was observed, before the treatment, the incidence of the syndrome was arranged with at least by the more:greasy moss (55%)> thin yellow fur (25%)> thin white coating (11.7%)> stripping less (6.7%)> yellow sticky coating (1.7%); after the treatment, the incidence of the syndrome was arranged with at least by the more:greasy coating (45%)> thin white coating (31.7%)> thin yellow fur (11.7%)> stripping less (10%)> yellow sticky coating (1.7%) compared changes in tongue before and after treatment, P< 0.05, before and after the tongue has a significant difference.4.In the complexion, before the treatment, the incidence of the syndrome was arranged with at least by the more:white (68.3%)> Black (20%)> red (8.3%)> yellow (3.3%); after the treatment, the incidence of the syndrome was arranged with at least by the more:white (53.3%)> Black (25%)> Red (11.7%)> yellow (10%), looking before and after treatment compared, P<0.05, before and after treatment were significantly different complexion.5. In the pulse, before the treatment, the incidence of the syndrome was arranged with at least by the more:small veins (45%)> Journal of veins (13%)> slippery pulse (16.7%)> the number of veins (10%)> String pulse (6.7%); after the treatment, the incidence of the syndrome was arranged with at least by the more:small veins (31.7%)> slippery pulse (26.7%)> Journal of veins (20%)> the number of contacts (11.7%)> String pulse (10%). P>0.05, no significant difference was showed before and after treatment.Conclusion1.The tongue color, Coating on the tongue, complexion of the patients were changed significantly with statistical significance before and after the treatment, The symptoms improved significantly were fatigue, shortness of breath, dry mouth, dry cough with less sputum, fever and night sweating, cough, phlegm white slightly;On the respect of syndrome, In general, the deficiency syndrome(qi deficiency, yin deficiency) was more than the positive syndrome(phlegm, blood stasis and heat toxin card), the changes before and after treatment are qi deficiency, yin deficiency, qi deficiency which improved significantly; the changes before and after treatment are phlegm, blood stasis and heat toxin syndrome which was Pointless.2. The NO.1 Prescription of lung cancer was composed by the rule "Strengthen earth to generate metal", the result showed that Qi deficiency and Yin deficiency was improved significantly by the The NO.1 Prescription of lung cancer, No enough effect was showed in the the evidence (blood stasis, phlegm, fever and toxic syndrome). Exorcism drugs was suggested on the further study.更多还原