【作者】 李柳；

【导师】 吴勉华；

【作者基本信息】 南京中医药大学 ， 中医内科学， 2010， 硕士

【摘要】 目的：以国医大师周仲瑛教授多年治疗胃癌的临床实践为基础,以最新的数据挖掘技术为手段,对周仲瑛教授辨治胃癌的临证经验及学术思想进行研究和总结,使之能够进一步指导中医药在胃癌治疗中的运用。方法：通过长期跟随周仲瑛教授临证抄方学习,对周仲瑛教授近三年来诊治的所有胃癌病案进行全面收集、整理,严格按照纳入标准、排除标准进行筛选,将符合标准的180例病案的临床资料建立病案数据库,运用频数法、因子分析和关联规则等方法着重挖掘、分析病案中症状、病机证素、证候、治法、方药之间的规律,并结合周仲瑛教授的临证经验对挖掘结果进行分析、归纳、总结。结果：180例患者中男性130例,女性50例,平均年龄61.03±12.25岁。所有诊次中出现频数大于30%的实性病机证素为瘀、湿、热、痰、郁和毒。证候方面,虚证以脾胃虚弱,气阴两伤最多,分别占48.33%和52.78%；实证方面以湿热中阻,癌毒内蕴最多,分别占41.11%和27.78%。周老治疗胃癌用药范围广泛,180例病案中所用药物共计198种,主要集中在抗癌解毒、理气解郁、清热化湿、祛瘀化痰和益气养阴药方面。结论：通过研究发现,癌毒蕴胃是胃癌的病机关键,而正气亏虚、癌毒内蕴是胃癌的发病基础。癌毒作为基本的病理因素,常依附于湿热痰瘀诸邪,形成瘀毒、热毒、痰毒、湿毒等复合病机致病。其临床证型包括肝胃不和证、湿热中阻证、痰气瘀阻证、瘀毒内蕴证、脾胃虚弱证、气阴两伤证和特殊的气虚阳微证。抗癌解毒、扶正祛邪是胃癌的基本治法,治疗上以通降为本,提倡复法大方,多法并用。用药方面强调抗癌解毒药要贯彻治疗始终,常用的抗癌解毒药有仙鹤草、蛇舌草、石打穿、泽漆、山慈菇、肿节风、半枝莲、制南星、威灵仙、红豆杉、独角蜣螂等。同时理气解郁亦在治疗中占有重要地位。更多还原

【Abstract】 Objective:To summarize Professor Zhou Zhongying’s academic idea and clinical experience in diagnosing and treating gastric cancer which can give a helpful guidance to modern TCM treatment in gastric cancer on the basis of his clinic practice for dozens of years and modern data mining technology.Methods:Through long time study following in Professor Zhou Zhongying, all gastric cancer cases from his clinic in later three years were collected. According to include and exclude criteria,180 cases were picked up and established a gastric cancer database. In order to find out the rules of syndrome, pathogenesis, symptom and medication, data mining technology like frequencies, factor analysis and association analysis were used. The analysis results were discussed and summarized combined with Professor Zhou’s clinical experience.Results:All 180 cases of gastric cancer,130 are male and 50 are female, the average age is 61.03±12.25 years old. According to frequency analysis results, the pathogenesis over 30% includes blood stasis, heat, dampness, phlegm and cancerous toxin.In the aspect of syndromes, the frequent deficiency syndromes are deficiency of spleen and stomach, insufficiency of qi and yin, which take 48.33% and 52.78% respectively; the frequent excessive syndromes are obstruction of dampness and heat, accumulation of cancerous toxin and blood stasis, which takes 41.11% and 27.78% respectively.198 drugs were used in all 180 cases which focus on anti-cancer, relieving toxin, soothing liver-qi, clearing heat and dampness, removing phlegm and blood stasis, replenishing qi and nourishing yin.Conclusions:According to this study, obstruction in stomach by cancerous toxin is the key of pathogenesis. Qi deficiency and retention of cancerous toxin is the basis of morbidity. As basic pathologic factor, cancerous toxin is always combined with other pathologic factors and form combined pathogenesis like cancerous toxin with blood stasis, cancerous toxin with heat, cancerous toxin with dampness, cancerous toxin with phlegm and cause the disease. The essential syndromes include disharmony of liver and stomach, obstruction of dampness and heat, retention of phlegm and blood stasis, accumulation of cancerous toxin and blood stasis, deficiency of spleen and stomach, insufficiency of qi and yin. The syndrome of qi deficiency and yang exhaustion is seldom but special.In the aspect of treatment principle, the basic principle is to anti-cancer and relieving toxin, strengthening vital qi. Based on dredging and descending stomach qi, decoction according to combined treating principles should be formulated. In the aspect of medication, drugs for anti-cancer and relieving toxin should be used in the whole stage. The common-used drugs include Xianhecao, Sheshecao, Shidachuan, Zeqi, Shancigu, Zhongjiefeng, Banzhilian, Zhinanxing, Weilingxian, Hongdoushan, Dujiaoqianglang and so on.The principle of regulating qi and relieveing the depression also play an inportment part in the whole treatment.更多还原