1.广州中医药大学第二临床医学院,广东省广州市白云区机场路12号,510405
2.广东省中医院
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收稿:2023-07-24,
修回:2023-10-15,
纸质出版:2024-01-02
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赵新月,王桂彬,司徒红林等.林毅病-证-症结合辨治巩固期乳腺癌经验[J].中医杂志,2024,65(01):26-30.
ZHAO Xinyue,WANG Guibin,SITU HongLin.Experience of LIN Yi in Disease-Syndrome-Syptom Differentiation and Treatment of Breast Cancer in Consolidation Phase[J].Journal of Traditional Chinese Medicine,2024,65(01):26-30.
赵新月,王桂彬,司徒红林等.林毅病-证-症结合辨治巩固期乳腺癌经验[J].中医杂志,2024,65(01):26-30. DOI: 10.13288/j.11-2166/r.2024.01.005.
ZHAO Xinyue,WANG Guibin,SITU HongLin.Experience of LIN Yi in Disease-Syndrome-Syptom Differentiation and Treatment of Breast Cancer in Consolidation Phase[J].Journal of Traditional Chinese Medicine,2024,65(01):26-30. DOI: 10.13288/j.11-2166/r.2024.01.005.
总结林毅教授运用病-证-症结合思想分型辨治巩固期乳腺癌的临床经验。认为乳腺癌巩固期以正气亏虚为根本病机,在治疗中强调识病为本,以扶正为主、祛邪为辅,常以四君子汤、参苓白术散、六味地黄汤等为基础方健脾益肾扶正,辅以白花蛇舌草、薏苡仁、莪术等祛除癌毒。认为不同分子分型乳腺癌生物学特性对中医辨病辨证论治有重要意义,故临床多结合乳腺癌的分子亚型进行辨证选方:针对性激素受体阳性者,以补先天、益肾精为要,方以自拟白花芪杞汤加减;性激素受体阴性者,当以健脾补肾为先,重在健脾,方以白花芪苓汤加减。同时提出需依据患者的临床表现分清主次,病症相兼结合对症用药,并参考现代医学实验室指标进行针对性用药。
This article summarized the clinical experience of Professor LIN Yi in applying the idea of disease-syndrome-syptom combination to the differentiation and treatment of breast cancer in consolidation phase. It is believed that the fundamental pathogenesis of breast cancer in consolidation phase is deficiency of healthy
qi
, so the treatment should emphasize on reinforcing healthy
qi
as the main and eliminating pathogen as the supplement. Commonly,
Sijunzi Decoction
(四君子汤),
Shenling Baizhu Powder
(参苓白术散), and
Liuwei Dihuang Decoction
(六味地黄汤) are used as the basic formula to strengthen the spleen and kidney to reinforce healthy
qi
, and Baihua Sheshe Cao (
Scleromitrion diffusum [Willd.] R.J.Wang
), Yiyiren (
Coix lacryma
-
jobi L.
), and ezhu (
Curcuma aromatica Salisb.
) are used to eliminate cancer toxin. It is also believed that the biological characteristics of different molecular subtypes of breast cancer are of great significance to the syndrome differentiation and treatment in traditional Chinese medicine, therefore, the formulas used in clinical practice are often selected taking into considerations of molecular subtypes of breast cancer. For those with positive sex hormone receptor, the most important thing is to replenish the congenital and benefit kidney essence, with modified
Baihua Qiqi Decoction
(白花芪杞汤); for those with negative sex hormone receptor, the first step is to strengthen spleen and replenish kidneys, and it is especially important to strengthen the spleen with
Baihua Qiling Decoction
(白花芪苓汤). At the same time, it is suggested that the primary and the secondary symptoms of patients should be differentiated, and the diseases and symptoms, as well as the modern medical laboratory indicators should be combined to give suitable medication.
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