Article(id=1322922752075772860, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322922680609014711, articleNumber=null, orderNo=null, doi=10.13193/j.issn.1673-7717.2025.02.018, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=null, receivedDateStr=null, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793338962811, onlineDateStr=2026-10-30, pubDate=1739116800000, pubDateStr=2025-02-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793338962811, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793338962811, creator=13701087609, updateTime=1793338962811, updator=13701087609, issue=Issue{id=1322922680609014711, tenantId=1146029695717560320, journalId=1255847919539208197, year='2025', volume='43', issue='2', pageStart='1', pageEnd='258', issueExtLink='null', onlineDate='null', pubDate='1739116800000', pubDateStr='2025-02-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793338945772, creator='13701087609', updateTime=1793340618065, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322929694785536732, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322922680609014711, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322929694785536733, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322922680609014711, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=80, endPage=83, ext={EN=ArticleExt(id=1322922752289682365, articleId=1322922752075772860, tenantId=1146029695717560320, journalId=1255847919539208197, language=EN, title=Exploring Diagnosis and Treatment of Primary Liver Cancer by Chinese Medical Master ZHOU Zhongying Based on Compound Pathogenesis Theory, columnId=1256183361521967297, journalTitle=Chinese Archives of Traditional Chinese Medicine, columnName=Target on National Project, runingTitle=null, highlight=null, articleAbstract=

Primary liver cancer(PLC)is referred to as“liver cancer”,the onset of which is insidious,and the patients are often in the advanced stage of the disease when they are diagnosed. Professor ZHOU Zhongying is good at identifying and treating diseases as a whole,and proposes that the common pathogenesis of acute and difficult diseases is a composite pathogenesis. Starting from the theory of compound pathogenesis,this paper explored the clinical diagnosis and treatment ideas of Professor ZHOU Zhongying in the treatment of PLC. It is believed that the combination of multiple pathological factors is the pathogenesis characteristic of PLC,among which damp-heat and blood stasis are the basic pathogenesis of PLC,and cancer metaplasia is the key link of PLC pathogenesis. Based on the theory of composite pathogenesis,the treatment of PLC can adopt the idea of multimethod combination and compound formula,which mainly included the treatment of vital Qi and evil spirits,the reconciliation of the five Zang-organs,the regulation of Qi,blood and fluid,and the treatment of anti-cancer and detoxification.

, authors=Juanjuan BU1, Xiaoyun DOU2, Meng SUN2, Fang YE2, authorsList=Juanjuan BU, Xiaoyun DOU, Meng SUN, Fang YE, authorCompany=null, correspAuthors=Fang YE, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322922752629420990, articleId=1322922752075772860, tenantId=1146029695717560320, journalId=1255847919539208197, language=CN, title=基于复合病机论探讨国医大师周仲瑛原发性肝癌辨治思路, columnId=1256183362172142382, journalTitle=中华中医药学刊, columnName=国家项目点击, runingTitle=null, highlight=null, articleAbstract=

原发性肝癌(primarylivercancer,PLC)简称“肝癌”,发病隐匿,患者确诊时往往已处于疾病晚期,属于全身脏腑、气血津液紊乱的状态,病情复杂难辨。周仲瑛教授擅从整体辨治疾病,临证首重病机,提出急难病症的共性病机特征为复合病机。从复合病机论出发,探析周仲瑛教授辨治PLC的临床诊疗思路。认为多病理因素复合是PLC的病机特征,其中湿热瘀毒是PLC的基本病机,癌毒化生是PLC的病机转化关键环节;基于复合病机论治疗PLC可采用多法同用、复法制方的思路,主要包括扶正祛邪、调和五脏、通调气血津液、抗癌解毒治法。

, authors=补娟娟1, 豆晓云2, 孙萌2, 叶放2, authorsList=补娟娟, 豆晓云, 孙萌, 叶放, authorCompany=null, correspAuthors=叶放, authorNote=

补娟娟(1998-),女,甘肃天水人,医师,硕士,研究方向:肝脏病临床。

, correspAuthorsNote=
叶放(1965-),男,江苏徐州人,教授、主任医师,博士研究生导师,博士,研究方向:基于名医经验开展中医内科病证病机理论的基础与临床应用。E-mail:。
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补娟娟(1998-),女,甘肃天水人,医师,硕士,研究方向:肝脏病临床。

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补娟娟(1998-),女,甘肃天水人,医师,硕士,研究方向:肝脏病临床。

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基于复合病机论探讨国医大师周仲瑛原发性肝癌辨治思路
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补娟娟 1 , 豆晓云 2 , 孙萌 2 , 叶放 2
中华中医药学刊 | 国家项目点击 2025,43(2): 80-83
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中华中医药学刊 |国家项目点击 2025 , 43 (2) : 80 -83
基于复合病机论探讨国医大师周仲瑛原发性肝癌辨治思路
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补娟娟1, 豆晓云2, 孙萌2, 叶放2
作者信息
  • 1.高邮市中医医院,江苏 高邮 225600
  • 2.南京中医药大学国医大师周仲瑛传承工作室,江苏 南京 210023
通讯作者:
叶放(1965-),男,江苏徐州人,教授、主任医师,博士研究生导师,博士,研究方向:基于名医经验开展中医内科病证病机理论的基础与临床应用。E-mail:。
作者简介:

补娟娟(1998-),女,甘肃天水人,医师,硕士,研究方向:肝脏病临床。

Exploring Diagnosis and Treatment of Primary Liver Cancer by Chinese Medical Master ZHOU Zhongying Based on Compound Pathogenesis Theory
Juanjuan BU1, Xiaoyun DOU2, Meng SUN2, Fang YE2
Affiliations
  • 1.Gaoyou City Traditional Chinese Medicine Hospital,Gaoyou 225600,Jiangsu,China
  • 2.National Medical Master ZHOU Zhongying Inheritance Studio,Nanjing University of Chinese Medicine,Nanjing 210023,Jiangsu,China
出版时间: 2025-02-10 doi: 10.13193/j.issn.1673-7717.2025.02.018
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原发性肝癌(primarylivercancer,PLC)简称“肝癌”,发病隐匿,患者确诊时往往已处于疾病晚期,属于全身脏腑、气血津液紊乱的状态,病情复杂难辨。周仲瑛教授擅从整体辨治疾病,临证首重病机,提出急难病症的共性病机特征为复合病机。从复合病机论出发,探析周仲瑛教授辨治PLC的临床诊疗思路。认为多病理因素复合是PLC的病机特征,其中湿热瘀毒是PLC的基本病机,癌毒化生是PLC的病机转化关键环节;基于复合病机论治疗PLC可采用多法同用、复法制方的思路,主要包括扶正祛邪、调和五脏、通调气血津液、抗癌解毒治法。

复合病机  /  原发性肝癌  /  复法制方  /  癌毒  /  周仲瑛

Primary liver cancer(PLC)is referred to as“liver cancer”,the onset of which is insidious,and the patients are often in the advanced stage of the disease when they are diagnosed. Professor ZHOU Zhongying is good at identifying and treating diseases as a whole,and proposes that the common pathogenesis of acute and difficult diseases is a composite pathogenesis. Starting from the theory of compound pathogenesis,this paper explored the clinical diagnosis and treatment ideas of Professor ZHOU Zhongying in the treatment of PLC. It is believed that the combination of multiple pathological factors is the pathogenesis characteristic of PLC,among which damp-heat and blood stasis are the basic pathogenesis of PLC,and cancer metaplasia is the key link of PLC pathogenesis. Based on the theory of composite pathogenesis,the treatment of PLC can adopt the idea of multimethod combination and compound formula,which mainly included the treatment of vital Qi and evil spirits,the reconciliation of the five Zang-organs,the regulation of Qi,blood and fluid,and the treatment of anti-cancer and detoxification.

compound pathogenesis  /  primary liver cancer  /  compound formula  /  carcinotoxicity  /  ZHOU Zhongying
补娟娟, 豆晓云, 孙萌, 叶放. 基于复合病机论探讨国医大师周仲瑛原发性肝癌辨治思路. 中华中医药学刊, 2025 , 43 (2) : 80 -83 . DOI: 10.13193/j.issn.1673-7717.2025.02.018
Juanjuan BU, Xiaoyun DOU, Meng SUN, Fang YE. Exploring Diagnosis and Treatment of Primary Liver Cancer by Chinese Medical Master ZHOU Zhongying Based on Compound Pathogenesis Theory[J]. Chinese Archives of Traditional Chinese Medicine, 2025 , 43 (2) : 80 -83 . DOI: 10.13193/j.issn.1673-7717.2025.02.018
原发性肝癌(primarylivercancer,PLC)是一种发生在肝细胞或肝内胆管上皮细胞的恶性肿瘤,是全球最常见的、恶性程度最高的恶性肿瘤之一,对人们的健康产生了严重的危害。据我国国家癌症中心肿瘤登记数据显示,PLC位于我国主要恶性肿瘤发病谱第4位,恶性肿瘤死亡人数顺位排序第2位,我国PLC的发病率和死亡率均远高于全球平均水平[1-2]。现代PLC治疗以多学科、多治疗方法为主,主要包括肝切除术、肝移植术、局部消融治疗、肝动脉化疗栓塞术、放射治疗、全身治疗等多种手段[3]。中医辨证论治在PLC的治疗上具有显著优势,不仅能提高免疫力、杀灭肿瘤细胞、改善患者生命质量,亦能防治放疗和化疗不良反应弥补西医的诸多不足,达到缓解痛苦、改善症状、控制复发转移、延长生存期的目的[4]。但在临床治疗过程中,中医证候决策存在明显的经验性、不确定性、模糊性等特点,影响了整个辨证的过程及中医临床疗效的评价,也在一定程度上限制了中医理论的推广和应用[5]。此外,现有的PLC辨证方式多以辨证分型为主,未能揭示肝癌病机本质及其演变的复杂性。
国医大师周仲瑛教授(以下尊称“周老”)擅治各种急难杂症,临证首重病机,并创立中医病机辨证体系。中医病机辨证体系的基本框架是以病理因素为纲,主体证候病机为条目,兼夹病机、复合病机为主要单元而构建[6]。周老[7]认为,肿瘤的病机整体呈现复合趋势,具有多因复合和多病位复合的特点。抓住核心病机是治疗疾病的关键,其中湿热瘀毒是肝病的核心病机[8-9],为肝病的治疗加减提供了依据。因此,本文从复合病机论出发,浅析周仲瑛教授基于复合病机论辨治原发性肝癌的经验,以期为原发性肝癌的临床诊疗提供新思路。
周老在临床诊疗过程中发现内科难治病的核心病机都是以复合病机为特点[10],病性都属本虚标实。认为人体整体为一气,从不同认知角度,一气又可分五脏六腑、气血津液、六经、营卫等不同理论模型,而八纲之中,阴阳、虚实、寒热、表里各自成体系。不同理论模型都有自身整体观体系,在病理上各理论模型都有完整的病机构成要素,如以虚实为纲,则其中的“实”包括风、寒、湿、热、火、毒等10种,“虚”包括五脏气血津液亏虚,虚实之间复合为患则为复合病机,即“复合病机论”[11]是指各种病机要素相互兼夹、孳生、转化、复合为患,从而表现为不同而复杂的致病特点。此外周老指出病机要素的多元交叉、因果转化是复合病机的病理基础、病证动态变化的根源,其内涵包括病机要素中的病性、病位、病理因素和病势等复合为患。
中医古籍中并无肝癌这一病名,根据其症状、病因、病机及辨治特点可归为“积聚”“黄疸”“臌胀”“胁痛”“血证”“肝积”“癥瘕”等疾病范畴。周老擅长以虚实为纲认识本病病机,提出[12]正气亏虚是肝癌发生、发展、转移的基础,癌毒内生是肝癌发生的关键,癌毒因素在于气滞湿热瘀毒互结,并指出“癌肿虽病在局部,但失调在脏腑,虚损在全身,癌毒蕴结脏腑,阻滞气机,导致相关脏腑经络功能的失调”[13]。张宾等[14]对周老传承工作室电子病案库中周老诊治的门诊病案进行数据挖掘,其病机证素频数统计结果显示湿热瘀毒互结为51.61%、肝脾两伤为46.95%。肝癌患者大多由慢性肝炎、肝硬化等疾病发展而来,病程良久,湿热疫毒久羁,脏腑受损,气血津液代谢失常,进一步产生湿、痰、热、瘀等病邪,多种病理因素胶结复合则内生癌毒,形成湿热瘀毒互结、肝脾两伤的基本病机。
早在《内经》时期古代医家就已认识到肝病的形成与湿热、热毒、血瘀、痰湿等因素有关,这些病理因素可致胁痛、黄疸、癥积。如《素问·六元正气大论篇》:“湿热相搏……民病黄瘅。”谓湿热互相搏结可致发黄。张仲景在其《伤寒杂病论》中也多次提到黄疸除与湿热相关外,瘀热相搏也是其重要病机之一。如《金匮要略》:“脾色必黄,瘀热以行。”后世医家对此种观点也有颇多论述,如《千金要方》:“凡遇时行热病,多必内瘀发黄”,认为湿浊、瘀热、湿热等邪相互胶结转化是黄疸、鼓胀形成的主要原因。此后《医学心悟》:“瘀血发黄,亦湿热所致。瘀血与积热熏蒸,故见黄色也”,明确提出湿热与瘀血相互搏击导致黄疸。通过前人从不同角度对PLC致病因素的阐述可知,PLC确为湿、热、瘀、毒等多种病理因素相互搏结、复合为患而生。
周仲瑛教授通过多年临床实践经验将肝病病机概括为“湿热瘀毒”,湿、热、瘀、毒、郁、痰等病理因素之间相互孳生、相互转化、相互胶结和合为患,湿热酿瘀,瘀血生湿郁热,都是“湿热瘀毒互结”常见病理状态,这些病理状态可显可隐,但始终客观存在[15]。后周珉教授首次明确提出“湿热瘀毒”在各种肝病过程中都有存在[16-17]。现今,湿热瘀毒理论也被各医家广泛运用于临床各种疾病辨治过程中,如王琦教授[18]以“肾虚夹湿热瘀毒”为现代病机治疗男性不育症;赵振昌教授[19]以“湿热内蕴、瘀毒阻络”治疗痛风性肾病的急性发作等。表明“湿热瘀毒”复合病机为多种内科疾病的核心病机特征。
《金匮要略心典》云:“毒,邪气蕴结不解谓之”;喻嘉言认为:“病久不解,可蕴结成毒”,皆言邪气久羁可酿毒。根据癌的致病性及难治性,周老提出“癌毒”学说[20],认为癌病为患,必夹毒伤人,指出癌毒[21]属毒邪之一,但又与普通的毒邪有所不同,为内外多种因素作用下、人体脏腑功能失调基础上产生的一种对人体有明显伤害性的病邪,是导致肿瘤发生的一种特异性致病因子。癌毒是特指可衍生恶性肿瘤的特殊毒邪,癌毒的存在是恶性肿瘤形成的先决条件,也是恶性肿瘤不同于其他疾病的根本所在。癌毒是肿瘤所特有的,异于中医基础理论所述的其他病因病机[22]。
周老认为湿热瘀毒是肝病的核心病机,但肝炎、肝硬化、肝癌之湿热瘀毒又有所不同。肝炎之湿热瘀毒是疫毒之邪与湿热瘀等病理因素相互胶结和合、互生互化;肝硬化由肝炎-肝纤维化进一步发展而来,病程日久,疾病涉及全身,湿热瘀毒之邪久羁,从而产生瘀毒、湿毒、热毒等病理因素,新生病理因素又可与原有病理因素复合,导致疾病复杂多变,因此其“毒”邪不仅表示疫毒之邪,也包含病邪之盛、病程之长所带来的复杂的失常代谢过程;PLC多由肝炎、肝硬化进展而生,故其湿热瘀毒既有肝炎、肝硬化之湿、热、瘀、疫毒、湿毒、热毒、瘀毒等致病因素,亦有各致病因素日久不去而酿生的癌毒,而癌毒的化生也标志着PLC的形成。
十二官不得相失也,一脏有病必牵及他脏。《素问·经脉别论篇》曰:“饮入于胃,游溢精气……揆度以为常也。”《素问·玉机真脏论篇》言:“五脏相通,移皆有次”,五脏基于其生理特性相互联系,又因生克制化相互传变,疾病初起可为一脏受累,日久必致脏腑皆损。《难经·五十五难》曰:“积者,五脏所生,聚者,六腑所成也。”阐述了积聚多脏腑同病的特点。PLC作为慢性消耗性疾病进展而来,病程日久,各个脏腑必因此受累。
一方面,肺病则气机失调,心病则血液运行失常、情志失调,脾病则血不归常道、津液运行失常、后天失养,肾病则水液藏泻失职、先天之本受损,气血津液失常可致气郁、痰聚、水停、血凝、湿生,湿瘀之邪日久又可化热伤阴,湿热瘀蕴结肝脏,久之则可酿毒,先后天之本亏虚无力抗邪则邪气愈盛,进一步导致PLC的形成。另一方面,PLC湿热瘀毒之邪久羁不去,又可导致气血津液失常、阴阳失调,气机失常则影响肺之宣降;血行失常、情志失调、瘀热扰心又可致心病;津液运行失常、肝木乘土可致脾失其常;湿热、瘀热之邪久蕴,加之肝癌放化疗耗伤阴精,久则肾阴亏虚。因此PLC是以肝脏为中心的全身性疾病。
在复合病机论指导下,临诊处方时可采用复法制方的思路。复法制方是指基于两种或两种以上的治法配伍用药抑或是两张以上的小方组合使用,具有多法兼备、药物众多、多而不乱的特点,实现了对整体观的灵活运用。周老临证常以虚实相因病机为核心,尤为关注病理因素和脏腑病机,针对病机之主次轻重缓急复法制方,结合气机的升降出入、虚实寒热的从化、五脏之间生克制化关系、经络循行、五运六气等理论,随证制方,使患者从整体上实现阴平阳秘[23]。
周老[24]“中医辨治肿瘤十法”中提出“我们提倡中医辨治肿瘤当以病机为主导,交叉复合,复法组方,既有规范,又要变通,如是审证求机,活化辨证,辨机论治,万举万当。由此可见十法之中,百法备焉。”这一见解对肿瘤等难治病症具有非常普遍指导意义。
PLC的治疗应时刻注重扶正祛邪兼施。遵《医宗必读·积聚》分初、中、末三期论治,即初者,病邪初起……正气消残,则任受补。然PLC发病隐匿,患者确诊时多已为中末期,正气虚损已然存在,因此在就诊之初即可配伍使用扶正之品,以助正气祛邪外出。如《临证指南医案》说:“积聚内起……经年病久,正气已怯……必疏补两施,盖缓攻为宜。”此外,癌毒虽为凶猛之邪,祛邪亦不可太过峻烈,以免伤及正气,或生他变。《内经·六元正纪大论篇》便有云“大积大聚,其可犯也,衰其大半而止,过者死”。周老认为[25]癌体局部为实,整体为虚,虚实夹杂之病,延至晚期,整体衰竭,成为败局,既不可攻,又不可补,唯有姑息治疗,以延朝夕,健胃以助受纳。常用香砂六君子汤、益胃汤等之品。
肝气可启化诸脏,使脏腑之气化生有根;肝阴阳和调,启动脏腑生化不息,血气和顺,津液敷布有序,五脏安和。今肝脏自病,余脏必受其害。肝肺共主气机之升降,PLC患者出现胁痛胁胀,咳嗽气喘等气机失调表现时,可在治肝的同时兼顾肺气的宣发肃降,适当配伍调理肺气之品。周老临床常酌加青皮、陈皮、泽漆等行气之品。肝心共主人之精神情志,若患者出现精神恍惚、情志抑郁、心烦失眠等症状时,可在疏肝理气的基础上酌加清心火、安心神之品,周老常加竹茹、合欢皮、合欢花、黄连、郁金等药。脾胃为后天之本,得胃气则生,失胃气则死,脾胃运化腐熟功能失司,湿热郁蒸肝胆,可致黄疸发生,而肝病亦可传脾,因此肝病的治疗应始终重视调理脾胃,周老常用鸡内金、白术、焦山楂、砂仁等健脾和胃之品。肝肾精血同源、互资互制,水木相生,加之PLC患者多由瘀热久羁所致,部分患者就诊时已经历了西医放化疗等治疗手段,不免伤及肝肾之阴,因此临床治疗时应不忘顾护阴津,周老常辨证加入生地黄、枸杞子、女贞子、吴茱萸、山药等滋阴。
气血津液一整体,互生互化、协调互用,作为人体生命活动的物质基础,共同维持着人体正常的生理机能。PLC由气血津液失调而生,治疗必气血津液并治。气行则血行,气滞则血瘀;气为血之帅,血为气之母;气能生血,血能养气;气能生津行津摄津,津能生气载气;津能生血,血可化津,津血同源。因此气血津液中一者有病,必牵及整个人体运行,因此在治疗时当全面兼顾。如血虚者,可在补血的同时适当配伍补气之品,若见大出血时可用大剂量补气药,一则补气生血,二则气能摄血;因气虚导致的血瘀、津液不足、口角流涎、遗尿、多汗等可酌加补气药物;因气的推动功能下降,出现血瘀、痰湿水饮时,可配伍补气行气之品,以助气行血、行津。
因PLC之湿热瘀毒不同于肝炎肝硬化,癌毒的化生是其病机转化的关键,故抗癌解毒须贯穿PLC治疗始终。周老认为“肿瘤非常病,用药非常药”,提出祛除癌毒有解毒、攻毒之别,两者可联合应用,但当有主次之分。PLC多由湿热瘀毒所致,因此多择清热解毒药物治疗,如山慈菇、白花蛇舌草、石打穿、半枝莲、肿节风、漏芦、夏枯草、龙葵、制南星等药物[12]。癌毒具有猛烈性、顽固性的特点,因此攻毒多选用力量峻猛的草药或虫类药,但应注意视正气虚损程度酌加,主要适用于邪毒炽盛但正气未虚者,使用攻毒药物搜毒、剔毒,以达到以毒攻毒之效,还应注意攻毒药物的使用不可用力过猛,以免损正,加重病情。周老[26]临床常用的攻毒药主要有土鳖虫、九香虫、露蜂房、守宫、蟾皮、全蝎、蜈蚣、红豆杉、马钱子等。
陈某某,男,53岁。2009年12月24日初诊。80年代中期曾患乙型病毒性肝炎,7月14日因发热于市某院住院,检查拟诊原发性肝癌、门静脉癌栓,未予特殊处理。后于其他医院行介入治疗1次,曾发高热超10 d,后在上海某医院行介入治疗2次,仍有发热。并在医院行伽马刀治疗1次,肝功能基本正常。近查CA-199:66.5 U/mL,呈贫血貌,自觉所苦不多,食纳欠香,二便正常。舌质黯,苔黄腻,脉弦滑。腹部CT示:肝癌伴门脉癌栓介入治疗后,部分病灶见碘油沉积;腹膜后细小结节影。肝内另见类圆形较低密度影,考虑小囊肿。西医诊断:原发性肝癌;中医诊断:肝癌。病机总属湿热瘀毒互结,肝阴脾气两伤。处方:炙鳖甲(先煎)15 g,炮山甲(先煎)6 g,北沙参10 g,天冬10 g,麦冬10 g,太子参12 g,焦白术10 g,仙鹤草15 g,茯苓10 g,炙甘草3 g,八月札12 g,莪术6 g,白花蛇舌草20 g,半枝莲20 g,龙葵20 g,山慈菇15 g,制南星12 g,炙蜈蚣3条,红豆杉10 g,鸡血藤15 g,灵芝5 g,砂仁(后下)3 g,炙鸡内金10 g,水红花子12 g。14剂,水煎服,日1剂。
2010年1月7日二诊:肝区间有隐痛,食纳欠馨,腹不胀,二便正常,口干。舌质黯紫,苔淡黄薄腻,脉细弦。病机总属湿热瘀毒互结,肝脾两伤。处方:炙鳖甲(先煎)15 g,炮山甲(先煎)6 g,北沙参12 g,天冬10 g,麦冬10 g,太子参12 g,焦白术10 g,仙鹤草15 g,茯苓10 g,炙甘草3 g,八月札12 g,莪术9 g,白花蛇舌草20 g,半枝莲20 g,龙葵20 g,山慈菇15 g,制南星12 g,炙蜈蚣3条,红豆杉10 g,鸡血藤15 g,灵芝5 g,砂仁(后下)3 g,炙鸡内金10 g,水红花子12 g炒神曲10g,佩兰10 g。14剂,水煎服,日1剂。
2010年1月20日三诊:肝区间有隐痛,左后背隐有不舒,腹不胀,食纳知味,二便正常。复查血常规:白细胞计数(WBC)5.66×109/L,红细胞计数(RBC)3.61×1012/L,血红蛋白(HB)121 g/L,血小板计数(PLT)106×109/L。甲胎蛋白(AFP)7.8 ng/mL,癌胚抗原(CEA)4.45 ng/mL,糖类抗原199(CA199)21.74 ng/mL,铁蛋白672.7 ng/mL(23.9~336.2 ng/mL)。生化:谷草转氨酶(AST)56 U/L,谷丙转氨酶(ALT)81 U/L,球蛋白(GLO)42.5 g/L,A/G 0.7,γ-谷氨酰转肽酶(GGT)112 U/L。舌质黯隐紫,苔黄薄腻,脉弦。处方:1月7日方加石打穿20 g。14剂,水煎服,日1剂。
2010年2月4日四诊:肝区隐痛基本缓解,腹不胀,食纳知味,左肩背隐疼,二便正常。舌质黯隐紫,苔淡黄薄腻,脉细滑。处方:1月7日方加片姜黄10g,石打穿20 g。
后患者自觉症状稳定,无明显痛胀,复查胸+全腹CT平扫:①肝硬化,肝内呈介入改变,详见上述,肝左叶及右后叶内囊性低密度影,是否为囊肿或转移灶请结合B超或外院CT。②胸部未见明显异常。复查多项肝癌标志物(-)。基本按1月7日方随证加减。

按 本案患者曾患乙型病毒性肝炎,湿热瘀毒之邪蕴结体内,相互胶结和合,日久则酝酿成毒,癌毒之邪又与湿热瘀毒等邪气相互滋生、兼夹转化,进一步加重病情;湿热瘀毒之邪耗气伤津则肝病气阴两伤,肝病日久又可传脾,致使脾气亦虚;故病机总属湿热瘀毒互结,肝阴脾气两伤。舌质黯,苔黄腻,脉弦滑亦符合此病机之象。治疗以清热化瘀、抗癌解毒散结、补气养阴为主,炙鳖甲、炮山甲、八月札、莪术、山慈菇、白花蛇舌草、石打穿、半枝莲、红豆杉、龙葵、制南星、蜈蚣清热解毒、化瘀散结以抗癌;北沙参、天冬、麦冬、太子参、仙鹤草、鸡血藤、灵芝补气养阴补血以扶正;焦白术、茯苓、砂仁、鸡内金、神曲健脾和胃以助胃气;炙甘草调和诸药。诸药配合,谨守病机,多法同用,复法制方,故获良效。

复合病机论基于内科难治病的重要发病特征,充分体现了中医认知疾病的整体观、辨证观特色,是对传统病机学理论体系的完善和补充[27]。对于PLC此类急难杂症的治疗,西医放化疗、手术等治疗手段的确取得了一定的成效,但对于产生的不良反应以及复发转移等情况西医仍无有效解决方案。中医药在此方面显示出独特的优势,通过整体审查,全面了解其脏腑气血津液紊乱的病机状态,整体调治、全面兼顾,与西医诊疗协同作用,起到增效减毒的效果。
周老擅用整体思维审查疾病之病因病机,并以病机为切入点探查疾病发生发展规律,通过PLC多病理因素复合、多脏腑同病的特点,治疗上注重扶正祛邪、通调气血津液、脏腑和调、抗癌解毒,多法同用,复法制方,整体调治,使机体达到阴平阳秘的状态。
  • 国家重点研发计划“中医药现代化”重点专项(2022YFC3500200; 2022YFC3500201)
  • 江苏省(社会发展)重点研发计划项目(BE2019723)
  • 江苏省高校自然科学基金面上项目(23KJB360005)
  • 中国中医科学院学部委员学术传承与传播专项-学部委员周仲瑛国医大师学术思想与临证经验传承研究项目(CI2022E028XB)
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2025年第43卷第2期
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doi: 10.13193/j.issn.1673-7717.2025.02.018
  • 首发时间:2026-10-30
  • 出版时间:2025-02-10
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国家重点研发计划“中医药现代化”重点专项(2022YFC3500200; 2022YFC3500201)
江苏省(社会发展)重点研发计划项目(BE2019723)
江苏省高校自然科学基金面上项目(23KJB360005)
中国中医科学院学部委员学术传承与传播专项-学部委员周仲瑛国医大师学术思想与临证经验传承研究项目(CI2022E028XB)
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    1.高邮市中医医院,江苏 高邮 225600
    2.南京中医药大学国医大师周仲瑛传承工作室,江苏 南京 210023

通讯作者:

叶放(1965-),男,江苏徐州人,教授、主任医师,博士研究生导师,博士,研究方向:基于名医经验开展中医内科病证病机理论的基础与临床应用。E-mail:。
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2种不同金属材料的力学参数
科
Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)
属
Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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