1.首都医科大学附属北京中医医院 北京 100010
2.北京中医药大学
于加乐,女,在读硕士生
#张董晓,女,博士,主任医师、教授,博士生导师,E-mail:morningdong@163.com
纸质出版日期:2023-03-30,
收稿日期:2022-08-21,
移动端阅览
于加乐, 张子辰, 陈雯, 等. 吕培文治疗乳腺癌术后类围绝经期综合征经验[J]. 现代中医临床, 2023,30(2):64-68.
YU Jiale, ZHANG Zichen, CHEN Wen, et al. Lyu Peiwen’s experience in treating perimenopausal-like syndrome following breast cancer surgery[J]. Modern Chinese Clinical Medicine, 2023,30(2):64-68.
于加乐, 张子辰, 陈雯, 等. 吕培文治疗乳腺癌术后类围绝经期综合征经验[J]. 现代中医临床, 2023,30(2):64-68. DOI: 10.3969/j.issn.2095-6606.2023.02.014.
YU Jiale, ZHANG Zichen, CHEN Wen, et al. Lyu Peiwen’s experience in treating perimenopausal-like syndrome following breast cancer surgery[J]. Modern Chinese Clinical Medicine, 2023,30(2):64-68. DOI: 10.3969/j.issn.2095-6606.2023.02.014.
乳腺癌是我国最常见的女性恶性肿瘤,激素受体阳性的浸润性乳腺癌患者,皆应接受术后辅助内分泌治疗,内分泌治疗常用的他莫昔芬和芳香化酶抑制剂均是通过抑制或降低体内雌激素水平达到抑制癌细胞生长或增值的目的,体内激素水平被动下降会引发子宫内膜增厚、月经失调、潮热、阴道不适、乏力、失眠、肌肉关节痛等,这一系列不良反应与围绝经期综合征相似,将其称为类围绝经期综合征,属中医“绝经前后诸症”的范畴。吕培文教授认为乳腺癌术后类围绝经期综合征的表现与气血失和、肝肾亏虚密切相关,在治疗时以调和气血、调补肝肾为主要治法,在遣药组方时,以“四藤二红”及五子衍宗丸为基础加减运用。从审证求因、本于气血,诸症丛生、责之肝肾,兼顾情志、气畅血调几方面探讨从调和气血、调补肝肾论治的理论依据。从治病求本、调和气血,调补肝肾、精血同调,调畅情志、疏肝理气几方面分析从调和气血、调补肝肾论治的遣药组方。结合临床验案对吕教授治疗乳腺癌术后类围绝经期综合征的诊疗思路及用药经验进行介绍。
Breast cancer is the most common female malignant tumor in China. Invasive breast cancer patients with positive hormone receptors are supposed to receive the adjuvant endocrine therapy after surgery. Tamoxifen and aromatase inhibitors
which are commonly used in the endocrine therapy
both inhibit the growth of cancer cells by suppressing or lowering estrogen levels in the body. A passive decrease in hormone levels can lead to some adverse reactions
such as thickened endometrium
menstrual disorder
hot flashes
vaginal discomfort
fatigue
insomnia
muscle and joint pains
and so on. Such adverse reactions
which are similar to perimenopausal syndrome
are termed perimenopausal-like syndrome
and it belongs to the category of "pre- and past-menopausal syndromes" in traditional Chinese medicine. Professor Lyu Peiwen believes that the manifestations of perimenopausal-like syndrome following the breast cancer surgery are closely related to disharmony between Qi and blood
and the deficiency of the liver and kidney. The main treatment method is to harmonize the Qi and blood and tonify the liver and kidney. The formula is based on "Siteng Er Hong" and Wuzi Yanzong Pill. This paper discusses the theoretical basis of harmonizing Qi and blood
tonifying the liver and kidney from such perspectives as determination of etiologic factors based on differentiation
elucidating etiology based on Qi and blood; multiple symptoms modulated from the liver and kidney; giving consideration to emotion
harmonizing Qi and blood flow. This paper analyzes the prescription of harmonizing Qi and blood
nourishing and modulating the liver and kidney from several aspects: searching for the primary cause of disease in treatment
harmonizing Qi and blood
nourishing and modulating the liver and kidney
modulating essence and blood together
regulating emotions
and soothing the liver and Qi.
类围绝经期综合征调和气血调补肝肾五子衍宗丸名医经验吕培文
perimenopausal-like syndromeharmonizing Qi and bloodtonifying the liver and kidneyWuzi Yanzong Pillfamous physicians’ experienceLyu Peiwen
中华医学会外科学分会乳腺外科学组.中国浸润性乳腺癌诊治临床实践指南(2022版)[J].中国实用外科杂志,2022,42(2): 121-127.
王跃,张爽,张虹,等.激素受体阳性/人表皮生长因子受体2阴性乳腺癌临床病理特征及预后[J].北京大学学报(医学版),2022,54(5): 853-862.
陈霞,罗凤.乳腺癌患者辅助内分泌治疗依从性现状及对策的研究进展[J].中华乳腺病杂志(电子版),2020,14(2): 116-119.
陈红,曾恩泉.乳腺癌类围绝经期综合征辨治体会[J].中医临床研究,2016,8(11): 102-104.
谈勇.中医妇科学[M].北京:中国中医药出版社,2016: 339.
郭娴.吕培文教授学术思想、临床经验总结及应用调和气血法治疗动脉硬化闭塞症临床研究[D].北京:北京中医药大学,2016.
中华人民共和国国家卫生健康委员会.乳腺癌诊疗指南(2022年版)[J].中国合理用药探索,2022,19(10): 1-26.
中国乳腺癌内分泌治疗专家共识专家组.中国乳腺癌内分泌治疗专家共识(2015年版)[J].中国癌症杂志,2015,25(9): 755-760.
李绘,李姣,黎浩江,等.乳腺密度自动测量与乳腺癌术后他莫昔芬治疗预后方法[J].科学技术与工程,2022,22(28): 12499-12504.
翁苗苗,梁梦迪,黄越,等.激素受体阳性乳腺癌化疗同期内分泌治疗的研究进展[J].中国临床研究,2022,35(9): 1261-1265.
高士栻.医学真传[M].宋咏梅,李圣兰,点校.天津:天津科学技术出版社,2000: 11.
郭娴.吕培文教授治疗周围血管病经验[J].中医学报,2016,31(5): 670-673.
傅山.傅青主女科[M]. 欧阳兵,整理.北京:人民卫生出版社,2006: 19.
陈自明.妇人大全良方[M]. 王咪咪,整理.北京:人民卫生出版社,2006: 450.
吴谦.医宗金鉴[M].郑金生,整理.北京:人民卫生出版社,2017: 233.
许慎.说文解字[M].杭州:浙江古籍出版社,2012: 48.
蔡晓星.基于养正除积法的固本解郁汤治疗肝郁脾虚型不寐病的临床观察[D].哈尔滨:黑龙江中医药大学,2021.
张董晓,付娜,黄巧,等.赵炳南“四藤”组合组方思路在乳腺疾病中的应用与发展[J].中医杂志,2021,62(4): 292-295.
魏锋,程显隆,荆文光,等.中药材及饮片质量标准研究有关问题思考[J].中国药学杂志,2022,57(18): 1493-1503.
刘青武,何秀娟,谭崇赋,等.吕培文应用“治翻车”协同四藤二红汤治疗慢性皮肤溃疡临床经验[J].北京中医药,2021,40(12): 1344-1347.
顾晓玲,徐凤,谢芸,等.《上海市中药饮片炮制规范》2018年版毒性饮片分析[J].中国中医药信息杂志,2021,28(11): 134-137.
陈贞,吕培文.吕培文运用中医调和法治疗外科疾病经验[J].北京中医药,2014,33(11): 821-823.
黄礼闯,赵梦亭,桑夏楠,等.三棱-莪术药对化学成分及药理作用研究进展[J].中华中医药杂志,2021,36(11): 6612-6616.
张时彻.摄生众妙方[M].张树生,点校.北京:中医古籍出版社,2004: 237.
叶垣.梁宏正运用五子衍宗方加味验案举隅[J].中国民间疗法,2021,29(21): 113-116.
孙志伟,李玉洲,张长城.五子衍宗丸药理作用及其临床研究进展[J].亚太传统医药,2010,6(12): 179-181.
钟赣生,中药学[M].北京:中国中医药出版社,2016: 588.
付娜,赵文洁,黄巧,等.吕培文“理、健、调”治疗乳癖经验[J].北京中医药,2020,39(12): 1242-1244.
0
浏览量
115
下载量
0
CSCD
关联资源
相关文章
相关作者
相关机构