202002临床名医

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202002临床名医

2020/02Ⅰ 1临床名医中医药人的国际精神家园 双月刊Bimonthly Clinic SpecialistsISSN 2563-2809 August 2020,N°2YouXiYin:Unknown cause treatment equals neither prevent nor reduce the deterioration of the health individual. 由玺印:不知病因的治疗等于杀人Doctors must be kind and helpful陈远维:医家要有“割股之心”The Experience Analysis of the First Master of Traditional Chinese Medicine Doctors in Treating Malignant Tumor首届国医大师治疗恶性肿瘤经验分析Analysis of the Clinical Dosage of Astragalus in Past Dynasties.历代黄芪临床用量分析Thoughts on the New Coronavirus Plague.曹... [收起]
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第1页

2020/02Ⅰ 1

临床名医

中医药人的国际精神家园 双月刊

Bimonthly

Clinic Specialists

ISSN 2563-2809 August 2020,N°2

YouXiYin:

Unknown cause treatment equals

neither prevent nor reduce the

deterioration of the health individual.

由玺印:不知病因的治疗等于杀人

Doctors must be kind and helpful

陈远维:医家要有“割股之心”

The Experience Analysis of the

First Master of Traditional Chinese

Medicine Doctors in Treating

Malignant Tumor

首届国医大师治疗恶性肿瘤经验分析

Analysis of the Clinical Dosage of

Astragalus in Past Dynasties.

历代黄芪临床用量分析

Thoughts on the New Coronavirus

Plague.

曹东义:新冠瘟疫的反思

第2页

Chen Yuanwei never said that he would inherit and innovate traditional Chinese medicine. His inheritance and

innovation of traditional Chinese medicine are entirely self-conscious of life. There is no relevant organization to

commend him, but he is deeply loved by patients at home and abroad. In addition to the role of a doctor, he has

his own winery, pig farm, and chicken farm. His mother's teaching of his "heart of love" allowed him to settle

down, establish a career, and establish a virtue. He has accomplished himself and blessed others. See page for

details.

陈远维从没有说过要对中医药继承和创新,他对中医药的继承和创新,完全是生命的自觉。没有相关机

构对他进行表彰,但是他深得海内外患者的厚爱。在医生这个角色之外,他有属于自己的酒厂、猪场、

鸡场。母亲对他 “割股之心”的教导,让他安身、立业、立德。既成就了自己,也福泽了他人。详见

73页。

第3页

Satisfactory effect makes the future of

Chinese medicine profession promising

◎Li Shanju

As of August 7, 2020, the new crown virus pandemic still shows no signs of

stopping overseas. According to relevant media pandemic data, the number of new

coronavirus infections outside of China has been confirmed to be 19195631, an increase

of 274439 from yesterday. In China, the outbreak in Wuhan during the Spring Festival,

the new outbreak in Fengtai, Beijing in late June, and the outbreak in Dalian in late July

were all effectively contained in a timely manner.

In the face of the COVID-19 pandemic, the Western medical community has

unanimously declared that there is no specific medicine. The reason why China is able

to contain the pandemic is because of the use of Chinese medicine. According to the

People’s Daily, during the fight against the pandemic in Wuhan, the whole medical

system promoted the application of effective prescriptions represented by "Qingfei

Paidu Decoction" in a timely manner, covering the entire medical observation period,

mild, common, severe, critical, and recovery period of the new coronavirus. , Forming

the "Wuchang Model" with the characteristics of Chinese medicine. Effectively reduce

the morbidity, turn-over rate, and death rate, increase the negative rate, and speed up

the recovery period. Among the 130 confirmed cases who were fixed and discharged in

July in Beijing, the rate of Chinese medicine participation was 100%. According to the

China Journal of Traditional Chinese Medicine, the use rate of Chinese medicine for the

treatment of new coronary pneumonia in Dalian has reached 100%. The effect allows us

to see that Chinese medicine is a treasure of the Chinese nation. The effect also allows

us to see that the future of Chinese medicine is promising. Because Chinese medicine

is not only effective in fighting the new crown pandemic, but Chinese medicine is still

effective in treating all kinds of modern diseases.

The key word for the clinical column of intractable diseases in this issue is

tumor.Tumors are what people call cancer. Tumors are as common as colds among

people today. Chinese medicine has very rich experience in treating tumors. Masters

of traditional Chinese medicine are models of contemporary Chinese medicine. The

2020/02Ⅰ 1

Foreword 卷首语

第4页

2

Ⅰ2020/02

临床名医|Clinic Specialist

summary and analysis of their clinical experience in treating tumors is very helpful

for clinical reference. The article "Analysis of the Experience of the First Masters of

Traditional Chinese Medicine in Treating Malignant Tumors" summarizes 14 masters

of traditional Chinese medicine (Deng Tietao, Guo Ziguang, He Ren, Li Furen, Li

Jiren, Li Zhenhua, Lu Zhizheng, Qiu Peiran, Xu Jingfan, Yan Dexin, Zhang Jingren,

Zhang Xuewen, Zhou Zhongying, Zhu Liangchun) The experience involved in lung

cancer, stomach cancer, esophageal cancer, bowel cancer, liver cancer, pancreatic

cancer, intracranial tumors, breast cancer, lymphoma, leukemia, kidney cancer and other

malignant tumors in various systems, in the hope that it can provide clinical diagnosis

and treatment of malignant tumors in Chinese medicine Reference.

The classic medical records column of this issue of the journal is also about tumor

cases. This article discusses his tumor treatment ideas through 3 cases of Professor Wang

Yanhui's treatment of tumors. In his long-term clinical experience, Professor Wang

vividly referred to the process of tumor treatment as "soil modification". In the entire

tumor treatment process, the treatment of Chinese medicine is not concerned with the

tumor itself, but the "soil" of the tumor. If the "soil" is not suitable for the germination

and growth of "seeds", tumors will not occur.

The famous doctor on the cover of this issue is Mr. Xi Yin. He is an expert in

hematology. Like Ge Youwen who prescribes Qingfei Paidu Decoction, he is littleknown, but he is a rare Chinese medicine practitioner in this era. He is a traditional

Chinese medicine practitioner, but he does not stick to stereotypes. He integrates

the benevolence of doctors into clinical practice, and he perfectly combines modern

technology with traditional Chinese medicine. Without the support of any capital, he

has overcome the difficulties in the treatment of leukemia clinically and obtained the

corresponding national patent. Our cover character introduced him because he is a

powerful faction who speaks with "real effect".

In the Specilits column, we launched the teachers Chen Yuanwei and Zhang

Jinbo. Chen Yuanwei never said that he would inherit and innovate traditional Chinese

medicine. His inheritance and innovation of traditional Chinese medicine are entirely

self-conscious of life. There is no relevant organization to commend him, but he is

deeply loved by patients at home and abroad. His mother's teaching of "the heart of

love" allowed him to settle down, establish a career, and establish real effects in clinical

practice. He achieved himself and blessed others.

There are many wonderful things in this issue. For example, we have newly opened

the "Secrets of Chinese Medicine" and "Acupuncture and Moxibustion" columns,

which have strong guiding significance for the clinical practice of Chinese medicine.

For example, Teacher Dongyi Cao reflected on the new crown plague. Many wonderful

things will not be repeated here. May it be beneficial to you.

August 7, 2020 Shenzhen

第5页

2020/02Ⅰ

3

疗效让中医药事业未来可期 ◎李善举

截至2020年8月7日,新冠疫情在海外依然没有停止的迹象。据相关媒体数据显示,中国之外的新冠病

毒感染数据累计确诊19195631例,较昨日新增274439例。而在中国,从春节时期的武汉疫情,到6月下旬北

京丰台新发地疫情,再到7月下旬大连的疫情,都被及时有效地遏制。

面对新冠疫情,西医界一致认为没有特效药。而中国之所以能够成功遏制疫情,极大程度上是因为中

医药的参与。据《人民日报》报道,武汉抗疫时,医疗全系统及时推广应用“清肺排毒汤”为代表的有效

方药,覆盖新冠病毒医学观察期、轻型、普通型、重型、危重型、恢复期诊疗全过程,形成了具有中医药

特色的治疗模式。有效降低了发病率、转重率、病亡率,提高了治愈率,加快了恢复期康复。而北京7月份

治愈出院的130例确诊病例中,中医参与救治率为100%。《中国中医药报》报道,大连新冠肺炎治疗中医

药使用率也达到100%。疗效让我们看见,中医药是中华民族的瑰宝;疗效还让我们看见,中医药事业未来

可期——因为中医药不仅抗击新冠疫情有效,其在治疗形形色色的现代疾病时依然能够妙手回春。

本期杂志大病临床栏目的关键词是肿瘤,也就是人们所说的癌症。在今天的民众中,肿瘤已经像感冒

一样具有普遍性。中医治疗肿瘤有着十分丰富的经验。国医大师是当代中医的楷模,对他们治疗肿瘤临床

经验的总结和分析,十分有助于临床借鉴。《首届国医大师治疗恶性肿瘤经验分析》一文总结了14位国医

大师(邓铁涛、郭子光、何任、李辅仁、李济仁、李振华、路志正、裘沛然、徐景藩、颜德馨、张镜人、

张学文、周仲瑛、朱良春)的临床经验,涉及肺癌、胃癌、食管癌、肠癌、肝癌、胰腺癌、颅内肿瘤、乳

腺癌、淋巴癌、白血病、肾癌等各个系统的恶性肿瘤,以期能够为中医临床辨治恶性肿瘤提供参考。

本刊“经典医案”栏目也是关于肿瘤的临床案例。通过王彦晖教授治疗肿瘤的3则验案,来探讨其治疗

肿瘤的思路。在长期的临床实践中,王教授把肿瘤治疗的过程形象地称之为“土壤改造”。在整个肿瘤的

治疗过程中,中医药关注的不是肿瘤本身,而是肿瘤的“土壤”。如果“土壤”不适合“种子”的萌芽生

长,肿瘤就不会发生。

这一期的封面名医是由玺印老师,他是血液病专家,像开出清肺排毒汤的葛又文一样,名不见经传,

却是这个时代少有的中医大家。他是传统中医人,却不墨守陈规,把医者仁心融入临床实践,让现代科技

与传统中医完美结合。在没有任何资本的支持下,在临床上攻克白血病治疗难关,取得了相应的国家专

利。我们的封面人物之所以推出他,是因为他是用“疗效”说话的实力派。

在杏林英才栏目中,本期推出的是陈远维和张金波老师。陈远维很少宣扬自己在中医药继承和创新方

面的贡献,他对中医药热爱,完全是生命的自觉。没有相关机构对他进行表彰,但是他深得海内外患者的

厚爱。母亲对他以“割股之心”的典故进行教导,让他临床时以疗效安身、立业、立德,既成就了自己,

也福泽了他人。张金波的慕名求医者遍布海内外,在中医院工作的他,门诊挂号、预约的人往往排号到凌

晨十二点,甚至有的人在前一天的下午来等号,临床疗效让他拥有巨大的社会影响力。

本期杂志还有很多精彩:新开的“中药之秘”和“针灸实战”栏目,对中医临床实践有很强的指导意

义;另外,曹东义老师还对新冠疫情进行了诸多反思……精彩不在这里一一赘述。愿君开卷有益。

2020年8月7日深圳

Foreword 卷首语

第6页

临床名医

Clinic Specialist

August 2020,N°2

学术专家委员会(按姓氏笔画排序)

王道坤 甘肃中医药大学教授

刘方柏 四川省乐山市名中医

刘保延 世界针灸学会联合会主席

李赛美 广州中医药大学教授

陈其广 中国社会科学院中医药国情调研组组长

傅延龄 北京中医药大学教授

张金波 山东省烟台市中医医院

编辑部地址 147, 270 3 Ave NE, Calgary,AB, T2A 2L5 Canada

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Clinic Specialists

Super Nature Solutions Ltd.

Clinic Specialists

August 2020 The second issue

Liye Zhao

Dongyi Cao

Shanju Li

Lijun Cao

Xiang Ruan

Peter Zhao

Yonghong Yuan

Peter Zhao

Kemin Li

Zhixiang Wang

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临床名医

Super Nature Solutions Ltd.

《临床名医》杂志社

2020年8月第二期

赵立业

曹东义

李善举

曹丽君

阮湘

Peter Zhao

原永红

Peter Zhao

李克敏

王志翔

Academic Expert Committee (sorted by surname strokes):

Daokun Wang Professor of Gansu University of Traditional Chinese Medicine

Fangbai Liu a famous Chinese medicine doctor in Leshan City, Sichuan Province

Baoyan Liu Chairman of the World Federation of Acupuncture and Moxibustion Societies

Saimei Li Professor, Guangzhou University of Traditional Chinese Medicine

Qiguang Chen Team Leader, Chinese Medicine Research Group, Chinese Academy of Social Sciences

Yanling Fu Professor, Beijing University of Chinese Medicine

Zhang jumbo Yantai Traditional Chinese Medicine Hospital, Shandong Province

Editorial Office Address 147, 270 3 Ave NE, Calgary, AB, T2A 2L5 Canada

Editorial Department Phone 403-703-0120

Pricing RMB:30元 CAD:5元

Submission email qihuangchuanren@foxmail.com

第7页

目录Ⅰcontents

Foreword|卷首语

01 Satisfactory effect makes the future of Chinese medicine profession promising ◎Li Shanju

03 疗效让中医药事业未来可期 ◎李善举

Intractable diseases| 大病临床

06 Discussing the application of high dosage of astragalus in the treatment of malignant tumors

◎Jia Yingjie

10 论重剂黄芪在恶性肿瘤治疗中的运用 ◎贾英杰

12 The Experience Analysis of the First Master of Traditional Chinese Medicine Doctor in Treating

Malignant Tumor. ◎Author: Tian Hu and Tian SiSheng

16 首届国医大师治疗恶性肿瘤经验分析 ◎田虎 田思胜

Classic medical cases record|经典医案

19 Discussion on Wang Yanhui's thoughts on treating tumors based on 3 cases ◎Wang Yujie Xi Shengyan

Wang Yanhui

25 基于验案3则探讨王彦晖治疗肿瘤的思路◎王玉洁 奚胜艳 王彦晖

The secret of Chinese herbal medicine application|中药之秘

29 Analysis of the Clinical Dosage of Astragalus in Past Dynasties ◎Zhang Lin Lin Yiqun Fu Yanling

35 历代黄芪临床用量分析 ◎张林 林轶群 傅延龄

Clinical practice of acupuncture treatment|针炙实战

39 Thirty Patients with Apoplexy and Aphasia Treated with Tongue Three Needles◎Li Xiangli Cai

Jingzhou Jiang Ganghui

43 舌三针治疗中风失语症30例 ◎李湘力 蔡敬宙 江钢辉

45 One of the series of acupuncture treatment of neuropathic pain: diabetic foot◎ Zhao Liye

48 针灸治疗神经性疼痛系列之糖尿病足◎赵立业

Experiences of clinical masters |名家心得

50 Thoughtson the New Coronavirus Plague. ◎ caodongyi yizhe/zhangfengrong chensirong

54 曹东义:新冠瘟疫的反思 ◎曹东义 译者/张枫戎 陈思蓉

56 与肿瘤博弈的策略与智慧 ◎王振华

Cover clinical specialists | 封面名医

60 Unknown cause treatment equals neither prevent nor reduce the deterioration of the health of an

individual ◎Li Shan Ju

65 由玺印:不知病因的治疗等于杀人 ◎李善举

Outstanding medical experts|杏林英才

69 Chen Yuanwei, doctors must have a benevolent heart ◎Li Shanju

73 陈远维:医家要有“割股之心” ◎李善举

76 Zhang Jinbo, Chinese medicine has the effect of "covering the cup" in treating insomnia ◎Li Shanju

79 张金波:中医治失眠有“覆杯”之效 ◎李善举

第8页

6 Ⅰ2020/02

临床名医|Clinic Specialist

Discussing the application of high dosage

of astragalus in the treatment of malignant

tumors

◎Jia Yingjie

Astragalus was first published in "Shen Nong's

Materia Medica": Astragalus is sweet, warm and non-toxic.

The main treatment is carbuncle and prolonged sepsis, pus

drainage and pain relief, epilepsy, five hemorrhoids and rat

fistula. Tonic deficiency, children are all sick. Astragalus

has always been respected and reused by doctors of the

past dynasties. The author prefers to use heavy doses of

astragalus for clinical treatment, and only heavy doses can

cure serious illnesses. Now I will share some experience of

using heavy doses of astragalus for treatment of malignant

tumors with colleagues.

1. Tumor patients with weak constitution

"Materia Medica Seeking Truth" pointed out:

"Astragalus is the longest of all Qi-tonifying medicines, so

it is known as senile." "Yixue Zhongzhong canxilu" said:

"Astragalus can replenish qi, and can also raise qi, good at

treating chest atmosphere Sinking-chest tightness", it can

be seen that tonifying Qi is not better than astragalus.

Malignant tumor is a malignant wasting disease. The

author summarizes its basic pathogenesis as "the internal

deficiency of Vital qi, coexistence of poison and blood

stasis". The so-called "the place where the Vital Qi is

weak is the place where the evil is left." The lack of Vital

Qi is the root of the disease. It is common for patients to

have symptoms of qi deficiency and weakness, especially

those who have received radiotherapy, chemotherapy, and

surgery or advanced patients. The clinical manifestations

are mostly shortness of breath, fatigue, and weak pulse.

For such patients, Astragalus is often the leader in the

clinic, and the black box theory is used in the dose to ask

Abstract: The author has been engaged in the clinical work of traditional Chinese medicine for malignant tumors

for more than 30 years. I regard astragalus as a gemstone for the incursions, and I have a deep understanding of the

exact effect of "heavy dosage of astragalus" in the treatment of malignant tumors. Therefore, the specific application

of heavy dosage of astragalus in physical weakness, hand-foot syndrome, refractory oral ulcers after chemotherapy

and long-term non healing of wounds after tumor surgery will be introduced, and the application characteristics of

astragalus in compatibility and dosage will be discussed based on clinical experience.

Keywords :Astragalus; Heavy dose; Tumor

第9页

2020/02Ⅰ 7

for directions. Initially, 30 g is used as an exploratory

medication, and then gradually increased to 60 g, 90 g,

and up to 120 g according to the condition of the patient.

While using a heavy dose of Astragalus to replenish

qi, it is not forgotten to nourish the root of its growth.

Tang Zonghai said in "Blood Syndrome" that Qi, water

and hormones are the family: "The Qi that covers the

human body is born in the sea of Qi under the dantian.

The kidney and bladder under the umbilicus, the place

where the water belongs... steaming its water, Turning into

qi, like the Kan Gua of "Yi", a yang is born in the water

and is the root of growth", so increasing water can benefit

qi. Therefore, the author often "seeking yang in the yin"

during the clinical treatment. While using the heavy dose

of Astragalus to replenish the deficiency, combined with

yin-nourishing genera such as Shengmaisan, Shengdi,

Dendrobium, etc., the source of vitality is endless, and

the weak body can gradually recover. When encountering

patients with deficiency, extreme leanness and thinness,

Huangqi Shengmai San is the basic prescription, and good

results are obtained.

A s t r a g a l u s i s b e t t e r t h a n t o n i c . M o d e r n

pharmacological studies have proved that it has anti-tumor

effects. It can be described as strengthening the body

and anti-cancer, killing two birds with one stone. The

so-called dispelling evils does not hurt the Vital qi, and

strengthening the Vital qi without keeping the evils, this is

what Huangqi is also called.

2. Hand-foot syndrome

Hand-foot syndrome is also called palm extension

sensory loss erythema. The clinical manifestations are

mainly heat, pain, erythematous swelling of the fingers/

toes. In severe cases, it can develop to desquamation,

ulcers and severe pain, which affect daily life. A variety

of chemotherapeutic drugs and molecular targeted drugs

can cause hand-foot syndrome. The oral chemotherapeutic

Xeloda is the most serious, which has attracted people's

attention.

Hand-foot syndrome belongs to the category of "Bi

syndrome" in Chinese medicine. The author believes that

the fundamental pathogenesis of hand-foot syndrome

caused by chemotherapy is "Qi deficiency and blood

stasis". After chemotherapy, the poison hits the spleen

and stomach, and the spleen and stomach are damaged.

Stagnation, the muscles and veins are lost in nourishment,

resulting in skin numbness and dullness.

The treatment of hand-foot syndrome with heavydose astragalus is mainly affected by Huangqi Guizhi

Wuwu Decoction and Buyang Huanwu Decoction. "The

Synopsis of the Golden Chamber" Huangqi Guizhi Wuwu

Decoction was originally designed for "blood arthralgia",

and "Yilin Gaicuo" Buyang Huanwu Decoction was

originally designed for "hemiplegia", but the pathogenesis

is "qi deficiency and blood stasis" ", the two prescriptions

are both heavy-dose, using Astragalus as the king herbal

medicine to warm and invigorate qi. When the author

treats hand-foot syndrome, the commonly used amount

of Astragalus is 60 ~ 120 g, and then take Astragalus

and Guizhi Wuwu Decoction to reconcile the method of

Yingwei and Buyang Huanwu Decoction for promoting

blood circulation and dredging collaterals. The prescription

is often supplemented by a large amount of Qi herbal

medicine. With a small amount of products for promoting

blood circulation and channeling, reconciling Yingwei,

vigorous qi will lead to blood circulation, activating

blood without hurting Vital Qi, and play the power of

tonifying qi, activating blood and dredging collaterals.

The numbness that does not heal for many years will be

combined with insect medicine on the basis of reusing

astragalus, such as the whole scorpion, centipede, and

viper. "Su Wen·Tai Yin Yang Ming Lun": "All limbs are

endowed with qi function in the stomach, but cannot reach

Intractable diseases| 大病临床|

第10页

8 Ⅰ2020/02

临床名医|Clinic Specialist

the meridian. It must be due to poor spleen Qi. Exuberant

Spleen Qi is the result of endowment", which means that

the spleen governs the limbs. The author focuses on the

spleen and stomach in the clinic. The selected Huangqi

Guizhi Wuwu Decoction has the function of sweetening

and warming, and the heavy dosage of Astragalus will

promote the vitality of the energy and middle jiao to act qi

and blood generation, improve the blood circulation for

nourish four limbs so that numbness of hands and feet can

be healed.

3. Intractable oral ulcers after chemotherapy

Chemotherapy is one of the main treatments for

malignant tumors. While chemotherapeutic drugs kill

tumor cells and increase the cure rate of malignant tumors,

they also affect the proliferation of normal cells such as

the hematopoietic system and gastrointestinal mucosal

epithelial cells. Among them, oral ulcers are called

"aphthous" in Chinese medicine, which is chemotherapy

for malignant tumors. One of the most common

complications.

Oral ulcers have recurring attacks, which are difficult

to heal over the years, and even may involve the vulva

and eyes. When a doctor sees oral ulcers, he will say that

there is a fire, and use the three yellow genus herbs to

directly break it down, but they will not see the spleen

and stomach damage, and the ulcer will be worse day by

day. As everyone knows, this fire is a "deficiency fire",

which treatment has no effect and hurts the stomach.

"Jingyue Quanshu" said: "Those who do not heal the oral

sore for years, this is also a deficiency fire." This disease

is closely related to the weakened immune function, and

is similar to Behçet's syndrome in Western medicine,

that is, "Fox disease" in Chinese medicine. The author

believes that this is mostly caused by the deficiency of

both qi and yin. The treatment is divided into the attack

period and the remission period. The attack period can

treat both the symptoms and the root cause. Adopting dual

measures simultaneously is commonly used. Astragalus

30 ~ 60 g, Rehmannia glutinosa 30 g, Coptis 10 g, Lotus

seed heart 12 g are beneficial Qi nourishes yin, cleans

toxin and promotes muscle and clears heart and fire. In

the remission period, the main treatment is to fix the

root cause. The author often uses Astragalus to replenish

qi and nourish yin, and cooperate with the method of

strengthening the spleen and stomach to improve Middle

Jiao Qi. So why worry about the recurrence of ulcers? In

short, when treating patients with intractable oral ulcers

第11页

2020/02Ⅰ 9

after chemotherapy, no matter what happens During the

attack period or the remission period, Astragalus is used

to replenish qi and nourish yin. During the attack period, it

can also clear the heart and fire, and during the remission

period, it can strengthen the spleen and stomach. "The

Synopsis of the Golden Chamber" advocates the use

of licorice Xiexin Decoction, and the heavy dosage of

licorice to replenish vital energy. Whether it is astragalus

or licorice, modern research shows that both can improve

human immunity.

4. The wound does not heal for a long time

after tumor operation

Many patients with malignant tumors suffer

from deficiency of Qi and blood, and long-term nonhealing of wounds after operation is one of the common

symptoms. Chen Ziming's "Surgery Mirror" believes:

"If the treatment of carbuncle is incompatible for a long

time, the flesh is white and the pus is small. The blood

is deficient and cannot circulate, and the sore is cold and

astringent." Li Dongyuan emphasized that "ulcers belong

to both Qi and blood deficiency , We must use the method

of replenishment." Chen Shiduo’s "Act of the Heaven and

Earth" emphasizes that the yin syndrome sore and ulcer

are especially urgent to use the method of replenishment.

The modern physician Zhao Bingnan pointed out that

the long-term non-healing of yin sores was mainly due

to insufficient blood. It can be seen that deficiency of qi

and blood is the primary cause of long-term non-healing

of wounds. The author believes that detoxification and

growth of muscle, nourishing blood and promoting blood

circulation are the main methods of treating this disease.

Astragalus is a traditional medicine for sores, which is

good at curing "long-term sepsis and ulcer". I often use

60-90 g of Astragalus as the main herbal medicine for

detoxification and muscle growth, and 20g of Angelica for

nourishing and promoting blood circulation.

For those with clear and white wounds exudate,

they often cooperate with Wandai Decoction to invigorate

the spleen and invigorate qi, and promote yang and

dehumidification. Wandai Decoction is from "Fu Qingzhu

Nvke", which was originally designed to treat spleen

deficiency. The author takes its function to promote

Yang and dehumidification. Once the dampness is gone,

the meridians will be smooth, and a little yang will help

Astragalus to exert its detoxification growth Muscle

power. He Shaoqi once said: "Ulcer, I don't know, but

I know that "poisoners need to be eliminated". This is

thought-provoking.

The author believes that oral ulcers are not healed

over the years and wounds are not healed for a long time,

both of which are manifestations of the body's vitality Qi

sinking on the body surface. Astragalus is good at treating

problems on the surface, and it is good at detoxifying

and regenerating muscles, healing sores, and using a

heavy dose of Astragalus. "Yiqi Decoction" promotes

the discharge of the poison in skin and muscles, so that

the "skin" and "mucosa" can heal. The author regards

Astragalus as a treasure in the clinic, and when using it

drastically, it starts every 30 g and gradually increases to

60 g and 90 g to 120 g.

Astragalus is a unique traditional Chinese medicine

in the treatment of malignant tumors. Malignant tumors

belong to the category of "accumulation" in traditional

Chinese medicine. Large accumulations and large gather

should be treated with heavy doses, otherwise it will be of

no avail.

(This article was originally published in the Chinese

Journal of Basic Science of Traditional Chinese Medicine,

author unit: The First Affiliated Hospital of Tianjin

University of Traditional Chinese Medicine)

References (omitted)

Intractable diseases| 大病临床|

第12页

10 Ⅰ2020/02

临床名医|Clinic Specialist

论重剂黄芪在恶性肿瘤治疗中的运用

◎贾英杰

据《神农本草经》记载: “黄芪味甘,微温,无

毒。主痈疽久败疮,排脓止痛,大风癫疾,五痔鼠

瘘。补虚,小儿百病。”黄芪一直为历代医家所推崇

和重用。笔者临证喜用重剂黄芪,非重剂不足以撼重

病,现将临证运用重剂黄芪治疗恶性肿瘤的些许体会

与同道共享。

1.体虚的肿瘤患者

《本草求真》指出: “黄芪为补气诸药之长,是

以有耆之称。”《医学衷中参西录》言: “黄芪,能

补气,兼能升气,善治胸中大气下陷。”可见补气莫

过于黄芪。

恶性肿瘤属于恶性消耗性疾病,笔者将其基本

病机概括为“正气内虚,毒瘀并存”。所谓“正虚之

处,便是留邪之所”,正气亏虚是发病的根本。患者

常见一派气虚羸弱之象,尤其是接受放疗、化疗和手

术治疗的患者或者晚期患者,临床多表现为气短、乏

力、脉弱等虚候。针对此类患者临证时常以黄芪挂帅

为君,在剂量上运用黑箱原理以投石问路,初用30g

为试探性用药,然后根据病情反馈,渐加至 60g、90

g,多至120g。

在用重剂黄芪补气的同时,不忘滋其生化之根

源。唐宗海在《血证论》中言气、水本一家: “盖人

身之气,生于脐下丹田气海之中。脐下者肾与膀胱,

水所归宿之地……蒸其水,使化为气,如《易》之坎

卦,一阳生于水中,而为生气之根。”故补水可生

气。因此笔者临证时常于“阴中求阳”,在用重剂黄

芪补虚的同时,伍以生脉散、生地、石斛等养阴之

属,使生气之源泉不绝,羸弱之躯可日渐复元。每遇

虚极羸瘦之患者,多以黄芪生脉散为基础方,收到良

效。

黄芪长于补虚,现代药理研究证明其具有抗肿

瘤作用,可谓扶正抗癌,一举两得。正所谓祛邪不伤

正,扶正不留邪,此实乃黄芪之谓也。

2.手足综合征

手足综合征又称为掌拓感觉丧失性红斑,临床主

要表现为指/趾的热、痛、红斑性肿胀,严重者可发展

至脱屑、溃疡和剧烈疼痛而影响日常生活。多种化疗

药物及分子靶向药物可导致手足综合征,以口服化疗

药希罗达最为严重,这些反应引起人们的高度重视。

手足综合征属于中医“痹症”范畴。笔者认为,

化疗致手足综合征的根本病机为“气虚血瘀”,化疗

后药毒直中脾胃,脾胃一损气血生化乏源,阴血不

足,脉道空虚,营卫失和,血行滞涩,筋脉失于濡

养,导致肌肤麻木、感觉迟钝。

摘要:笔者从事恶性肿瘤的中医临床工作已30余载,视黄芪一药为起沉疴之瑰宝,深刻体会到“重剂黄

芪”在恶性肿瘤治疗中的确切疗效。故将介绍重剂黄芪在体虚、手足综合征、化疗后顽固性口腔溃疡和肿瘤术

后创口久不愈合方面的具体应用,并结合临床经验探讨黄芪在配伍和剂量上的应用特色。

关键词:黄芪; 重剂; 肿瘤

第13页

2020/02Ⅰ 11

运用重剂黄芪治疗手足综合征主要是受黄芪桂

枝五物汤和补阳还五汤的启发。《金匮要略》黄芪桂

枝五物汤本为“血痹”而设,《医林改错》补阳还五

汤本为“半身不遂”而设,然论病机则均属“气虚血

瘀”,两方均重用黄芪为君以甘温补气。笔者在治疗

手足综合征时,黄芪常用量为60~120g,再取黄芪桂

枝五物汤调和营卫之法与补阳还五汤活血通络之用,

方中每每大量补气药中佐以少量活血通脉、调和营卫

之品,气旺则血行,活血而又不伤正,共奏补气活血

通络之功。麻木经年不愈者则在重用黄芪的基础上配

合动物药,如全蝎、蜈蚣、蕲蛇之属每每奏效。《素

问·太阴阳明论》曰:“四肢皆禀气于胃,而不得至

经,必因于脾,乃得禀也。”即脾主四肢之意也。笔

者临证重脾胃,所选黄芪桂枝五物汤有甘温建中之功

用,且又重用黄芪,则中焦健运、气血生化有源,加

之活血通脉之法,由是则四末得以濡养,手足麻木可

愈。

3.化疗后顽固性口腔溃疡

化疗是恶性肿瘤的主要治法之一。化疗药物在杀

伤肿瘤细胞、提高恶性肿瘤治愈率的同时,对增殖旺

盛的正常细胞如造血系统、胃肠黏膜上皮细胞等均有

影响,其中口腔溃疡中医称之为“口疮”,是恶性肿

瘤化疗最常见的合并症之一。

口腔溃疡反复发作,经年难愈,甚者可累及外

阴及眼部。有医者见口腔溃疡便言有火,用三黄之属

直折之,然徒见脾胃损伤,溃疡一日甚于一日。殊不

知此火乃“虚火”,直折无功,反伤胃气。《景岳全

书》曰: “口疮连年不愈者,此虚火也。”本病与免

疫功能低下密切相关,类似于西医的白塞氏综合征,

即中医的“狐惑病”。笔者认为此多由气阴两虚所

致,治疗上分为发作期和缓解期,发作期标本兼治,

双管齐下,常用黄芪 30~60g,生地黄30g,黄连10 g,

莲子心12g益气养阴、托毒生肌,兼清心火。缓解期

治本为主,笔者常用黄芪、生地黄以益气养阴,配合

健脾和胃之法以运中土,如此何虑溃疡再起? 总之,

在治疗化疗后顽固性口腔溃疡患者时,无论发作期还

是缓解期均重用黄芪、生地黄以益气养阴,发作期兼

清心火,缓解期则健运脾胃。《金匮要略》提倡用甘

草泻心汤,重用甘草以益气补中。无论黄芪也好,甘

草也罢,现代研究表明二者均能提高人体免疫力。

4.肿瘤术后创口久不愈合

恶性肿瘤患者多气血亏虚,术后创口久不愈合是

常见症之一。陈自明《外科宝鉴》认为:“治痈久不

合者,其肉白而脓少者,此气血具虚,不能潮运,而

疮口冷涩也。”李东垣强调:“溃疡属气血俱虚,固

在所当补。”陈士铎《洞天奥旨》强调:“阴证疮疡

尤以大补为急。”

近代医家赵炳南提出阴疮久不愈合,主要是因为

气血不足。由此可见,气血亏虚是创口久不愈合的首

要原因。笔者认为脱毒生肌、养血活血为治疗本病的

大法。黄芪是传统疮药,善治“久败疮”,笔者常用

黄芪60~90g托毒生肌为君,当归20g养血活血为臣。

对于创口渗液清稀色白者常配合完带汤,以健

脾益气,升阳除湿。完带汤出自《傅青主女科》,本

为治疗脾虚带下而设,笔者取其升阳除湿之功用,湿

邪一去经络得通,且微微一点阳气,有助于黄芪发挥

其托毒生肌之功。何绍奇曾说: “溃疡云云,我所不

知,我但知‘陷者升之’。”此语发人深思。

笔者认为,口腔溃疡经年不愈和创口久不愈合,

均是体内元气下陷在体表的表现,黄芪一物善于走

表,又长于托毒生肌敛疮,运用重剂黄芪实取其补中

益气汤“陷者升之”之意,使“皮肤”“黏膜”得以

愈合。笔者临证视黄芪为瑰宝,且运用时大刀阔斧,

每每30g起步,渐加至60g、90g,甚则多至120g,每

获良效。黄芪在恶性肿瘤的治疗中处于独一无二的地

位,恶性肿瘤属于中医“积”的范畴,大积大聚宜用

重剂治之,否则如隔靴搔痒,无济于事。

(本文原载于〈中国中医基础学杂志〉,作者单

位:天津中医药大学第一附属医院)

参考文献(略)

Intractable diseases| 大病临床|

第14页

12 Ⅰ2020/02

临床名医|Clinic Specialist

The Experience Analysis of the First Master

of Traditional Chinese Medicine Doctor in

Treating Malignant Tumor.

◎Author: Tian Hu and Tian SiSheng

In this article, by searching the literature on

Wanfang database, Weipu database, and China HowNet

database with the theme of "Master of Traditional

Chinese Medicine" and excluding duplicate literature

materials, this article summarizes and analyzes all the

journal literature with experience in treating malignant

tumors.A total of 14 masters of traditional Chinese

medicine doctors’ experience summary (respectively

Deng Tietao, Guo Ziguang, He Ren, Li Furen, Li Jiren,

Li Zhenhua, Lu Zhizheng, Qiu Peiran, Xu Jingfan, Yan

Dexin, Zhang Jingren, Zhang Xuewen, Zhou Zhongying,

Zhu Liangchun) involved in the treatment of malignant

tumors. There are 231 documents, involving malignant

tumors of various systems such as lung cancer, gastric

cancer, esophageal cancer, bowel cancer, liver cancer,

pancreatic cancer, intracranial tumors, breast cancer,

lymphoma, leukemia, kidney cancer, etc. The theoretical

characteristics are analyzed as follows.

1 Emphasize the importance of deficiency of

Vital Qi in tumor pathogenesis.

Pathogenesis is the mechanism of the occurrence,

development and change of diseases in Chinese medicine,

and is the theoretical hypothesis for explaining and

analyzing the outcome of diseases, which can effectively

guide the clinical practice of Chinese medicine.Regarding

the etiology and pathogenesis of malignant tumors,

masters of traditional Chinese medicine generally

believe that the lack of Vital Qi is the internal basis

for the occurrence and metastasis of the disease.In "Su

Wen · Comment on Fever", it is said: "If evil is taken

together, its vital Qi must be weak."<<Su Wen>> said:

"The righteous qi is inside, and evil cannot be done."

<<Lingshu>> said: "Void and evil are deep in the body,

cold and heat fight each other, staying for a long time, but

Abstract: Masters of traditional Chinese medicine doctors are role models of contemporary Chinese medicine.

Summarizing and analyzing their clinical experience will greatly inherit and promote traditional Chinese medicine. The

article aims to summarize and analyze the experience of the first master of traditional Chinese medicine doctors in the

treatment of malignant tumors, with a view to discovering the characteristics of traditional Chinese medicine treatment

of malignant tumors, and provide guidance for the clinical differentiation of malignant tumors in traditional Chinese

medicine.

Keywords: master of traditional Chinese medicine doctors, malignant tumor, experience analysis.

第15页

2020/02Ⅰ 13

inward... Evil is in the middle and does not reverse. For

muscle tumor... intestinal tumor... past tumor, press it with

your hand."Each master has his own different theoretical

interpretations of this theory. Professor Deng Tietao’s

"Phlegm and Blood Stasis Related Theory" believes that

phlegm is the primary stage of blood stasis, and blood

stasis is the further development of phlegm turbidity.

Phlegm and blood stasis are both pathogenic factors and

pathological products.Professor He Ren believes that

the occurrence of cancer is a manifestation of a serious

deficiency of Vital Qi. Professor Li Furen believes that

urinary system tumors belong to the "deficiency of the

essence", which means that the five internal organs are

weak in qi-transformation function."Biaoshi" refers

to damp turbidity, soaking and stagnation, forming a

"tumor", of which the original deficiency is the root.

Professor Lu Zhizheng believes that the main pathological

feature of malignant tumors is the deficiency of Vital

Qi and the excess of evil.Xu Jingfan, an veteran TCM

doctor in the diagnosis and treatment of gastrointestinal

tumors, emphasized the deficiency of qi and stagnation

of qi, and obstruction of phlegm and blood stasis is the

key to the pathogenesis. Zhang Jingren, an old Chinese

doctor, believes that the pathogenesis of multiple

myeloma is the deficiency of liver and kidney qi and yin,

and the target of external evils, phlegm and blood stasis

blocking the collaterals. Zhu Liangchun believes that the

occurrence of tumors is the result of the combined effects

of internal and external factors. Deficiency of Vital Qi

is an important internal cause of tumor occurrence and

development. Insufficient Vital Qi and Qi deficiency and

blood can lead to dysfunction of viscera, qi stagnation,

blood stasis, toxins, dampness and accumulation. A series

of pathological changes, such as sputum coagulation and

mutual aggregation, eventually form tumors.Professor

Zhou Zhongying first proposed the theory of "cancer

toxins cause disease", which is an innovation of TCM

tumor theory. Cancer toxin is caused by the dysfunction

of the internal and external factors of the body, which

ultimately leads to the occurrence and development of

malignant tumors. It is a specific pathological product

and pathogenic factor, and is compatible with phlegm,

blood stasis, dampness, heat and other diseases. A

poisonous evil that metabolizes and can cement each

other. Zhou Lao's theory of "cancer toxin" can explain

the characteristics of malignant tumors with rapid onset

and rapid metastasis, and provide theoretical guidance for

the clinical application of anticancer and detoxification

Chinese medicines.

In summary, it is not difficult to see that the tumor

pathogenesis theory of each system, whether it is the

"phlegm and blood stasis theory" or the "cancer toxicity

theory", is based on the deficiency of Vital qi. Vital qi

is the qi of the whole body, which has the function of

maintaining the normal physiological functions of the

human body. Exogenous pathogenic pathogenic qi,

internal injury diet, emotional internal injury, etc. will

affect the operation of righteous qi. The onset of tumors

does not occur overnight, but a long-term loss of Vital

Qi and the accumulation of pathogenic factors, which

gradually form cancer stasis and develop into tumors.

Based on this, it can be inferred: The prevention of

tumor is in daily life and eating habits. As the "Huangdi

Neijing·" says: "Vulture evil and thief wind, avoid it for

a time, calm emptiness, follow it with true qi, keep the

spirit inward, and keep the disease off for safety." Have a

regular life and don't work rashly."

2 Emphasize the combination of disease

differentiation and syndrome differentiation.

The incidence of malignant tumors is related to

the deficiency of Vital Qi, and the malignant tumors of

each site have their own characteristics. Therefore, in the

clinical treatment of malignant tumors, the masters of

Chinese medicine emphasize the combination of disease

Intractable diseases| 大病临床|

第16页

14 Ⅰ2020/02

临床名医|Clinic Specialist

differentiation and syndrome differentiation. On the basis

of syndrome differentiation and treatment, combined

with the onset and transformation characteristics of

tumors at various locations, treatment is often achieved

with good results.Deng Tietao believes that the treatment

of removing phlegm and blood stasis can treat various

stages of lung cancer; the early treatment of breast cancer

is mainly based on stagnation of qi and phlegm and

coagulation. In the middle and late stages, deficiency of

qi and phlegm and stasis are more common. Activating

blood circulation and removing blood stasis throughout

the treatment process; for the treatment of esophageal

cancer, the pathogenesis of yin deficiency and heat

formation, phlegm and blood stasis internal resistance

should be grasped. Li Jiren believes that syndrome

differentiation and disease differentiation have their own

characteristics in tumor diagnosis and treatment, and they

should be combined to give full play to their advantages.

Zhou Zhongying emphasized that in the process of

gastric cancer treatment, attention should be paid to the

relative stability of gastric cancer patients' syndromes and

the duality of evolution and transformation, so that the

medicines can be changed according to the syndromes,

and corresponding treatment methods and prescriptions

should be given according to the changes of the disease

syndromes. This embodies Zhou Lao’s clinical thinking

of combining syndrome differentiation with disease

differentiation.Zhu Liangchun pointed out incisively that

syndrome differentiation and treatment are the essence of

traditional Chinese medicine, as well as a key factor for

effective treatment, as well as the advantage of traditional

Chinese medicine in treating tumors.In the treatment of

tumors in traditional Chinese medicine, we should pay

attention to the differentiation of symptoms and signs, and

grasp the body’s yin and yang imbalance and the state

of struggle between evil and Vital Qi. At the same time,

with the help of modern medical diagnosis technology,

digestive tract tumors include squamous cell carcinoma,

adenocarcinoma, tubular adenocarcinoma, and marrow.

Differentiated adenocarcinoma, diffuse adenocarcinoma,

mucinous adenocarcinoma, well-differentiated, poorly

differentiated, etc. These modern diagnosis knowledge

can know the evolution, development, and outcome of

the disease, but it cannot guide TCM to differentiate

and treat. Therefore, it is necessary to distinguish

between Combination of disease differentiation. Disease

differentiation and treatment is to grasp the disease at

the overall level of disease occurrence and development,

and syndrome differentiation and treatment is to grasp

the disease at a certain stage of disease development.

Only by combining disease differentiation and treatment

with syndrome differentiation can the disease be grasped

objectively and systematically, while achieving the best

therapeutic effect.

3 Emphasize the integration of Chinese and

Western medicine.

Any medicine has its advantages and limitations, and

Chinese medicine and Western medicine are no exception.

For the treatment of malignant tumors, the advantage of

traditional Chinese medicine is to support Vital Qi and

increase physical strength, and the advantage of western

medicine is to suppress cancer and fight cancer. The

advantages of the two medicines must be fully considered

and combined to achieve the desired therapeutic effect.

Professor He Ren pointed out that in the diagnosis and

treatment of tumors, a comprehensive approach combining

Chinese and Western medicine should be adopted to give

full play to their respective advantages. In the process of

tumor treatment, Zhu Liangchun has always advocated the

principle of combining Chinese and Western medicine.

Zhu Lao pointed out that after surgery, combined

with traditional Chinese medicine in radiotherapy and

chemotherapy can increase efficacy and reduce toxicity,

and effectively control tumor recurrence and metastasis.

第17页

2020/02Ⅰ 15

Intractable diseases| 大病临床|

At the same time, there are data reports: The following

cancer cells in tumor patients cannot be removed by

radiotherapy, chemotherapy and surgery. These cancer

cells may metastasize within 5 years. At this level of

cancer cells, the use of Chinese medicine can adjust the

human body Autoimmune function enables it to suppress

and kill cancer cells.

From the viewpoint of the masters of traditional

Chinese medicine on the integration of Chinese and

Western medicine, it is not difficult to find that the

combination of Chinese and Western medicine is a

combination of Chinese and Western medicine treatment

methods, not a combination of Chinese and Western

medicine theories. It is the theory of Chinese medicine

and Western medicine that treat diseases according to their

respective understanding theories.

4 Emphasize the combination of reducinging

evil Qi and increasing Vital Qi.

At present, it is generally believed that malignant

tumors are a long-term disease. During the process

of disease occurrence, development, metastasis, and

recurrence, there is always the problem of fighting

between evil Qi and Vital Qi. How to deal with the

relationship between attacking evil and strengthening

the Vital Qi will greatly affect The therapeutic effect

of malignant tumors. Li Jiren, an old Chinese doctor,

believes that the treatment of tumors should be combined

with strengthening the body and eliminating pathogens.

Supporting is the premise and foundation. On the basis of

strengthening the Vital Qi, the essence of tumor treatment

can be grasped in a timely and appropriate manner. He

Ren emphasized that TCM treatment should follow the

12-character rule of "continuously strengthening the

body, eliminating evils Qi at the right time, and treating

according to symptoms". Zhou Zhongying believes that

the anti-cancer and detoxification method is the basic

treatment principle for the treatment of tumors, but it is

necessary to pay attention to the physical condition. In the

process of the ups and downs of the Vital Qi and evil Qi,

it is necessary to choose the right amount, and use the right

amount of tonic to strengthen the body's immune function

to help the evil to go out. Combination of reducing evil Qi

and strengthening the body Vital Qi is a broad concept,

including the combination of traditional Chinese medicine

for promoting blood circulation and removing blood stasis,

clearing heat and dispelling stagnation, promoting qi and

stagnation, nourishing qi and nourishing blood, warming

the kidney and promoting yang, invigorating the spleen

and stomach, as well as modern medical radiotherapy and

chemotherapy Combination of treatment and maintenance

treatment of Chinese medicine. It should be used flexibly

in clinical practice, and should be used in a timely

manner, so as to avoid the occurrence of "deficiency and

excess being mixed" errors. Malignant tumors are a major

problem in the medical field today. Traditional Chinese

medicine has its unique advantages in treating malignant

tumors.

Masters of traditional Chinese medicine are role

models in the field of traditional Chinese medicine.

Summarizing and analyzing their experience in treating

malignant tumors is necessary for the clinical practice

of traditional Chinese medicine and the only way for

traditional Chinese medicine to be passed on. This

article analyzes and summarizes the experience of the

first masters of traditional Chinese medicine in treating

malignant tumors, hoping to provide a reference for the

clinical diagnosis and treatment of malignant tumors in

Chinese medicine.

(Author's unit: Shandong University of Traditional

Chinese Medicine, School of Management, Shandong

University of Traditional Chinese Medicine)

第18页

16 Ⅰ2020/02

临床名医|Clinic Specialist

首届国医大师治疗恶性肿瘤经验分析

◎田虎 田思胜

本文通过对万方数据库、维普数据库、中国知

网数据库采用以“国医大师姓名”为主题进行文献搜

索,并剔除重复文献资料后,将所有辨治恶性肿瘤经

验的期刊文献进行总结、分析。首届国医大师经验

总结共有14位( 分别为邓铁涛、郭子光、何任、李辅

仁、李济仁、李振华、路志正、裘沛然、徐景藩、颜

德馨、张镜人、张学文、周仲瑛、朱良春) 涉及恶性

肿瘤的治疗,共有文献 231 篇,涉及肺癌、胃癌、食

管癌、肠癌、肝癌、胰腺癌、颅内肿瘤、乳腺癌、淋

巴癌、白血病、肾癌等各个系统的恶性肿瘤,其理论

特色分析如下。

1 强调正气亏虚在肿瘤发病中的重要性

病机是中医学研究疾病发生、发展、变化的机

理,是阐释和分析疾病转归的理论假说,能够有效指

导中医临床。关于恶性肿瘤的病因、病机,国医大

师们普遍认为正气亏虚是疾病发生和转移的内在基

础。《素问·评热病论》中讲:“邪之所凑,其气必

虚。”《素问·刺法论》中讲:“正气存内,邪不可

干。”《灵枢·刺节真邪》中讲:“虚邪之入于身也

深,寒与热相搏,久留而内著……邪气居其间而不

反,发为筋瘤……肠瘤……昔瘤,以手按之坚”。

各个医家对于此理论又有各自不同的理论阐释。

邓铁涛教授的“痰瘀相关理论”,认为痰是瘀的初级

阶段,瘀是痰浊的进一步发展,痰瘀既是致病因素同

时也是病理产物。何任教授认为癌症的发生,是正气

亏虚严重的表现。李辅仁教授认为泌尿系肿瘤属于

“本虚标实”,“本虚”即五脏气化功能虚弱不足,

“标实”是指湿浊浸渍瘀滞,结为“肿瘤”,其中本

虚是为根本。路志正教授认为正虚邪实是恶性肿瘤的

主要病理特点,正虚导致邪实,邪实进一步加剧正

虚,形成恶性循环。徐景藩老中医辨治消化道肿瘤强

调中虚气滞,痰瘀交阻是病机关键。张镜人老中医认

为多发性骨髓瘤的病机乃肝肾气阴亏虚为本,外邪夹

痰瘀阻络为标。朱良春认为肿瘤的发生是内、外因共

同作用的结果,正虚是肿瘤发生发展的重要内因,正

气不足,气血虚弱,导致脏腑功能失调,出现气滞、

血瘀、毒邪、湿聚、痰凝互结等一系列病理变化,最

终形成肿瘤。

周仲瑛教授首次提出“癌毒致病”学说,是中

医肿瘤理论的创新。癌毒是在内外多种因素作用下,

机体发生脏腑功能失调而产生,最终导致恶性肿瘤发

生、发展,是一种特异性病理产物和致病因子,是和

痰、瘀、湿、热等病邪相互化生并能与之胶结的一种

毒邪。周老的“癌毒”理论能够很好地解释恶性肿瘤

起病暴戾、转移发展迅速的特点,并为临床运用抗癌

解毒类中药提供理论指导。

摘要: 国医大师是当代中医的楷模,对其临床经验的总结和分析,将会极大程度上继承和发扬中医中药。

文章旨在总结、分析首届国医大师治疗恶性肿瘤的经验,以期能够发掘出恶性肿瘤的中医治疗特色,为中医临

床辨治恶性肿瘤提供指导。

关键词: 国医大师;恶性肿瘤;经验分析

第19页

2020/02Ⅰ 17

综上不难看出,各个系统肿瘤发病理论,无论是

“痰瘀理论”,还是“癌毒理论”,其发生的基础均

是正气亏虚。正气即一身之气,具有维持人体正常生

理功能的作用。外感致病邪气、内伤饮食、情志内伤

等均会影响正气的运行。肿瘤的发病并非一朝一夕而

成,而是长时间的正气亏耗、致病因素日积月累的侵

犯,逐渐形成癌毒淤积,发为肿瘤。

据此可以推测: 肿瘤的预防在日常生活、饮食习

惯。正如《黄帝内经·上古天真论》中讲:“法于阴

阳,和于术数,食饮有节,起居有常,不妄作劳……

虚邪贼风,避之有时,恬淡虚无,真气从之,精神内

守,病安从来。”

2 强调辨病与辨证相结合

恶性肿瘤的发病和正气亏虚有关系,且每个部

位的恶性肿瘤又有各自的特点,故临床治疗恶性肿瘤

时,国医大师特别强调辨病和辨证相结合。在辨证论

治的基础上,结合各个部位肿瘤的发病、转变特点,

进行施治,往往取得良好疗效。

邓铁涛认为,采用除痰祛瘀为治则治疗各个时

期的肺癌;对于乳腺癌的治疗早期以气滞痰凝为主,

中晚期以正气亏虚、痰瘀互结多见,治疗以理气化

痰、活血祛瘀贯穿治疗过程; 对于食管癌的治疗要抓

住阴亏热结、痰瘀内阻这一病机,以养阴清热、除痰

祛瘀、理气和胃为基本治则。李济仁认为,辨证论治

与辨病论治在肿瘤诊治方面各有特点,应将二者结合

起来共同发挥其优势。周仲瑛强调,在胃癌治疗过程

中,应当注意胃癌病人证候的相对稳定和演变转化的

双重性,使药随证转,按其病证变化,给予相应的治

法、方药。这体现了周老辨证与辨病相结合的临证思

路。朱良春精辟地指出,辨证论治是中医学的精华,

也是治疗取效的关键因素,更是中医治疗肿瘤的优势

所在。在肿瘤的中医治疗中我们要注重辨证,从整体

把握人体的阴阳失调、邪正斗争的状态,同时借助于

现代医学的诊病技术,消化道肿瘤有鳞癌、腺癌、管

状腺癌、髓样腺癌、弥散腺癌、粘液腺癌、高分化、

低分化等之分,这些现代辨病诊断知识可知病情的演

变、发展、转归,但却不能指导中医去辨证论治,所

以必须将辨证与辨病相结合。辨病论治是在疾病发生

发展整体水平上对疾病的把握,辨证论治是在疾病发

展的某一阶段进行把握。将辨病论治和辨证论治相结

合,才能全面客观系统的对疾病进行把握,同时达到

最好的治疗效果。

3 强调中西医结合

任何一门医学均有其优势和局限性,中医学和西

医学也不例外。对于恶性肿瘤的治疗,中医学的优势

是扶助正气、增强体力,西医学的优势是抑癌抗癌,

要充分考虑并结合两种医学的优势,方能达到理想的

治疗效果。何任教授指出,肿瘤的证治,应采取中西

医结合的办法,充分发挥各自的优势。在肿瘤的治疗

过程中,朱良春一贯提倡中西医相结合的治疗原则。

朱老指出,在术后,放、化疗中配合中药可以增效减

毒,有效地控制肿瘤复发转移。同时有资料报道: 肿

瘤患者体内106

以下的癌细胞是放、化疗和手术无法清

除的,这些癌细胞在5年内有转移的可能,而癌细胞

在这种水平的状态下,用中药可调整人体的自身免疫

功能,使之有能力将癌细胞抑制、杀灭。

通过对国医大师中西医结合的观点,不难发现中

西结合是中西医治疗方法的结合,并非中西医理论的

结合,是中医理论和西医理论按照各自对疾病的认识

理论进行治疗。

4 强调攻邪与扶正相结合

目前普遍认为,恶性肿瘤属于一种长期消耗性

疾病,在疾病发生、发展、转移、复发等过程中,始

终存在邪正抗争的问题,如何处理好攻邪和扶正的关

系,将在很大程度上影响恶性肿瘤的治疗效果。李济

仁老中医认为对于肿瘤的治疗应予扶正与祛邪并用。

扶正是前提和基础,在扶正的基础上适时、适度祛

邪,方能把握肿瘤治疗的精髓。何任强调中医药治疗

Classic medical cases record|经典医案

第20页

18 Ⅰ2020/02

临床名医|Clinic Specialist

应遵循“不断扶正,适时祛邪,随证治之”的 12 字

法则。周仲瑛认为抗癌祛毒之法是治疗肿瘤的基本治

则,但需关注体质状况,在正邪消长的过程中需恰当

选择,适量运用扶正补益药,使机体免疫功能增强,

以助邪外出。攻邪扶正结合是一个广义的概念,既包

括中药活血化瘀、清热散结、行气通滞和补气养血、

温肾助阳、补脾和胃等相结合,也包括现代医学放化

疗治疗和中医药维持治疗相结合。临床中应灵活运

用,而且要适时运用,以免发生“虚虚实实”之误。

恶性肿瘤是当今医学界的一大难题,中医中药治疗恶

性肿瘤具有其独有的优势。

国医大师是中医界的楷模,对其治疗恶性肿瘤的

经验进行总结和分析,是中医临床所必需的,也是中

医传承的必经之路。本文通过对首届国医大师治疗恶

性肿瘤的经验进行分析总结,以期能够为中医临床辨

治恶性肿瘤提供参考依据。

(作者单位:山东中医药大学,山东中医药大

学管理学院)

参考文献(略)

●黄芪药用价值

性味归经:味甘,性微温;归脾、肺经。

功能主治:补气固表,托毒排脓,利尿,生肌。用于气虚乏力、久泻脱肛、自汗、水肿、子宫脱

垂、慢性肾炎蛋白尿、糖尿病、疮口久不愈合。

黄芪,中药材名。本品为豆科植物蒙古黄芪的根。春、秋季采挖,除去泥土、须根及根头,晒至

六七成干,理直扎捆后晒干。功能主治为:补气固表,托毒排脓,利尿,生肌。用于气虚乏力、久泻

脱肛、自汗、水肿、子宫脱垂、慢性肾炎蛋白尿、糖尿病、疮口久不愈合。

第21页

2020/02Ⅰ 19

Discussion on Wang Yanhui's thoughts on treating tumors based

on 3 cases

◎Wang Yujie Xi Shengyan Wang Yanhui

Professor Wang Yanhui has focused on the clinical,

teaching and scientific research of Chinese medicine for

more than 30 years, and has accumulated rich experience

in clinical diagnosis and treatment. He has profound

clinical attainments in tongue and pulse conditions, and

is good at the prevention and treatment of tumors, wet

diseases, and febrile diseases. The author is fortunate to

learn from his left and right, and now enumerate 3 clinical

treatment cases of tumors, which are beneficial to the

public.

Lung Cancer Case:

A patient, female, 69 years old. First visit on July 18,

2014. Main complaint: Found lung tumor for 2 years and

diagnosed lung cancer for more than 2 months (moderately

differentiated adenocarcinoma stage IV). History of

present illness: The patient found pulmonary spaceoccupying lesions during physical examination 2 years

ago, but did not pay attention to it, and was diagnosed as

stage IV lung cancer by systematic examination 2 months

ago. No special treatment is currently being given.Present

illness: cough, coughing, a little white sputum, occasional

chest pain, dry mouth, backache, poor appetite, difficulty

sleeping, and dreaming. Stool once in 1-2 days, dry and

thin in quality, yellow urine, and nocturia twice. The

tongue is lavender (+), and the fur is thin and greasy. The

pulse on the right sinks (+) thin (+) is empty (++), and

the left floating string is empty.Family history: His sister

had breast cancer. Western medicine diagnosis: lung

cancer. TCM diagnosis: cancer. Syndrome differentiation:

deficiency of lung and spleen qi, stagnation of Gallbladder

and phlegm disturbance, stagnation of qi and blood stasis.

Therapy: tonic the spleen and lungs, resolve phlegm

and promote movement of Gallbladder, regulate qi and

promote blood circulation. Recipe: Wendan Decoction.

Codonopsis 30g, Poria 50g, Tangerine Peel 20g, Ginger

Pinellia 50g, Curcuma 30g, Triangular 30g, Sichuan

Achyranthes 20g, Fritillaria 50g, Mountain Mushroom

20g, Stir-fried Atractylodes 12g, Albizia Peel 50g, Stirfried Jujube Seed 30g, Ginger 6g, 15g jujube, 45g raw

keel, 60g raw oyster, 20g loquat leaf, 10g roasted licorice.

Abstract: This article discusses the treatment of tumors through 3 cases of Professor Wang Yanhui's treatment of

tumors. Professor Wang Yanhui has more than 30 years of clinical diagnosis and treatment experience. He has profound

knowledge in tongue and pulse conditions. He is good at preventing and treating tumors, phlegm-dampness diseases

and febrile diseases. It is believed that in the prevention and treatment of tumors in traditional Chinese medicine, the

three basic needs of diet, sleep, and stool should be met first, and the pathogenesis of "qi" should be grasped, and

pathological products such as phlegm-dampness and blood stasis should be emphasized. Mainly, take "Yin Ping Yang

Secret" as the guiding ideology throughout diagnosis and treatment.

Keywords: TCM theory; tumor; pathogenesis; symptom combination; Yin-ping-yang secretion

Classic medical cases record|经典医案

第22页

20 Ⅰ2020/02

临床名医|Clinic Specialist

7 doses, 1 dose a day, decocted in water, 2 doses a day. On

the basis of this prescription, the treatment can be adjusted

according to the symptoms. In the second visit on July

25, 2014, the patient's symptoms resolved. The tongue

is pale (+) purple (+), and the coating is thin and white;

the right string of the pulse is thin, and the left string

(+) is thin. On the basis of the above, add 50g of Radix

Ginseng, 25g of Ganoderma lucidum, 50g of Fritillaria

Zheiensis, and 10g of Aster; change of Zedoary Turmeric

50g, Triangle 50g; 14 doses, decoct the same as before. I

came back to the clinic on October 29, 2014, and felt no

discomfort. However, according to the examination, the

tongue is purple (+) and the tip is red, and the coating is

thin and white. Pulse left string (+) thin (+), right empty

(+). Continue to treat. Also, because the patient has a

period of extreme deficiency of the right pulse, adding

Astragalus can sometimes be used up to 80g per dose.

As of December 26, 2014, the patient felt no discomfort,

with purple tongue (+) and thin white fur. The right

pulse is empty (+), and the left string (+) is thin (+). The

prescription was changed to: Codonopsis 20g, Astragalus

20g, Tangerine peel 15g, Ginger Pinellia 50g, Araceae

30g, Curcuma 50g, Triangle 50g, Chuan Achyranthes

25g, Poria 20g, Fried Atractylodes 12g, Fried Fructus

Aurantii 5g, Fritillaria 50g, Large 15g jujube, 6g ginger,

12g roasted licorice. 14 doses, the decoction method is

the same as before. Continue to replenish the spleen and

lungs, resolve phlegm, activate blood and remove blood

stasis. After treatment, the patient is in good condition.

Recipe analysis: dried tangerine peel, ginger pinellia,

flat fritillary, zhejiang fritillary, shanci mushroom, loquat

leaves, raw oysters, etc. to reduce phlegm and promote

choleretics; stir-fried jujube seed, albizia peel, raw keel,

etc. to soothe the nerves; Codonopsis, Poria, stir-fry

Atractylodes macrocephala, roasted licorice, astragalus,

Taizishen, Ganoderma lucidum, etc. nourish the spleen and

lungs; Sanleng, turmeric, Sichuan achyranthes bidentata,

etc. promote blood circulation and remove blood stasis.

Throughout the treatment process, clarify the relationship

between strengthening the body and eliminating evil, the

guiding ideology of "yin and yang balance".

Liver Cancer Case

A patient, male, 60 years old. First visit on

September 2, 2013. Main complaint: more than 1

year after liver cancer surgery. History of present

illness: The patient was diagnosed with liver cancer by

Western medicine at the end of July 2012, with a size

of 3cm×4cm, underwent surgical resection and then

interventional surgery. The patient suffers from chest and

hypochondriac pain, stools 2 to 3 times a day, loose time,

wake up early, and soreness. The tongue is pale (+) purple

(+), and the coating is white and sticky. Pulse left string

(+) sliding (+) large (+), right sliding (+). Family history:

His father had liver cancer. Western medicine diagnosis:

primary liver cancer. TCM diagnosis: cancer.TCM

syndrome differentiation: liver depression and spleen

deficiency, qi stagnation, phlegm, dampness and blood

stasis. Treatment: Soothing the liver and invigorating the

spleen, regulating qi and dissipating phlegm, promoting

blood circulation and removing blood stasis, softening the

firmness of the body. Recipe: Shenling Baizhu Powder.

Poria 30g, dried tangerine peel 15g, ginger pinellia 50g,

fried citrus aurantium 5g, fried atractylodes 15g, evodia

3g, green leaf 20g, vinegar soft-shelled turtle 30g,

Sichuan achyranthes 15g, turmeric 50g, three-sided 50g,

red peony 25g, fried white lentils 20g, Alisma 30g, fried

jujube seed 20g, Albizia julibrissin 30g, raw keel 30g,

raw oyster 60g, vinegar corydalis 25g, Chuan neem 15g,

Zhejiang fritillary 50g, white oldenlandia diffusa 20g, raw

licorice 10g. 7 doses, decocted in water, 1 dose per day.

Based on this formula, add or subtract with the disease.

At the second visit, the symptoms were relieved.

A comparison of the CT report of the third clinic on

September 13, 2013 with the previous report showed

第23页

2020/02Ⅰ 21

that a new intrahepatic tumor was found. On October 6,

2013, at the 4th clinic, I had chest pain, chest tightness,

and hypochondriac pain. The tongue is pale (+) purple

(+), and the coating is white and sticky. Pulse left string

(+), right string (+) sliding (+) thin (+). The prescription

is changed to: Codonopsis 15g, Poria 90g, Stir-fried

Atractylodes 10g, Tangerine Peel 15g, Vinegar Corydalis

30g, Albizia Julibrissin 30g, Magnolia officinalis 15g,

Evodia 3g, Ginger Pinellia 50g, Curcuma 30g, Yin

Chen 20g, Triangular 30g, Horse Money 0.3 g, Shanzi

mushroom 20g, Zhejiang fritillary 50g, fried jujube seed

20g, raw keel 50g, vinegar-made turtle shell 30g, divine

song 15g, raw oyster 60g. 14 doses, the decoction method

is the same as before. During the defensive treatment for

2 months. The 13th clinic on December 15, 2013: chest

tightness, sigh, hypochondriac pain, stomach upset. The

tongue is purple (+), the tip is red, and the fur is white and

greasy (+). Pulse left string, right string (+). On October

6th, 10g Amomum villosum, 10g of green calyx plum,

10g of Chinese neem and 30g of Alisma were prescribed.

In order to further consolidate the soothing of the liver,

regulate the qi and soothe the nerves, the sautéed jujube

seed 50g and the albizia peel 50g were once changed. The

22nd visit on March 28, 2014: I woke up early recently

and had more urine. The tongue is purple (+), and the

coating is pale yellow and greasy (+). The left string of

pulse slides and the right string slides. On the basis of the

foregoing, the prescription added 20g of Plantago Seed,

50g of Alisma, 15g of Big Abdomen, 15g of Chuan Seed,

minus Codonopsis. Clinic 24 on May 9, 2014: Recently,

CT examination reported stable condition. Interventional

therapy was performed again on July 24, 2014. By the

31st clinic on August 22, 2014: I felt short of breath,

sighed, and throbbed pain in the liver area. The tongue is

pale (+) purple (+), and the coating is white and greasy (+).

Pulse left string (+) floating (+), and string (+) thin (+).

The prescription is adjusted to: Poria 20g, Tangerine Peel

20g, Ginger Pinellia 50g, Curcuma 50g, Triangle 50g,

Sichuan Achyranthes 30g, Araceae 30g, Jiao Shenqu 20g,

Raw Keel 50g, Raw Oyster 90g, Fried Atractylodes 12g,

Fried White Lentil 25g, 30g Corydalis vinegar, 15g green

grass, 30g soft-shelled turtle shell made with vinegar, 10g

roasted licorice, 30g acacia bark, 30g Alisma, and 12g

Gastrodia. The decoction method is the same as before.

On the basis of this prescription, treatment is

performed according to the tongue, pulse and symptoms.

On September 9, 2014, interventional therapy was

performed again. It's hard to sleep. On October 22, 2014,

interventional therapy was performed again. During the

physical examination, his condition was stable. By the

62nd clinic on December 11, 2015, my tongue was purple

(+) and the coating was white and greasy. Pulse left string

(+) slide (+), right slide (+). The adjusted prescription

is: Poria 20g, Tangerine Peel 20g, Ginger Pinellia 50g,

Curcuma 50g, Triangular 50g, Sichuan Achyranthes 30g,

Araceae 30g, Shenqu 20g, Raw Keel 50g, Raw Oyster

90g, Fried Atractylodes 12, Fried White Lentil 25g,

Vinegar Corydalis 30g, Fructus sinensis 15g, Vinegar

soft-shelled turtle 30g, Roasted licorice 10g, Albizia

julibrissin 30g, Alisma 30g, Gastrodia 12g, Raw puhuang

30g, Big belly 20g, Raw coix seed 30g, Magnet 50g,

Shegan 15g, Red Flower 10g. The decoction method is

the same as before. Compared with the previous period,

it gradually increases the intensity of removing dampness

and phlegm, promoting blood circulation and removing

blood stasis, while taking into account the importance of

calming the stress, ensuring adequate sleep, and conducive

to the body's homeostasis. The follow-up treatment

is based on this formula, and the syndrome is treated

according to the changes of symptoms. Radiofrequency

ablation of intrahepatic lesions was performed on March

29, 2016. At the 74th visit on June 26, 2016, she had

discomfort in both sides, sighed with joy, and frequent

nocturia. Purple tongue (+), white and sticky coating.

Pulse left string (+) floating (+) sliding (+), right string (+)

thin. The adjusted prescription is: vinegar Corydalis 50g,

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22 Ⅰ2020/02

临床名医|Clinic Specialist

stir-fried white peony 50g, stir-fried Citrus aurantium

6g, Poria 60g, tangerine peel 15g, Sichuan achyranthes

bidentata 30g, curcuma 30g, three-sided 30g, ginger

pinellia 30g, stir-fried atractylodes 15g, acacia peel

50g, and Alisma 50g , Raw oysters 100g, raw keel 50g,

Codonopsis 50g, Fritillaria 50g, fried perilla seeds 30g,

cassia twig 8g, araceae 30g, burnt hawthorn 20g, roasted

licorice 10g. The defensive treatment is continued, and the

decoction method is the same as before. During the period,

according to the changes of the patient's tongue, pulse and

symptoms, once changed each dose of vinegar Corydalis

80g, fried white peony 80g, each dose added 50g of green

stone, 30g of raw coix seed, and 10g of Chuanmeizi. As of

August 17, 2016, 15 interventions have been performed.

The patient has been treated with Chinese medicine at the

same time and has a good quality of life.

Note: In the recipe, Codonopsis, Poria, Fried

Atractylodes, Fried White Lentils, etc. to invigorate the

spleen and nourish qi, Fried White Peony, Fried Fructus

Aurantii, Albizia Peel, Chuan Neem, etc. Soothes the

liver and regulates Qi, Tangerine Peel, Ginger Pinellia,

Fritillaria, Raw Oysters , Zhe Fritillaria, Shan Ci

Mushroom, Vinegar-made Soft-shelled Turtles, etc.

to reduce phlegm, soften firmness and disperse knots;

Triangular, Curcuma turmeric promotes qi and bloodbreaking; Blue stone, raw keel, magnet and other

important towns soothe the stress.

Ovarian Cancer Case

A patient, female, 61 years old. First visit on May

25, 2016. Main complaint: 2 years after ovarian cancer,

cancer metastasis was found for 1 month. History of

present illness: The patient presented with an abdominal

mass in April 2014 and was diagnosed with stage Ⅱc

of ovarian cancer, followed by surgery and 8 courses of

chemotherapy. It was found that CA199 and CA125 were

elevated 8 months ago. PET-CT showed that: partly 1

month ago The peritoneum and mesentery are thickened,

and metabolism is increased. Considering tumor metastasis

with peritoneal effusion, 2 courses of chemotherapy have

been given. Engrave: Fatigue, dry mouth, occasional chest

tightness, flustered, occasional expectoration, stomach

discomfort, anorexia, sleep soundly, bowel movements

every day, medium quality, urinary regulation. The tongue

is pale (++) purple (+), and the coating is thick yellow (+)

greasy. Pulse left empty (+) string (+) thin (+), right string

(+) thin (+) deep. Family history: His father had stomach

cancer. Western medicine diagnosis: postoperative ovarian

cancer with metastasis. TCM diagnosis: cancer, tumour.

Syndrome differentiation: spleen and kidney yang

deficiency, qi stagnation and phlegm stasis. Recipe: Fuzi

Lizhong Decoction. Codonopsis 15g, cooked aconite

6g, scutellaria baicalensis 12g, dried ginger 6g, ginger

pinellia 15g, poria 60g, araceae 15g, curcuma 20g, fried

atractylodes 30g, fried raspberry 30g, ginger magnolia

20g, fried aurantium 10g, raw keel 50g, albizia bark 50g,

20g burnt hawthorn, 80g raw oysters, 10g cassia twigs, 30g

corydalis made from vinegar. 7 doses, decocted in water,

1 dose per day. Based on this prescription, chemotherapy

is performed at the same time during treatment, and the

medication is added or subtracted according to various

symptoms after chemotherapy. 3rd consultation on July

27, 2016: morning nausea, excessive white phlegm,

backaches and sweats, difficulty sleeping, decreased

platelets, anemia, easy awakening, poor bowel motility,

soft stools, aversion to cold, and fever. The tongue is pale

(+) purple (+), and the coating is white and sticky. Pulse

left string (+), right thin (++). Adjust the prescription

and take the prescription in the morning: Astragalus 30g,

Codonopsis 10g, Scutellaria baicalensis 12g, Dried ginger

8g, Ginger Pinellia 15g, Poria 30g, Tangerine peel 15g,

Fried Atractylodes 45g, Ginger Magnolia 15g, Fried

Fructus Aurantii 6g, Chuan Achyranthes 20g, Agrimony

20g, Bupleurum 12g, White Peony 15g, Roasted Licorice

12g, Magnet 50g; Evening prescription: Codonopsis 20g,

第25页

2020/02Ⅰ 23

Scutellaria 12g, Ginger Pinellia 15g, Albizia Julibrissin

50g, Stir-fried Atractylodes 45g, Stir-fried Jujube Seed

50g, Baiziren 30g, Polygonatum 10g, Qingzhu Stone 50g,

magnet 50g, Danshen 30g, Poria 25g, Stir-fried Citrus

aurantium 6g, Tangerine peel 15g, Mother-of-pearl 50g,

Ginger officinalis 20g, Night vine 30g, vinegar Corydalis

45g, Roasted licorice 10g. Take 5 doses for each side,

decoct in water, and take half a dose for each side each

day. The fourth consultation on August 10, 2016: The

patient's complaints were greatly reduced. After treatment,

based on the changes in the patient’s tongue, pulse, and

symptoms, once every dose of Astragalus in the morning

prescription was used 50g, and the prescription at night

increased the types and doses of the prescriptions for

tranquilizing the nerves. Clinic 7 on September 21, 2016:

There was pain in the liver area, and CA199 was elevated.

I have no obvious discomfort, my tongue is pale (+) purple

(+), and the coating is white and sticky. Pulse left string

(+) virtual (+), right virtual (+). Adjust the prescription

and take it in the morning: Astragalus 25g, Codonopsis

10g, Scutellaria 12g, Dried Ginger 8g, Ginger Pinellia

20g, Poria 30g, Tangerine Peel 15g, Fried Atractylodes

45g, Ginger Magnolia 15g, Fried Fructus Aurantii 6g,

Chuan Achyranthes 20g, Agrimonia 20g, Bupleurum 12g,

fried white peony 15g, roasted licorice 12g, magnet 50g,

eucommia 20g, cassia twig 10g, zedoary 30g, three-sided

30g, araceae 20g, fried perilla 30g, single life 10g; evening

prescription: Codonopsis 25g, Scutellaria 12g, ginger

pinellia 20g, albizia bark 50g, fried atractylodes 45g, fried

jujube seed 50g, cypress kernel 30g, polygonatum 10g,

blue stone 50g, magnet 50g, salvia 30g, poria cocos 25g,

fried orange peel 6g, tangerine peel 15g, mother-of-pearl

50g, 20g ginger magnolia, 30g Yejiao vine, 45g corydalis

vinegar, 10g roasted licorice, 30g zedoary turmeric, 30g

three-row, 20g araceae, 15g eucommia, 30g flat fritillary.

The usage is the same as above. After treatment, the

patient has a good quality of life.

Analysis: Prescriptions of Codonopsis, Astragalus,

Poria, Stir-fried Atractylodes, Zhigancao, Guizhi,

Bupleurum, Agrimonia, etc. to invigorate the spleen

Yang; Tangerine peel, Ginger Pinellia, Triangle, Zedoary,

Stir-fried Perilla Seed, Ping Fritillaria Huatan Ruan Jian

San Knot; raw white peony root, albizia julibrissin peel,

fried jujube seed, fried citrus aurantium, ginger magnolia,

vinegar-made Corydalis, salvia, etc. to soothe the stress

and relieve pain; calm shen such as mother-of-pearl,

magnets, and blue stone to soothe the stress; hawthorn,

fried raspberry, etc. Regulate qi; invigorate the kidney

and replenish essence such as Baiziren, Huangjing, and

Eucommia.

Discussion on Tumor Treatment:

Based on the diagnosis and treatment characteristics

of the above three tumor treatments, several thoughts of

Professor Wang Yanhui in the treatment of tumors can be

preliminarily explored.

1. First focus on the three basic needs of patients:

Diet, sleep and urine and stool are the three basic needs

of the human body. The current health habit of "like to

replenish but hate to reduce " is misleading, and it often

causes contemporary people to get sick not because of

"deficiency" but because of excessive calorie intake.

Regardless of the symptom, it is advisable to treat the

patients first and emergency treatment. One of the reasons

is that the fullness of the liquid is difficult to enter, the

medicine and food are not available, and the acquired

source of failure is gastric failure. For the treatment

of gastrointestinal tumors, in addition to conventional

Western medical treatment, there is another feature that

must be emphasized, that is, it is necessary to pay full

attention to adjusting the diet, which is one of the key

factors in the prevention and treatment of cancer in this

system.

2. Mainly grasp the pathogenesis of "Qi" All human

beings are only qi and blood, and all physiological

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24 Ⅰ2020/02

临床名医|Clinic Specialist

activities in the human body are based on the activities of

the qi mechanism and the process of qi transformation.

Disorders of qi transformation include deficiency of Vital

qi and excess of evil qi. The pathogenesis of "qi" often

includes deficiency of qi, stagnation of qi, inversion of

qi, and depression of qi. Therefore, the treatment focuses

on regulating "qi". In summary, it mainly includes two

aspects: qi supplement (Vital qi) and Qi regulation (less

evil qi) . To invigorate qi is to replenish lung qi, spleen

qi, and kidney qi when the viscera has a deficiency of

qi. In short, it is to make the body's Vital qi sufficient.

Qi regulation includes the conditioning of various forms

of pathogenesis such as stagnation of qi, qi inversion, qi

depression, and qi dysfunction. Among them, except for

some qi depression caused by qi deficiency, qi inversion

and qi dysfunction are mostly caused by qi stagnation.

Developed on the basis of, so Qi stagnation is common

and also a primary pathological product. Generally

speaking, the pathogenesis of "qi" is mainly grasped, and

it can be said that the relationship between strengthening

the body and eliminating evil is grasped.

3. Pay attention to pathological products such as

phlegm dampness and blood stasis Professor Wang

believes that cancer is essentially empirical. Phlegm

turbidity and blood stasis run through the entire course

of the cancer. In the pathogenesis of cancer, phlegm and

blood stasis are relatively unchanged. The pathological

mechanisms of Qi stagnation, cold and heat, lung

deficiency, spleen deficiency, and kidney deficiency are

variable.

4. Focus on the combination of image-puzzle and

symptom based on the differentiation of symptoms and

signs. The characteristic of TCM dialectical thinking is

image thinking based on image thinking and supplemented

by logical thinking. Evidence is an understanding of

the overall state of life from the perspective of system

function, which is the image of the overall state of life

activity. Each different "image-puzzle " has its own

vision and blind spots. At the same time, thinking in

images has the characteristics of vagueness. In the process

of syndrome differentiation and treatment in TCM,

coupled with the symptoms of the body, it can be quickly

differentiated and treated. It is a precise treatment process

from qualitative to quantitative.

5. Taking "Yin Ping Yang Secret-Yin Yang

Balance" as the guiding ideology throughout diagnosis

and treatment, one of the core ideas of Professor Wang's

diagnosis and treatment of tumors is to restore the body's

self-regulation ability through the intervention of Chinese

medicine to achieve a "Yin Ping Yang secret-Yin Yang

balance" status. Professor Wang believes that "yin and

yang secret-yin and yang balance" is a philosophical

expression of health and can be used as the guiding

ideology for long-term clinical diagnosis and treatment.

In his long-term clinical experience, Professor

Wang vividly referred to the process of tumor treatment as

"soil modification". In the entire tumor treatment process,

the treatment of Chinese medicine is not concerned with

the tumor itself, but the "soil" of the tumor. If the "soil"

is not suitable for the germination and growth of "seeds",

tumors will not occur. In a sense, grasping the state of the

human body, carrying out correct "soil modification", and

implementing the idea of "yin and yang secret-yin and

yang balance" are of great significance to the prevention

and treatment of tumors in Chinese medicine.

(This article was originally published in the Chinese

Journal of Traditional Chinese Medicine in January 2019,

and was deleted when it was published. Author unit:

Department of Traditional Chinese Medicine, School of

Medicine, Xiamen University, Xiamen Key Laboratory

of Dampness and Neuroimmunity of Traditional Chinese

Medicine)

第27页

2020/02Ⅰ 25

基于验案3则探讨王彦晖治疗肿瘤的思路

◎王玉洁 奚胜艳 王彦晖

王彦晖教授30余年来专注于中医临床、教学和科

研,积累了丰富的临床诊疗经验,在舌象和脉象上的

临证造诣颇深,擅长肿瘤、湿病、温病等的防治。笔

者有幸随其左右学习,现列举其临床治疗肿瘤病案3

则,以飨同道。

肺癌病案

患者某,女,69岁。2014年7月18日初诊。主

诉:发现肺部占位2年,确诊肺癌2月余(中分化腺癌

Ⅳ期)。

现病史:患者2年前体检时发现肺部占位性病

变,未予重视,2月前系统检查确诊为肺癌Ⅳ期,

目前未予特殊治疗。刻下:咳嗽,阵咳,少许白

痰,偶胸痛,口干,腰酸,纳差,难寐,多梦。大

便1-2天一行,质时干时稀,小便黄,夜尿2次。舌

淡紫(+),苔薄白腻。脉右沉弦(+)细(+)虚

(++),左浮弦虚。家族史:其妹妹曾患乳腺癌。西

医诊断:肺癌。

中医诊断:癌病。辨证:肺脾气虚、胆郁痰扰、

气滞血瘀。

治则:补益脾肺、化痰利胆、理气活血。方药:

温胆汤加减。党参30g,茯苓50g,陈皮20g,姜半夏

50g,莪术30g,三棱30g,川牛膝20g,平贝母50g,

山慈菇20g,炒白术12g,合欢皮50g,炒酸枣仁30g,

生姜6g,大枣15g,生龙骨45g,生牡蛎60g,枇杷叶

20g,炙甘草10g。7剂,每日1剂,水煎,每日2服。

以该方为基础,随症加减治疗。2014年7月25日二

诊,患者诸症缓解。舌淡(+)紫(+),苔薄白;脉

右弦细,左弦(+)细。在上方基础上加太子参50g,

灵芝25g,浙贝母50g,紫菀10g;改莪术50g,三棱

50g;14剂,煎服同前。到2014年10月29日再来诊,

自觉无不适。但根据诊查,舌紫(+)尖红,苔薄

白。脉左弦(+)细(+),右虚(+)。继续施治。

又因患者有一段右脉极虚,加入黄芪有时可用到每

剂80g。至2014年12月26日,患者自觉无不适,舌紫

(+),苔薄白。脉右虚(+),左弦(+)细(+)。

处方变更为:党参20g,黄芪20g,陈皮15g,姜

半夏50g,制天南星30g,莪术50g,三棱50g,川牛膝

25g,茯苓20g,炒白术12g,炒枳壳5g,平贝母50g,

大枣15g,生姜6g,炙甘草12g。14剂,煎服法同前。

继续补益脾肺、化痰、活血祛瘀。一直治疗至今,患

者状态良好。

按:陈皮、姜半夏、平贝母、浙贝母、山慈菇、

枇杷叶、生牡蛎等化痰利胆;炒酸枣仁、合欢皮、生

龙骨等理气重镇安神;党参、茯苓、炒白术、炙甘

草、黄芪、太子参、灵芝等补益脾肺;三棱、莪术、

川牛膝等活血化瘀。在整个治疗过程中,理清扶正与

摘要:文章通过3则王彦晖教授治疗肿瘤的验案,探讨其治疗肿瘤的思路。王彦晖教授具有30余年的临床

诊疗经验,在舌象和脉象上的造诣颇深,擅长肿瘤、湿病和温病等防治。认为在肿瘤的中医药防治中,首先应

该满足饮食、睡眠、二便的三大基本需求,主要抓住“气”的病机,重视痰湿、瘀血等病理产物,以象、症结

合辨证为主,把“阴平阳秘”作为贯穿诊疗的指导思想。

关键词:中医理论;肿瘤;病机;象症结合;阴平阳秘

Classic medical cases record|经典医案

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26 Ⅰ2020/02

临床名医|Clinic Specialist

祛邪之间的关系,始终灌输“阴平阳秘”的指导思

想。

肝癌病案

患者某,男,60岁。2013年9月2日初诊。主诉:

肝癌手术后1年余。

现病史:患者于2012年7月底经西医检查诊断为

肝癌,大小3cm×4cm,行手术切除,后又行介入手

术。现胸胁痛,大便每日2到3次,时溏,早醒,吞

酸。舌淡(+)紫(+),苔白黏腻。脉左弦(+)滑

(+)大(+),右滑(+)。家族史:其父亲曾患肝

癌。西医诊断:原发性肝癌。

中医诊断:癌病。中医辨证:肝郁脾虚、气滞痰

湿血瘀。

治法:疏肝健脾、理气化痰、活血祛瘀、软坚

散结。方药:参苓白术散化裁。茯苓30g,陈皮15g,

姜半夏50g,炒枳壳5g,炒白术15g,吴茱萸3g,茵

陈20g,醋制鳖甲30g,川牛膝15g,莪术50g,三棱

50g,赤芍25g,炒白扁豆20g,泽泻30g,炒酸枣仁

20g,合欢皮30g,生龙骨30g,生牡蛎60g,醋延胡索

25g,川楝子15g,浙贝母50g,白花蛇舌草20g,生甘

草10g。7剂,水煎服,每日1剂。以此方为基础,随

症加减。第2诊即诉症状缓解。2013年9月13日第3诊

CT报告与此前报告对比显示发现新的肝内占位。2013

年10月6日第4诊,时胸部抽痛,胸闷,胁痛。舌淡

(+)紫(+),苔白黏。脉左弦(+),右弦(+)滑

(+)细(+)。

处方变更为:党参15g,茯苓90g,炒白术10g,

陈皮15g,醋延胡索30g,合欢皮30g,厚朴15g,吴茱

萸3g,姜半夏50g,莪术30g,茵陈20g,三棱30g,马

钱子0.3g,山慈菇20g,浙贝母50g,炒酸枣仁20g,

生龙骨50g,醋制鳖甲30g,神曲15g,生牡蛎60g。14

剂,煎服法同前。期间守方治疗2个月。2013年12月

15日第13诊:胸闷叹息,胁痛,胃不适。舌紫(+)

尖红,苔白腻厚(+)。脉左弦,右弦(+)。10月

6日处方加砂仁10g,绿萼梅10g,川楝子10g,泽泻

30g。为进一步巩固疏肝理气安神,一度改每剂炒酸

枣仁50g,合欢皮50g。2014年3月28日第22诊:近日

早醒,尿多。舌紫(+),苔淡黄腻厚(+)。脉左弦

滑右滑。处方在前述基础上加用每剂车前子20g,泽

泻50g,大腹皮15g,川楝子15g,减去党参。2014年

5月9日第24诊:近日CT检查报告病情稳定。2014年7

月24日又行介入治疗。到2014年8月22日第31诊:时

觉气短,叹息,肝区抽痛。舌淡(+)紫(+),苔

白腻厚(+)。脉左弦(+)浮(+),又弦(+)细

(+)。

处方调整为:茯苓20g,陈皮20g,姜半夏50g,

莪术50g,三棱50g,川牛膝30g,制天南星30g,焦神

曲20g,生龙骨50g,生牡蛎90g,炒白术12g,炒白扁

豆25g,醋延胡索30g,茵陈15g,醋制鳖甲30g,炙甘

草10g,合欢皮30g,泽泻30g,天麻12g。煎服法同

前。

在此方基础上,随着舌象、脉象和症状辨证施

治。2014年9月9日,再次行介入治疗。时难入寐。

2014年10月22日,又一次行介入治疗。期间体检病

情稳定。到2015年12月11日第62诊,舌紫(+),苔

白腻。脉左弦(+)滑(+),右滑(+)。调整处方

为:茯苓20g,陈皮20g,姜半夏50g,莪术50g,三棱

50g,川牛膝30g,制天南星30g,神曲20g,生龙骨

第29页

2020/02Ⅰ 27

50g,生牡蛎90g,炒白术12,炒白扁豆25g,醋延胡

索30g,茵陈15g,醋制鳖甲30g,炙甘草10g,合欢皮

30g,泽泻30g,天麻12g,生蒲黄30g,大腹皮20g,

生薏苡仁30g,磁石50g,射干15g,红花10g。煎服法

同前。相较前期逐渐加重祛湿化痰,活血化瘀的力

度,同时兼顾重镇安神,保证睡眠充足,利于机体自

稳态。后续治疗以此为基础方,随象与症的变化辨证

治疗。2016年3月29日行肝内病灶射频消融术。2016

年6月26日第74诊,双胁不适,喜叹息,夜尿频。舌

紫(+),苔白黏。脉左弦(+)浮(+)滑(+),

右弦(+)细。调整处方为:醋延胡索50g,炒白芍

50g,炒枳壳6g,茯苓60g,陈皮15g,川牛膝30g,莪

术30g,三棱30g,姜半夏30g,炒白术15g,合欢皮

50g,泽泻50g,生牡蛎100g,生龙骨50g,党参50g,

平贝母50g,炒紫苏子30g,桂枝8g,制天南星30g,

焦山楂20g,炙甘草10g。持续守方治疗,煎服法同

前。期间根据患者舌象、脉象及症状之改变,一度

改每剂醋延胡索80g,炒白芍80g,每剂另加青礞石

50g,生薏苡仁30g,川楝子10g。截止2016年8月17日

为止,共行15次介入治疗。患者同时中药治疗至今,

生活质量良好。

按:在方中党参、茯苓、炒白术、炒白扁豆等

健脾益气,炒白芍、炒枳壳、合欢皮、川楝子等疏肝

理气,陈皮、姜半夏、平贝母、生牡蛎、浙贝母、山

慈菇、醋制鳖甲等化痰软坚散结;三棱、莪术行气破

血;青礞石、生龙骨、磁石等重镇安神。

卵巢癌病案

患者某,女,61岁。2016年5月25日初诊。主

诉:卵巢癌术后2年,发现癌转移1月。

现病史:患者2014年4月因腹部肿块就诊,确诊

为卵巢癌Ⅱc期,后行手术及8个疗程化疗,8个月前

发现CA199及CA125升高,1个月前PET-CT示:部分

腹膜及肠系膜增厚,代谢升高,考虑肿瘤转移伴腹腔

积液,已经行2个疗程化疗。

刻下:疲乏,口干,偶胸闷心慌,偶咯痰,胃痞

不适,纳差,寐可,大便日一行,质中,小便调。舌

淡(++)紫(+),苔厚黄(+)腻。脉左虚(+)弦

(+)细(+),右弦(+)细(+)沉。家族史:其父

亲曾患胃癌。

西医诊断:卵巢癌术后伴转移。中医诊断:癌

病、癥瘕。辨证:脾肾阳虚、气滞痰瘀。方药:附子

理中汤化裁。党参15g,熟附子6g,黄芩12g,干姜

6g,姜半夏15g,茯苓60g,制天南星15g,莪术20g,

炒白术30g,炒莱菔子30g,姜厚朴20g,炒枳壳10g,

生龙骨50g,合欢皮50g,焦山楂20g,生牡蛎80g,桂

枝10g,醋制延胡索30g。7剂,水煎服,每日1剂。以

此方为基础,在治疗期间同时化疗,根据化疗后各种

症状加减用药。2016年7月27日3诊:晨起恶心,痰白

量多腰酸汗多,难入寐,血小板下降,贫血,易醒,

肠蠕动差,便软,恶寒,恶热。舌淡(+)紫(+),

苔白黏。脉左弦(+),右细(++)。

调整方药,早上服用方:黄芪30g,党参10g,黄

芩12g,干姜8g,姜半夏15g,茯苓30g,陈皮15g,炒

白术45g,姜厚朴15g,炒枳壳6g,川牛膝20g,仙鹤

草20g,柴胡12g,白芍15g,炙甘草12g,磁石50g;

晚上服用方:党参20g,黄芩12g,姜半夏15g,合欢

皮50g,炒白术45g,炒酸枣仁50g,柏子仁30g,黄精

10g,青礞石50g,磁石50g,丹参30g,茯苓25g,炒

枳壳6g,陈皮15g,珍珠母50g,姜厚朴20g,夜交藤

30g,醋制延胡索45g,炙甘草10g。两方各5剂,水煎

服,每日各方服半剂。2016年8月10日第4诊:患者

诉诸症大减。之后治疗,在此基础上根据患者的舌

象、脉象及症状的变化,一度早上方中每剂黄芪用

到50g,而晚上服用方则加大重镇安神的方药种类及

剂量。2016年9月21日第7诊:现肝区时痛,CA199升

高。余无明显不适,舌淡(+)紫(+),苔白黏腻。

脉左弦(+)虚(+),右虚(+)。

调整处方,早上服用方:黄芪25g,党参10g,

黄芩12g,干姜8g,姜半夏20g,茯苓30g,陈皮15g,

炒白术45g,姜厚朴15g,炒枳壳6g,川牛膝20g,仙

鹤草20g,柴胡12g,炒白芍15g,炙甘草12g,磁石

50g,杜仲20g,桂枝10g,莪术30g,三棱30g,制天

Classic medical cases record|经典医案

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28 Ⅰ2020/02

临床名医|Clinic Specialist

南星20g,炒紫苏子30g,独活10g;晚上服用方:党

参25g,黄芩12g,姜半夏20g,合欢皮50g,炒白术

45g,炒酸枣仁50g,柏子仁30g,黄精10g,青礞石

50g,磁石50g,丹参30g,茯苓25g,炒枳壳6g,陈皮

15g,珍珠母50g,姜厚朴20g,夜交藤30g,醋延胡

索45g,炙甘草10g,莪术30g,三棱30g,制天南星

20g,杜仲15g,平贝母30g。用法同上。一直治疗至

今,患者生活质量良好。

按:方中党参、黄芪、茯苓、炒白术、炙甘草、

桂枝、柴胡、仙鹤草等健脾升阳;陈皮、姜半夏、三

棱、莪术、炒紫苏子、平贝母化痰软坚散结;生白

芍、合欢皮、炒酸枣仁、炒枳壳、姜厚朴、醋制延胡

索、丹参等理气安神兼理气止痛;珍珠母、磁石、青

礞石等重镇安神;山楂、炒莱菔子等消食理气;柏子

仁、黄精、杜仲等补肾填精。

肿瘤治疗思路探讨

根据上述3则肿瘤治疗验案的诊疗特点,可以初

步探析出几点王彦晖教授治疗肿瘤的思路。

1. 首要注重患者三大基本需求 饮食、睡眠和二

便是人体的三大基本需求。现在“喜补恶泻”的养生

习惯误导,常常导致当代人患病不是因为“虚”,而

是因为过分摄入热量。对中满者,无论其属标属本,

都主张先治急治,原因之一即是中满者水浆难入,药

食不纳,后天之源衰竭,即是胃气衰竭。对于消化道

肿瘤的治疗,除常规西医治疗外还有一个特点须强

调,即是必须充分注重调整饮食,乃防治本系统癌症

的关键因素之一。

2. 主要抓住“气”的病机 人之所有惟气与血,

人体内所有的生理活动都是以气机活动和气化过程为

基础的。气化失常包括正气虚,邪气实。“气”的病

机常见包括气虚、气滞、气逆、气陷,因而在治疗中

注重从调理“气”入手,概括起来主要包括补气(正

气足)和理气(邪气少)两大方面。补气就是出现各

脏腑气虚的情况来补肺气、补脾气、补肾气等,总而

言之就是要使人体的正气能够充分。理气包括气滞、

气逆、气陷、气机横犯等多种形式病机出现时的调

理,其中除部分气陷由气虚所致外,气逆、气机横犯

则大多是在气滞的基础上发展而来,因此气滞是常见

的,也是初级的病理产物。总体上主要抓住了“气”

的病机,可以说就把握住了扶正与祛邪的关系。

3. 重视痰湿、瘀血等病理产物 王教授认为,癌

症本质上是实证,痰浊和瘀血贯穿于癌症病程的全过

程,在癌症的病理病机中,痰瘀是相对不变的,而气

滞、寒热、肺虚、脾虚、肾虚等病理病机则是可变

的。

4. 以象、症结合辨证为主 中医辨证思维的特点

是以形象思维为主、逻辑思维为辅的意象思维。证是

从系统功能角度对整体生命状态的一种认识,也就是

整体生命活动状态之象。各个不同的“象”具有自身

的视野和盲区。同时形象思维具有模糊性的特点,在

中医的辨证施治过程中,再加上机体的症状,便能迅

速辨证以施治,是由一个定性到定量的精准治疗过

程。

5. 把“阴平阳秘”作为贯穿诊疗的指导思想 王

教授诊疗肿瘤的一个核心思想是通过中医药的干预,

使得机体的自我调节能力恢复,达到一个“阴平阳

秘”的状态。王教授认为“阴平阳秘”是对健康的一

种哲学表述,可以把它作为长期临床诊疗的指导思

想。

在长期的临床经验中,王教授把肿瘤治疗的过

程形象地称之为“土壤改造”。在整个肿瘤的治疗过

程中,中医药的治疗关注的不是肿瘤本身,而是肿瘤

的“土壤”。如果“土壤”不适合“种子”的萌芽生

长,肿瘤就不会发生。从某种意义上说,抓住人体所

处的状态,进行正确的“土壤改造”,贯彻“阴平阳

秘”的思想,对中医肿瘤的防治具有重要意义。

(本文原载于2019年1月〈中华中医药杂志〉,

刊发时有删减。作者单位:厦门大学医学院中医系,

厦门市中医湿病与神经免疫重点实验室)

参考文献(略)

第31页

2020/02Ⅰ 29

Abstract: Objective To summarize the characteristics of the clinical dosage of Astragalus from the Han Dynasty

to the present. Methods Excel 2007 was used to establish a database of doses of Astragalus in the past dynasties. The

most representative medical works of each dynasty were selected. The name of the prescription containing Astragalus,

the total amount of Astragalus, the amount of Astragalus, the flavor of the whole prescription, the amount of water

added, and the method of administration were entered. The frequency, the most commonly used amount, the upper limit

of the commonly used amount, the lower limit of the commonly used amount, the maximum dosage, the minimum

dosage and the average dosage of Astragalus were counted, and the characteristics of the dosage of Astragalus in the

past dynasties were analyzed based on the literature. Results The dosage of Astragalus in the past dynasties fluctuated

greatly (the peak was reached in the Qing Dynasty, and the daily dosage was about 298.4 g), and the remaining dosage

was basically stable after a significant decline from Han to Song Dynasty. Conclusions High dosage of Astragalus

is generally used for muscular surface limb disease syndromes and stroke sequelae for patients with hemiplegia and

paralysis due to deficiency syndrome. When used for other diseases, the dosage may vary depending on the disease.

Keywords: Astragalus; clinical dosage; literature research

Analysis of the Clinical Dosage of Astragalus in Past Dynasties

◎Zhang Lin Lin Yiqun Fu Yanling

Astragalus is the dried root of legume Astragalus

mongolicus or Astragalus membranaceus. Excavate in

spring and autumn to remove fibrous roots and roots.

Judging from the existing literature, the earliest medicinal

records of Astragalus appear in "Shen Nong's Materia

Medica" (hereinafter referred to as "Ben Jing"). "This

Classic" lists Astragalus as the top grade: "Astragalus,

sweet, slightly warm.Main carbuncle and long-term

failure, excretion of pus and pain relief, gale and disease,

five hemorrhoids, rat fistula, tonic deficiency, all diseases

in children. One wears grits. "Producing valleys". "The

People's Republic of China Pharmacopoeia" (2010

edition, hereinafter referred to as "Pharmacopoeia") The

description of the functions and indications of Astragalus

is: "Invigorate Qi and promote Yang, strengthen the

surface and stop sweating, promote hydration and

reduce swelling, nourish body fluid, nourish blood, and

promote to remove the stagnation. Arthralgia cleans

toxins to expel pus, astringe sores and build muscle. It

is used for qi deficiency and fatigue, lack of food, loose

stools, subsidence of qi, chronic diarrhea and prolapse

of the anus, bleeding in the stool, superficial deficiency

and spontaneous sweating, qi deficiency and edema,

internal heat and thirst, blood deficiency and chlorosis,

hemiplegia, arthralgia, numbness, carbuncle intractable,

chronic ulcer Not astringent". In the clinical application of

traditional Chinese medicine, there is a difference between

raw astragalus and processed astragalus. Raw astragalus

tends to take the surface and distill water, and is longer

than solid surface to stop sweating, diuresis and swelling,

promote to remove stagnation and numbness, clean

toxins and expel pus, condense sores and build muscle,

Roasted Astragalus is astragalus that has been stir-fried

with honey. Its power of nourishing qi and nourishing

The secret of Chinese herbal medicine application|中药之秘

第32页

30 Ⅰ2020/02

临床名医|Clinic Specialist

doctor interviews from 11 Chinese hospitals in 8 provinces

and cities (autonomous regions) across the country data.

1. 2 Prescription inclusion and exclusion criteria

Include oral decoctions containing astragalus;

exclude prescriptions for oral decoctions, pills, powders,

ointments, pills, decoctions for external use, and pediatric

prescriptions with unclear flavor composition and no

dosage records.

1. 3 Research methods

Use Excel 2007 software to enter the data, enter

the prescription name, total amount of astragalus, the

amount of astragalus, the number of flavors of the whole

prescription, the amount of water, and the method of

administration one by one to establish a database of

doses of astragalus. Count the frequency of occurrence of

Astragalus, the most commonly used amount, the upper

limit of the commonly used amount, the lower limit of

the commonly used amount, the maximum dosage, the

minimum dosage, and the average dosage. The interval

value of [P25~P75] is used to indicate the usual dose

range.

Conversion standard: When entering the dose

value, it will be converted to the value of "g" according

to the weights and measures conversion table of the past

generations to facilitate later data analysis. The specific

conversion method is as follows: Han Dynasty 1 catty =

16 tael = 220 g, that is, 1 tael = 13. 8 g [3]; Tang Dynasty

1 catty = 16 taels = 220 g, that is, 1 tael = 13. 8 g; In Song

Dynasty, Jin and Yuan Dynasty, the dosage of medicinal

materials was mostly in money, 1 catty = 16 taels = 640 g,

1 tael = 10 yuan = 40 g; Ming Dynasty 1 jin = 16 taels =

596. 8 g, 1 tael is approximately 37.3 g; 1 jin in the Qing

Dynasty is now 596. 8 g, 1 tael = 37. 3 g; Modern 1 tael =

31. 25 g; contemporary 1 catty = 500 g, 1 tael = 50 g.

2 results:

2. 1 Astragalus dosage range in past dynasties

middle energy becomes stronger, and its functions of

removing the surface and diuresis are weakened. It is

longer than warming the spleen and stomach, replenishing

qi and raising yang. Because of the different effects of

growing and roasting astragalus, The dosage should be

different. The usual dosage of Astragalus given in the

Pharmacopoeia ranges from 9 to 30 g.

The following is a detailed analysis of the clinical

dosage of Astragalus in the past dynasties in combination

with relevant literature.

1 Materials and methods:

1. 1 Source of information:

This research uses the most representative and

influential medical works and data from the Han Dynasty

to the present. The specific bibliography and data sources

are as follows: Han Dynasty Zhang Zhongjing "Treatise

on Febrile and Miscellaneous Diseases"; Tang Dynasty

Wang Tao "Weitai Secrets" 》; Xu Shuwei's "Puji's

Basic Principles" in the Song Dynasty, Pang Anshi's

"Treatise on Febrile Diseases" and the "Taiping Huimin

Heji Jufang" promulgated by the Song government; Liu

Wansu's "Xuanming Lunfang" and Zhang Zihe's "Rumen

Shiqin", Li Dongyuan "Internal and External Disorder

Distinguishing Theory"; Ming Dynasty Zhang Jingyue

"Jingyue Quanshu", Wang Ji "Shishan Medical Cases", Wu

Youke "Plague Theory"; Qing Dynasty Cheng Zhongling

"Medical Insights", Fu Qingzhu "Fu Qingzhu Female

Cases "Medical Records of Ye Tianshi" by Ye Tianshi;

Modern (late Qing to 1949) Zhang Xichun, "Medical

Records of Chinese and Western References", Zhao Ehua,

"Medical Records of Cao Yingfu", Ran Xuefeng "Medical

Records of Ran Xuefeng"; Contemporary Chen Ruichun

"Chen Ruichun on Febrile Diseases " , Deng Tietao's

"Summary of Deng Tietao's Clinical Experience", Chen

Ming and other "Selected Cases of Liu Duzhou", as well

as the outpatient oral decoction prescriptions and famous

第33页

2020/02Ⅰ 31

The secret of Chinese herbal medicine application|中药之秘

It can be seen from Table 1 that the range of

commonly used doses, average doses, most commonly

used doses, and minimum doses of Astragalus in the past

dynasties did not fluctuate much. However, there was a

significant decline from the Han and Tang Dynasties to

the Song Dynasty. The changes in the other periods were

all around 10 g. The maximum dosage fluctuates greatly,

reaching 298.4 g in the Qing Dynasty.

2. 2 Characteristics of Astragalus Dosage in Han and

Tang Dynasty

It can be seen from Table 1 that the dosage range of

Astragalus in the Han and Tang Dynasties is similar and

the dosage range is narrow, but the average dosage and

commonly used dosage are the historical maximum. Zhang

Zhongjing’s "Treatise on Febrile Diseases" does not

use astragalus in the prescriptions, only Fangji Huangqi

Decoction, Aconitum Decoction, Huangqi Guizhi Wuwu

Decoction, Fangji Fuling Decoction, Astragalus Peony

and Guizhi Bitter Decoction, Guizhi plus Astragalus are

included in the "Golden Chamber Synopsis" soup. Among

the 6 prescriptions, the most commonly used daily dose of

Astragalus is 3 taels, which is about 41.4 g today, divided

into 3 doses, and the single dose is about 13. 8 g. The

maximum dosage is Huangqi Shaoyao Guizhi Bittersweet

Decoction, of which 5 taels of Astragalus, totaling about

69 g, divided into 3 doses, and the single dose is 23 g.

Since the earliest preparation method of astragalus was

steaming in the Southern Dynasty and Song Dynasty, and

the method of honey roasting was only produced in the

Song Dynasty, Zhang Zhongjing's astragalus should be

raw astragalus, and most of the prescriptions used for the

treatment of body surface disease. For example, Fangji

Huangqi Decoction treats rheumatism and Fengshui,

Huangqi Guizhi Wuwu Decoction treats blood numbness,

Fangji Fuling Decoction treats skin water, Astragalus

Peony and Guizhi Bittersweet Decoction and Guizhi plus

Huangqi Decoction treat yellow sweat. In this regard,

"Ben Cao Si Bian Lu" believes that "Astragalus Xuanying

Wei is confined, sparse and supplementary." It can be

seen that the Han Dynasty substitutes a large dose of raw

astragalus, mainly taking its effect on removing stagnation

and Bi and on antiperspiration.

The maximum dose of Astragalus in Wang Tao's

"Waitai Secret Yaofang" in the Tang Dynasty is 5 taels,

which is about 69 g today. There are 5 prescriptions in

total. Three of them originated from Zhang Zhongjing's

prescription, and the remaining two prescriptions reused

Astragalus, one to invigorate qi to drain pus, and the other

to invigorate qi to produce blood. Among them, Qianjin

Shuqi Decoction is used to treat postpartum deficiency

and heat. Although the amount of Astragalus 5 is large, it

is also used in combination with a large number of yin and

blood nourishing medicines such as 1 catty of Rehmannia

glutinosa and 2 peony, so there is no problem in using it.

2. 3 Characteristics of Astragalus Dosage in Song

Dynasty

It can be seen from Table 1 that due to the prevalence

of boiled powder in the Song Dynasty and various

reasons, the overall dosage was relatively small, but at the

same time it was also used by doctors with a large amount.

For example, in Song Dynasty Pang Anshi's "Treatise

on General Diseases of Febrile Diseases" Huangqi

Decoction contains two halves of Astragalus 2, which

is about 100 g today. Huangqi Decoction comes from

表1 历代黄芪使用频次及用量统计表(g)

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临床名医|Clinic Specialist

"Treatise on General Diseases of the Febrile·Volume

Part·Dampness Syndrome", which states that "Dampness

condition is a disease, the whole body is painful, feverish,

the body is like smoked yellow, it still cures rheumatism,

the pulse is floating, the body is heavy, sweating is bad, it

is suitable for Huangqi Soup. Two halves of Huangqi, two

halves of Fangji, one or two licorice, one and two halves

each of Atractylodes, ginger, sixteen dates. Juice, 4 liters

of water, fry to 2 liters, detox, one cup of warm drink,

long food Serve again".

This prescription is also derived from Zhang

Zhongjing Fangji Astragalus Decoction, and its indications

are derived from "The Synopsis of the Golden Chamber"

"Wet family is a disease, all of which is aching, fever,

body color is as yellow as yellow" and "rheumatism,

floating pulse, body weight, sweating, evil The wind is

the master of Fangji Huangqi Decoction. The dosage is

doubled in the same proportion as the original dosage of

Fangji Huangqi Decoction.

2. 4 Characteristics of Astragalus Dosage from Jin

Yuan to Ming Dynasty

According to Table 1, it can be seen that the dosage

of Astragalus in the Jin Yuan period and the Ming

Dynasty was low, the maximum dosage and the minimum

dosage were both low, and the dosage was kept in a

relatively low dosage range, the maximum dosage was

only about 40 g. Among them, the maximum amount

of astragalus is from Li Dongyuan's "Lanshi Secret

Store·Janxia·Miscellaneous Diseases" Danggui Buxue

Decoction. The formula uses 1 tael of Astragalus, and the

total amount is about 40 g. Because it is only used for 1

serving, the daily dose is consistent with each serving. The

amount is 40 g. "Danggui Buxue Decoction: Treats women

with muscle heat, dryness, red eyes, redness, polydipsia

and drinking, day and night, the pulse is voluminous and

empty, and there is no repressing of it. Astragalus is one

or two, Angelica is two dollars, and made of wine. Take

one serving on the upper mouth, two cups of water, fry

until one cup, remove the slag, slightly warm, and serve

empty.” From the name of the prescription, it is known

that it is designed to replenish blood, and later generations

will also interpret this prescription as a woman’s blood

deficiency and fever. square. Astragalus is 5 times the

amount of Angelica sinensis, it nourishes qi to produce

blood, and it is warm to remove heat.

The maximum dosage of Astragalus in the Ming

Dynasty was 1 tael, which is about 37. 3 g today, and a

total of 4, which are found in the prescriptions for treating

malaria in "Xianxingzhai Medical Notes" and Tuoli

Baidu Powder, and the prescriptions for taking medicine

after ulceration. "Experience Dacheng" in the treatment

of sudden fainting. Among them, the prescription for

treating malaria in "Xianxingzhai Medical Notes" and

the prescription for treating sudden fainting in "Medical

Experience Dacheng" both use astragalus and ginseng

to make stubborn diseases to recover. For example, it is

recorded in the "Xian Xing Zhai Medical Guang Notes":

"Gu Boqin suffers from malaria,...with a clear spleen

drink. More than 20 doses of malaria, the body is weak.

Zhong Chunzhi, laughed and said: This is too empty, it is

necessary to participate , I'm not wrong. I put a large dose

of ginseng and Astragalus , one or two doses. Ginseng

one or two, astragalus honey one or two, anemarrhena

honey five cents, tangerine peel two cents, dried kudzu

cents, licorice eight cents, Five coins in plaster". Tuoli

Baidu powder and medication after ulceration can be

found in the "Xian Xing Zhai Medical Notes" in the

swollen toxin chapter. Astragalus is used to take the effect

of "treating carbuncle in long-term infection, draining pus

and relieving pain".

2.5 Characteristics of Astragalus Dosage in Qing

Dynasty

It can be seen from Table 1 that the maximum

amount of Astragalus in the Qing Dynasty reached

the highest peak in history. The maximum dosage of

Astragalus in the Qing Dynasty was 8 taels, which is about

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2020/02Ⅰ 33

298.4 g today. It was found in Chen Shiduo's "Secret

Records of Shishishi": A prescription for treating bipedal

pain, lower back pain, and a prescription for treating crane

and knee wind, and Wang Qingren's <<Medical Forest

Correction

>> Huangqi Taohong Decoction.This is explained

in the "Secret Record of the Stone Chamber", saying,

"This recipe uses astragalus to replenish qi, and the reason

why the two feet can move and move, the qi can do it.

The disease of the knee problem is the lack of qi. It is

naturally difficult to walk, and if you use half a catty of

Astragalus, your qi will be very strong....If the evil qi

is gone, the Vital qi will be strengthened. The reason

why this skill is quick.As far as it is concerned, it is like

referring to the theory of "the foot receives blood and

can walk" in "Suwen·Generation of the Five Internal

Organs". Qi produces blood, and qi produces blood.

Astragalus replenishes qi through the heart to help blood

flow, and has the functions of nourishing qi and blood,

and promoting to remove stagnation and arthritis.

Chen Shiduo's prescriptions have a large amount

of Chinese medicine, which stems from his unique

understanding of the "seven prescriptions" (namely,

the size is urgent, even the odd and even complex). He

believes that “the generous one is not based on the

quantity, but on the strong. The one with strong flavor

is the big one, the one with strong taste is big, the one

with nourishing taste is big, the one with offensive taste

is big, how can you use as many medicines as generous.

There are also many kinds of herbal medicines in Chinese

medicine, but the one that cannot be said to be many is

generous, ... the meaning of generosity is large dosage in

intention, not just in the use of as many herbal medicines."

Because of his understanding of "generous", he uses more

and larger amounts in prescriptions. Huangqi Taohong

Decoction is used to treat postpartum convulsions. Wang

Qingren believes that the first symptom of convulsions is

always caused by insufficient qi, not rising, and no return.

Therefore, Huangqi is used to invigorate qi to invigorate

Yang. After giving birth, there must be opportunities for

blood loss and degassing, so Astragalus is right. If it is a

convulsion caused by febrile disease, severe heat and yin

damage, it is not advisable to use large doses of astragalus.

2. 6 Characteristics of Astragalus Dosage in Modern

Times

It can be seen from Table 1 that the dosage of

Astragalus in modern times continued the characteristics

of the Qing Dynasty. Although the common dosage and

average dosage were not like the Han and Tang Dynasties,

the maximum amount was larger, and the common dosage

and average dosage gradually increased during this

historical period.

"Deng Tietao's Clinical Experience" uses Astragalus

up to 240 g in the treatment of hemiplegia and paraplegia.

This recipe is a supplement for Buyang Huanwu

Decoction, and the re-use of Astragalus should be based

on what Wang Qingren said: "The vitality is merged to

the left and right, the illness is half-sickness, there is the

symptom of merger? In one body, you will see the various

states of qi loss. If it suddenly merges into the upper body

and cannot go down, the sick legs will become paralyzed."

Therefore, astragalus is used to replenish qi, and the qi

feet can make the legs proud. However, if astragalus

is used in this way, the cause of the disease should be

carefully examined, the pulse should be corrected, and the

medication should be used with caution.

Zhang Xichun said: "However, in Wang's book, it

is not stated how the pulse is like. If the pulse is weak

and weak, it can be seen with its prescription. If the pulse

is solid and powerful, the human brain will suffer from

congestion and the warmth of astragalus and its tonic, in

order to help its blood to go up, it will be dangerous and

immediate. This must not be careless.

Those who use high-dose drugs in modern times

must mention Li Ke. In "Li Ke's Experience in Acute,

Critical and Difficult and Difficult Diseases of Old

The secret of Chinese herbal medicine application|中药之秘

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34 Ⅰ2020/02

临床名医|Clinic Specialist

Chinese Medicine", the amount of astragalus used for

many times reached 240 g, such as "This is Qi deficiency

and fever, and the true yang gradually recovers. The

atmosphere is not full. The original prescription adds

240 g of Astragalus, 3 doses. Sixth diagnosis: Displeased

heat goes away and feels chest tightness. The lungs are

delicate organs, and the nourishment is too much, and

the hyperactivity is harmful. ,... Add 60 g of Astragalus

to replenish qi and transport blood, and the rest of the

medicine remains unchanged." Li Ke believes that

Astragalus is "peaceful in medicinal properties, and it is

difficult to perform well if it is not exceptionally reused."

It can be seen from the above medication that although its

dosage is large, it has its own measure. Astragalus 240 g is

prescribed only for 3 doses. When you see chest tightness,

you will know that it is too much tonic, and the amount

will be reduced immediately, and the amount will be

reduced again in the prescription for a long time. It shows

that there is a more important point when using large-dose

drugs, that is, adding or subtracting the amount according

to the symptoms. Therefore, drugs may have miraculous

effects in large doses, but they need to be courageous and

careful to use them freely.

In addition, it has also been reported to treat simple

obesity and deficient sores with Astragalus up to 250 g.

There are also different opinions on the different doseeffects of Astragalus. Lan Xiongfei believes that when the

amount of Astragalus is less than 15 g, blood pressure can

be increased, and more than 35 g can be reduced. Zhong

Hong believes that 5 to 10 g is required for the rising sun,

while Yang Guoying believes that it needs more than 30

g. Lan Xiongfei and Zhong Hong believe that Astragalus

less than 30 g can diuresis, and more than 30 g can

inhibit diuresis. Lei Genping believes that when diabetic

nephropathy occurs with proteinuria and edema of both

lower extremities, astragalus dosage between 90 and 120

g can significantly reduce blood sugar, diuresis, swelling,

and protein. Zhang Zhiyuan believes that in the treatment

of simple obesity, the dosage of Astragalus is about 150-

250 g. If it is less than 60 g, the effect of replenishing qi,

promoting water and removing fat is very poor. When

Astragalus is used, adverse reactions may occasionally be

seen. Lei Genping proposes 3 treatment methods: 1. Itchy

skin. It can be cured with ebony, Fangfeng and Kochia

scoparia; 2. Abdominal distension can be cured by adding

tangerine peel; 3. Hiccups can sometimes be seen with

high-dose astragalus, and can be resolved with inula,

ocher, and persimmon pedicle

3 Conclusion:

In summary, the range of commonly used dosage,

average dosage, most commonly used dosage and

minimum dosage of Astragalus in the past dynasties did

not fluctuate much, except that there was a significant

decline from the Han and Tang to Song dynasties, while

the maximum dosage fluctuated greatly, the highest in the

Qing Dynasty. Up to 298.4 g. Throughout the changes

in the dosage of Astragalus in various periods, it is used

more frequently and in a larger dosage for the treatment of

musculo-surface and limb diseases. It is also used for the

treatment of stroke sequelae with hemiplegia and paralysis

due to deficiency syndrome, while the treatment of other

diseases is based on The amount of primary and secondary

relationships such as etiology, disease nature, etc., may

vary depending on the symptoms.

(This article was originally published in the March

2015 issue of "Journal of Traditional Chinese Medicine",

author units: Beijing University of Traditional Chinese

Medicine School of Basic Medicine, Beijing University

of Traditional Chinese Medicine First Clinical School;

Beijing University of Traditional Chinese Medicine

School of Continuing Education)

第37页

2020/02Ⅰ 35

摘要:目的 总结黄芪从两汉至今的临床用量特点。 方法 采用Excel 2007建立历代黄芪剂量数据库,选取

各朝代最具代表的医学著作,录入含有黄芪方剂的方名、总药量、黄芪药量、整方药味数、加水量、服法等。

统计黄芪出现的频次、最常用量、常用量上限、常用量下限、最大用量、最小用量、平均用量,并结合文献分

析历代黄芪用量特点。 结果 黄芪历代用量规律除最大用量波动较大(清代达峰值,日服量约为298.4g)外,其余

量大致规律为汉唐至宋明显下降后基本保持稳定。 结论 黄芪用于肌表肢体病证及中风后遗症偏瘫痿痹属虚证

者一般用量较大,用于其余病证时则根据病症不同,用量或大或小,随症变化。

关键词:黄芪;临床用量;文献研究

历代黄芪临床用量分析

◎张林 林轶群 傅延龄

黄芪为豆科植物蒙古黄芪或膜荚黄芪的干燥根。

春、秋二季采挖,除去须根和根头。从现有文献看,

黄芪最早的药用记载出现在《神农本草经》(以下简称

《本经》)。《本经》列黄芪为上品,书中记载:“黄

耆,味甘,微温。主痈疽久败创,排脓止痛,大风

癞疾,五痔,鼠瘘,补虚,小儿百病。一名戴糁。

生山谷。”《中华人民共和国药典》(2010版,以下

简称《药典》)关于黄芪功能主治的记述为:“补气升

阳,固表止汗,利水消肿,生津养血,行滞通痹,托

毒排脓,敛疮生肌。用于气虚乏力,食少便溏,中气

下陷,久泻脱肛,便血崩漏,表虚自汗,气虚水肿,

内热消渴,血虚萎黄,半身不遂,痹痛麻木,痈疽难

溃,久溃不敛。”中医临床应用上有生黄芪与炙黄芪

的区别。生黄芪偏于走表而利水,长于固表止汗、利

水消肿、行滞通痹、托毒排脓、敛疮生肌。炙黄芪为

用蜂蜜拌炒过后的黄芪,其益气补中之力变强,走表

及利水的功能减弱,长于温补脾胃、补气升阳。由于

生、炙黄芪作用有异,所以在用量时宜有所区别。

《药典》给出的黄芪的常用量范围为9~30g。

以下结合相关文献详细,分析历代黄芪临床用量

规律。

1.资料与方法

1.1 资料来源

本研究以汉代至今,历代最具代表性、影响较大

的医学著作和数据资料为研究对象,具体书目及数据

来源如下:汉代张仲景 《伤寒杂病论》;唐代王焘

《外台秘要》;宋代许叔微 《普济本事方》、庞安时

《伤寒总病论》 及宋政府颁布的 《太平惠民和剂局

方》;金元时期刘完素 《宣明论方》、张子和《儒门

事亲》、李东垣《内外伤辨惑论》;明代张景岳 《景

岳全书》、汪机《石山医案》、吴又可《瘟疫论》;

清代程钟龄《医学心悟》、傅青主《傅青主女科》、

叶天士《叶天士医案大全》;近代(清末至 1949年) 张

锡纯《医学衷中参西录》、招萼华《曹颖甫医案》、

冉雪峰《冉雪峰医案》;当代陈瑞春《陈瑞春论伤

寒》、邓铁涛《邓铁涛临床经验辑要》、陈明等《刘

渡舟验案精选》以及来源于全国不同区域8 个省市(自

治区)的11家中医院的门诊内服汤剂处方及名医访谈的

相关数据。

1.2 方剂纳入及排除标准

The secret of Chinese herbal medicine application|中药之秘

第38页

36 Ⅰ2020/02

临床名医|Clinic Specialist

纳入含有黄芪的内服汤剂; 排除药味组成不明确

和没有剂量记载的内服汤剂处方,丸、散、膏、丹、

外用煎方及儿科用方。

1.3 研究方法

采用 Excel 2007 软件录入数据,将含有黄芪方剂

的方名、总药量、黄芪药量、整方药味数、加水量、

服法等逐一录入,建立历代黄芪剂量数据库。统计

黄芪出现的频次、最常用量、常用量上限、常用量下

限、最大用量、最小用量、平均用量。采用[~] 的

区间值表示常用剂量范围。

折算标准:录入剂量值时一律按历代度量衡换算

表换算成“g”的数值,以便于后期数据分析,具体换

算方法如下:汉代1斤=16两=220g,即1两=13.8g;唐代

1斤=16两=220g,即1两=13.8g;宋代金元时期药材剂

量多以钱为单位,1斤=16两=640g,1两=10钱=40g;

明代1斤=16两=596.8g,1两约为37.3g;清代1斤合

今596.8g,1两=37.3g;近代1两=31.25g;当代1斤

=500g,1两=50g。

2.结果

2.1 历代黄芪用量范围

由表 1 可以看出,黄芪历代常用量范围、平均用

量、最常用量和最小用量变化波动并不大,唯从汉唐

至宋代有较明显下降,其余各时期的变化均处于 10 g

上下的水平,而其最大用量则波动较大,最高于清代

可达 298.4 g。

2.2 汉唐时期黄芪用量特点

由表1可以看出,汉唐的黄芪用量范围相似,用

量范围较窄,但平均用量及常用量为历史最大值。张

仲景《伤寒论》方剂中未用黄芪,仅《金匮要略》中

载防己黄芪汤、乌头汤、黄芪桂枝五物汤、防己茯苓

汤、黄芪芍药桂枝苦酒汤、桂枝加黄芪汤。此6方中

黄芪最常用日服量为3两,合今约41.4g,分3次服,

单次服量约为13.8g。最大用量为黄芪芍药桂枝苦酒

汤,其中黄芪5两,合今约69g,分3次服,单次服量

为 23 g。由于黄芪最早炮制方法为南朝宋时的蒸制,

蜜炙法是在宋代才产生的,故张仲景所用黄芪应均为

生黄芪,其方所治也多为体表病证。如防己黄芪汤治

风湿、风水,黄芪桂枝五物汤治血痹,防己茯苓汤治

皮水,黄芪芍药桂枝苦酒汤和桂枝加黄芪汤治黄汗。

对此《本草思辨录》认为,“黄芪宣营卫之壅蔽,疏

表而亦补表”。可见汉代用较大剂量生黄芪,主取其

行滞通痹、固表止汗之效,其作用部位主要在卫表肌

腠。

唐代王焘《外台秘要方》中黄芪的最大剂量为5

两,合今约69g,共有5首方剂。其中3首源自张仲景

之方,剩余2方重用黄芪,一以益气排脓,一以益气

生血。其中千金蜀漆汤为治疗产后虚热,黄芪5两用

量虽大,亦是与生地黄1斤、芍药2两等大量滋阴养血

药合用,故用之亦无防碍。

2.3 宋代黄芪用量特点

由表1可以看出,此期由于宋代煮散的盛行及多

方面原因,整体用量偏小,但在同时期亦有用量颇大

的医家。如宋代庞安时《伤寒总病论》黄耆汤中黄芪

2两半,合今约100g。黄芪汤出自《伤寒总病论·卷

第三·湿证》,曰:“湿家之为病,一身疼,发热,

身如熏黄,仍治风湿,脉浮身重,汗出恶风,宜黄耆

汤。黄耆二两半,防己二两,甘草一两,白术、生姜

各一两半,枣十六个。㕮咀,水四升,煎至二升,去

滓,温饮一盏,食久再服。”

此方亦源自张仲景防己黄芪汤,其主治源自

《金匮要略》“湿家之为病,一身尽疼,发热,身色

如熏黄也”及“风湿,脉浮,身重,汗出,恶风者,

防己黄芪汤主之”。其用量为防己黄芪汤原剂量等比

表1 历代黄芪使用频次及用量统计表(g)

第39页

2020/02Ⅰ 37

例翻倍。

2.4 金元至明代时期黄芪用量特点

根据表1可以看出,金元时期和明代黄芪的用量

偏低,最大用量及最小用量均为低值,用量都保持在

一个相对较低的用量范围,最大量仅为40g左右。其

中黄芪最大用量出自李东垣《兰室秘藏·卷下·杂病

门》当归补血汤,方中黄芪用1两,合今约40g,因只

作1服,故日服量与每次服量均为40g。“当归补血

汤: 治妇人肌热,燥热,目赤面红,烦渴引饮,昼夜

不息,其脉洪大而虚,重按全无。黄芪一两,当归身

二钱,酒制。上咀,都作一服,水两盏,煎至一盏,

去渣,稍热,空心服。”从方名可知其为补血所设,

后人亦将此方解作妇人血虚发热之方。而黄芪5倍于

当归之量,补气以生血,甘温以除热。

明代黄芪的最大用量为1两,合今约37.3g,共有

4处,分别见于《先醒斋医学广笔记》中治疟之方及

托里败毒散、溃后服药之方和《医验大成》中治卒然

晕倒之方。其中《先醒斋医学广笔记》治疟之方及

《医验大成》治卒然晕倒之方均以黄芪与人参相伍,

使顽疾速瘥。如《先醒斋医学广笔记》中记载: “顾

伯钦患疟,……用清脾饮。二十余剂而疟不止,体尪

弱。仲淳至,笑曰:此虚甚,非参不可,吾徒不谬

也。投以大剂参、芪,一剂而瘥。人参一两,黄芪蜜

炙一两,知母蜜炙五钱,陈皮二钱,干葛二钱,甘草

八分,石膏五钱。”托里败毒散及溃后服药见于 《先

醒斋医学广笔记》肿毒篇中,用黄芪取其 “主痈疽久

败创,排脓止痛”之效。

2. 5 清代黄芪用量特点

由表 1 可以看到,清代黄芪的最大量达到了历史

最高峰。清代黄芪最大用量为8两,合今约298. 4g,

分别见于陈士铎《石室秘录》治两足痛、腰以下痛之

方和治鹤膝风之方,以及王清任《医林改错》 黄芪桃

红汤中。《石室秘录》中对此有解释,曰 “此方妙

在用黄芪以补气,盖两足之所以能动而举步者,气以

行之也。今鹤之病则人之气虚不能周到,行步自然艰

难,今用黄芪半斤,则气旺极矣。……邪气去则正气

自固,此功之所以速成也。若以为人不能受,畏而不

用,则反害之矣”。视其所论,似参 《素问·五脏生

成》“足受血而能步”之说。气生则血生,气行则血

行,黄芪补宗气以贯心脉助血运,起补气养血、行滞

通痹之功。

陈士铎方中药量偏大,这源于他对 “七方”( 即

大小缓急奇偶复) 的独特理解。他认为, “大方者,

非论多寡,论强大耳。方中味重者为大,味厚者为

大,味补者为大,味攻者为大,岂用药之多为大乎。

虽大方之中亦有用多者,而终不可谓多者即是大方

也,……大方之义,在用意之大,不尽在用药之多

也”。因其对 “大方”的理解,故而在组方用药时

多用量较大。黄芪桃红汤用于治疗产后抽风,王清任

认为抽风一症总由气虚不固、不升、不归所致,故重

用黄芪补气固摄升阳。既是产后,则必有失血脱气之

机,故黄芪与之正对。若为温病大热伤阴之抽风,则

不宜用大剂量黄芪,恐其甘温助热,反更伤阴。

2.6 近现代黄芪用量特点

从表1可以看出,近、现代黄芪的用量延续着清

代时期的特点,常用量及平均用量虽不及汉唐,但最

大量较大,且常用量及平均用量在这段历史时期有

逐渐上升的趋势。《邓铁涛临床经验辑要》治偏瘫

截瘫方中使用黄芪达240g。言此方为补阳还五汤加

味,则其重用黄芪之意当从王清任所言:“元气归并

左右,病半身不遂,有归并上下之症乎? 余曰,元气

亏五成,下剩五成,周流一身,必见气亏诸态。若忽

然归并于上半身,不能行于下,则病两腿瘫痿。”故

重用黄芪以补气,气足则两腿得荣而能行。但如此

重用黄芪,应详审病因,平脉辨证,谨慎用药。如

张锡纯言: “然王氏书中,未言脉象何如。若遇脉之

虚而无力者,用其方原可见。若其脉象实而有力,

其人脑中多患充血,而复用黄芪之温而升补者,以助

其血愈上行,必至凶危立见,此固不可不慎也。”现

代使用大剂量药物者,必当提及李可,其于《李可老

中医急危重症疑难病经验专辑》中多次黄芪用量达

240g,如“此属气虚发热,真阳渐复,大气不充。原

方加生黄芪240g,3剂。六诊: 烦热退净,颇觉胸闷。

肺为娇脏,升补太过,亢则为害,生芪减为120g,

The secret of Chinese herbal medicine application|中药之秘

第40页

38 Ⅰ2020/02

临床名医|Clinic Specialist

余药不变,……加生黄芪60g,以益气运血,余药不

变”。李可认为黄芪“药性和平,又非破格重用难以

奏功”。从上文用药可以看出,其用量虽大,但自有

分寸。黄芪240g只开3剂,一见胸闷即知升补太过,

立减其量,而在长时间服用的方子中又再减其量。足

见在使用大剂量药物时还有更重要的一点,那就是据

症加减其量。所以,药物在大剂量时或有奇效,但需

要有胆识、有细心者方能运用自如。

此外,亦有报道治疗单纯性肥胖及虚性疮疡黄芪

用至 250g 者。而关于黄芪不同量效作用,亦有不同

观点。兰雄飞认为,黄芪用量小于15g时可升压,大

于35g可降压。钟洪认为升阳举陷需5~10g,而杨国

瑛则认为需大于30g。兰雄飞及钟洪认为,30g以下黄

芪可利尿,大于30g则抑制利尿。雷根平则认为,在

糖尿病肾病出现蛋白尿、双下肢水肿时,黄芪用量在

90~120g之间有明显降糖、利尿、消肿、消蛋白的作

用。张志远认为,在治疗单纯性肥胖时,黄芪用量在

150~250g左右为宜,若少于60g则益气利水消脂作用

甚差。黄芪在使用时偶可见不良反应,雷根平提出了

3 点治疗方法: 1、皮肤瘙痒。用乌梅、防风、地肤子

可治; 2、腹胀,加用陈皮可治; 3、用大剂量黄芪偶可

见呃逆发作,用旋覆花、赭石、柿蒂可解。

3 结语

综上所述,黄芪历代常用量范围、平均用量、最

常用量和最小用量变化波动并不大,唯从汉唐至宋代有

较明显下降,而其最大用量则波动较大,最高于清代可

达298.4g。纵观各个时期黄芪用量变化,其在用治肌表

肢体病证时多生用且用量较大,用于中风后遗症偏瘫痿

痹属虚证时用量亦较大,而治疗其他病证时则根据病

因、病性等主次关系用量或大或小,随症变化。

(本文原载于2015年3月刊〈中医杂志〉,作者

单位:北京中医药大学基础医学院 、北京中医药大学

第一临床医学院; 北京中医药大学继续教育学院)

参考文献略

(上接第44页)“脾足太阴之脉,上膈,挟咽,连舌

本,散舌下。”“肾足少阴之脉……其直者,从肾上

贯肝膈,入肺中循喉咙,挟舌本。”可见,通过针刺

与舌相关的穴位,可以调节脏腑,疏通诸经气血,有

利于语言功能的恢复。

我校靳瑞教授所创的“靳三针”之舌三针临床

疗效显著,其舌Ⅰ针为上廉泉,又名舌本,为任脉脉

气所发,该穴的深部正当舌体根部,与舌体的运动

有密切关系。舌Ⅱ针和舌Ⅲ针分别称为左、右旁廉

泉。《医经理解》记载:“廉泉,舌根下之左右两

廉出泉脉也,又曰足少阴舌下各一,则廉泉非一穴

也。”即《素问·刺疟篇》所述的“舌下两脉者,廉

泉穴也”。故以上廉泉穴为主,加之左右旁廉泉组成

了“舌三针”。针刺舌三针,不但加强了舌体根部刺

激,而且有取合谷刺的含义,正如《灵枢·官针》篇

曰:“合谷刺,左右鸡足,针于分肉之间,以取肌

痹,脾之应也。”舌体根部是心包经、脾经、任脉经

所过之处,多气多血,取舌三针行合谷刺,加强了针

刺的强度,促使语言功能恢复。从解剖位置分析,舌

三针位于甲状软骨与舌骨之间,深部有舌下神经的分

支和下颌舌骨肌神经等分布,通过刺激舌体根部的末

梢神经反射性地增强了中枢神经系统的兴奋性。反复

刺激改变反应阈值,增加神经纤维的激活数量,形成

反射,从而对语言中枢受损变性的细胞进行调节,使

周围未受损变性的大脑皮层功能进行弥补代偿,重建

语言活动的神经通路,使患者言语功能得以恢复。

本临床研究结果表明,舌三针疗法操作简便,患

者顺应性好,语言功能恢复较快,疗效确切,不失为

一种值得推广的治疗方法。

(本文原载于2009年7月刊〈针灸临床杂志〉,

作者单位:广州市第一人民医院,广州中医药大学第

一附属医院)

参考文献(略)

第41页

2020/02Ⅰ 39

Abstract: Objective: To observe the clinical effect of tongue three needle on stroke aphasia. Methods: Sixty

patients were randomly divided into a tongue three needle acupuncture treatment group and a traditional therapy

control group. The treatment group was treated with tongue three needles (Shang Lianquan, Left and Right Side

Lianquan) at acupoints in the treatment group; the control group was treated with traditional stroke treatment

Acupuncture points for aphasia (Yumen, Lianquan, Tongli). After the end of the two courses of treatment, the clinical

efficacy was statistically analyzed. Results: The total effective rate of the tongue three needle treatment group was

86.67%, and that of the control group was 73.33%, which was statistically significant (P<0.05). Conclusion: Tongue

three needle is effective in treating apoplexy with aphasia. It is easy to operate and easy to promote.

Keywords: Aphasia; Stroke; Acupuncture and Moxibustion; Tongue Three Needles

Thirty Patients with Apoplexy and Aphasia Treated with Tongue

Three Needles

◎Li Xiangli Cai Jingzhou Jiang Ganghui

Aphasia is one of the common sequelae of stroke

patients. Epidemiological investigations show that at

least one third of stroke patients are accompanied by

speech dysfunction of varying degrees. Acupuncture

has accumulated a lot of experience in the treatment of

this disease, but there are also ambiguities in diagnosis

and unclear mechanisms. "Jin Sanzhen" is a new type of

acupuncture therapy. Its acupuncture and moxibustion

prescriptions are mostly three-needle. The curative effect

is very good. It is welcomed by the majority of patients and

is praised as the "New School of Lingnan Needle Change"

by the acupuncture circle. Tongue Three Needle is mainly

used for diseases related to swallowing dysfunction, but

also for diseases related to speech dysfunction. In this

study, Beijing Medical University "Chinese Aphasia Test

(ABC)" was used to objectively evaluate the treatment

of patients with aphasia and aphasia with three-tongue

acupuncture. The curative effect is good. The report is as

follows.

1 Clinical data

1.1 "Research objects" 60 patients were all inpatients

of the Department of Traditional Chinese Medicine,

Guangzhou First People's Hospital. They were divided

into Tongue Three Needle treatment group and traditional

therapy control group according to the order of treatment

and randomized natural numbers. The two groups of

patients were statistically processed in terms of gender,

age, and course of disease, and the differences were not

significant (P>0.05), and they were comparable. See Table

1.

Table 1 Comparison of general conditions of two

groups of stroke aphasia patients

Tongue Three Needle Group Cases Male

Female Course of disease Ages Cerebral infarction

Clinical practice of acupuncture treatment|针炙实战

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40 Ⅰ2020/02

临床名医|Clinic Specialist

respectively in Shanglian Open 0.8 inches beside the

spring. Points matching: upper limb hemiplegia with

Jiquan, Chize, Neiguan, lower limb hemiplegia with

Zhong, Zusanli, Sanyinjiao. (2) Needle: In this study, a

disposable stainless steel needle with a diameter of 0.35

mm and a length of 25 mm to 40 mm was selected. The

length of the needle is determined by the weight of the

patient. (3) Operation: When acupuncture the tongue

with three needles, the patient takes the supine position,

uniformly chooses 40 mm long needles, 75% alcohol

for routine local disinfection, one-handed rapid needle

insertion, and the needle tip is 45°-60° obliquely

towards the tongue base. Into 25~35 mm, on the basis of

getting qi, use the lifting and twisting technique for 20 s to

make the patient's tongue feel sore, numb, swollen, painful

and sound. The needle is retained for 30 minutes and

twisted once every 10 minutes. Twirl for 20 s each time,

flattening and reducing techniques, after the needle is out,

encourage the patient to speak as loudly as possible. When

acupuncture points on the limbs, use straight needles with

a needle depth of 25-35 mm. The needle is lifted and

twisted. The needle is retained for 30 minutes, and twisted

once every 10 minutes. The treatment was continued for 5

days a week with 2 days of rest, and every two weeks was

a course of treatment.

2.2 "Traditional Therapy Control Group"

(1) Prescription: Refer to the relevant treatment

methods in the textbook "Acupuncture and Moxibustion"

in the TCM planning textbook for general higher

education, and choose Yamen, Lianquan, and Tongli.

Dumb door: 0.5 cun above the median of the posterior

hairline, below the first cervical vertebra; Lianquan:

anterior median line, above the Adam's apple, the

depression of the upper edge of the hyoid bone; Tongli:

the radial side of the tendon of the flexor carpi ulnaris,

above the transverse stripes of the wrist 1 inch. The points

are the same as the treatment group. (2) Three needles

with the same tongue. (3) Operation: When acupuncture

Cerebral hemorrhage

Control Group

1.2  Case selection

(1) Diagnostic criteria: The cases are in compliance

with the "Key Points for Diagnosis of Various

Cerebrovascular Diseases" revised by the Fourth National

Cerebrovascular Disease Academic Conference of the

Chinese Medical Association in 1995 and Beijing Medical

University "Chinese Aphasia Complete Test (ABC)"

regarding aphasia The diagnosis.

(2) Inclusion criteria: ①Comply with "Key Points

for Diagnosis of Cerebrovascular Diseases" and "Chinese

Aphasia Test (ABC)" for the diagnosis of aphasia;

②Agree to receive Tongue Three Needle treatment;

③Normal mind, able to cooperate with language function

score Scale check; ④Age over 18 years old and under 70

years old; ⑤The first onset, the course of the disease is

within half a year.

(3) Exclusion criteria: ①Patients with consciousness

impairment; ②Patients with severe hearing and vision

impairment; ③Patients with cognitive and intellectual

impairments, such as dementia, which hinder the

assessment of language function; ④Patients with

depression or mental illness; ⑤Combined with severe

medical diseases By.

2  treatment method

2.1 ``Tongue three needle treatment group

(1) prescription: Tongue three needle: The first

needle is Shanglianquan, in the depression between

the hyoid bone and the mandibular edge in the middle

of the jaw; the second needle and the third needle are

表1 两组中风失语病患者一般情况比较

第43页

2020/02Ⅰ 41

3.4  Treatment results and analysis

3.4.1 "Comparison of the language function scores

of the two groups of stroke aphasia patients" is shown in

Table 2.

The results in Table 2 show that before treatment, the

treatment group and the control group have no significant

differences in the scores of spontaneous conversation,

understanding, retelling, naming, reading, and writing

(P>0.05), indicating that the two groups are comparable;

after treatment There was no significant improvement in

the comprehension scores of the two groups of patients

(P>0.05), and the scores of spontaneous conversation,

retelling, naming, reading, and writing were significantly

improved (P<0.05).

3.4.2 "Comparison of the total curative effect of

the two groups of stroke aphasia patients" see Table 3.

The results in Table 3 show that the two groups of stroke

aphasia patients have significantly improved the degree of

aphasia. Compared with the control group, the treatment

group has a significant difference in efficacy (P<0.05),

suggesting that the treatment group is significantly better

than the control group.

Clinical practice of acupuncture treatment|针炙实战

the dumb door, the patient takes a sitting position, makes

the head slightly forward, relaxes the nape muscles, and

slowly pierces 13-25 mm in the direction of the mandible;

acupuncture Lianquan, and the needle tip penetrates into

the base of the mouthpiece 25~35 mm; acupuncture

through the inside, straight puncture 8~13 mm. After

acupuncture at the above 3 points to obtain qi, the lifting

and inserting twisting technique was applied for 20 s, and

the acupoint matching technique was the same as that of

the treatment group. The treatment was continued for 5

days a week with 2 days of rest, and every 2 weeks was

a course of treatment. Both groups of patients received

conventional stroke medication at the same time, that is,

intravenous infusion of citicoline and ligustrazine were

given, and antihypertensive, hypoglycemic drugs or other

symptomatic treatments were given at the same time.

3  Observation of the result

3.1 Observation indicators Before treatment and

after two courses of treatment, all patients were scored

according to the scale developed by Beijing Medical

University ``Chinese Aphasia Test Set'', and recorded

6 items of spontaneous conversation, comprehension,

retelling, naming, reading, and writing The score of

language function.

3.2  The efficacy evaluation standard evaluates

the above 6 language functions of patients, and evaluates

the efficacy according to the improvement of the overall

language function before and after treatment according

to the following standards: improvement rate = (score

after treatment-score before treatment) / (normal scorescore before treatment) × 100%. Significantly effective:

improvement rate ≥ 50%; effective: 30% ≤ improvement

rate <50%; progress: 10% ≤ improvement rate <30%;

invalid: improvement rate <10%.

3.3 "Statistical analysis method" t test is used for

measurement data, and x2 test is used for count data.

表3 两组中风失语病患者总疗效比较 (例)

表2 两组中风失语病患者语言功能评分比较 (x±s)

第44页

42 Ⅰ2020/02

临床名医|Clinic Specialist

4  Discussion

Traditional Chinese medicine believes that the

etiology and pathogenesis of aphasia in stroke is that wind,

fire, phlegm, and blood stasis block the heart and kidney

meridians, disturb the mind, block the tongue orifices,

cause the tongue to become strong and silent, the disease

is in the heart and brain, involving the spleen and kidney,

etc. Viscera. The tongue is directly or indirectly connected

with the five internal organs and six organs through the

circulation of meridians, meridians, and meridians. For

example, "Lingshu·Meridian" says: "The difference

between hand and Shaoyang,... The origin, belonging

to the head", "the pulse of the spleen, feet, and Taiyin,

the upper diaphragm, pinching the pharynx, connecting

the tongue, and dispersing the tongue", "the pulse of the

kidneys, feet and shaoyin... …the straight one, from the

kidney to the liver and diaphragm, into the lungs In the

throat, hold the tongue.” It can be seen that acupuncture

at the acupoints related to the tongue can regulate the

viscera, dredge the qi and blood of the meridians, and help

the recovery of language function.

The tongue three needles of "Jin Sanzhen" created

by Professor Jin Rui of our school have significant clinical

effects. The tongue I needle is Shanglianquan, also known

as the tongue base, which is issued by the Renmai pulse.

The deep part of the point is the tongue. The root is

closely related to the movement of the tongue. Tongue Ⅱ

needle and tongue Ⅲ needle are called left and right side

Lianquan respectively. "Medicine Classics Understanding"

records: "Lianquan, the left and right under the root of

the tongue, the two Lian out of the spring pulse, also said

that there is one under the tongue of Foot Shaoyin, then

Lianquan is not a point." Said "Lianquan acupoint is also

for those with two veins under the tongue". Therefore, the

above Lianquan points are the main points, and the left

and right sides of Lianquan form the "three tongues"

Acupuncturing the tongue with three needles not

only strengthens the stimulation of the root of the tongue,

but also has the meaning of taking Hegu stimulation. Just

as the "Lingshu·Official Needle" article says: "Hegu

stimulation, the left and right thumb and index finger,

the needle between the divided flesh, Taking muscle

numbness, the spleen responds.” The root of the tongue

is the place where the pericardium, spleen, and Renmai

meridians pass. There is a lot of energy and blood. The

three needles of the tongue are used for Hegu puncture,

which strengthens the intensity of acupuncture and

promotes language Function recovery.

From the anatomical position analysis, the tongue

three needles are located between the thyroid cartilage

and the hyoid bone. There are branches of the hypoglossal

nerve and the mandibular hyoid muscle nerves in the

deep. It reflexively enhances the excitement of the central

nervous system by stimulating the peripheral nerves at

the root of the tongue. . Repeated stimulation changes the

response threshold, increases the activation number of

nerve fibers, and forms reflexes, thereby regulating the

damaged and degenerated cells of the language center,

so that the surrounding undamaged and degenerated

cerebral cortex function can compensate and rebuild the

neural pathway of language activity. The patient's speech

function can be restored.

The results of this clinical study show that the threeacupuncture tongue therapy is easy to operate, patients

have good compliance, and language function recovers

quickly. The positive result is a treatment method worth

promoting.

(This article was originally published in the

Journal of Clinical Acupuncture and Moxibustion in July

2009, author unit: Guangzhou First People's Hospital,

Guangzhou University of Traditional Chinese Medicine

First Affiliated Hospital)

第45页

2020/02Ⅰ 43

摘要:目的:观察舌三针对中风失语症的临床疗效。方法:将60例患者随机分成舌三针治疗组和传统疗

法对照组,治疗组穴位取“靳三针”之舌三针(上廉泉、左右旁廉泉);对照组采用传统治疗中风失语症的

穴位(哑门、廉泉、通里)。在2个疗程结束后分别统计分析临床疗效。结果:舌三针治疗组的总有效率为

86.67%,对照组为73.33%,两组相比有统计学意义(P<0.05)。结论:舌三针治疗中风失语症疗效较好,且操

作简便,易于推广。

关键词:失语;中风;针灸疗法;舌三针

舌三针治疗中风失语症30例

◎李湘力 蔡敬宙 江钢辉

失语症是脑卒中患者的常见后遗症之一。流行病

学调查显示,至少有1/3的脑卒中患者伴有不同程度的

言语功能障碍,本病针刺治疗已积累不少经验,但也

存在诊断模糊和机理不清之处。“靳三针”是一种新

的针灸疗法,其针灸处方多为三针,疗效甚好,深受

广大患者欢迎,被针灸界誉为“岭南针变新学派”。

舌三针主要应用于吞咽功能障碍方面的疾病,而言语

功能障碍方面疾病也应用较多。本研究采用北京医科

大学“汉语失语成套检测(ABC)”对舌三针治疗

中风失语症患者进行客观评价,疗效较好,现报道如

下。

1 临床资料

1.1 研究对象 60例患者均为广州市第一人民

医院中医科住院病人,按就诊顺序,用自然数的随机

排列表法分为舌三针治疗组和传统疗法对照组。两组

患者在性别、年龄、病程等方面经统计学处理,差异

无显著性意义(P> 0.05),具有可比性,见表1。

1.2 病例选择

(1)诊断标准:病例均符合1995年中华医学会

第四届全国脑血管病学术会议修订的《各类脑血管疾

病诊断要点》及北京医科大学“汉语失语成套检测

(ABC)”关于失语症的诊断。

(2)纳入标准:①符合《各类脑血管病诊断要

点》以及“汉语失语成套检测(ABC)”关于失语症

的诊断;②同意接受舌三针治疗;③神志正常,能够

配合语言功能评分量表检查;④年龄在18岁以上,70

岁以下;⑤第1次发病,病程在半年内。

(3)排除标准:①合并有意识障碍者;②严重

的听力和视力障碍者;③有认知及智能障碍,如痴呆

等妨碍语言功能评估者;④抑郁症或精神病者;⑤合

并严重内科疾病者。

2 治疗方法

2.1 舌三针治疗组 (1)处方:舌三针:第一

针为上廉泉,在颌下正中一寸舌骨与下颌缘之间的凹

陷中;第二针、第三针分别在上廉泉旁开0.8寸。配

穴:上肢偏瘫配极泉、尺泽、内关,下肢偏瘫配委

中、足三里、三阴交。(2)针具:本研究选用一次

性不锈钢毫针,直径为0.35mm,长度为25~40mm,

Clinical practice of acupuncture treatment|针炙实战

表1 两组中风失语病患者一般情况比较

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44 Ⅰ2020/02

临床名医|Clinic Specialist

针具长短的选择依据病人胖瘦决定。(3)操作:针

刺舌三针时,患者取仰卧位,统一选用40mm长度的

毫针,75%酒精常规局部消毒,单手快速进针,针尖

向舌根方向呈45~60°斜刺入25~35mm,在得气的

基础上,行提插捻转手法20s,使患者舌根有酸麻胀

痛感并发出声音者佳,留针30 min,每10min捻转1

次,每次捻转20 s,平补平泻手法,出针后鼓励患者

尽量大声说话。针刺肢体穴位时,采取直刺,针刺深

度为25~ 35mm,提插捻转,以患者得气为度,留针

30min,每10min捻转1次,平补平泻。每周连续治疗5

天,休息2天,每两周为1个疗程。

2.2 传统疗法对照组 (1)处方:参照普通高

等教育中医药规划教材《针灸学》中相关治疗方法,

取哑门、廉泉、通里。哑门:后发际正中直上0.5寸,

第一颈椎下;廉泉:前正中线上,喉结上方,舌骨上

缘凹陷处;通里:尺侧腕屈肌腱桡侧缘,腕横纹上1

寸。配穴同治疗组。(2)针具同舌三针组。(3)操

作:针刺哑门时,患者取坐卧位,使头微前顷,项肌

放松,向下颌方向缓慢刺入13~25mm;针刺廉泉,

针尖向咽喉舌根部刺入25~35mm;针刺通里,直刺

8~13 mm。以上3穴在进针得气后,行提插捻转手法

20 s,平补平泻手法,配穴手法同治疗组。每周连续

治疗5天,休息2天,每2周为1个疗程。两组患者均同

时接受常规中风病的药物治疗,即给予静滴胞二磷胆

碱和川芎嗪,同时给予降压、降糖药物或其他对症处

理。

3 疗效观察

3.1 观察指标 所有患者在治疗前、治疗两个

疗程后,均按照北京医科大学《汉语失语成套测验》

制定的量表进行语言功能评分,记录自发谈话、理

解、复述、命名、阅读、书写6项语言功能的得分。

3.2 疗效评定标准 评价患者上述6项语言功

能,并依据治疗前后总体语言功能的改善情况按如下

标准进行疗效评定:改善率=(治疗后得分-治疗前得

分)/(正常得分-治疗前得分)×100%。显效:改善

率≥50%;有效:30%≤改善率<50%;进步:10%≤

改善率< 30%;无效:改善率< 10%。

3.3 统计分析方法 计量资料采用t检验,计数

资料采用检验。

3.4 治疗结果与分析

3.4.1 两组中风失语症患者语言功能评分比较 

见表2。

表2结果表明,在治疗前治疗组与对照组比较,

二者自发谈话、理解、复述、命名、阅读、书写能

力评分差异无显著性(P>0.05),表明两组具有可比

性;治疗后,两组患者理解能力评分无显著性提高

(P>0.05), 自发谈话、复述、命名、阅读、书写能

力评分均有显著性提高(P<0.05)。

3.4.2 两组中风失语患者总疗效比较 见表3。

表3结果表明,两组中风失语症患者失语程度均有明

显改善,治疗组与对照组比较,疗效差异有显著性

(P<0.05),提示治疗组疗效明显优于对照组。

4 讨论

中医学认为,中风失语症的病因病机系风、火、

痰、瘀阻滞心肾经络,上扰神明,闭阻舌窍,致舌强

不语,病位在心脑,涉及脾肾等脏腑。而舌通过经

络、经别、经筋的循行,直接或间接的与五脏六腑相

联系,如《灵枢·经脉》云:“手少阳之别,……循

经入于心中,系舌本,属目。”(下转第38页)

表3 两组中风失语病患者总疗效比较 (例)

表2 两组中风失语病患者语言功能评分比较 (x±s)

第47页

2020/02Ⅰ 45

One of the series of acupuncture treatment of neuropathic pain:

diabetic foot

◎ Zhao Liye

Neuropathic pain is often described as a shooting

or burning pain. It can go away on its own but is often

chronic. Sometimes it is unrelenting and severe, and

sometimes it comes and goes. It often is the result of nerve

damage or a malfunctioning nervous system. The impact

of nerve damage is a change in nerve function both at the

site of the injury and areas around it.

One example of neuropathic pain is called phantom

limb syndrome. This rare condition occurs when an arm

or a leg has been removed because of illness or injury,

but the brain still gets pain messages from the nerves that

originally carried impulses from the missing limb.

Neuropathic pain symptoms may include:Shooting

and burning pain,Tingling and numbness。some

common causes of neuropathic pain include:

Alcoholism/Amputation/Chemotherapy/Diabetes/

Liye Zhao, MD(China), is the founder of the China Traditional Chinese Medicine Center in Calgary,

Alberta, Canada. He has acupuncture and herbal product licenses from Alberta and Health Canada.

Dr. Zhao graduated from Beijing University of Traditional Chinese Medicine, Beijing Medical University,

Hunan University of Traditional Chinese Medicine. He received rigorous training in Chinese and Western

medicine. He has practiced medicine in Canada and China for more than 30 years. He has a wealth of treatments

for diabetes, hypertension, hyperlipidemia, obesity and infertility. Academic and clinical experience of infertility.

Due to the background of integrated Chinese and Western medicine, Dr. Zhao can inject the essence of

Chinese and Western medicine into the development of patented Chinese herbal medicine. There are more than a

dozen Canadian NPN herbal certifications and production and research and development bases. Participated in the

EEG topographic map, microcirculation tester and 912 fluid in the prevention and treatment of endotoxin acute

DIC experimental research and won the first prize of scientific and technological achievements of the Beijing

Administration of Traditional Chinese Medicine in 1992.

Since opening the first clinic in Calgary in 1998, Dr. Zhao has helped more than tens of thousands of patients

to realize their aspirations for health and wellness. Use Chinese medicine methods to treat various difficult-to-treat

diseases, such as chronic pain, hypertension/hyperglycemia, infertility, menopausal syndrome, etc.

Dr. Zhao is an active member of the Alberta Acupuncture Association and is responsible for various aspects

of the provincial government's acupuncture legislation, examinations and licenses.

Dr. Zhao often explains comprehensive knowledge of Chinese medicine to professionals and patient groups,

and promotes the use of Chinese medicine. This article introduces Dr. Zhao's experience in treating diabetic foot,

one of the neuropathic pain series.

编者按

Clinical practice of acupuncture treatment|针炙实战

第48页

46 Ⅰ2020/02

临床名医|Clinic Specialist

Facial nerve problems/HIV infection or AIDS/Multiple

myeloma/Multiple sclerosis/Nerve or spinal cord

compression from herniated discs or from arthritis in the

spine/Shingles/Spine surgery/Syphilis/Thyroid problems

Neuropathic Pain Treatment:Anticonvulsant and

antidepressant drugs are often the first line of treatment.

Some neuropathic pain studies suggest the use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as

Aleve or Motrin, may ease pain. Some people may require

a stronger painkiller. Be sure to discuss the pros and cons

of the medicine you take with your doctor.

If another condition, such as diabetes, is involved,

better management of that disorder may alleviate the pain.

Effective management of the condition can also help

prevent further nerve damage.

In cases that are difficult to treat, a pain specialist

may use an invasive or implantable device to effectively

manage the pain. Electrical stimulation of the nerves

involved in neuropathic pain may significantly control

the pain symptoms.Acupuncture has a very significant

effect on neuropathic pain. This article focuses on

the acupuncture treatment of diabetic foot.The main

symptoms of diabetic foot disease are lower limb pain

and skin ulcers. In the early stage, the feet will feel itchy,

cold, whitish or purple, tingling, numbness, dullness or

loss of the extremities, walking like stepping on cotton,

and sudden pain in the lower limbs when walking, and

you must rest It takes a while to continue walking; later,

the skin of the feet often ulcerates and necrosis, and the

wound does not heal for a long time. The necrosis can

penetrate into the tendons, ligaments, and bones, and

eventually the patient has to undergo amputation and

cause disability.

Acupuncture treatment of diabetic foot, according to

its clinical characteristics to take meridian and acupoints.

Such as intermittent claudication: usually occurs

in the early stage of the disease, which is manifested as

numbness, pain and cramps behind the buttocks, thighs,

and calves after walking for a certain distance, leading

to claudication, and even squatting to rest in severe

cases, after the symptoms have completely disappeared

Can continue walking. Traditional Chinese medicine

syndrome differentiation is mostly qi stagnation, wind

and cold elements block the meridians, local acupuncture

is performed according to the meridian and acupoints

where the pain is located or close to, and acupuncture

stimulation is used to dredge the meridians according

to the patient's physique. The main acupuncture points

should be used on the Huantiao, Juliao and Zhibian. The

best effect is that the local pain is immediately relieved

when the patient receives the acupuncture and the ring

jumps and the conduction to the lower limbs is carried

out. In the details, accurate acupuncture points should

be taken into consideration. The depth and angle of the

stimulus, the amount and conduction of the stimulation,

and the acupuncture point, the patient’s symptoms are

significantly relieved or even disappear completely. At the

same time, the patients with thigh symptoms add Fengshi,

Xi Yangguan or Chengfu, Yinmen and Weizhong. For

calf symptoms, add Yanglingquan, Feiyang, Xuanzhong

and other acupoints. The difference in effect is reflected in

the difference in technique.

Resting pain: usually occurs in the middle of the

disease, manifested as pain in the toe or the end of the toe

in a quiet situation, and the pain is more obvious when

lying down, especially at night, and it takes a few steps

to relieve it. In traditional Chinese medicine, blood stasis

is blocked in the blood vessels, phlegm and dampness is

blocked in the meridians, and redness, swelling, heat and

pain are in the joints. The treatment of this period requires

the combination of acupuncture and medicine. While

treating pain, it is necessary to improve the circulation of

blood vessels, meridians and joints to eliminate stasis. The

acupuncture points are selected on the basis of the adjacent

meridians and acupoints. As a whole, it is necessary to

consider lowering blood sugar, removing blood stasis

第49页

2020/02Ⅰ 47

and swelling, and reducing weight and abdomen. Taking

advantage of acupuncture and traditional Chinese

medicine in overall treatment and treatment of the cause,

within one week of treatment, the patient's blood sugar,

swelling and pain, weight, and peripheral circulation of

the limbs have been significantly improved, and longterm treatment can achieve control and cure of diabetic

foot.

Diabetic foot cases: Diabetic patients have a

long course of disease (>10 years), accompanied by

albuminuria and/or reduced estimated glomerular filtration

(eGFR), if there are no signs or symptoms of other

primary causes of kidney injury, Diabetic kidney disease

(DKD) can usually be diagnosed clinically.

Some symptoms do not appear until late in the

disease, such as fatigue, anorexia, and limb edema.

Signs include the discovery of hypertension, edema,

and the resulting microvascular complications (diabetic

retinopathy and neuropathy). In this case, how to use

acupuncture treatment to improve kidney function,

increase GFR, improve vision, and improve peripheral

circulation? Mr. A, 65 years old, due to uncontrolled

blood sugar, over 10 for a long time, high blood pressure

taking diuretics, resulting in poor kidney function, GFR

is lower than 60 (normally greater than 60), and he has

gout, diabetic feet, redness and pain, and decreased vision.

Acupuncture and moxibustion: Regulate the movement

of spleen and stomach to dissipate phlegm and dampness,

relieve Tianshu, Yinling, invigorate Shangqiu, Gongsun

gains spleen-yang, Taichong dredges the Qi machine,

combined with local acupoints on the foot, has only

been treated in the clinic for more than one year, and

blood sugar control is very good Well, the HA1c index

decreased, and the GFR improved significantly to 68. Gout

disappeared, diabetic foot pain relieved within a week, and

lower limb edema disappeared. The acupuncture treatment

made him very satisfied!

Conclusion: There are approximately 10 million

diabetic patients in the United States, and foot disease

is the main reason for 20% of diabetic patients to be

hospitalized, and lower extremity problems are the most

common diseases that require surgery. About two-thirds

of non-traumatic lower limb amputations occur in patients

with diabetes. According to statistics, the amputation

rate of lower limbs in diabetic patients is 40 times that of

non-diabetic patients, and about 15% of diabetic patients

will develop foot ulcers in their lifetime. In addition,

diabetic foot ulcers can also complicate or induce other

acute cardiovascular and cerebrovascular events, and

even induce acute complications of diabetes, such as

ketoacidosis, hypertonic coma, and systemic sepsis, which

directly threaten the lives of patients. For the problem

of diabetic foot, it must not be neglected. Introduction

and promotion of acupuncture treatment of diabetic foot,

which greatly reduces the incidence of diabetic foot and

reduces government medical expenses, is a good thing

for the people and the country. The author of the article

hopes to attract the attention of relevant professionals and

patients.

Clinical practice of acupuncture treatment|针炙实战

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48 Ⅰ2020/02

临床名医|Clinic Specialist

针灸治疗神经性疼痛系列之糖尿病足

◎赵立业

神经性疼痛通常被描述为放射或烧灼性疼痛。

它可以自行消失,多是慢性的。 它的疼痛时常发作,

来来往往,痛不欲生。 多是神经损伤或神经系统功能

障碍的结果。神经损伤表现在损伤部位及其周围区域

神经功能的改变。

神经性疼痛的一个例子称为幻肢综合症。当由于

疾病或受伤而将手臂或腿部切除后,就会发生这种罕

见情况,但是大脑仍然会从最初从缺失肢体产生冲动

的神经中获得疼痛信息。

神经性疼痛症状可能包括:穿击痛、灼痛、酸胀

和麻木。神经性疼痛的一些常见原因包括:酗酒、截

赵立业医学博士,是中国中医药中心在加拿大阿尔伯塔省卡尔加里的创始人,并有阿尔伯塔省

的针灸和加拿大卫生部草药产品许可证。赵医生毕业于北京中医药大学,北京医科大学,湖南中医药

大学, 接受过中西医的严格培训,在加拿大和中国行医30余年,拥有丰富的学术和临床经验。

由于拥有中西医结合的学术背景,赵医生能将中、西医的精华注入到中草药的专利开发。已经

获得十几个加拿大NPN草药认证,并拥有生产和研发基地。曾参与过脑电地形图、微循环测试仪及

912液防治内毒素急性DIC实验研究获得1992年北京中医管理局科技成果一等奖。

自从1998年在卡尔加里开第一个诊所以来,赵医生已经帮助超过数万名患者,实现患者健康和

保健的的愿望。用中医药方法,治疗各种难以治疗的疾病,如慢性疼痛、高血压、高血糖、不孕不

育、更年期综合症等。

赵医生是阿尔伯塔省针灸协会的活跃成员,负责省政府针灸立法、考试和执照的多方面工作。

赵医生经常在对专业人士和患者团体讲解全面的中医药知识,推广中医药的使用。本文章介绍赵博士

治疗神经性疼痛系列之糖尿病足的经验。

编者按

肢、化学疗法、糖尿病、面神经问题、HIV感染或艾

滋病、多发性骨髓瘤、多发性硬化症、椎间盘突出症

或脊柱关节炎引起的神经或脊髓压迫、带状疱疹、脊

柱外科、梅毒、甲状腺问题。

神经性疼痛的治疗,抗惊厥药和抗抑郁药通常是

治疗的第一线。一些神经性疼痛研究表明,使用非甾

体抗炎药(NSAID)(例如Aleve或Motrin)可以缓解

疼痛。有些人可能需要更强的止痛药,请务必与您的

医生讨论服用该药的利弊。

如果涉及另一种疾病,例如糖尿病,则对该疾病

的更好的治疗可以减轻疼痛。有效地控制病情还有助

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