摘要
化疗相关性血小板减少症(chemotherapy-induced thrombocytopenia,CIT)是肿瘤治疗的常见不良反应。其临床表现轻重不一,轻者可见皮下瘀点、瘀斑,重者可致组织器官出血,甚至危及生命。现代医学认为,CIT的主要发生机制是化疗药物诱导骨髓抑制,进而导致血小板生成不足。在临床实践中,CIT的治疗面临止血与预防血栓形成的矛盾难题,且现有治疗手段存在局限性。在中医范畴,CIT可归属于“血证”“紫癜”。本文提出,CIT的核心病机本质在于“虚”“毒”“瘀”三者的动态交织。其中,瘀血既是重要的病理产物,也是推动病情进展的枢纽环节。在应用“止血-消瘀-宁血-补虚”四法时,需依据疾病分期进行动态调整:急性期以凉血止血为主,迅速控制出血;亚急性期侧重益气宁血,固护根本;慢性期则宜通补兼施,调和阴阳。治疗CIT时应注重“祛瘀生新”在打破“出血→瘀滞→虚损”恶性循环中的核心价值。
Chemotherapy-induced thrombocytopenia(CIT)is a common adverse reaction in cancer treatment.Its clinical manifestations vary in severity,mild cases manifest as subcutaneous petechiae or ecchymoses,while severe cases may lead to hemorrhage in tissues or organs,even threatening life.Modern medicine holds that the main mechanism of CIT is that chemotherapy drugs induce bone marrow suppression,which leads to insufficient platelet production.In clinical practice,the treatment of CIT faces the contradiction between hemostasis and prevention of thrombosis,and existing treatment methods have limitations.In traditional Chinese medicine(TCM),CIT falls under the categories of“blood syndrome”and“purpura”.This paper proposes that the core pathogenesis of CIT involves a dynamic interplay of“deficiency”,“toxicity”,and“stasis”.Among them,blood stasis acts not only as a pathological product but also as a pivotal driver of disease progression.When applying the four therapeutic principles——“hemostasis-stasis resolution-blood pacification-deficiency tonification”,dynamic adjustments should be made according to the disease stage.In the acute phase,the main method is to cool blood and pacify blood,quickly halting hemorrhage.In the subacute phase,emphasis is placed on nourishing qi,pacifying blood,and strengthening the foundation.In the chronic phase,both obstrucion-removing and tonifying methods are used to balance yin and yang.In the treatment of CIT,“resolving stasis to regenerate new blood”is emphasized as the key mechanism for reversing the vicious cycle of“bleeding→stasis→deficiency”.
作者
谭思齐
易良杰
甘论玲
TAN Siqi;YI Langjie;GAN Lunling(Department of Oncology,Huizhou Hospital of Guangzhou University of Chinese Medicine,Huizhou 516000 Guangdong,China)
出处
《中医肿瘤学杂志》
2025年第4期48-53,共6页
Journal of Oncology in Chinese Medicine
基金
广东省中医药局科研项目(编号:20231347)。
关键词
血证论
化疗相关性血小板减少
肿瘤
blood syndrome theory
chemotherapy-induced thrombocytopenia
tomor
