摘要
肺癌是全球面临的重大公共卫生问题,发病率与死亡率均位居首位,且年龄标准化发病率和死亡率逐年上升,严重影响肺癌患者的生命健康。根治性手术切除是肺部恶性肿瘤的主要治疗手段,但术后常见呼吸功能、黏膜功能、心理功能等多维度功能障碍,不仅降低患者生活质量、影响治疗耐受度与治疗周期,并与预后生存呈负相关,促进疾病复发转移。目前肺癌术后功能障碍是亟待解决的关键临床问题,缺乏规范化、标准化的肺癌术后康复治疗管理及中医辨治策略。聚焦肺癌术后大气下陷的基础核心病机,在“肺主气”经典中医理论指导下,基于“五观辨治”理论中的核心观,创新提出快速康复期“大气下陷”核心病机的呼吸功能障碍、术后辅助治疗期“阴虚气陷”核心病机的黏膜功能障碍与巩固治疗期“气陷膹郁”核心病机的心理功能障碍;并构建分阶段动态功能保护策略:快速康复期益气升陷,辨治注重欲升先降;辅助治疗期养阴举陷,方药配伍寓通于补;巩固治疗期达郁托陷,临证施治动静结合;并在各阶段功能康复的临证辨治中扶正培本兼顾祛邪清源。首提中医药术后功能保护理念,为肺癌术后全周期、分阶段、动态功能保护策略提供中医辨治新思路,也将助力我国中西协同的肿瘤防治综合方案体系构建与发展。
Lung cancer(LC)is a significant global public health issue,with both its incidence and mortality rates ranking among the highest worldwide.The age-standardized incidence and mortality rates are increasing annually,posing a serious threat to the life and health of LC patients.Radical surgical resection is the primary treatment for malignant lung tumors.However,postoperative multidimensional functional impairments,including respiratory,mucosal,and psychological functions,are common.These impairments not only reduce patients'quality of life and affect their treatment tolerance and duration,but also negatively correlate with prognosis,facilitating disease recurrence and metastasis.At present,postoperative functional dysfunction after LC surgery remains a key clinical challenge that urgently needs to be addressed.There is a lack of standardized and regulated postoperative rehabilitation treatment management and traditional Chinese medicine(TCM)differentiation and treatment strategies for LC.Focusing on the core underlying pathogenesis of"Qi sinking"after LC surgery,and guided by the classical TCM theory of"lungs governing Qi",this study,based on the core concept of the"five perspectives on treatment"theory,innovatively proposes the respiratory dysfunction as the core pathogenesis of"Qi sinking in the chest"during the rapid rehabilitation phase,mucosal dysfunction as the core pathogenesis of"Yin deficiency and Qi sinking"during the postoperative adjuvant treatment phase,and the psychological dysfunction as the core pathogenesis of"Qi sinking with emotional constraint"during the consolidation phase.Accordingly,stage-specific dynamic functional protection strategies are constructed.In the rapid rehabilitation phase,the strategy emphasizes tonifying Qi and uplifting sinking Qi,with differentiation and treatment based on the principle of"descending before ascending".In the adjuvant treatment phase,the approach focuses on nourishing Yin and uplifting Qi,with prescription combinations that integrate unblocking and tonification.In the consolidation phase,the strategy aims to resolve constraint and uplift Qi,with clinical treatment emphasizing a combination of dynamic and static methods.At each stage of functional rehabilitation,clinical differentiation and treatment should support healthy Qi and eliminate pathogenic factors simultaneously.This study is the first to propose the concept of postoperative functional protection in TCM,offering a new approach for TCM differentiation and treatment in the full-cycle,stage-based,and dynamic protection of postoperative function in LC patients.It is expected to contribute to the construction and development of an integrated TCM-Western medicine comprehensive program for cancer prevention and treatment in China.
作者
曹璐畅
朱广辉
高瑞珂
徐曼曼
朱潇雨
侯炜
张英
李杰
CAO Luchang;ZHU Guanghui;GAO Ruike;XU Manman;ZHU Xiaoyu;HOU Wei;ZHANG Ying;LI Jie(Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China)
出处
《中国实验方剂学杂志》
北大核心
2025年第18期86-93,共8页
Chinese Journal of Experimental Traditional Medical Formulae
基金
国家重点研发计划“中医药现代化”重点专项(2023YFC3503300,2023YFC3503301,2023YFC3503305)
中央高水平中医医院临床科研业务费专项(HLCMHPP2023001,HLCMHPP2023097,HLCMHPP2023085)。
关键词
肺癌
术后
康复
功能障碍
大气下陷
lung cancer
postoperative
rehabilitation
dysfunction
Qi sinking
