摘要
肝细胞癌(hepatocellular carcinoma,HCC)是我国常见恶性肿瘤,其发病机制复杂,预后较差。全国名中医凌昌全教授在中医防治肿瘤领域经验丰富,重视水湿内停对肝癌发生发展的影响。本文从“水湿犯肝”角度,系统探讨其病因病机及“以清为固、以通为补”的辨证施治思想。该病因病机主要由“肝损湿生”和“水泛责肝”纠互循环而生;“肝损湿生”涉及肝与脾、三焦、肺、肾等脏腑功能失调的相互影响,如肝病传脾致脾失运化而生湿,肝失疏泄致三焦水道不畅,肝病及肺致肺失通调水道,肝损及肾致肾不主水等;“水泛责肝”则强调湿邪阻滞气机,导致气郁湿滞、血水互结,进而加重肝郁,促进癌毒生成。在治疗上,凌教授秉持“清利通调、兼顾标本”原则,形成“以清为固、以通为补”的特色治则。一方面通过淡渗利湿之品导湿邪从小便而出,祛邪治标;另一方面恢复三焦气化功能,使脏腑气机畅达,达到扶正固本的目的。在用药上,常用金钱草、垂盆草、茯苓皮等甘淡渗利之品,注重辨证配伍,攻补兼施。此论治特色不仅为丰富了中医肿瘤病机学内涵,更为肝癌的中医治疗提供新的思辨路径、增加患者临床获益。
Hepatocellular carcinoma(HCC)is a common malignant tumor in China with complex pathogenesis and poor prognosis.Professor Ling Changquan,a National Famous Traditional Chinese Medicine(TCM)Doctor,has extensive experience in the TCM prevention and treatment of tumors,placing particular emphasis on the impact of water-dampness retention in the occurrence and progression of liver cancer.This article systematically explores the etiology and pathogenesis from the perspective of“water-dampness invading liver”and examines his differentiation and treatment philosophy of“consolidation through clearing,supplementation through dredging”.The etiology and pathogenesis primarily arise from the mutual cycling of“liver damage generating dampness”and“water overflow affecting liver”.“Liver damage generating dampness”involves the interrelated dysfunction between liver and other organs such as spleen,triple energizer,lung,kidney.For instance,liver disease transmits to spleen,causing spleen dysfunction in transportation and transformation and dampness generation;liver dysfunction in promoting free flow causes poor water passage in triple energizer;liver disease affecting lung impairs the lung’s function of regulating water passage;liver damage involving kidney results in kidney failure to govern water.“Water overflow affecting liver”emphasizes how dampness pathogen obstructs qi activity,leading to qi depression and dampness stagnation,blood-water combination,which further aggravates liver depression and promotes the formation of cancerous toxin.In treatment,Professor Ling adheres to the principle of“clearing,facilitating,dredging,and regulating while considering both manifestation and root”,forming the characteristic treatment rule of“consolidation through clearing,supplementation through dredging”.On one hand,he uses bland and infiltrating dampness-percolating medicinals to guide dampness pathogen out through urination,eliminating pathogenic factors to treat manifestations.On the other hand,he restores triple energizer qi transformation function,enabling smooth organ qi activity to achieve the goal of supporting healthy qi and consolidating the root.In medication selection,he commonly uses sweet,bland,and percolating medicinals such as Lysimachia christinae,Sedum sarmentosum,and Poria cocos peel,emphasizing syndrome differentiation in compatibility and combining attack with supplementation.This treatment characteristic not only enriches the connotation of TCM tumor pathogenesis theory but also provides new approahes of syndrome differentiation for TCM treatment of liver cancer and increases clinical benefits for patients.
作者
郑天啸
周慧灵
韩睿
ZHENG Tianxiao;ZHOU Huiling;HAN Rui(Department of Traditional Chinese Medicine Oncology,The First Affiliated Hospital of Naval Medical University,Shanghai 200433,China;Department of Chinese Medicine,Naval Medical University,Shanghai 200433,China;Department of Chinese Medicine Oncology,Naval Medical Center,Naval Medical University,Shanghai 200052,China;Ling Changquan National Famous TCM Practitioner Inheritance Studio,Shanghai 200433,China)
出处
《中医肿瘤学杂志》
2025年第5期74-85,共12页
Journal of Oncology in Chinese Medicine
基金
国家自然科学基金项目(编号:82204864)
国家中医药管理局第二届凌昌全全国名中医传承工作室建设项目(编号:国中医药办人教函〔2022〕245号)。
关键词
肝癌
水湿犯肝
以通为固
清利
liver cancer
water-dampness invading liver
consolidation through facilitation
clearing and draining
