摘要
癌性疼痛是恶性肿瘤患者最常见的并发症之一,严重影响患者的生活质量。西医治疗本病以阿片类药物为主,长期使用易导致药物耐受、成瘾及多种不良反应。“络以通为用”理论出自叶桂(字天士)《临证指南医案》,为癌性疼痛的辨证论治提供了重要的理论依据和临床指导。基于“久病入络”与“久痛入络”理论,癌性疼痛病机呈现由气及血、由实转虚、由经入络的渐进性演变过程,各阶段病机相互关联,最终形成“气滞–痰瘀–毒损”的病理转换模式。早期肝失疏泄致气滞络痹,表现为胀痛走窜且随情绪波动;中期气滞入血、痰瘀互结,络脉阻滞而见固定刺痛、夜间加重;晚期痰瘀化毒、络虚失养,出现顽固性疼痛持续不解,伴形销骨立。针对不同阶段采用分期论治策略:早期治宜疏肝调气、和络止痛,主要应用柴胡、香附等疏肝理气药配伍延胡索、郁金等活血止痛之品;中期重在化痰祛瘀、通络消癥,选用半夏、白芥子等化痰药配合全蝎、蜈蚣等虫类药及鸡血藤等藤类药;晚期强调扶正通络、解毒祛瘀,以黄芪、人参等补益药为主,佐以三棱、莪术等破血药及半枝莲等解毒药。临床实践表明,该理论指导下的辨证施治可有效缓解癌性疼痛,改善患者生活质量。未来应进一步深化络病理论在癌性疼痛领域的应用与发展,推动中医络病理论体系的创新与完善。
Cancer pain is one of the most common complications in malignant tumor patients,severely affecting quality of life of patients.Western medicine primarily relies on opioids to treat this disease,yet long-term use may lead to medicine tolerance,addiction,and various adverse effects.The theory of“collaterals should be unobstructed”originated from YE Gui’s work Linzheng Zhinan Yi’an(《临证指南医案》),providing a critical theoretical foundation and clinical gui dance for the syndrome differentiation and treatment of cancer pain.Based on the theories of“long-term diseases entering collaterals”and“long-term pain entering collaterals”,the pathogenesis of cancer pain follows a progressive evolution process from Qi(气)stagnation to blood stasis,from excess to deficiency,and from meridians to collaterals.The pathogenesis at each stage is interrelated,ultimately forming a pathological transformation pattern of“Qi stagnation-phlegm stasis-toxin damage”.In the early stage,liver Qi stagnation leads to collateral obstruction,manifesting as migratory distending pain that travel and worsen with emotional fluctuations.In the intermediate stage,Qi stagnation progresses into the blood,with phlegm and blood stasis mutually binding,and the collaterals are blocked,resulting in fixed stabbing pain which is worsened at night.In the late stage,phlegm and blood stasis transform into toxins,and the collaterals become deficient and lack nourishment,resulting in intractable persistent pain accompanied by emaciation.Stage-specific treatment strategies are proposed as follows:early-stage therapy focuses on the method of soothing liver and regulating Qi,and harmonizing collaterals to relieve pain,primarily selecting soothing liver and regulating Qi medicines such as Chaihu(Radix Bupleuri)and Xiangfu(Rhizoma Cyperi)combined with invigorating blood circulation and alleviating pain medicines such as Yanhusuo(Rhizoma Corydalis)and Yujin(Radix Curcumae);the treatment in the intermediate stage emphasizes the therapy of resolving phlegm to dispel stasis,and unblocking collaterals to dissipate masses,mainly employing resolving phlegm medicines such as Banxia(Rhizoma Pinelliae)and Baijiezi(Semen Sinapis)alongside insect medicines such as Quanxie(Scorpio)and Wugong(Scolopendra)as well as vine herbs such as Jixueteng(Caulis Spatholobi);the treatment of the late stage prioritizes the method of reinforcing healthy Qi to unblock collaterals,and detoxifying and removing stasis,mainly selecting reinforcing medicines such as Huangqi(Radix Astragali)and Renshen(Radix Ginseng)supplemented by activating blood medicines such as Sanleng(Rhizoma Sparganii)and Ezhu(Rhizoma Curcumae),along with detoxifying medicines such as Banzhilian(Herba Scutellariae Barbatae).Clinical practice demonstrates that syndrome differentiation and treatment guided by this theoretical framework can effectively alleviate cancer pain and improve patients’quality of life.Future research should further explore the application and development of collateral disease theory in the management of cancer pain,promoting the innovation and refinement of collateral disease theory of traditional Chinese medicine.
出处
《中医临床研究》
2025年第27期9-13,共5页
Clinical Journal Of Chinese Medicine
基金
中央高水平中医医院临床研究和成果转化能力提升项目——医疗机构制剂研发与新药转化专项(HLCMHPP2023078)。
关键词
癌性疼痛
络病
络以通为用
通络
Cancer pain
Collateral disease
Collaterals should be unobstructed
Unblocking collaterals
