| 严楷蕾,陈嘉斌,彭丞,等.柴可群辨治结直肠癌的临诊经验及组方用药研究[J].浙江中医药大学学报,2023,47(10):1151-1157. |
| 柴可群辨治结直肠癌的临诊经验及组方用药研究 |
| Clinical Experience and Prescription Regularity of CHAI Kequn in the Treatment of Colorectal Cancer |
| DOI：10.16466/j.issn1005-5509.2023.10.008 |
| 中文关键词: 结直肠癌 健脾祛湿 化痰解毒 分期论治 组方用药 肠清方 柴可群 |
| 英文关键词: colorectal cancer invigorating the spleen and removing dampness resolving phlegm and detoxifying treatment by stages prescription drug Changqing Formula CHAI Kequn |
| 基金项目:浙江省柴可群名老中医专家传承工作室建设项目(GZS2017001)；浙江省自然科学基金项目(LQ21H290003)；浙江省中医药优秀青年人才基金项目(2021ZQ016) |
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| 中文摘要: |
| [目的] 分析柴可群治疗结直肠癌的临诊经验，获得核心组方“肠清方”，并阐明辨治不同临床分期结直肠癌的用药规律。[方法] 临床观察76例接受中医药治疗的结直肠癌患者，主要观察指标为总生存期(overall survival，OS)，运用Kaplan-Meier法及COX回归模型进行生存分析，运用Apriori算法、复杂系统熵聚类等方法获得肠清方核心组方，并根据不同临床分期进一步阐明用药规律。[结果] 接受中医药治疗的结直肠癌患者的中位总生存期(median overall survival，mOS)为46.0个月，Ⅱ～Ⅲ期患者mOS未出现，Ⅳ期患者的mOS为39.0个月；Ⅱ～Ⅲ期脾虚痰湿证患者具有较好的生存获益，Ⅳ期脾肾阳虚证患者的生存获益不佳。肠清方核心组方为“太子参、甘草、当归、半夏、柴胡、枳壳、黄柏、桂枝、薏苡仁、虎杖”；“薏苡仁、虎杖”为Ⅱ～Ⅲ期特色用药，“桂枝、淫羊藿”为Ⅳ期特色用药。[结论] 柴师注重健脾祛湿、化痰解毒辨治结直肠癌，Ⅱ～Ⅲ期强调健脾化湿、益气养血、清热解毒，Ⅳ期偏重温养气血、散寒通络，并形成了“肠清方”核心组方。 |
| 英文摘要: |
| [Objective] To evaluate the clinical experience of CHAI Kequn in the treatment of colorectal cancer， obtain the core formula “Changqing Formula” and clarify the medication rule of distinguishing and treating colorectal cancer in different clinical stages. [Methods] Seventy-six patients with colorectal cancer receiving traditional Chinese medicine(TCM) were clinically observed， and the main observation index was overall survival(OS). Kaplan-Meier method and COX regression model were used to analyze survival. The Apriori algorithm and complex system entropy clustering methods were used to obtain the core formula of Changqing Formula， and the medication rules were further clarified according to different clinical stages. [Results] The median overall survival(mOS) of colorectal cancer patients receiving TCM treatment was 46.0 months， mOS was not present in stages Ⅱ~Ⅲ patients and 39.0 months in stage Ⅳ patients. Stage Ⅱ~Ⅲ patients with spleen deficiency phlegm-dampness syndrome had better survival benefit， stage Ⅳ patients with spleen-kidney Yang deficiency syndrome had poor survival benefit. The core ingredients of Changqing Formula were “Pseudostellariae Radix(Taizishen)， Radix Glycyrrhiza(Gancao)， Angelica Sinensis(Danggui)， Pinelliae Rhizoma(Banxia)， Radix Bupleuri(Chaihu)， Aurantii Fructus(Zhiqiao)， Cortex Phellodendri(Huangbo)， Ramulus Cinnamomi(Guizhi)， Coicis Semen(Yiyiren) and Polygoni Cuspidati Rhizoma et Radix(Huzhang)”. Polygoni Cuspidati Rhizoma et Radix(Huzhang) and Coicis Semen(Yiyiren) were featured drugs at stages Ⅱ~Ⅲ， while Ramulus Cinnamomi(Guizhi) and Epimedium grandiflorum(Yinyanghuo) were featured drugs at stage Ⅳ. [Conclusion] CHAI Kequn pays attention to invigorating the spleen and dispelling dampness， resolving phlegm and detoxifying in differentiation and treatment of colorectal cancer. In stages Ⅱ~Ⅲ， CHAI Kequn emphasizes invigorating the spleen and dispelling dampness， invigorating Qi and nourishing blood， clearing heat and detoxifying， and in stage Ⅳ， it focuses on warmly invigorating Qi and blood， dispelling cold and dredging collateral， and forms the core formula of Changqing Formula. |
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