【作者】 张敏；

【导师】 樊巧玲；

【作者基本信息】 南京中医药大学 ， 方剂学， 2016， 硕士

【摘要】 目的：分析痰与恶性肿瘤的相关性及痰邪在胃肠道恶性肿瘤中的致病特点,探讨胃肠道恶性肿瘤方剂中化痰类药物的配伍应用,为胃肠道恶性肿瘤的临床治疗提供参考。方法：1、理论研究：全面论述痰的概念及成因,回顾历代医家对“痰”、“痰邪致癌”的认识发展络脉,初步总结食道癌、胃癌、大肠癌的病因病机及其临床表现与痰的关系。2、统计分析：将符合收录标准的治疗胃肠道恶性肿瘤的393首方剂,进行术语规范化,然后按方名、方源、组成、主病、证型等细目建立EXCEL统计表,采用SPSS统计学方法对各细目进行数据处理,并采用Rapid Miner软件对数据进行关联分析,探讨化痰类药物在胃肠道恶性肿瘤病中的应用。结果：1、本研究共收录治疗胃肠道恶性肿瘤方剂393首,化痰类药物使用达648味次,涉及23味中药,其他药物使用达4708味次,涉及19种门类,359味药物。高频化痰药分别为半夏、瓜蒌、旋覆花、天南星、贝母。2、根据对化痰类药物性味的统计发现：化痰类药物中无酸味药,其中辛味药、苦味药及咸味药使用频次较高。3、研究发现在不同的病种及证型中化痰类药物均被多次运用,并占主要地位,且在化痰抗癌的同时,常需配伍其他类别药物以提高疗效,主要配伍补虚药(22.75%)、清热药(15.32%)、理气药(9.06%)、活血化瘀药(8.08%)、利水渗湿药(6.43%)及消食药(4.42%)。4、根据关联分析结果显示：胃肠道恶性肿瘤病中常用的化痰类药对中多以半夏、贝母、旋覆花为核心,分别为半夏、茯苓；半夏、陈皮；半夏、旋覆花;旋覆花、代赭石；半夏、厚朴；半夏、瓜蒌；贝母、郁金；贝母、沙参。结论：1、祖国医学认为痰有广义、狭义之分,五脏功能异常、津液、水谷精微代谢障碍、气血运行失畅均可造成痰邪的产生。2、痰的诸多特性与肿痛特性相类似,痰为恶性肿瘤的重要病因,即可作为病理产物又可作为致病因素而致瘀、毒产生,形成痰、瘀、毒胶结之势。胃肠道恶性肿瘤病中因脾为生痰之源,脾胃运化失司则水湿不化,聚而成痰,故痰与食道癌、胃癌、大肠癌关系密切,且其特性也在以上病种中的临床表玑上多有反映。3、通过对食道癌、胃癌、大肠瘤的方剂统计分析可知,化痰类药物不仅在治疗胃肠道恶性肿瘤方剂中占较大比重,并且应用于疾病治疗伞程,常配伍扶正、清热解毒、活血化瘀、理气之品,以达协同抗癌之效。更多还原

【Abstract】 Objective:To analyze the correlation between phlegm and malignant tumors and pathogenic characteristics of phlegm in gastrointestinal carcinoma. Explore the compatible application of phlegm drugs in gastrointestinal carcinoma prescription and to provide reference for the clinical treatment of gastrointestinal carcinoma.Methods:1、Theoretical research:expound the concept and cause of phlegm all round, review the ancient physicians’ understanding development about "phlegm " and "phlegm causing cancer" and reach preliminary conclusions of etiology and pathogenesis of esophageal cancer, gastric cancer, colorectal cancer and their clinical manifestations as well as their relations with sputum.2、The statistical analysis:after terminology standardization of the first one among 393 prescriptions meeting the standard for the treatment of gastrointestinal malignant tumors, EXCEL statistical tables should be established according to the prescription name, source, composition, main disease, and card type and so on, process the data of particulars using SPSS statistical method, do correlation analysis by software Rapid Miner, and explore the application of phlegm drugs in gastrointestinal malignancies.Results:1、This study covers 393 prescriptions for the treatment of gastrointestinal cancer, including phlegm drugs which are used up to 648 times, and 23 kinds of Chinese medicine are involved among them. In addition, other drugs are used up to 4,708 times, involving 19 categories,359 drugs. High frequency apophlegmatisant are Pinellia ternata,Fructus trichosanthis,Inula britannica chinensis, Araceae, and Fritillaria.2、According to the statistics of property and flavor of phlegm drugs, no sour drugs are found in phlegm drugs among which acrid and savory drugs are frequently used.3、The study showed that phlegm drugs have been used many times in different diseases and syndromes, and occupied the main status while eliminating phlegm and fighting cancer. It often need compatibility of other categories of drugs such as tonic drugs (22.75%), heat clearing drugs (15.32%), Qi regulating drugs (9.06%), drugs for promoting blood circulation and removing blood stasis (8.08%), diuretics for eliminating dampness (6.43%) and digestant drug(4.42%) to improve the curative effect.4、According to the correlation analysis result, medicines which are commonly used for eliminating phlegm in gastrointestinal malignant tumors take Pinellia ternata,Fritillaria thun-bergli,and Inula britannica chinensis as the core. And they can be classified into Pinellia ternata, Poria cocos;Pinellia ternata, dried orange peel; Pinellia ternata,Inula britannica chinensis; Inula britannica chinensis,reddle;Pinellia ternata,Magnolia officinalis;Pinellia ternata, Fructus trichosanthis; Fritillaria thun-bergli,Radix curcumae;Fritillaria thun-bergli, the root of straight ladybell.Conclusion:1、It is believed that in traditional Chinese medicine, the sputum can be classified in a broad and narrow sense. Phlegm can be caused by the abnormal function of the five internal organs, body fluid, essence of water and grain subtle metabolic disorders, and unsmooth blood running.2、Many characteristics of sputum are similar to those of tumor. Sputum is an important cause of malignant tumor, It can be a pathological product and pathogenic factor as well to cause blood stasis and toxin, and cementation potential of phlegm, blood stasis and toxin. Because spleen is the source of phlegm in gastrointestinal carcinoma, if spleen and stomach can’t coordinate the course of metabolism and our body water will stay and accumulate to form sputum. So phlegm and esophageal cancer, gastric cancer, colorectal cancer which have close connection and their characteristics also are also reflected in the clinical manifestations of the above diseases.3、Through prescription statistics analysis of esophageal cancer, gastric cancer, colorectal cancer, we know that phlegm drugs are not only proportionally significant in the prescription of gastrointestinal malignant tumor treatment, but also can be applied to the whole course of disease treatment with compatibility of strengthening the body resistance, heat clearing and detoxifying, promoting blood circulation to remove blood stasis, and Qi regulation to achieve synergistic anti-cancer effect.更多还原