从《理虚元鉴》“治虚三本”论治化学治疗相关骨髓抑制

Treatment of chemotherapy-associated myelosuppression based on the “three sources for treating deficiency” in Lixu Yuanjian

关键词:  化学治疗  骨髓抑制  《理虚元鉴》  肺  脾  肾

Key words:  chemotherapy  myelosuppression  Lixu Yuanjian  lung  spleen  kidney

摘要:

“治虚三本”是汪绮石治疗虚劳病的核心理论，骨髓抑制是化学治疗极为常见的不良反应之一，可以归属于中医“虚劳”范畴。“治虚三本”理论对骨髓抑制的发生、发展及治疗具有重要指导意义。文章认为脾胃虚损贯穿化学治疗始终，邪犯肺脾、卫气受损，邪阻中焦、脾虚不摄，病久及肾、髓亏血枯与化学治疗后粒（白）细胞减少、血小板减少、贫血等密切相关，而邪热燔灼、瘀血内生是病情缠绵难愈的关键。基于此，文章提出补肺益气、健脾养血，补脾调中、清热凉血，补肾填精、润髓活血等治法，以期为中药治疗骨髓抑制提供借鉴。

Abstract:

The theory of “three sources for treating deficiency” is the core principle of WANG Qishi in treating consumptive diseases. Myelosuppression is one of the most common adverse reactions to chemotherapy and can be categorized under the scope of “consumptive disease”（xulao） in traditional Chinese medicine. The theory has significant guiding value for the occurrence，development，and treatment of myelosuppression. The article proposes that spleen and stomach deficiency runs through the entire process of chemotherapy. The pathogenesis involving pathogenic factors attacking the lung and spleen with impairment of defensive qi；pathogenic factors obstructing the middle energizer with spleen deficiency failing to govern；and prolonged illness affecting the kidney with marrow depletion and blood dryness is closely related to post-chemotherapy granulocytopenia（leukopenia），thrombocytopenia，anemia，etc. Pathogenic heat scorching and the generation of blood stasis are key factors causing the condition to linger and be difficult to cure. Based on this，propose therapeutic methods such as tonifying the lung to supplement qi，strengthening the spleen to nourish blood；tonifying the spleen to regulate the middle energizer，clearing heat and cooling blood；and tonifying the kidney to replenish essence，moistening the marrow and activating blood circulation，aiming to provide a reference for the treatment of myelosuppression with traditional Chinese medicine.