摘要
恶性胸腹腔积液病机为三焦阻滞,水饮内停,元气运行受阻,血液凝滞,痰瘀内结,治疗应在行气利水、淡渗利湿或峻下逐水、逐瘀利水通利三焦的基础上,兼顾肺、脾,肾三脏的功能失调。通利三焦多为宣上通下的行气利水药物,如柴胡、枳实、桔梗等,同时配以淡渗利湿药物或者峻下逐水药物以通调水道,如茯苓、猪苓、泽泻等,尚需加用利水逐瘀药物,如水蛭、桃仁、泽兰等。兼顾肺、脾,肾三脏的功能失调,分别以开宣肺气、健脾益气、温补肾阳之法,开宣肺卫通利三焦用以麻黄为基础的方药如越婢汤、越婢加术汤、甘草麻黄汤及大小青龙汤;健脾渗湿疏利三焦用以黄芪为基础的方药如防己茯苓汤、桂枝加黄芪汤、桂枝苦酒汤;温补肾阳用附子,干姜。同时尚需要考虑恶性肿瘤癌毒这一主要病理因素,加用祛除癌毒之邪药物如山慈菇、蛇六谷、全蝎等。
The pathogenesis of malignant pleural and peritoneal effusion is attributed to obstruction in the triple energizer,internal retention of water and fluid,blocked circulation of original qi,blood stasis,and internal accumulation of phlegm and stasis.The treatment should focus on regulating qi and inducing diuresis,draining dampness with bland diuretics,or drastic water elimination,removing stasis and and inducing diuresis for dredging the triple energizer as well as addressing the dysfunctions of the lung,spleen,and kidney.Regulating the triple energizer involves using qi-regulating and diuresis-inducing drugs to promote flow from the upper to the lower parts,such as Chaihu(Radix Bupleuri),Zhishi(Fructus Aurantii Immaturus),Jiegeng(Radix Platycodonis),etc.Additionally,drugs that drain dampness with bland diuretics or eliminate drastic water,such as Fuling(Poria),Zhuling(Polyporus),Zexie(Rhizoma Alismatis),etc.can be added to regulate the water pathways.Drugs that dispel stasis and induce diuresis,such as Shuizhi(Hirudo),Taoren(Semen Persicae),Zelan(Herba Lycopi),etc.are also required.Addressing the dysfunction of the lung,spleen,and kidney includes promoting the lung′s qi-dispersing function,invigorating the spleen and replenishing qi,and warming kidney yang respectively.To promote the lung′s qi-dispersing function and regulate the triple energizer,Mahuang(Herba Ephedrae)-based formulas such as Maidservant From Yue Decoction,Maidservant From Yue Decoction plus Rhizoma Atractylodis Macrocephalae,Licorice and Ephedra Decoction,Major Green Dragon Decoction,and Minor Green Dragon Decoction are used.For invigorating the spleen,draining dampness and regulating the triple energizer,Huangqi(Radix Scutellariae)-based formulas such as Stephania Root and Poria Decoction,Cinnamon Twig Decoction Plus Astragalus,Cinnamon Twig Decoction Plus Bitter Wine can be applied.For warming kidney yang,Fuzi(Radix Aconiti Lateralis Preparata)and Ganjiang(Rhizoma Zingiberis)can be used.Additionally,considering the main pathological factor of cancer toxin in malignant tumors,anti-cancer drugs such as Shancigu(Pseudobulbus Cremastrae seu Pleiones),Sheliugu(Amorphophallus rivieri Duriedu),Quanxie(Scorpio),etc.should be added.
作者
吴嫣然
李婧
王定坤
苏浩
陈刚
WU Yanran;LI Jing;WANG Dingkun;SU Hao;CHEN Gang(Tongji Hospital Affiliated to Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei,China,430022)
出处
《河南中医》
2024年第10期1502-1506,共5页
Henan Traditional Chinese Medicine
基金
国家自然科学基金面上项目(81874423)
国家自然科学基金青年项目(82204960)。
关键词
恶性胸腹腔积液
三焦
行气利水
淡渗利湿
峻下逐水
逐瘀利水
malignant pleural and peritoneal effusion
triple energizer
regulating qi and inducing diuresis
draining dampness with bland diuretics
drastic water elimination
removing stasis and and inducing diuresis
