基于藏象理论探讨化疗药的药物毒性

恶性肿瘤是威胁人类健康的重要疾病,虽然近年来靶向和免疫疗法逐步在恶性肿瘤的治疗中应用,能在一定程度上缓解患者的痛苦,但亦存在不良反应大、易耐药等问题。目前,化疗仍是恶性肿瘤治疗的主要手段,化疗在杀伤肿瘤细胞的同时,对正常细胞也有损害,常导致骨髓抑制、消化道不良反应、肝肾功能损害、口腔黏膜反应等药物毒性。虽然现代医学治疗化疗药药物毒性有一定疗效,仍存在局限性。中医药治疗恶性肿瘤历史悠久,认为化疗为药物毒邪侵袭机体,加重机体"虚""毒""瘀",致使气血脏腑损伤,以脾胃、肝肾最为明显,导致骨髓抑制、肝肾功能损伤等不良反应,研究证实运用中医药治疗具有较好临床疗效。因此,需要从中医学基础理论出发,探寻新的治疗方法。藏象理论作为中医学理论体系的核心部分,与中医学的望、闻、问、切相联系,不断发展完善,对疾病的诊治具有重要的指导意义。本研究以中医藏象理论为指导,以中医病因病机为基础,从骨髓抑制、消化道不良反应、肝肾功能损伤、口腔黏膜反应等化疗药常见药物毒性的临床表现着手,即化疗药药物毒性的外在征象,将脏腑的病理表现与生理功能相联系,由象及藏,系统归纳了各类常见化疗药的药物毒性的脏腑特点,为临床运用中医药治疗化疗药物毒性提供新的治疗思路和方法,促进中医藏象理论在诊治疾病中的应用。

Toxicity of Chemotherapeutics Based on Viscera-state doctrine

Malignant tumors are important diseases that threaten human health. Although targeting and immunotherapy have been gradually applied in the treatment of malignant tumors in recent years,which can alleviate the suffering of patients to a certain extent,there are still problems of large adverse reactions and easy drug resistance. At present,chemotherapy is still the main method for the treatment of malignant tumors. While killing tumor cells,chemotherapy also damages normal cells,which often leads to drug toxicity,such as bone marrow suppression,gastrointestinal adverse reactions,liver and kidney function damage,and oral mucosal reactions. Although modern medicines have a certain effect on the toxicity of chemotherapy drugs,there are still limitations. Traditional Chinese medicine(TCM)has a long history of treating malignant tumors,and considers that chemotherapy is a drug with toxin invading the body,exacerbating the "deficiency", "toxin" and "stasis" of the body,causing damage to Qi,blood and organs,especially in spleen,stomach,liver and kidney,and leading to bone marrow suppression,liver and kidney function injury and other adverse reactions. Studies have confirmed that the use of TCM treatment has a better clinical efficacy. Therefore,new therapies shall be explored based on the basic theory of traditional Chinese medicine. As the core part of the theoretical system of TCM,Viscera-state doctrine is closely related to looking,listening,questioning and feeling the pulse of TCM,and has constantly developed and improved. It has important significance in guiding diagnosis and treatment of diseases.This study is guided by viscera-state doctrine of TCM and based on the etiology and pathogenesis of TCM. It starts with the clinical manifestations of common drug toxicity of chemotherapy drugs,such as bone marrow suppression,gastrointestinal adverse reactions,liver and kidney function damage,oral mucosal reactions,which are external signs of the toxicity of chemotherapeutic drugs,and associates pathological manifestations of viscera to physiological functions. From elephants and Tibetans, it systematically summarizes the viscera characteristics of various common chemotherapeutic drugs and provides new ideas and methods for clinical use of TCM in treating the toxicity of chemotherapeutic drugs,so as to promote the application of viscera-state doctrine in diagnosis and treatment of diseases.