·祖国医学对癌证的认识
·The View of Traditional Chinese Medicine on Hemopathy
·血液病病因病机
·Etiology and Pathogenesis of Hemopathy
·血液病辨证施治
·Syndrome-Differentiation Treatment of Hemopathy
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| 血液病常识 |
| Common Sense of Hemopathy |
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| 祖国医学对癌证的认识 | 一 、癌证概述
1、癌证是多种原因引起人体细胞反应性增生而形成的异常新生物，这种增生组织的细胞具有异常的结构和功能，其生长能力旺盛，与整个身体的代谢不协调，并具有相当程度和范围的增殖性。癌细胞具有以下三个特征:1. 癌细胞的增殖和分化失去控制，表现为持续性增殖和分化不良。2. 癌细胞与邻近细胞和组织间的功能不协调，从而改变了正常的组织机构形式，表现出侵犯周围组织(浸润性生长) 和向远处转移。3. 癌细胞具有一定的遗传性。
2、良性肿瘤和恶性肿瘤的区别
根据肿瘤生长特性及对人体的影响和危害不同，肿瘤可分为良性和恶性两类。良性肿瘤和恶性肿瘤之间并没有绝对的界限，恶性程度最低的恶性肿瘤与良性肿瘤相似，某些良性肿瘤因其生长在重要脏器周围，对人体也可构成极大的危害。人们日常所说的癌即指恶性肿瘤，癌症患者即泛指恶性肿瘤患者。
二、祖国医学对肿瘤的认识
1、中医文献有关肿瘤的描述
我国在代中医文献对多种肿瘤的记载内容较为丰富，从公元前221年的秦汉时期到20世纪30年代乃至新中国成立后的今天都有据可查。
我国最早的医书《内经》中，对肿瘤的病因解释为“营卫不通”，“寒气客与外与卫气相搏”，“喜怒不适……寒湿不时邪气胜之，积聚已留”。还有“脾脉微急，为膈中，食饮入而还出，后沃沫”、“下膈者，食啐时乃出”。从文中描写进食后的反应来看，前者很像食管癌，后者很像胃窦癌。
《灵枢?水胀篇》中说：“石瘕生于胞中，寒气客于子门，子门闭塞，气不得通，恶血当泻不泻，以留止，日以益大，状如怀子，月事不以时下，皆生于女子”。按其所述，子宫生肿块是寒邪侵入，影响气血运行，月经不下，瘀血积聚凝滞久为不散，形成肿块，与子宫肿瘤颇为相似。
同时期《难经?五十五难》中说“气之所积者曰积，气之所聚者曰聚，故积者为五脏所生，聚者六腑所成也。积者阴气也，其始发有常处，其痛不离其部，上下有所终始，左右有所穷处。聚者阳气也，其始发无根本，上下无所留止，其痛无常处，谓之聚。”相当于腹腔肿瘤。还有“在胃脘覆大如盘，久不愈，令人四肢不收，发黄疸，饮食不为肌肤。”相当于胃、肝、胰等上腹部晚期肿瘤。
此外张仲景著《金匮要略》、张思邈著《千金药方》、
2、祖国医学对肿瘤病因的认识
祖国医学认为肿瘤不是局部性疾病，而是全身性疾病的局部表现，在致病因素中比较注重内因。因为肿瘤是一类病而不是一种病，所以致病因素是比较复杂的，某种因素可以引起不同的肿瘤，一种肿瘤又可能是各种因素作用的结果。在长期的实践中，古代医学家对肿瘤病因有朴素的认识，归纳起来，不外乎外因和内因两个方面。外因是邪气、邪毒；内因是七情刺激、五脏六腑的蓄毒、气血阴阳的失调和正气的虚弱。但外邪主要是由于人体先有内虚，因为“邪之所凑，其气必虚，”即外因必须通过内因而起作用。由于上述内、外致病因素的作用，使机体内环境失调，脏腑经络气血功能障碍，引起气滞、血瘀、痰凝、湿聚、热毒内蕴等病理变化，如不及时处理，日积月累，互相交结，以致造成肿瘤的发生。
1）、外邪因素 所谓外邪，祖国医学主要是指六淫之邪侵犯人的机体，影响人的脏腑经络。它不但能够使人发生一般的疾病，积聚体内，不及时调整处理，日久不散，也会引起体内阴阳气血的变化，进而使用权经络堵塞，邪毒蕴积而发生肿核、肿块。
2）、精神因素 中医认为，肿瘤发病的内因包括七情的刺激、五脏六腑的蓄毒、气血阴阳的失调和正气的虚弱，其中内伤七情在肿瘤的发病中占有重要的地位。因为内在精神因素的作用，可以使机体内环境失于相对平衡，脏腑经络气血功能障碍，从而导致气滞、血瘀、痰凝、湿聚等病变，至一定程度可生瘤。
七情(喜、怒、忧、思、悲、恐、惊) 是七种不同的情志变化.七请太过或不及 ,都会导人体生理上的一系列病理变化而发生疾病.如<<景岳全书>>曰:”噎膈一症,必以忧愁思虑，积劳积郁。再如对“乳癌“，陈实功谓” 乳癌“由于忧思郁结，所愿不遂，肝脾气逆，以致经络阻塞，结积成核，。又如（医宗金鉴）论：：＇失荣＂证为＂由忧思郁怒，气郁血热，与痰凝而成。薛立斋论：＂五瘤＂为一则曰：怒动肝火，再曰郁结伤脾。＂［诸病源侯论］中提到：夫妇不睦愤怒忧郁，遂病漏下（包括子宫癌症状在内）。这些都说明了内在的精神因素和癌瘤的发生有着极其重要的关系。而以愤怒忧郁，情志不遂为产生癌瘤的诱发原因之一。
３．医学对癌症病机的认识
癌症病机可概括为气滞，血瘀，痰凝，湿聚，热毒内蕴，正气亏损等六型：
1． 气滞 ＂气＂即是功能，又是人体精微的物质基础。气的功能活动称为气机，表现为升降出入，运行全身，增强和调节各组织器官的功能和补充各组织器官所需要的营养物质。正如张景岳所说：＂人之有生，全赖此气＂。
２，血瘀 血随气行，血的阻滞凝结，由折跌损伤或过寒过热，或血行不畅引起，故血瘀多伴气滞。气血的凝滞不散久而久之，便成瘀积肿块，在临床中如肝气郁结，肝失疏泄而不条达，日积月累，致肝血瘀滞，肝区疼痛，肝脏肿大或硬化等而导致肿瘤癌变。
３，痰凝 痰在正常人体中是不存在的。只有在不利的病邪影响下才能有痰。痰与脾虚有很大的关系。脾虚者健运失司，体内水湿不化，津液不布，郁滞不通，便会凝滞成痰，或由于邪热烁津，凝结成痰。［丹溪心法］谓：痰之为物，随气升降，无处不到，凡人身上，中，下有块者，多是痰。汁沫与血相搏凝聚不得散而积成矣。
４，湿聚 湿邪侵入人的机体，停留滞着，便会阻碍阳气的活动。，影响气的流通，导致气滞．气郁．。如湿邪侵犯肌肉，经络就会引起四肢麻木，关节酸痛等证；湿邪内阻肠胃，影响脾的运化，气血阻滞气机不畅，导致脾胃运化功能的减弱，而助长湿的凝聚，二者互为因果，引起机体的病理变化。
５热毒内蕴 热毒, 是指邪热郁火郁结日久而成为热毒。热毒内蕴机体脏腑, 经络, 不及时进行处理, 郁久不散, 也能导致营血不和, 经络阻隔, 气血瘀滞等病理变化。[内经] 说，” 诸痛疡疮; 皆属于心,” 。心主火, 火性燥动是发生疮疡的根本”。 如[医宗金鉴. 外科心法痈疽总论]: 痈疽原是火毒生, 经络阻塞气血凝。” 就是说不论痈或疽,( 阳症或阴症) 都是由火毒致经络阻塞, 气血凝滞所致。此外, 情志抑郁的五志之火, 亦能导致机体的病理变化。
6, 正气亏损 虚与实是人体抗病力的强弱和病邪致病力之间互相斗争的两个方面。实是指病邪盛实。虚证的出现, 或日久病伤正, 或因出血, 失精, 大汗, 或因外邪侵袭, 伤及正气(阳邪容易伤人阴液, 阴邪容易伤人阳气) 等, 从而形成” 精气夺则虚” 的虚证。虚证主要表现为全身气, 血, 阴阳的不足, 反映脏腑功能的衰退。虚证, 在祖国医学里面又有气虚, 血虚, 阴虚, 阳虚之分。
三 、中医对血液病的认识
在祖国医学这个宝库中,有些记载类似现代的血液病,今日,可用它来指导中医治疗血液病的临床实践.简述于下:
如急性白血病的发热兼出血症候,认为与伏邪,温病的某些症候有相似之处.<<素问 阴阳应象大论>>云: “冬伤于寒,春必病温”.后世温病学家称之为伏气温病或伏邪.此乃冬时受寒,伏而不去即发病;寒邪内郁,日久化热,至春天阳气开泄,或因风寒触动伏邪,导致爆发.发病急,热势盛,常兼溲血,下血或 血等症.此外, 温病学说中的温邪,湿热所出现的临床症候,与急性白血病的发热,出血症候亦相近似;所不同的是急性白血病患者的血液中绝大多数可见白血病细胞.吴鞠通<<温病条辨>>云:“太阴湿病,血从上溢者,犀角地黄汤合银翘散主之.”薛生白<<温热病篇>>云: “温热证,上下失血或汗血,毒邪深入营分,走窜欲泄.”余师愚<<疫病篇>>云: “邪犯五脏,则三阴络莫不和,血行乖度,渗入大肠而便血.”上述论点,指出温邪,湿热均可迫血妄行,损伤络脉,因而在临床出现发热兼出血的夹杂证.
如各种原因引起的进行性贫血及脑出血的临床表现,与中医论著中的“急虚”和 “虚劳”病症有相似之处.<<素问 玉机真,脏论>>云: “急虚,身中卒至,五脏绝闭,脉道不通,气不往来,譬圩堕溺,不可为期.”是指发病急而不省人事(相当于脑出血),,比喻它如堕崖,溺水,病程极短,迅速死亡.<<金匮要略>>云: “男子面色薄者,主渴及亡血,卒喘悸,脉浮者,里虚也.”是指患者大失血后,面色枯白无华,出现心跳重,呼吸快等代偿症状,这时候的浮脉,实际上是动脉扩张,因为是亡血伤阴,虽然口渴欲饮而非表热,故而是里虚证.
如各种白血病有肝,脾,淋巴结肿大.而肝,脾,淋巴结肿大与中医论著中的“症积”,“马刀侠瘿”等症有相似之处.“症”者,真也,是指有形之症,积于腹中,牢固不动,按之应手.巢氏<<诸病源候论>>云:“盘劳不移者是积也,言其形状可征验也.“积”者,脏病也,为阴气所结,发有常除,始终不移.<<难经五六十难>>云:“肝之积名曰肥气,在左肋下,如覆杯,有头足”;“皮纸积名脾气在未完覆大如盘”;“肺之积名曰息贲,在右肋下, 覆大如杯.”实际上,息贲是右叶肝肿大,痞气是左叶肝肿大,肥气是脾肿大,所以,中医书中的“症积”是指腹腔内实质性脏器肿大,相当于今之肝,,脾肿大.<<金匮要略>>提到了“马刀侠瘿”.据曹颖甫注文说:“马刀之状,若长形小蚌,生于腋下,坚硬如石”; “侠瘿则为颈项,连连如惯珠.”足以说明马刀似腋下淋巴结肿大,而前瘿则为颈前,后淋巴结肿大.
如缺铁性贫血在祖国医学中有很多名称,在宋,元时代称为“食劳气黄”,“积黄”,“黄肿”,到明,清时代,又称之为“黄胖”或“黄病”.
但亦有一些病证,却包括了许多内科疾病和血液病的某一症状,如<<血证论>>,中的脑衄,唐氏称其在临床上“口鼻具出血”, “如衄甚不止,身热脉浮,喘促足厥者,乃气随血泄,阴脱阳亡.
急性再障或慢性重型再障,急性白血病,原发性
血小板减少性紫癜,血友病以及某些内科疾患,均可发生出血不止而导致失血性休克,终而死亡.历代医学治疗“血证”,各有特长,而以明代<<景岳全书>>叙述的比较完美.张介宾云:“血虚为热者,以凉补之;血有因于气虚者,宜补其气”;“血有虚而滞者,益补之,活之”;“血有寒滞不化及火不归源者,宜温之”;“血有动乱不宁者,宜清之和之”;“血有涩者,宜利之”;“血有病于风湿者,以散之,燥之.”此外,清代末年<<血证论>>提出治疗出血的四大步骤,在临床上有一定使用价值,唐容川云:“惟以止血为第一要法.血止之后,其离经而未吐出者是为淤血,故以消淤为第二法.止吐, 消淤以后,又恐血再潮动,则需用药安之,故以宁血为第三法.邪之所凑,其正必虚.去血既多,阴无有不虚,故又益补虚为收工之法.四者,乃通治血证之大纲.
历代医家在治疗“血症”的实践过程中,也发现了一些禁忌症.<<如<<血证论>>云:“失血虚劳,最忌泄泻”,以脾胃败坏,生化无源故也. “血家最忌感冒,以阴血受伤,不可发汗故也.”在今日临床上经常见到血液病患者,往往在感冒或泄泻之后,疾病恶化,或者反复发作.
The View of Traditional Chinese Medicine on Hemopathy
View of Traditional Chinese Medicine on Hemopathy
Some records in the treasure house of traditional Chinese medicine are similar to modern hemopathy. Nowadays, we could use them to instruct the clinical practice of treatment of hemopathy in traditional Chinese medicine, which is described as follows:
The fever and hemorrhage of acute leukemia are thought to be similar to some symptoms of warm disease. Manifestation of Yin and Yang from the Macrocosm to the Microcosm in Plain Questions: “if the person is injured by cold in winter, then warm disease would happen in spring.” The scholars of warm diseases of later ages called it as that warm disease caused by incubating qi or hidden pathogen are aroused by cold in winter; the cold pathogen accumulates in interior and transforms heat with passing of time; the disease is caused by that the yang qi opens and disperses in spring, or that the wind-cold stirs the hidden pathogen. The disease comes on urgently with syndromes of intense heat, hematuria, hemafecia, or bleeding from five aperture or subcutaneous tissue. In addition, clinical symptoms of warm pathogen and warm-heat in science of warm disease are similar to the fever and hemorrhage of acute leukemia; the only difference between them lies in that there is leukemia cells found in the blood of most of acute leukemia patients. Wu Jutong’s Detailed Analysis of Epidemic Warm Diseases: “if disease of Taiyin dampness has symptom of blood flowing upward, the xijiao dihuang decoction, and yinqiao powder would work.” Xue Shengbai’s Chapter of Warm Heat Disease: “as for the symptom of warm heat, there are losses of blood upward and downward as well as sweat with hemorrhage, the toxicity and pathogen invades the nutrient tier, moves and migrates inside the body.” Yu Shiyu’s Chapter of Plague Disease: “the pathogen invades the five viscera, which leads to disharmony of three yin and channels and disorder of blood flow, and then the blood oozes into the large intestine.” The above arguments point out that warm pathogen and dampness-heat could cause hyperactivity of blood and injury channels, which show as the clinical manifestations of fever and hemorrhage.
For example, clinical manifestations of pernicious anemia and cerebral hemorrhage caused by various causes are similar to the symptoms of “acute deficiency” and “consumptive disease in treatises in tradition Chinese medicine. Plain Questions: On the Jade Secrets and True Organs says: “acute deficiency, with wind - stroke, five zang viscera and vessels block, qi does not flows, which are just like falling off the cliff and drowning and have short course of disease.” The statement means that patient losses consciousness because the disease comes on urgently. And the statement compares the disease to falling off the cliff and drowning, because the course of disease is extremely short and the patient dies once the disease comes on. Synopsis of Golden Chamber: “A man with pale complexion is thirsty and suffers from loss of blood, has fast pounding heartbeat and faster breath. The floating pulse is actually the interior deficiency.” The statement means that: after massive hemorrhage, the patient has a pale complexion and compensation symptoms like fast pounding heartbeat and faster breath. And the floating pulse at this moment is actually the arteriectasia. Because the loss of blood injures yin, the thirst with desire to drink is not the superficies heat but the syndrome of interior deficiency.
For example, various types of leukemia have syndromes of intumescence of liver, spleen and lymph node, which are similar to the syndromes of “splenomegaly” and “saber and pearl-string lumps.” “Syndrome” is true that refers to tangible syndromes accumulating in abdomen, which is firm and dislikes being pressed. General Treatise on Causes and Manifestations of All Diseases of Chao Yuanfang: “the firm lump that does not move refers to mass, of which the shape could be verified. “Mass” is the zang-viscera disease that accumulated by yin qi, occurs in permanent positions and does not move all the time. Fifty-sixth Question in Classic on Medical Problems says: “accumulation in liver is called Fei qi (liver cirrhosis), under the left lateral thorax, like overturning cup and has head and foot;” “accumulation in spleen is called hypochondriac mass, existing in stomach, and is as big as a plate when it is overturning;” “accumulation in lung is called Xiben (rapid and asthmatic breath), existing under right lateral thorax, and is as big as a cup when it is overturning.” In fact, Xiben refers to intumescence of right liver lobe, glomus qi refers to intumescence of right liver lobe, and Fei qi refers to intumescence of spleen. Therefore, “splenomegaly” in traditional Chinese medical book refers to intumescence of substantial organs in abdomen, which equals to intumescence of liver and spleen nowadays. Synopsis of Golden Chamber once referred the “saber and pearl-string lumps.” It is noted by Cao Yingfu that “the shape of saber lumps is similar to small clam, occurs in armpit and is as hard as stone;” “pearl-string lumps exist in neck, one beat after another like threaded pearls.” It shows that saber lump is similar to lymph node enlargement in armpit and pearl-string lump is similar to lymph node enlargement before and after the neck.
However, some diseases include some symptom of many internal diseases and hemopathies. For example, Tang Rongchuan said that the clinical manifestations of severe epistaxis in the Blood Disease Theory are “hematemesis and epistaxis”; “if severe bleeding could not stop, there would be fever and floating pulse; if the patient’s feet are deadly cold, the symptom is caused by qi leakage with blood flow and the separation of yin and yang.
Acute aplastic anemia or chronic severe aplastic anemia, acute leukemia, primary
The thrombocytopenic purpura, hemophilia and some medical diseases would cause lasting hemorrhage, which may lead to hemorrhagic shock and then death at last. Medicine in all ages had their own advantages in treating “blood syndromes,” and the more perfect medical book is Jingyue's Complete Works in Ming Dynasty. Zhang Jiebin said that: “as for patient suffering from blood deficiency with mild fever, nourish them by cooling; as for the blood deficiency caused by qi deficiency, invigorate qi;” “as for patient suffering from blood deficiency and stagnation, replenish and activate blood;” “as for patient suffering from disease of cold accumulated in blood and the fire not returning to its source, warm the blood;” “as for patient suffering from blood stasis, promote blood flow;” “as for blood with rheumatism, dispel and dry blood.” In addition, the On Blood Syndromes in late of Qing Dynasty put forward the four steps for treating hemorrhage, which have certain use value in clinical treatment. Tang Rongchuan said: “Arresting bleeding is of the most importance. After arresting bleeding, because the blood with abnormal flow is static blood, so the removing blood stasis is the second important step. After removing blood stasis, in order to avoid stirring blood, it is necessary to use medicines to calm the blood, thus calming blood is the third important method. Where the pathogen goes, there must be deficiency of vital qi. For heavy loss of blood, there must be yin deficiency. So method deficiency nourishing is the last step. These four steps are generally applicable to treatment of blood syndromes.
Medical specialists in all ages found some contraindications in practice of treating “blood syndromes.” For example, Blood Syndromes says: “patient suffering from blood loss and consumptive disease must avoid diarrhea,” because the spleen and stomach are impaired and there is no source for production and transformation. “Person suffering from hemorrhage must avoid catching a cold, because the yin blood is impaired and sweating shall be avoided.” In clinical treatment of patient of hemopathy, the conditions of patient would always deteriorate or the disease relapses repeatedly after catching a cold or suffering from diarrhea.
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