本文關(guān)鍵詞：陸明學(xué)術(shù)思想與臨床經(jīng)驗(yàn)總結(jié)及經(jīng)驗(yàn)方治療絕經(jīng)前乳腺癌臨床療效觀察　出處：《北京中醫(yī)藥大學(xué)》2017年博士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 臨床經(jīng)驗(yàn) 經(jīng)驗(yàn)方 乳腺癌 學(xué)術(shù)思想

【摘要】：1研究目的1.1總結(jié)陸明教授的學(xué)術(shù)思想、臨證經(jīng)驗(yàn)及遣方用藥方法、規(guī)律,并追溯其理論淵源。1.2對(duì)陸明教授應(yīng)用扶正祛邪理論治療絕經(jīng)前乳腺癌的臨床療效進(jìn)行總結(jié),用以指導(dǎo)臨床實(shí)踐。2研究方法2.1通過(guò)臨床跟師、臨證抄方、隨堂聽課及教學(xué)查房,并結(jié)合深度訪談的定性研究方法,對(duì)陸明教授的中醫(yī)學(xué)術(shù)論文、醫(yī)案、論著、經(jīng)典回顧性病例等原始資料收集、整理、分析,總結(jié)其學(xué)術(shù)思想、淵源及臨證經(jīng)驗(yàn)。2.2采取前瞻性臨床研究方法,將120例絕經(jīng)前激素受體陽(yáng)性乳腺癌患者隨機(jī)分為治療與對(duì)照兩組,以陸明教授臨證經(jīng)驗(yàn),運(yùn)用扶正祛邪經(jīng)驗(yàn)方治療6個(gè)月,總結(jié)臨床療效。3研究結(jié)果3.1陸明教授學(xué)術(shù)思想研究結(jié)果3.1.1學(xué)習(xí)學(xué)術(shù)淵源:注重經(jīng)典,靈活實(shí)踐,兼容并蓄,融匯諸家,師承前賢。3.1.2陸明教授顧護(hù)胃氣論,主張辨證用藥以顧護(hù)胃氣為先,對(duì)中晚期腫瘤患者重護(hù)胃氣,對(duì)肝癌患者中醫(yī)治療從脾胃論治。3.1.3總結(jié)陸明教授惡性腫瘤的中醫(yī)治療理論,主張腫瘤微觀辨證論,腫瘤的中醫(yī)治療采取部位、陰陽(yáng)、經(jīng)絡(luò)辨證方法,中醫(yī)治療將化療及靶向治療藥物進(jìn)行寒熱燥濕分類,采取多方法治療、多途徑給藥,惡性積液從寒論治的相關(guān)新論。3.2陸明教授臨證經(jīng)驗(yàn)研究結(jié)果3.2.1陸明教授的臨證用藥特色鮮明,擅用蟲類藥、參類藥,多采取復(fù)方大劑以全面地兼顧病情。3.2.2陸明教授的腫瘤食療義理經(jīng)驗(yàn)行之有效,適宜的飲食有益于腫瘤患者的康復(fù)并減輕術(shù)后、放化療后的毒副反應(yīng)。3.2.3陸明教授將病因辨證與臟腑辨證相結(jié)合治療肺癌,臨證經(jīng)驗(yàn)效果甚佳。3.2.4對(duì)陸明教授治療體表腫瘤、乳腺癌、食管癌、惡性淋巴瘤、慢性萎縮性胃炎、慢性非特異性潰瘍性結(jié)腸炎、脂肪肝的臨證經(jīng)驗(yàn)進(jìn)行系統(tǒng)梳理總結(jié),為中醫(yī)臨床的發(fā)展提供新思路。3.3以扶正祛邪經(jīng)驗(yàn)方治療絕經(jīng)前激素受體陽(yáng)性乳腺癌患者鞏固期的研究結(jié)果3.3.1觀察指標(biāo)3.3.1.1相關(guān)腫瘤標(biāo)記物:①治療后兩組患者血清中的CA125與CA153抗原含量比較,對(duì)照組顯著高于治療組(p0.05),有統(tǒng)計(jì)學(xué)意義。②治療后兩組患者血清中的CEA抗原含量比較,p0.05,無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)果表明陸明教授經(jīng)驗(yàn)方可降低機(jī)體血清中腫瘤抗原CA125與CA153的水平。3.3.1.2各項(xiàng)激素水平:①兩組患者治療后各項(xiàng)激素水平比較,p0.05,無(wú)統(tǒng)計(jì)學(xué)意義。②兩組患者治療前后各項(xiàng)激素水平比較,經(jīng)統(tǒng)計(jì)學(xué)檢驗(yàn)分析,p0.05,有統(tǒng)計(jì)學(xué)意義�？傮w分析,他莫昔芬、陸明教授經(jīng)驗(yàn)方+他莫昔芬治療均不升高乳腺癌患者的激素水平,具有調(diào)節(jié)作用,經(jīng)驗(yàn)方在調(diào)節(jié)激素水平方面具有優(yōu)勢(shì)。3.3.1.3骨密度:對(duì)兩組患者治療前后的骨密度值進(jìn)行比較,治療前兩組患者的骨密度對(duì)比差異不明顯(p0.05),無(wú)統(tǒng)計(jì)學(xué)意義。兩組患者治療前后骨密度值的組內(nèi)對(duì)比差異明顯(p0.05),但對(duì)照組患者的骨密度較治療前減低,治療組則升高,兩組治療后的骨密度值組間對(duì)比差異同樣顯著(p0.05),表明經(jīng)驗(yàn)方對(duì)絕經(jīng)前乳腺癌患者的骨密度有顯著提升效果。3.3.1.4子宮內(nèi)膜厚度:①治療前兩組患者的子宮內(nèi)膜厚度比較,p0.05,差異不具統(tǒng)計(jì)學(xué)意義,具有可比性;②對(duì)照組治療前后子宮內(nèi)膜厚度比較,p0.05,治療前后差異具有統(tǒng)計(jì)學(xué)意義;③治療組治療前后子宮內(nèi)膜厚度比較,p0.05,差異不具統(tǒng)計(jì)學(xué)意義。上述結(jié)果說(shuō)明:單純運(yùn)用他莫昔芬治療絕經(jīng)前乳腺癌確實(shí)會(huì)引起患者子宮內(nèi)膜增厚,而聯(lián)合中藥經(jīng)驗(yàn)方治療后,患者子宮內(nèi)膜非但沒有增厚,還略有減少,可有效改善他莫昔芬不良反應(yīng)。3.3.1.5生存質(zhì)量變化:對(duì)乳腺癌患者采取經(jīng)驗(yàn)方治療,對(duì)比其治療前后的生理狀況、情感狀況、社會(huì)/家庭狀況、機(jī)體功能狀況、附加關(guān)注等方面情況。兩組患者治療后生存質(zhì)量總積分比較,經(jīng)統(tǒng)計(jì)學(xué)檢驗(yàn)分析,p0.05,有統(tǒng)計(jì)學(xué)意義。①對(duì)照組:治療前后的生理狀況比較,經(jīng)統(tǒng)計(jì)學(xué)檢驗(yàn)分析(t=3.109,P=0.008),p0.05,有統(tǒng)計(jì)學(xué)意義;治療前后情感狀況比較,經(jīng)統(tǒng)計(jì)學(xué)檢驗(yàn)分析(t=2.239,P=0.017),p0.05,有統(tǒng)計(jì)學(xué)意義;治療前后社會(huì)/家庭狀況比較,經(jīng)統(tǒng)計(jì)學(xué)檢驗(yàn)分析(t=0.266,P=0.785),p0.05,無(wú)統(tǒng)計(jì)學(xué)意義;治療前后機(jī)體功能狀況比較,經(jīng)統(tǒng)計(jì)學(xué)檢驗(yàn)分析(t=-0.448,P=0.665),p0.05,無(wú)統(tǒng)計(jì)學(xué)意義;治療前后附加關(guān)注比較,經(jīng)統(tǒng)計(jì)學(xué)檢驗(yàn)分析(t=-0.776,P=0.507),p0.05,無(wú)統(tǒng)計(jì)學(xué)意義;治療前后量表總分比較,經(jīng)統(tǒng)計(jì)學(xué)檢驗(yàn)分析(t=-0.915,P=0.374),p0.05,無(wú)統(tǒng)計(jì)學(xué)意義。②治療組:治療前后生理狀況、情感狀況、社會(huì)/家庭狀況、機(jī)體功能狀況、附加關(guān)注、量表總分比較,p0.05,有統(tǒng)計(jì)學(xué)意義�？傮w分析:對(duì)絕經(jīng)前乳腺癌患者應(yīng)用經(jīng)驗(yàn)方治療可提高其生存質(zhì)量評(píng)分,有效改善其生存質(zhì)量。3.3.1.6中醫(yī)證候總分變化:兩組患者治療后中醫(yī)證候總分比較,p0.05,有統(tǒng)計(jì)學(xué)意義。總體分析表明:經(jīng)驗(yàn)方的運(yùn)用,能明顯改善患者的潮熱汗出、煩躁、抑郁、疲倦乏力、食少納差、手足麻木、腰膝酸軟、夜寐差等臨床癥狀和體征。3.3.1.7KPS評(píng)分變化:兩組患者治療前后KPS評(píng)分比較,經(jīng)統(tǒng)計(jì)學(xué)檢驗(yàn)分析,p0.05,有統(tǒng)計(jì)學(xué)意義,總體分析表明:經(jīng)驗(yàn)方的運(yùn)用,能提高患者的生活質(zhì)量。3.3.2臨床療效判定:兩組患者治療前后,中醫(yī)證候改善情況有統(tǒng)計(jì)學(xué)差異,p0.05。結(jié)果表明:經(jīng)驗(yàn)方能顯著提高證候療效,較單純他莫昔芬組具有明顯優(yōu)勢(shì)。兩組患者治療前后KPS評(píng)分改善情況比較,有統(tǒng)計(jì)學(xué)意義,p0.05。結(jié)果表明:經(jīng)驗(yàn)方能明顯改善絕經(jīng)前乳腺癌患者生活質(zhì)量。4結(jié)論4.1陸明教授在三十余載的中醫(yī)臨床工作中,主張以中醫(yī)經(jīng)典理論為根,辨證論治觀點(diǎn)為本,強(qiáng)調(diào)中西醫(yī)互相學(xué)習(xí),講究融會(huì)貫通,力倡運(yùn)用現(xiàn)代方法以確定疾病的病位和性質(zhì),從而提高中醫(yī)治療水平,與此同時(shí)敏銳洞悉國(guó)內(nèi)外醫(yī)學(xué)的發(fā)展動(dòng)態(tài),注重學(xué)習(xí)新知識(shí)新思維,倡導(dǎo)與時(shí)俱進(jìn)的醫(yī)學(xué)思維觀念及科學(xué)合理的臨床治療方法,值得繼承與發(fā)揚(yáng)。4.2在臨床中應(yīng)用扶正祛邪經(jīng)驗(yàn)方治療絕經(jīng)前激素受體陽(yáng)性乳腺癌患者鞏固期可減輕他莫昔芬不良反應(yīng),明顯提高其臨床療效及預(yù)后生存質(zhì)量,從而改善其復(fù)發(fā)及轉(zhuǎn)移情況,因此具有較好的臨床應(yīng)用價(jià)值及推廣意義。
[Abstract]:1 Objective: 1.1 summary of Professor Lu Ming's academic thoughts and clinical experience of prescription method, and traces the theoretical origin of.1.2 clinical curative effect on Application of Fuzhengquxie theory of Professor Lu Ming treating premenopausal breast cancer were summarized, in order to guide the clinical practice of.2 2.1 through clinical research method with the teacher, certificate copy party, attending lectures and teaching rounds, and qualitative research, in-depth interviews, academic papers, Chinese medicine on Professor Lu Ming's medical records, books, classic case review of original data collection, collation, analysis, summarized the academic thought and clinical experience of.2.2 origin, take prospective clinical research methods, 120 premenopausal hormone receptor positive breast cancer patients were randomly divided into treatment group and control group in two, Lu Ming Professor clinical experience, using Fuzhengquxie experience for 6 months, 3.1 Lu Ming Professor summarize the clinical efficacy of.3 results The results of 3.1.1 learning academic origin: focus on the classic, flexible practice, integrate various teachers, fully inclusive and equitable, former.3.1.2 Professor Lu Ming protecting stomach qi theory, advocated by TCM drugs protecting stomach qi first, in patients with advanced tumors support stomach, liver cancer patients in the medical treatment of treatment of traditional Chinese medicine theory to treat.3.1.3 summary of land the professor of malignant tumors from the stomach, advocate the tumor micro differentiation theory, Chinese medicine treatment of cancer to take part, yin and yang meridians method, Chinese medicine treatment of chemotherapy and target of cold dampness classification to drug treatment, taking treatment, many ways of delivery, from the cold treatment of malignant effusion associated.3.2 of Professor Lu Ming the clinical experience of the results of clinical medicine Professor Lu Ming's distinctive feature of 3.2.1, using insect class medicine, ginseng medicine, take a more comprehensive consideration of large compound agents in the condition of.3.2.2 tumor therapy Professor Lu Ming Yi Li The experience of effective, suitable diet is beneficial to the recovery of the patients with tumor and reduce the postoperative adverse reaction after chemotherapy.3.2.3 Lu Ming, will cause the combination of syndrome differentiation and syndrome differentiation in treatment of lung cancer, the effect is very good.3.2.4 clinical experience of Professor Lu Ming in treating superficial tumor, breast cancer, esophageal cancer, malignant lymphoma, chronic atrophic gastritis, chronic nonspecific ulcerative colitis, systematically summarize the fatty liver clinical experience, for the development of clinical medicine to provide a new way to experience.3.3 Fuzhengquxie Decoction in the treatment of premenopausal patients with hormone receptor positive breast cancer consolidation results 3.3.1 observed 3.3.1.1 related tumor markers: comparison of two groups of patients in serum CA125 and CA153 antigen content after treatment, the control group was significantly higher than the treatment group (P0.05), there was statistical significance. After the treatment of CEA antigen in two groups of patients in serum than A, P0.05, no statistical significance. The results show that the experience of Professor Lu Ming Fang can reduce the tumor antigen CA125 and CA153 in serum.3.3.1.2 levels of the hormone levels: the two groups were compared after treatment, the hormone level of P0.05 was not statistically significant. The hormone levels in the two groups before and after treatment, the statistical test analysis of P0.05 was statistically significant. The overall analysis, tamoxifen, Professor Lu Ming's experience of tamoxifen therapy were not elevated Decoction + hormone levels in patients with breast cancer and its role in regulating hormone level experience has the advantage of.3.3.1.3 mask bone density: compare bone density values before and after treatment in two groups of patients before treatment, bone density contrast differences between the two groups were not significant (P0.05), no statistically significant difference. The bone density in two groups before and after treatment within the group of contrast (P0.05), but the control group of patients with bone Lower density than before treatment, the treatment group increased bone density after treatment of the two groups of values of the differences between the two groups were also significantly (P0.05), showed that the experience of bone density in premenopausal breast cancer patients had significantly improved.3.3.1.4 endometrial thickness: before treatment, the endometrial thickness of two groups of patients with P0.05. The difference was not statistically significant, comparable; in the control group after treatment, the endometrial thickness P0.05, with statistically significant differences before and after the treatment; the treatment group before and after treatment, the endometrial thickness of P0.05, the difference was not statistically significant. The results showed: the simple use of tamoxifen in premenopausal breast cancer patients does cause endometrial thickening, and combined with traditional Chinese medicine experience after treatment, patients with endometrial thickening instead, also slightly reduced, can effectively improve the quality of life and adverse effects of.3.3.1.5 tamoxifen Change: take the experience of treatment for breast cancer patients, before and after the treatment of affective physiological condition, contrast condition, social / family status, functional status, additional concerns. Compare the total score of quality of life of two groups of patients after treatment, after statistical analysis and inspection, P0.05, was statistically significant. The control group: the physiological condition before and after treatment, analysis of the statistical test (t=3.109, P=0.008, P0.05), there was statistical significance; comparison of emotional status before and after treatment, analysis of the statistical test (t=2.239, P=0.017), P0.05, have statistical significance; social / family status before and after treatment, analysis of the statistical test (t=0.266, P=0.785). P0.05, no statistical significance; comparison of the status of the body function before and after treatment, analysis of the statistical test (t=-0.448, P=0.665), P0.05, no statistical significance; comparison of additional attention before and after treatment, analysis of the statistical test (t=-0.776 , P=0.507, P0.05), no statistical significance before and after treatment; the total scores of comparison, analysis of the statistical test (t=-0.915, P=0.374), P0.05, was not statistically significant. The treatment group: emotional physiological status, before and after the treatment, social / family status, functional status, additional attention score comparison, P0.05 there was statistical significance. The overall analysis of premenopausal breast cancer patients experience treatment can improve the quality of life score, effectively improve the life quality of.3.3.1.6 TCM syndrome score changes: the two groups were compared after treatment, TCM syndrome score of P0.05 was statistically significant. The overall analysis showed that using the experience, obviously to improve the patient's hot flashes sweating, irritability, depression, fatigue, eat less anorexia, numbness, Yaoxisuanruan, insomnia and poor clinical symptoms and signs of change:.3.3.1.7KPS scores KPS scores between the two groups before and after treatment by the system In terms of analysis and inspection, P0.05, have statistical significance, the overall analysis showed that using the experience, can improve the quality of life of.3.3.2 patients with clinical efficacy assessment: two groups of patients before and after treatment, TCM symptoms had significant difference, p0.05. results show that the empirical formula can significantly improve the therapeutic effect of syndrome, compared with tamoxifen group obvious advantages. Two groups of patients before and after treatment KPS score improvement compared with statistical significance, p0.05. results show that the experience can significantly improve premenopausal breast cancer patients life quality.4 conclusion 4.1 Lu Ming professor in clinical medicine for three years, advocated by the classical theory of TCM syndrome differentiation is the root view for this emphasis on traditional Chinese and Western medicine, learn from each other, pay attention to mastery, advocating the use of modern methods to determine the disease location and nature of the disease, so as to improve the level of Chinese medicine treatment at the same time, a keen insight into the domestic and foreign medicine The development of dynamic learning, learning new knowledge, thinking of the times and promote medical scientific and reasonable methods of clinical treatment, worthy of inheriting and developing the.4.2 application experience Fuzhengquxie Decoction in the treatment of premenopausal women with hormone receptor positive breast cancer patients with a period of consolidation can reduce the side effects of tamoxifen in the clinic, improve the clinical curative effect and survival quality thus, to improve its recurrence and metastasis, so it has better clinical application value and popularization significance.

【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類號(hào)】：R249;R273

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 陳震宏;許盈;舒敬德;徐乃喜;;中藥方治療乳腺癌術(shù)后并發(fā)癥療效觀察[J];新中醫(yī);2015年09期

2 田歡;張莉;林洪;張廣路;莫婷;金宇;;乳腺癌患者中醫(yī)體質(zhì)特征與證候規(guī)律的相關(guān)性研究[J];世界中醫(yī)藥;2015年07期

3 谷雨;華海清;;中醫(yī)辨證分型與乳腺癌預(yù)后的相關(guān)性研究[J];西部中醫(yī)藥;2015年04期

4 趙亞婷;胡萬(wàn)寧;張景華;宋艷華;趙海潞;;情志因素對(duì)乳腺癌預(yù)后的影響[J];中國(guó)臨床研究;2015年03期

5 周競(jìng)崢;劉勇;羅玲;孟令占;程俊;劉娜;劉文琴;高麗萍;;急性放射性肺炎中醫(yī)藥研究概述[J];中國(guó)中醫(yī)急癥;2015年03期

6 黃羚;江媚;劉寧遠(yuǎn);徐慧;岳立云;李潤(rùn)澤;;三陰性乳腺癌患者中醫(yī)體質(zhì)類型分析及其與TOP2A基因表達(dá)的相關(guān)性[J];中國(guó)中醫(yī)藥信息雜志;2015年01期

7 劉瑩瑩;哈木拉提·吾甫爾;鄧皖利;陸明;;陸明治療乳腺癌處方春季用藥特色研究[J];中國(guó)中醫(yī)藥信息雜志;2014年11期

8 戚益銘;沈敏鶴;阮善明;楊一天;;乳腺癌病因病機(jī)及中醫(yī)證治的研究進(jìn)展[J];黑龍江中醫(yī)藥;2014年05期

9 何俊安;;乳腺癌的患病因素與中醫(yī)未病先防的相關(guān)性研究[J];現(xiàn)代中西醫(yī)結(jié)合雜志;2014年14期

10 張嘉慶;王殊;謝菲;;中國(guó)乳腺癌外科治療發(fā)展回顧[J];中華乳腺病雜志(電子版);2014年02期

，

本文編號(hào)：1434403