李佩文教授治疗肝癌的临床经验整理研究
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摘要
原发性肝癌指原发于肝细胞或肝内胆管细胞的恶性肿瘤,是临床常见的恶性肿瘤之一。在我田人多数患者合并由乙肝及肝硬化病史,肝癌起病隐匿,高度恶性,进展迅猛,手术后复发率高,放疗化疗等西医治疗措施不敏感,效果差,晚期患者生存期仅3-6个月左右死亡率高,5年生存期仅4-7%,是严重危害人类健康的主要疾病之一。
导师李佩文教授从事中西医结合治疗肿瘤临床工作逾四十年,对肝癌的治疗积累了丰富的经验。认为肝癌的治疗原则应该是综合治疗,患者需要接受包括外科于术、经肝动脉灌注栓塞化疗、射频治疗、局部消融、无水酒精注射,甚至全身化疗、放疗等治疗方式。认为中医药在肝癌的全过程中均可发挥积极作用：早期中药干预可以预防慢性肝炎、肝硬化向肝癌转化；肝癌术后用中药可以预防肿瘤的复发转移；栓塞、放化疗后使用中药可以减轻治疗的副反应；晚期肝癌患者使用中药治疗,可以减轻临床症状,缓解肝癌并发症,提高生活质量,延长生存期。
多年的临床实践,李老师在原发性肝癌的病因病机、发病特点、辨证施治及遣方用药上积累了丰富的经验,有自己独到的见解,并收到了良好的临床疗效。
李老师在病因病机上重视肝郁脾虚血瘀,肝脾肾三脏同病。湿、热、气、血、毒结聚成块,形成肝积。
在临证中,李老师认为中医诊病,望、闻、问、切四诊合参,缺一不可。李老师尤其重视舌象,从舌质舌苔判断邪盛正衰、判定体质状态、推定预后,并指导用药。治疗上主要以扶正培本、健脾疏肝为基本治则。
在治疗中老师将肝癌分为四种类型,辨证施治用药：(1)肝郁脾虚型：治法疏肝健脾,理气散结。以逍遥散、柴胡疏肝散、枳实消痞丸加减。(2)肝胆湿热型：治法清热利胆,化湿解毒。以茵陈蒿汤、五苓散、龙胆泻肝汤加减。(3)瘀血阻滞型：治法行气活血,化瘀消癓。以化肝煎、膈下逐瘀汤加减。(4)肝肾阴虚型：治法滋补肝肾,凉血软坚。以知柏地黄丸、一贯煎加减。
在辨证治疗中,老师强调：
1、证型不是一成不变的：肝癌发展的整个历程中,其邪正盛哀不是单一不变的,随着病程的进展,证型会相应发生变化。如早期患者邪气盛而正气不虚,多为实证,肝郁气滞明显：中期虚实夹杂,血瘀、痰湿、气血亏、脾虚、肝胃不和等均可见到；晚期则正气虚为主,多为虚证,以肝肾阴亏多见。而某个阶段可能有多重证型同见。西医的治疗方式不同也产生不同的中医分型。
2、辨证同时要辨病：肝癌为恶性肿瘤,肿瘤的诊治有区别于其它内科疾病的特点,老师非常重视在中医辨证的同时,亦不忘“辨病”。
临床论治用药特点包括：
1、首重养血：肝为刚脏,藏血主疏泄,体阴而用阳；从病理变化看,肝阳易亢,肝风易动。故李老师一再强调要充分认识到肝体应柔,肝病一定要注意养血。
2、强调疏肝行气药物的使用：肝主疏泄,喜调达,恶抑郁。所以肝病多有气机不畅。临证中多加入行气疏肝之品。
3、活血化瘀药的使用：肝癌患者临床中比较常见的证型是气滞血瘀,活血化瘀的治法在肝癌的辨证施治中非常重要,临床经常用到。但是还要注意肝癌患者同时有凝血机制的异常,非常容易合并出血的发生,还需要慎用活血药,以防造成大出血危及患者性命。
4、有毒中药的使用：中医认为癌瘤的发生与毒邪内蕴有关,治疗上强调“以毒攻毒”,许多抗癌方中会用到斑蝥、全蝎、水蛭、蜈蚣、壁虎、马钱子、蟾蜍等毒虫之品。李老师强调：有毒之品可以用,但要因人因时因证治宜,不要盲目、大量、长时间使用有毒之品。
5、祛邪勿忘扶正：肿瘤属于慢性疾病,尤其是晚期肝癌,很难得到根治的机会,要做好长期与瘤共存的准备,更强调保护正气。
6、病证同治：肝癌治疗老师在中医辨证施治的同时,亦不忘“辨病”用药,病证同治。药方中多加入清热解毒、活血化瘀、软坚散结之品,直接针对“积”的治疗。
7、兼症用药：李老师除了辨证施治外,还重视兼症用药。中医的对症治疗有非常好的效果,明显提高了患者的生活质量,增强了患者的治疗信心。
8、重视引经药物：肝癌治疗中,李老师非常重视水红花子、八月札、凌霄花、鳖甲等药物的应用,几乎每方均会选择应用,甚至一方中几药全备,老师称它们为肝经药：
9、癌痛的预防：肝癌晚期疼痛的发生比例很高,达80-90%,老师在临床工作·中发现长期服用中药的患者疼痛的发生比例明显下降,中药在一定程度上能预防晚期肝癌患者癌性疼痛的发生并减少中度和重度镇痛药的临床使用。
对于晚期肝癌患者,李老师认为治疗的重点不是追求瘤体的缩小,而是改善病人的临床症状,提高其生活质量,最大限度地延长生存期。对晚期肝癌的并发症,如黄疸、腹水、癌性疼痛等的治疗亦有其独到之处,尤其是中药外用,收到简便廉验的效果。
中医认为黄疸是由于感受湿热疫毒等邪气,导致湿浊阻滞,肝胆功能失调,胆汁不循常道,外溢肌肤而引起的以日黄、身黄、尿黄为主要表现的病证。
李老师认为,黄疽的发病与湿邪关系最为密切,病机的关键是湿。黄疽的病因主要是湿热蕴结、肝胆郁热、脾胃虚寒和癓瘕积聚。临证中将黄疽分为阳黄与阴黄分别施治。
阳黄以湿热为主,阴黄以寒湿为主。治法主要为化湿邪利小便。阳黄：1.热重于湿：治法清热利湿,佐以泄下。方药：茵陈蒿汤加味。2.湿重于热：治法利湿化浊、佐以清热。方药：茵陈五苓散合甘露消毒丹加减。阴黄：1.寒湿困脾：治法健脾和胃、温化寒湿。方剂：茵陈术附汤加味。2.气血曲虚：治法：益气养血,佐以利湿退黄。方剂：八珍汤加味。3.正虚瘀结：治法大补气血,活血化瘀。方剂：八珍汤合化积丸为主方。
老师认为肝癌患者出现阴黄,不完全是寒湿所致,更多归因于血瘀、毒聚,阻于胆络而发黄,色黄而晦暗,真正为寒湿所致者临床上并不多。此时治疗上可以减少清热类药物,适当加入温化之品,如桂枝、附子、干姜等。更需要使用活血化瘀之药,如丹参、赤芍、我术、三七、蜈蚣等。
腹水是肝癌患者的常见并发症,是肝癌进入晚期的重要标志之一。腹水属中医臌胀范围。李老师认为腹水多是在正虚的基础上发生的,特别是肺、脾、肾三脏的虚损是积液发生的根本原因。
治疗腹水要针对病因病机,分清虚实,做到消中有补,补中有消,在祛邪的同时,要照顾正气。李老师临床上一般将腹水分为以下四型：1、痰湿内盛：治法：健脾利水、活血散结、抗癌解毒。以四君子汤合五苓散、五皮饮加减。2、血瘀水停：治泫活血化瘀,行气利水。以当归芍药散合少腹逐瘀汤加减。3、脾肾阳虚：治法温阳健脾,化气行水。以实脾饮、真武汤、苓桂术甘汤加减。4、肝肾阴亏：治法：滋养肝肾,利水散结。方剂：六味地黄汤合一贯煎加减。
对于腹水这样的晚期合并症,老师还强调中医外治,将中药外敷使用,经皮肤吸收而起效,避免了患者服药、输液之苦,病人乐于接受。老师以健脾利水、温阳化瘀为主要治法,最终筛选出有效药物研制而成了实脾消水浸膏,临床用于治疗恶性胸、腹水患者,取得了很好的效果。
疼痛是晚期肝癌患者常见症状之一,由肿瘤细胞浸润、转移、扩散或压迫肝脏尤其是肝包膜所致,是影响患者生存质量的重要因素。
李老师把疼痛的病因分为虚实两类：实证由于病邪侵袭与结聚,导致经络气血运行不畅,即“不通则痛”。虚证由于气血阴阳不足,脏腑经络失于润养或温煦而致疼痛,即“不荣则痛”。提出了行气、活血、通络、清热、散寒、养营等止痛原则。除内服药外,致力于外用药的研究,研制出了一些行之有效的药物。在癌痛方面,主要研制了痛块灵外用膏、痛块消巴布剂。
文中最后在临床研究中分析了李老师以健脾化瘀法治疗晚期原发性肝癌患者56例,通过患者治疗前后瘤体的变化、临床症状的减轻、生活质量的提高、AFP及肝功能的改善等指标,说明了健脾化瘀法治疗肝癌的有效性。
Primary hepatic carcinoma is one of the malignant tumors happened in liver cell or intrahepatic duct. In our country, the majority of patients are with hepatitis B and liver cirrhosis. Liver cancer onset domently, highly malignant, progress fast, high recurrence rate after surgery. The treatment of radiotherapy and chemotherapy is not sensitive. The effect is bad. The survival time of patients in late stage is only three to six months. Liver cancer has a high mortality rate, the rate of5years survival is only4-7%. So primary hepatic carcinoma is one of the main diseases which serious harm human's health.
My tutor professor Li Peiwen, who has worked on combining traditional Chinese and western medicine in treatment of cancer for more than forty years, has accumulated rich experience of the treatment in liver cancer. He thinks that the principle of treatment in liver cancer should be comprehensive treatment. Patients need to accept many therapy including surgery, the hepatic arterial infusion chemotherapy, radio frequency treatment, local ablation, absolute alcohol injection, even systemic chemotherapy and radiation therapy. He also thinks that TCM play a important effect in the whole process of liver cancer. In the early stag Chinese medicine intervention can prevent chronic hepatitis and cirrhosis developing to liver cancer; Postoperative liver cancer with Chinese traditional medicine can prevent cancer relapsing and metastasis; Patients with treatment of embolism, radiation and chemotherapy use traditional Chinese medicine can reduce the side effects; Advanced liver cancer patients use herbal treatment can alleviate clinical symptoms, ease complications liver cancer, improve the quality of life and prolong survival time.
Years of clinical practice, professor Li accumulated a plenty of experience in the cause of primary liver cancer, clinical characteristic, determination of treatment based on differentiation of syndromes. He has his own unique opinion to the disease and good effect.
Tn the disease cause and pathogenesis, professor Li emphasizes liver depression, spleen deficiency and blood stasis. He thinks it is disease in stomach, liver and spleen which lead to liver cancer. Wet, heat, qi, blood and poison form the masses.
Professor Li thinks synthesis of the four diagnoses:observation, listening and smelling, asking, palpationand pulse-taking are both important. Mr Li has paid more attention to tongue. We can judge the exuberance of pathogenic factors leading to weakness of vital qi, physical state and the drug use from tongue coating.
In the treatment of liver cancer teacher will divide patients into four types:1. Liver depression and spleen deficiency type:the treatment will be smoothing liver and strengthening spleen. The prescription is XiaoYaoSan, ChaiHuShuGanSan, ZhiShiXiaoPi decoction.2. Damp-heat in liver and gallbladder type:the treatment is clearing heat and normalizing gallbladder function, eliminating dampness. The prescription is YinChenHaoTang, WuLingSan and LongDanXieGan decoction.3. Obstruction of collaterals by blood stasis:the treatment is promoting qi and blood circulation, removing amass. The prescription is HuaGanJian, GeXiaZhu Yu decoction.4. Liver-Kidney Yin deficiency pattern:the treatment is nourishing liver kidney, cool blood and soft firm. The prescription is ZhiBaiDiHuangWan, YiGuanJian decoction.
In the determination of treatment based on differentiation of syndromes. Professor Li thinks:
1. Type of syndrome is not unchangeable:in the whole course of liver cancer, the type of syndrome will change with the progress of the cancer course.
2. Treatment based on not only differentiation of symptoms and signs but also of disease:liver cancer is malignant tumor. Cancer diagnosis and treatment are different from other disease. It is hard to cure. Professor Li attach important to differentiation of symptoms and signs. But at the same time he also does not forget disease differentiation.
Characteristic of the medicine used by my teacher involves:
1. The first heavy raise blood:liver for just dirty, storing blood zang Lord, Yin and Yang body with; Look from the pathological changes. YiKang liver Yang, GanFeng easy to move. So Mr Li emphasized repeatedly to fully realize liver body should be soft, liver disease must pay attention to keep blood.
2. Emphasizing the use of herbs for soothing the liver:liver govers dispersion, which likes regulating qi activity but hates dumps. Illness in liver is always companying with disorder of qi activity. Drugs for promoting qi circulation are often added in the therapy.
3. The use of the drug for activating blood circulation and eliminating stasis: in the liver cancer patients the most common type of clinical evidence is qi stagnancy and blood stasis. Therapy for activating blood circulation and eliminating stasis in the treatment of liver cancer is very important. But we must pay attention to the liver cancer patients at the same time there is abnormal blood coagulation mechanism which leads to merge bleeding. We should also use the blood activating herbs carefully, in case the massive haemorrhage can endanger the patient lives.
4. The use of toxic traditional Chinese medicine:the mass of traditional Chinese medicine think that tumor happened with poison and related implication. So it emphasized that the therapy of "fight fire with fire" should be used in treatment. Drugs of poisonous insect, such as BanMao QueXie, ShuiZhi, WuGong, BiHu, MaQianZi, ChanChu, etc are often used. Prefessor Li stresses that the poisonous insect can be used, but it should be used with consideration of individual's physique, climatic and season condition. We shouldn't blindly, large and long time use the toxic quality.
5. Removing the pathogen factor and don't forgetting to support vital qi: tumor belongs to chronic diseases, especially advanced liver cancer. It is difficult to get the opportunity to cure. So it should be done with the long-term coexistence of preparation, more emphasis on the protection of vital qi.
6. Disease and syndrome together being cured:In liver cancer TCM treatment, Professor Li emphasizes that treatment should be based on differentiation of disease together with syndrome differentiation. Teacher often add in the prescription of herbs to clearing away heat and toxic material, remove blood stasis. soft hard lumps and dispel nodes. These methods can remove the tumor directly.
7. Ingredients for the accompanying syndromes:besides syndrome differentiation, Professor Li also pays attention to use the drug to accompanying syndromes. Chinese medicine to the symptomatic treatment has very good effect which can obviously improve the patient's quality of life and increase the confidence of the patients.
8. Paying attention to the guiding medicinal herb:in liver cancer treatment, Professor Li attaches great importance to the use of ShuiHongHuaZi, BaYueZha, LingXiaoHua, BieJia. These herbs can be chosen to use in every prescription almost all used in one prescription. They are called by Professor Li of the liver channel medicine.
9. Prevent of cancer pain:in patients of late liver cancer the pain happened in a significant proportion of80-90%. Professor Li found that patients with long-term use of traditional Chinese medicine would have the lower occurrence of pain proportion. Chinese traditional medicine has a certain degree to prevent the happening of the pain and reduce moderate or severe pain in the advanced liver cancer patients.
For advanced liver cancer patients, Professor Li thinks the focus of therapy is not to pursue the narrowing of the tumors, but to improve the patient's clinical symptoms, improve the quality of life, the maximum extended survival. For advanced liver cancer the treatment of complications, such as jaundice. ascites, cancerous pain, also has its unique effect. Especially Chinese medicine for external use, the therapy is simple, inexpensive and valid.
To traditional Chinese medicine Jaundice is due to toxic damp-heat which lead to wet muddy block and liver function disorder. The secretion of bile is abnormal. The bile overflows to the skin which leads to the yellow of skin, eyes and urine.
Professor Li thinks that the outbreak of jaundice is connected with damp pathogen mostly. The key to pathogenesis is the damp. The main causes of jaundice are damp and hot accumulate knot, liver and gallbladder heat stagnation, deficiency in spleen and stomach with cold manifestations and abdominal masses. The main exogenous evil is damp-heat and the internal cause to damage of spleen and stomach, emotional depression. Jaundice is divided into two categories:Yang jaundice and Yin jaundice. Yang jaundice is due to damp and heat. Yin jaundice is due to invasion interior by cold-dampness, spleen Yang deficiency and bile overflow to the spill. Pathogenesis of Jaundice is connected with wet, poison and stasis closely. Professor Li emphasizes the basic principle of the treatment is clearing heat and toxic materials, removing dampness and jaundice, cool blood and promoting blood circulation.
The key of differentiation to jaundice is Yin and Yang. Yang jaundice is due to damp and hot. Yin jaundice is due to cold dampness. The main treatment is removing dampness by urinate. Yang jaundice:1. Heat overweight than wet:the treatment is clearing heat and damp adjuvant with purgation. The prescription is YinChenHao Decoction.2. Wet overweight than hot:the treatment is removing dampness and dissolving turbidity adjuvant with clearing heat. The prescription is YinChenWuLing and GanLuXioaDu decoction. Yin jaundice:1. Spleen besieged by cold-dampness:the treatment is strong spleen and stomach. The prescription is YinChenShuFu decoction.2. Deficiency of both Qi and blood:the treatment is invigorating Qi and blood companying with removing dampness and clearing yellow. Prescription is BaZhen decoction.3. Health energy deficiency and blood stasis:the treatment is reinforcing Qi and blood, promoting blood circulation by removing blood stasis. Prescription is:BaZhen and HuaJi decoction.
Professor Li thinks patients with liver cancer, who appears Yin yellow, are not completely caused by cold dampness, but due to blood stasis, poison stasis too. The yellow is tarnish not bright. At this time the treatment can reduce heat drugs and add herbs to warm yang, such as GuiZhi, FuZi, GanJiang etc. Especially the drug for invigorating blood circulating and eliminating stasis should be used such as DanShen, ChiShao, EShu, SanQi, WuGong etc.
Ascites is common complication in patients with liver cancer and is one of the important signs into the late stag of liver cancer. Ascites belongs to GuZhang range in traditional Chinese medicine. Professor Li holds that the happen of ascites basing on health energy deficiency, especially deficiency of lung, spleen and kidney.
The principle of treatment for ascites is expelling together with reinforce. Removing the evil and taking care of health energy at the same time. Professor Li divides ascites into several type while in treatment:1. Phlegm-dampness retention: treatment is invigorating spleen to reduce phlegm, invigorate blood circulation and anti-cancer. Prescription is SiJunZi, WuLingSan and WuPiYin decoction.2. Blood stasis causing water retention:the treatment is promoting blood circulation by removing stasis and promoting qi circulation for diuresis. Prescription is DangGuiShaoYaoSan and ShaoFuZhuYu decoction.3. Spleen-kidney Yang failure: the treatment should be warming Yang and invigorating spleen. ShiPiYin, ZhenWuTang, LingGuiZhuGan decoction are used.4. Liver-kidney Yin deficiency: treatment is nourishing liver and kidney, increasing secretion of urine. Prescription is Liu WeiDiHuang and YiGuanJian decoction.
For ascites, such late complications, the teacher also stressed the external use of traditional Chinese medicine. The herbs will be absorbed through the skin and work. The patients will avoid the suffering of the infusion and oral of the medicine. Professor Li developed an effective drug called ShiPiXiaoShui Extract which can be used in patients with hydrorax and ascites.
Pain is one of the common symptoms in advanced liver cancer patients. It is one of important factors which influence the quality of survival.
Professor Li divided the cause of pain into the actual two kinds: demonstration and deficiency. The pain of demonstration is due to stagnation of qi and blood. The pain of deficiency is due to the insufficient of qi, blood, Yin and Yang. He made the principle of treatment such as promoting flow of qi and blood circulation, removing obstruct in channels, clearing heat, expelling cold. In addition to the internal medicine. Professor Li committed to the external use of research and developed some effective drugs. In the pain treatment, he developed two kind of medicine:one is TongKuaiLing externally used paste, the other is called TongKuaiXiao cataplasm.
In the clinical study, there were56primary liver cancer patients selected. They were treated by the TCM of invigorating the spleen and removing blood stasis. By comparing the tumor size, the reduce of clinical symptoms and AFP, improving of quality life etc, the validity of the therapy of invigorating the spleen and removing blood stasis was proven.
导师李佩文教授从事中西医结合治疗肿瘤临床工作逾四十年,对肝癌的治疗积累了丰富的经验。认为肝癌的治疗原则应该是综合治疗,患者需要接受包括外科于术、经肝动脉灌注栓塞化疗、射频治疗、局部消融、无水酒精注射,甚至全身化疗、放疗等治疗方式。认为中医药在肝癌的全过程中均可发挥积极作用：早期中药干预可以预防慢性肝炎、肝硬化向肝癌转化；肝癌术后用中药可以预防肿瘤的复发转移；栓塞、放化疗后使用中药可以减轻治疗的副反应；晚期肝癌患者使用中药治疗,可以减轻临床症状,缓解肝癌并发症,提高生活质量,延长生存期。
多年的临床实践,李老师在原发性肝癌的病因病机、发病特点、辨证施治及遣方用药上积累了丰富的经验,有自己独到的见解,并收到了良好的临床疗效。
李老师在病因病机上重视肝郁脾虚血瘀,肝脾肾三脏同病。湿、热、气、血、毒结聚成块,形成肝积。
在临证中,李老师认为中医诊病,望、闻、问、切四诊合参,缺一不可。李老师尤其重视舌象,从舌质舌苔判断邪盛正衰、判定体质状态、推定预后,并指导用药。治疗上主要以扶正培本、健脾疏肝为基本治则。
在治疗中老师将肝癌分为四种类型,辨证施治用药：(1)肝郁脾虚型：治法疏肝健脾,理气散结。以逍遥散、柴胡疏肝散、枳实消痞丸加减。(2)肝胆湿热型：治法清热利胆,化湿解毒。以茵陈蒿汤、五苓散、龙胆泻肝汤加减。(3)瘀血阻滞型：治法行气活血,化瘀消癓。以化肝煎、膈下逐瘀汤加减。(4)肝肾阴虚型：治法滋补肝肾,凉血软坚。以知柏地黄丸、一贯煎加减。
在辨证治疗中,老师强调：
1、证型不是一成不变的：肝癌发展的整个历程中,其邪正盛哀不是单一不变的,随着病程的进展,证型会相应发生变化。如早期患者邪气盛而正气不虚,多为实证,肝郁气滞明显：中期虚实夹杂,血瘀、痰湿、气血亏、脾虚、肝胃不和等均可见到；晚期则正气虚为主,多为虚证,以肝肾阴亏多见。而某个阶段可能有多重证型同见。西医的治疗方式不同也产生不同的中医分型。
2、辨证同时要辨病：肝癌为恶性肿瘤,肿瘤的诊治有区别于其它内科疾病的特点,老师非常重视在中医辨证的同时,亦不忘“辨病”。
临床论治用药特点包括：
1、首重养血：肝为刚脏,藏血主疏泄,体阴而用阳；从病理变化看,肝阳易亢,肝风易动。故李老师一再强调要充分认识到肝体应柔,肝病一定要注意养血。
2、强调疏肝行气药物的使用：肝主疏泄,喜调达,恶抑郁。所以肝病多有气机不畅。临证中多加入行气疏肝之品。
3、活血化瘀药的使用：肝癌患者临床中比较常见的证型是气滞血瘀,活血化瘀的治法在肝癌的辨证施治中非常重要,临床经常用到。但是还要注意肝癌患者同时有凝血机制的异常,非常容易合并出血的发生,还需要慎用活血药,以防造成大出血危及患者性命。
4、有毒中药的使用：中医认为癌瘤的发生与毒邪内蕴有关,治疗上强调“以毒攻毒”,许多抗癌方中会用到斑蝥、全蝎、水蛭、蜈蚣、壁虎、马钱子、蟾蜍等毒虫之品。李老师强调：有毒之品可以用,但要因人因时因证治宜,不要盲目、大量、长时间使用有毒之品。
5、祛邪勿忘扶正：肿瘤属于慢性疾病,尤其是晚期肝癌,很难得到根治的机会,要做好长期与瘤共存的准备,更强调保护正气。
6、病证同治：肝癌治疗老师在中医辨证施治的同时,亦不忘“辨病”用药,病证同治。药方中多加入清热解毒、活血化瘀、软坚散结之品,直接针对“积”的治疗。
7、兼症用药：李老师除了辨证施治外,还重视兼症用药。中医的对症治疗有非常好的效果,明显提高了患者的生活质量,增强了患者的治疗信心。
8、重视引经药物：肝癌治疗中,李老师非常重视水红花子、八月札、凌霄花、鳖甲等药物的应用,几乎每方均会选择应用,甚至一方中几药全备,老师称它们为肝经药：
9、癌痛的预防：肝癌晚期疼痛的发生比例很高,达80-90%,老师在临床工作·中发现长期服用中药的患者疼痛的发生比例明显下降,中药在一定程度上能预防晚期肝癌患者癌性疼痛的发生并减少中度和重度镇痛药的临床使用。
对于晚期肝癌患者,李老师认为治疗的重点不是追求瘤体的缩小,而是改善病人的临床症状,提高其生活质量,最大限度地延长生存期。对晚期肝癌的并发症,如黄疸、腹水、癌性疼痛等的治疗亦有其独到之处,尤其是中药外用,收到简便廉验的效果。
中医认为黄疸是由于感受湿热疫毒等邪气,导致湿浊阻滞,肝胆功能失调,胆汁不循常道,外溢肌肤而引起的以日黄、身黄、尿黄为主要表现的病证。
李老师认为,黄疽的发病与湿邪关系最为密切,病机的关键是湿。黄疽的病因主要是湿热蕴结、肝胆郁热、脾胃虚寒和癓瘕积聚。临证中将黄疽分为阳黄与阴黄分别施治。
阳黄以湿热为主,阴黄以寒湿为主。治法主要为化湿邪利小便。阳黄：1.热重于湿：治法清热利湿,佐以泄下。方药：茵陈蒿汤加味。2.湿重于热：治法利湿化浊、佐以清热。方药：茵陈五苓散合甘露消毒丹加减。阴黄：1.寒湿困脾：治法健脾和胃、温化寒湿。方剂：茵陈术附汤加味。2.气血曲虚：治法：益气养血,佐以利湿退黄。方剂：八珍汤加味。3.正虚瘀结：治法大补气血,活血化瘀。方剂：八珍汤合化积丸为主方。
老师认为肝癌患者出现阴黄,不完全是寒湿所致,更多归因于血瘀、毒聚,阻于胆络而发黄,色黄而晦暗,真正为寒湿所致者临床上并不多。此时治疗上可以减少清热类药物,适当加入温化之品,如桂枝、附子、干姜等。更需要使用活血化瘀之药,如丹参、赤芍、我术、三七、蜈蚣等。
腹水是肝癌患者的常见并发症,是肝癌进入晚期的重要标志之一。腹水属中医臌胀范围。李老师认为腹水多是在正虚的基础上发生的,特别是肺、脾、肾三脏的虚损是积液发生的根本原因。
治疗腹水要针对病因病机,分清虚实,做到消中有补,补中有消,在祛邪的同时,要照顾正气。李老师临床上一般将腹水分为以下四型：1、痰湿内盛：治法：健脾利水、活血散结、抗癌解毒。以四君子汤合五苓散、五皮饮加减。2、血瘀水停：治泫活血化瘀,行气利水。以当归芍药散合少腹逐瘀汤加减。3、脾肾阳虚：治法温阳健脾,化气行水。以实脾饮、真武汤、苓桂术甘汤加减。4、肝肾阴亏：治法：滋养肝肾,利水散结。方剂：六味地黄汤合一贯煎加减。
对于腹水这样的晚期合并症,老师还强调中医外治,将中药外敷使用,经皮肤吸收而起效,避免了患者服药、输液之苦,病人乐于接受。老师以健脾利水、温阳化瘀为主要治法,最终筛选出有效药物研制而成了实脾消水浸膏,临床用于治疗恶性胸、腹水患者,取得了很好的效果。
疼痛是晚期肝癌患者常见症状之一,由肿瘤细胞浸润、转移、扩散或压迫肝脏尤其是肝包膜所致,是影响患者生存质量的重要因素。
李老师把疼痛的病因分为虚实两类：实证由于病邪侵袭与结聚,导致经络气血运行不畅,即“不通则痛”。虚证由于气血阴阳不足,脏腑经络失于润养或温煦而致疼痛,即“不荣则痛”。提出了行气、活血、通络、清热、散寒、养营等止痛原则。除内服药外,致力于外用药的研究,研制出了一些行之有效的药物。在癌痛方面,主要研制了痛块灵外用膏、痛块消巴布剂。
文中最后在临床研究中分析了李老师以健脾化瘀法治疗晚期原发性肝癌患者56例,通过患者治疗前后瘤体的变化、临床症状的减轻、生活质量的提高、AFP及肝功能的改善等指标,说明了健脾化瘀法治疗肝癌的有效性。
Primary hepatic carcinoma is one of the malignant tumors happened in liver cell or intrahepatic duct. In our country, the majority of patients are with hepatitis B and liver cirrhosis. Liver cancer onset domently, highly malignant, progress fast, high recurrence rate after surgery. The treatment of radiotherapy and chemotherapy is not sensitive. The effect is bad. The survival time of patients in late stage is only three to six months. Liver cancer has a high mortality rate, the rate of5years survival is only4-7%. So primary hepatic carcinoma is one of the main diseases which serious harm human's health.
My tutor professor Li Peiwen, who has worked on combining traditional Chinese and western medicine in treatment of cancer for more than forty years, has accumulated rich experience of the treatment in liver cancer. He thinks that the principle of treatment in liver cancer should be comprehensive treatment. Patients need to accept many therapy including surgery, the hepatic arterial infusion chemotherapy, radio frequency treatment, local ablation, absolute alcohol injection, even systemic chemotherapy and radiation therapy. He also thinks that TCM play a important effect in the whole process of liver cancer. In the early stag Chinese medicine intervention can prevent chronic hepatitis and cirrhosis developing to liver cancer; Postoperative liver cancer with Chinese traditional medicine can prevent cancer relapsing and metastasis; Patients with treatment of embolism, radiation and chemotherapy use traditional Chinese medicine can reduce the side effects; Advanced liver cancer patients use herbal treatment can alleviate clinical symptoms, ease complications liver cancer, improve the quality of life and prolong survival time.
Years of clinical practice, professor Li accumulated a plenty of experience in the cause of primary liver cancer, clinical characteristic, determination of treatment based on differentiation of syndromes. He has his own unique opinion to the disease and good effect.
Tn the disease cause and pathogenesis, professor Li emphasizes liver depression, spleen deficiency and blood stasis. He thinks it is disease in stomach, liver and spleen which lead to liver cancer. Wet, heat, qi, blood and poison form the masses.
Professor Li thinks synthesis of the four diagnoses:observation, listening and smelling, asking, palpationand pulse-taking are both important. Mr Li has paid more attention to tongue. We can judge the exuberance of pathogenic factors leading to weakness of vital qi, physical state and the drug use from tongue coating.
In the treatment of liver cancer teacher will divide patients into four types:1. Liver depression and spleen deficiency type:the treatment will be smoothing liver and strengthening spleen. The prescription is XiaoYaoSan, ChaiHuShuGanSan, ZhiShiXiaoPi decoction.2. Damp-heat in liver and gallbladder type:the treatment is clearing heat and normalizing gallbladder function, eliminating dampness. The prescription is YinChenHaoTang, WuLingSan and LongDanXieGan decoction.3. Obstruction of collaterals by blood stasis:the treatment is promoting qi and blood circulation, removing amass. The prescription is HuaGanJian, GeXiaZhu Yu decoction.4. Liver-Kidney Yin deficiency pattern:the treatment is nourishing liver kidney, cool blood and soft firm. The prescription is ZhiBaiDiHuangWan, YiGuanJian decoction.
In the determination of treatment based on differentiation of syndromes. Professor Li thinks:
1. Type of syndrome is not unchangeable:in the whole course of liver cancer, the type of syndrome will change with the progress of the cancer course.
2. Treatment based on not only differentiation of symptoms and signs but also of disease:liver cancer is malignant tumor. Cancer diagnosis and treatment are different from other disease. It is hard to cure. Professor Li attach important to differentiation of symptoms and signs. But at the same time he also does not forget disease differentiation.
Characteristic of the medicine used by my teacher involves:
1. The first heavy raise blood:liver for just dirty, storing blood zang Lord, Yin and Yang body with; Look from the pathological changes. YiKang liver Yang, GanFeng easy to move. So Mr Li emphasized repeatedly to fully realize liver body should be soft, liver disease must pay attention to keep blood.
2. Emphasizing the use of herbs for soothing the liver:liver govers dispersion, which likes regulating qi activity but hates dumps. Illness in liver is always companying with disorder of qi activity. Drugs for promoting qi circulation are often added in the therapy.
3. The use of the drug for activating blood circulation and eliminating stasis: in the liver cancer patients the most common type of clinical evidence is qi stagnancy and blood stasis. Therapy for activating blood circulation and eliminating stasis in the treatment of liver cancer is very important. But we must pay attention to the liver cancer patients at the same time there is abnormal blood coagulation mechanism which leads to merge bleeding. We should also use the blood activating herbs carefully, in case the massive haemorrhage can endanger the patient lives.
4. The use of toxic traditional Chinese medicine:the mass of traditional Chinese medicine think that tumor happened with poison and related implication. So it emphasized that the therapy of "fight fire with fire" should be used in treatment. Drugs of poisonous insect, such as BanMao QueXie, ShuiZhi, WuGong, BiHu, MaQianZi, ChanChu, etc are often used. Prefessor Li stresses that the poisonous insect can be used, but it should be used with consideration of individual's physique, climatic and season condition. We shouldn't blindly, large and long time use the toxic quality.
5. Removing the pathogen factor and don't forgetting to support vital qi: tumor belongs to chronic diseases, especially advanced liver cancer. It is difficult to get the opportunity to cure. So it should be done with the long-term coexistence of preparation, more emphasis on the protection of vital qi.
6. Disease and syndrome together being cured:In liver cancer TCM treatment, Professor Li emphasizes that treatment should be based on differentiation of disease together with syndrome differentiation. Teacher often add in the prescription of herbs to clearing away heat and toxic material, remove blood stasis. soft hard lumps and dispel nodes. These methods can remove the tumor directly.
7. Ingredients for the accompanying syndromes:besides syndrome differentiation, Professor Li also pays attention to use the drug to accompanying syndromes. Chinese medicine to the symptomatic treatment has very good effect which can obviously improve the patient's quality of life and increase the confidence of the patients.
8. Paying attention to the guiding medicinal herb:in liver cancer treatment, Professor Li attaches great importance to the use of ShuiHongHuaZi, BaYueZha, LingXiaoHua, BieJia. These herbs can be chosen to use in every prescription almost all used in one prescription. They are called by Professor Li of the liver channel medicine.
9. Prevent of cancer pain:in patients of late liver cancer the pain happened in a significant proportion of80-90%. Professor Li found that patients with long-term use of traditional Chinese medicine would have the lower occurrence of pain proportion. Chinese traditional medicine has a certain degree to prevent the happening of the pain and reduce moderate or severe pain in the advanced liver cancer patients.
For advanced liver cancer patients, Professor Li thinks the focus of therapy is not to pursue the narrowing of the tumors, but to improve the patient's clinical symptoms, improve the quality of life, the maximum extended survival. For advanced liver cancer the treatment of complications, such as jaundice. ascites, cancerous pain, also has its unique effect. Especially Chinese medicine for external use, the therapy is simple, inexpensive and valid.
To traditional Chinese medicine Jaundice is due to toxic damp-heat which lead to wet muddy block and liver function disorder. The secretion of bile is abnormal. The bile overflows to the skin which leads to the yellow of skin, eyes and urine.
Professor Li thinks that the outbreak of jaundice is connected with damp pathogen mostly. The key to pathogenesis is the damp. The main causes of jaundice are damp and hot accumulate knot, liver and gallbladder heat stagnation, deficiency in spleen and stomach with cold manifestations and abdominal masses. The main exogenous evil is damp-heat and the internal cause to damage of spleen and stomach, emotional depression. Jaundice is divided into two categories:Yang jaundice and Yin jaundice. Yang jaundice is due to damp and heat. Yin jaundice is due to invasion interior by cold-dampness, spleen Yang deficiency and bile overflow to the spill. Pathogenesis of Jaundice is connected with wet, poison and stasis closely. Professor Li emphasizes the basic principle of the treatment is clearing heat and toxic materials, removing dampness and jaundice, cool blood and promoting blood circulation.
The key of differentiation to jaundice is Yin and Yang. Yang jaundice is due to damp and hot. Yin jaundice is due to cold dampness. The main treatment is removing dampness by urinate. Yang jaundice:1. Heat overweight than wet:the treatment is clearing heat and damp adjuvant with purgation. The prescription is YinChenHao Decoction.2. Wet overweight than hot:the treatment is removing dampness and dissolving turbidity adjuvant with clearing heat. The prescription is YinChenWuLing and GanLuXioaDu decoction. Yin jaundice:1. Spleen besieged by cold-dampness:the treatment is strong spleen and stomach. The prescription is YinChenShuFu decoction.2. Deficiency of both Qi and blood:the treatment is invigorating Qi and blood companying with removing dampness and clearing yellow. Prescription is BaZhen decoction.3. Health energy deficiency and blood stasis:the treatment is reinforcing Qi and blood, promoting blood circulation by removing blood stasis. Prescription is:BaZhen and HuaJi decoction.
Professor Li thinks patients with liver cancer, who appears Yin yellow, are not completely caused by cold dampness, but due to blood stasis, poison stasis too. The yellow is tarnish not bright. At this time the treatment can reduce heat drugs and add herbs to warm yang, such as GuiZhi, FuZi, GanJiang etc. Especially the drug for invigorating blood circulating and eliminating stasis should be used such as DanShen, ChiShao, EShu, SanQi, WuGong etc.
Ascites is common complication in patients with liver cancer and is one of the important signs into the late stag of liver cancer. Ascites belongs to GuZhang range in traditional Chinese medicine. Professor Li holds that the happen of ascites basing on health energy deficiency, especially deficiency of lung, spleen and kidney.
The principle of treatment for ascites is expelling together with reinforce. Removing the evil and taking care of health energy at the same time. Professor Li divides ascites into several type while in treatment:1. Phlegm-dampness retention: treatment is invigorating spleen to reduce phlegm, invigorate blood circulation and anti-cancer. Prescription is SiJunZi, WuLingSan and WuPiYin decoction.2. Blood stasis causing water retention:the treatment is promoting blood circulation by removing stasis and promoting qi circulation for diuresis. Prescription is DangGuiShaoYaoSan and ShaoFuZhuYu decoction.3. Spleen-kidney Yang failure: the treatment should be warming Yang and invigorating spleen. ShiPiYin, ZhenWuTang, LingGuiZhuGan decoction are used.4. Liver-kidney Yin deficiency: treatment is nourishing liver and kidney, increasing secretion of urine. Prescription is Liu WeiDiHuang and YiGuanJian decoction.
For ascites, such late complications, the teacher also stressed the external use of traditional Chinese medicine. The herbs will be absorbed through the skin and work. The patients will avoid the suffering of the infusion and oral of the medicine. Professor Li developed an effective drug called ShiPiXiaoShui Extract which can be used in patients with hydrorax and ascites.
Pain is one of the common symptoms in advanced liver cancer patients. It is one of important factors which influence the quality of survival.
Professor Li divided the cause of pain into the actual two kinds: demonstration and deficiency. The pain of demonstration is due to stagnation of qi and blood. The pain of deficiency is due to the insufficient of qi, blood, Yin and Yang. He made the principle of treatment such as promoting flow of qi and blood circulation, removing obstruct in channels, clearing heat, expelling cold. In addition to the internal medicine. Professor Li committed to the external use of research and developed some effective drugs. In the pain treatment, he developed two kind of medicine:one is TongKuaiLing externally used paste, the other is called TongKuaiXiao cataplasm.
In the clinical study, there were56primary liver cancer patients selected. They were treated by the TCM of invigorating the spleen and removing blood stasis. By comparing the tumor size, the reduce of clinical symptoms and AFP, improving of quality life etc, the validity of the therapy of invigorating the spleen and removing blood stasis was proven.
引文
[1]魏录莲,陈莲.中医药治疗原发性肝癌的研究进展.江西中医药.2006,37(281)：60-62
[2]史茜.原发性肝癌的中医药治疗研究.长春中医药大学学报.2008,24(4)：399-400
[3]贾晋斌,倪淑欣.肝癌治疗新药临床研究进展.中国医药生物技术.2011,6(2)：131-133
[4]陈小峰,华碧春.中医药治疗原发性肝癌的若干问题探讨.福建中医药大学学报.2011,21(3)：50-52
[5]钱彦方.肝癌临证探讨.中国中医药信息杂志.2006,13(1)：93-94
[6]黄金昶.原发性肝癌中医治疗体会.中国临床医生.2006,34(10)：59-60
[7]钱彦方,腰向颖.中医药论治肝癌21例分析.河北中医药学报.2010,2(3)：13-14
[8]陆运鑫.原发性肝癌的中医治疗研究进展.广西中医学院学报.2008,11(3)：96-98
[9]吴薏婷.肝癌从虚论治.浙江中医学院学报.2005,29(2)：3-4
[10]陆运鑫.原发性肝癌的中医药治疗研究进展.广西中医学院学报.2008,11(3)：96-98
[11]汤秀红.原发性肝癌中医病机初探.中医药学报.2010,38(6)：986-988
[12]赵磊,方晓芬,刘安家.周维顺治疗肝癌经验.山西中 医.2010,26(12)：9-10
[13]叶丽红,骆丹,张永红,等.原发性肝癌的临床辨证要点.时珍国医国药.20lO,21(11)：2960-2961
[14]王洪涛,洪枚,王文聪.原发性肝癌中医辨治体会.河北中医.2009,31(8)：1168-1169
[15]张婷素,山广志.中西医结合治疗原发性肝癌46例临床观察,江苏中医药.2011,43(6)：39-40
[16]李益中,陈枝俏.中医药治疗原发性肝癌的研究进展.山西中医学院学报.2006,7(3)：55-56
[17]白广德.中医及中西医结合治疗原发性中晚期肝癌的研究进展.辽宁中医药大学学报.2008,10(3)：148-151
[18]潘敏求,曾普华,潘博.中医药治疗中晚期原发肝癌的规律探析.中医药学刊.2003,21(10)：1641-1642
[19]高晓红.辨证合虎七散治疗原发性肝癌临床观察.长春中医药大学学报.2011,27(2)：94-95
[20]沈鹤敏,吴良村.运用中医治疗原发性肝癌.中国肿瘤.2000,9(5)：238-239
[21]尹先达.原发性肝癌的中医分型及治疗琐谈.光明中医.2008,23(8)：1182-1183
[22]周宜强.中晚期肝癌的治疗经验.江苏中医药.2008,40(9)：2-3
[23]王尚金.分型辨治原发性肝癌172例.河南中医.2004,24(12)：51-52
[24]邵梦扬.肝癌临床辨治体会.江苏中医药.2008,40(9)：4
[25]赵磊,方晓芬,刘安家.周维顺治疗肝癌经验.山西中医.2010,26(12)：9-10
[26]刘瑞林,徐祗永,李鹏等.中医中药治疗晚期肝癌48例体会.中国保健：医学研究版.2007,15(10)：117
[27]张建平,朱守洋,邬启全,等.原发性肝癌的中医治法探讨.中国中医急症.2009,18(10)：1635-1636
[28]王忠军.中西医结合治疗晚期肝癌34例.时珍国医国 药.2005,16(12)：1330-1331
[29]武嫣斐,王素萍,孙健民,等.原发性肝癌中医证型临床分布及证型标准.山两中医学院学报.2007,8(2)：21-23
[30]李小波,白丽萍,米新.辨证治疗原发性肝癌86例.山西中医.2006,22(2)：18-19
[31]万茜,章永红.原发性肝癌中医证候特征及与生存质量的关系.贵阳中医学院学报.2008,30(4)：27-28
[32]张红,张向业.原发性肝癌辨证分型与肿瘤标志物的相关性研究.中国中医急症.2010,19(5)：783-785
[33]吴国水.原发性肝癌中医辨治法则初探.实用中医内科杂志.2006,20(6)：608
[34]刘朝霞,周延峰,李秀荣.肝积方治疗中晚期肝癌36例.四川中医.2004,22(8)：44-45
[35]彭海燕,章永红,王瑞平等.补肝软坚方治疗肝癌100例临床观察.2004,23(1)：30-31
[36]黄智芬.黎汉忠,施智严,等.健脾消积口服液结合西药治疗Ⅱ、Ⅲ期肝癌40例的临床观察.中国中西医杂志.2003,23(3)：192-194
[37]付于,夏天.消瘤汤治疗肿瘤及调节免疫功能的实验研究.中国中西医结合杂志.2004,24(12)：1114-1115
[38]刘子厚,吴狄,芦义.肝胆康治疗原发性肝癌的临床及实验研究.中华临床医学研究杂志.2003,(82)：13517-13519
[39]李小波,白丽萍,米新.辨证治疗原发性肝癌86例.山西中医.2006,22(2)：18-19
[40]余水园.荡邪软坚补肝方治疗中晚期肝癌疗效观察.现代中西医结合杂志.2005,(6)：744-745.
[41]范先基,杨子玉.王三虎治疗肝癌经验.中国中医药信息杂志.2009,16(8)：86-87
[42]杨传标,郭德鸿,张曼等.中医药辨证治疗中晚期肝癌临床疗效观察.南方医科大学学报.2007,27(8)：1229-1230
[43]王俊显,周超凡,郑伟达.应用慈丹胶囊治疗原发性肝癌325例临床疗效观察.中国肿瘤临床.2005,32(21)：1255-1256
[44]朱霞.金龙胶囊治疗晚期原发性肝癌的疗效观察.现代中西医结合杂志.2003,12(16)：1739-1740
[45]杜亚菊,王曾铎,韩民子.华蟾素治疗晚期原发性肝癌30例近期疗效观察。中国初级卫生保健.2004,18(3)：87-88
[46]卢义涛,董颖,高承志.鸦胆子油乳剂注射液治疗晚期肝癌的临床疗效.现代预防医学.2005,32(7)：845-846
[47]顾晓侠,刘书林,陶玉华.岩舒注射液治疗中晚期肝癌32例临床观察.吉林中医药.2005,25(9)：19-20
[48]邓力,黎壮伟,吴薏婷,等.复方苦参注射液持续静滴联合TACE治疗中晚期肝癌30例.实用中医内科杂志.2010,24(11)：22-24
[49]叶险峰,周艳丽.肝癌中医外治法的临床研究概述.时珍国医国药.2006,17(3)430-431
[50]陈洪国,杜晓军.内外合用中晚期肝癌30例.山西中医.2005,21(5)：15-16
[51]李金昌,黄金活,稽玉峰,等.麝冰膏外敷治疗癌性疼痛278例.中医研究.2006,19(1)：36-37
[52]李旭英,雷陵,向淑珍.神农化瘤克癌膏外敷治疗肝癌癌痛30例.现代中医药.2010,30(3)：31-32
[53]庞亚萍.浅谈原发性肝癌的中医综合治疗.中外医疗.2010,(34)：182
[54]杨明镇,王慧,蒋国军,等.鸦胆子油乳介入治疗老年中晚期原发性肝癌.中国实验方剂学杂志.2011,17(2)：235-237
[55]祝洪福,任千里,王立乾,等.鸦胆子油在肝癌介入治疗中疗效探讨.医学影像学杂志.2010,20(5)：712-714
[56]王斌,田华琴,梁贵文,等.肝积方联合鸦胆子油乳剂介入治疗对中晚期原发性肝癌患者生活质量的影响.中国中西医结合杂志.2009,29(3)：257-260
[57]袁春义,谢琼,曾柏荣,等.华蟾素肝动脉持续灌注联合血管栓塞治疗原发性肝癌20例临床观察.2011,17(2)：16-18
[58]付志龙,曲卓慧,王焱.华蟾素联合介入疗法治疗中晚期肝癌的临床研究.中国实用医药.2010,5(34)：107-108
[59]董海涛,赵炜,卢雯平,等.华蟾素并肝动脉介入治疗原发性肝癌38例临床观察.中国中医药信息杂志.2008,15(3)：66-67
[60]彭齐荣,肖必,马珑,等.榄香烯治疗中晚期原发性肝癌的临床疗效观察.中西医结合肝病杂志.2010,20(5)：274-276
[61]陈平,黄平,吴建兵.榄香烯乳联合化疗药物肝动脉介入治疗中晚期肝癌.江西医学院学报.2005,45(5)：96-98
[62]耿坚,姚明荣,詹松华,等.中药辨证介入治疗原发性肝癌近期疗效观察.中国中西医结合影响学杂志.2010,8(2)：97-99
[63]侯风刚,赵刚,贺佳.文献中原发性肝癌中医单证辨证专家观点分析.成都中医药大学学报.2003,26(2)：56-57
[2]史茜.原发性肝癌的中医药治疗研究.长春中医药大学学报.2008,24(4)：399-400
[3]贾晋斌,倪淑欣.肝癌治疗新药临床研究进展.中国医药生物技术.2011,6(2)：131-133
[4]陈小峰,华碧春.中医药治疗原发性肝癌的若干问题探讨.福建中医药大学学报.2011,21(3)：50-52
[5]钱彦方.肝癌临证探讨.中国中医药信息杂志.2006,13(1)：93-94
[6]黄金昶.原发性肝癌中医治疗体会.中国临床医生.2006,34(10)：59-60
[7]钱彦方,腰向颖.中医药论治肝癌21例分析.河北中医药学报.2010,2(3)：13-14
[8]陆运鑫.原发性肝癌的中医治疗研究进展.广西中医学院学报.2008,11(3)：96-98
[9]吴薏婷.肝癌从虚论治.浙江中医学院学报.2005,29(2)：3-4
[10]陆运鑫.原发性肝癌的中医药治疗研究进展.广西中医学院学报.2008,11(3)：96-98
[11]汤秀红.原发性肝癌中医病机初探.中医药学报.2010,38(6)：986-988
[12]赵磊,方晓芬,刘安家.周维顺治疗肝癌经验.山西中 医.2010,26(12)：9-10
[13]叶丽红,骆丹,张永红,等.原发性肝癌的临床辨证要点.时珍国医国药.20lO,21(11)：2960-2961
[14]王洪涛,洪枚,王文聪.原发性肝癌中医辨治体会.河北中医.2009,31(8)：1168-1169
[15]张婷素,山广志.中西医结合治疗原发性肝癌46例临床观察,江苏中医药.2011,43(6)：39-40
[16]李益中,陈枝俏.中医药治疗原发性肝癌的研究进展.山西中医学院学报.2006,7(3)：55-56
[17]白广德.中医及中西医结合治疗原发性中晚期肝癌的研究进展.辽宁中医药大学学报.2008,10(3)：148-151
[18]潘敏求,曾普华,潘博.中医药治疗中晚期原发肝癌的规律探析.中医药学刊.2003,21(10)：1641-1642
[19]高晓红.辨证合虎七散治疗原发性肝癌临床观察.长春中医药大学学报.2011,27(2)：94-95
[20]沈鹤敏,吴良村.运用中医治疗原发性肝癌.中国肿瘤.2000,9(5)：238-239
[21]尹先达.原发性肝癌的中医分型及治疗琐谈.光明中医.2008,23(8)：1182-1183
[22]周宜强.中晚期肝癌的治疗经验.江苏中医药.2008,40(9)：2-3
[23]王尚金.分型辨治原发性肝癌172例.河南中医.2004,24(12)：51-52
[24]邵梦扬.肝癌临床辨治体会.江苏中医药.2008,40(9)：4
[25]赵磊,方晓芬,刘安家.周维顺治疗肝癌经验.山西中医.2010,26(12)：9-10
[26]刘瑞林,徐祗永,李鹏等.中医中药治疗晚期肝癌48例体会.中国保健：医学研究版.2007,15(10)：117
[27]张建平,朱守洋,邬启全,等.原发性肝癌的中医治法探讨.中国中医急症.2009,18(10)：1635-1636
[28]王忠军.中西医结合治疗晚期肝癌34例.时珍国医国 药.2005,16(12)：1330-1331
[29]武嫣斐,王素萍,孙健民,等.原发性肝癌中医证型临床分布及证型标准.山两中医学院学报.2007,8(2)：21-23
[30]李小波,白丽萍,米新.辨证治疗原发性肝癌86例.山西中医.2006,22(2)：18-19
[31]万茜,章永红.原发性肝癌中医证候特征及与生存质量的关系.贵阳中医学院学报.2008,30(4)：27-28
[32]张红,张向业.原发性肝癌辨证分型与肿瘤标志物的相关性研究.中国中医急症.2010,19(5)：783-785
[33]吴国水.原发性肝癌中医辨治法则初探.实用中医内科杂志.2006,20(6)：608
[34]刘朝霞,周延峰,李秀荣.肝积方治疗中晚期肝癌36例.四川中医.2004,22(8)：44-45
[35]彭海燕,章永红,王瑞平等.补肝软坚方治疗肝癌100例临床观察.2004,23(1)：30-31
[36]黄智芬.黎汉忠,施智严,等.健脾消积口服液结合西药治疗Ⅱ、Ⅲ期肝癌40例的临床观察.中国中西医杂志.2003,23(3)：192-194
[37]付于,夏天.消瘤汤治疗肿瘤及调节免疫功能的实验研究.中国中西医结合杂志.2004,24(12)：1114-1115
[38]刘子厚,吴狄,芦义.肝胆康治疗原发性肝癌的临床及实验研究.中华临床医学研究杂志.2003,(82)：13517-13519
[39]李小波,白丽萍,米新.辨证治疗原发性肝癌86例.山西中医.2006,22(2)：18-19
[40]余水园.荡邪软坚补肝方治疗中晚期肝癌疗效观察.现代中西医结合杂志.2005,(6)：744-745.
[41]范先基,杨子玉.王三虎治疗肝癌经验.中国中医药信息杂志.2009,16(8)：86-87
[42]杨传标,郭德鸿,张曼等.中医药辨证治疗中晚期肝癌临床疗效观察.南方医科大学学报.2007,27(8)：1229-1230
[43]王俊显,周超凡,郑伟达.应用慈丹胶囊治疗原发性肝癌325例临床疗效观察.中国肿瘤临床.2005,32(21)：1255-1256
[44]朱霞.金龙胶囊治疗晚期原发性肝癌的疗效观察.现代中西医结合杂志.2003,12(16)：1739-1740
[45]杜亚菊,王曾铎,韩民子.华蟾素治疗晚期原发性肝癌30例近期疗效观察。中国初级卫生保健.2004,18(3)：87-88
[46]卢义涛,董颖,高承志.鸦胆子油乳剂注射液治疗晚期肝癌的临床疗效.现代预防医学.2005,32(7)：845-846
[47]顾晓侠,刘书林,陶玉华.岩舒注射液治疗中晚期肝癌32例临床观察.吉林中医药.2005,25(9)：19-20
[48]邓力,黎壮伟,吴薏婷,等.复方苦参注射液持续静滴联合TACE治疗中晚期肝癌30例.实用中医内科杂志.2010,24(11)：22-24
[49]叶险峰,周艳丽.肝癌中医外治法的临床研究概述.时珍国医国药.2006,17(3)430-431
[50]陈洪国,杜晓军.内外合用中晚期肝癌30例.山西中医.2005,21(5)：15-16
[51]李金昌,黄金活,稽玉峰,等.麝冰膏外敷治疗癌性疼痛278例.中医研究.2006,19(1)：36-37
[52]李旭英,雷陵,向淑珍.神农化瘤克癌膏外敷治疗肝癌癌痛30例.现代中医药.2010,30(3)：31-32
[53]庞亚萍.浅谈原发性肝癌的中医综合治疗.中外医疗.2010,(34)：182
[54]杨明镇,王慧,蒋国军,等.鸦胆子油乳介入治疗老年中晚期原发性肝癌.中国实验方剂学杂志.2011,17(2)：235-237
[55]祝洪福,任千里,王立乾,等.鸦胆子油在肝癌介入治疗中疗效探讨.医学影像学杂志.2010,20(5)：712-714
[56]王斌,田华琴,梁贵文,等.肝积方联合鸦胆子油乳剂介入治疗对中晚期原发性肝癌患者生活质量的影响.中国中西医结合杂志.2009,29(3)：257-260
[57]袁春义,谢琼,曾柏荣,等.华蟾素肝动脉持续灌注联合血管栓塞治疗原发性肝癌20例临床观察.2011,17(2)：16-18
[58]付志龙,曲卓慧,王焱.华蟾素联合介入疗法治疗中晚期肝癌的临床研究.中国实用医药.2010,5(34)：107-108
[59]董海涛,赵炜,卢雯平,等.华蟾素并肝动脉介入治疗原发性肝癌38例临床观察.中国中医药信息杂志.2008,15(3)：66-67
[60]彭齐荣,肖必,马珑,等.榄香烯治疗中晚期原发性肝癌的临床疗效观察.中西医结合肝病杂志.2010,20(5)：274-276
[61]陈平,黄平,吴建兵.榄香烯乳联合化疗药物肝动脉介入治疗中晚期肝癌.江西医学院学报.2005,45(5)：96-98
[62]耿坚,姚明荣,詹松华,等.中药辨证介入治疗原发性肝癌近期疗效观察.中国中西医结合影响学杂志.2010,8(2)：97-99
[63]侯风刚,赵刚,贺佳.文献中原发性肝癌中医单证辨证专家观点分析.成都中医药大学学报.2003,26(2)：56-57