CN104510969A - 启膈化痰汤 - Google Patents

启膈化痰汤 Download PDF

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CN104510969A
CN104510969A CN201410688350.1A CN201410688350A CN104510969A CN 104510969 A CN104510969 A CN 104510969A CN 201410688350 A CN201410688350 A CN 201410688350A CN 104510969 A CN104510969 A CN 104510969A
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Abstract

本发明涉及一种治疗食道癌的启膈化痰汤，由以下原料药制成，瓜蒌20g、浙贝15g、清半夏12g、橘红15g、半枝莲20g、蚤休20g、白术20g、生薏苡仁10g、露蜂房10g、砂仁10g、酒大黄10g、黄连6g、胆南星15g、旋覆花（包煎）15g、丹参15g；气虚者加黄芪12g；胸痛者加延胡索10g、黄药子12g。水煎服，每日一剂。本发明诸药配伍具有润燥降气、开郁化痰、活血祛瘀之功效，治疗食管癌、反流性食管炎，切中病理，药效直接，效果显著。本发明诸药配伍具有润燥降气、开郁化痰、活血祛瘀之功效，治疗食管癌、反流性食管炎，切中病理，药效直接，效果显著。

Description

启膈化痰汤
技术领域
   本发明涉及中药技术领域，具体是一种治疗食道癌的启膈化痰汤。
背景技术
食管癌属祖国医学“噎膈”范畴,是临床常见的恶性肿瘤之一，其临床主要表现为吞咽时梗噎不顺或饮食不下，食入即吐。我国是食管癌高发国家，也是目前世界上食管癌病死率最高的国家之一，严重威胁着我国人民的生命健康。目前对食管癌的治疗包括手术、放疗、化疗、中医药治疗及晚期食管癌狭窄病人支架置入等多种治疗方法，其中中医药在食管癌的各个阶段均可应用,并有明显的疗效。因此,研究中医药防治食管癌,具有重要的意义。
发明内容
本发明的目的在于提供一种一种治疗食道癌的中药—启膈化痰汤。本发明中具有降逆化痰、解郁活血、恢复脾胃升降之机之功效，对痰气互结型食管癌有着较理想的治疗效果。
本发明的技术方案是：启膈化痰汤，由以下原料药制成，瓜蒌20g、浙贝15g、清半夏12g、橘红15g、半枝莲20g、蚤休20g、白术20g、生薏苡仁10g、露蜂房10g、砂仁10g、酒大黄10g、黄连6g、胆南星15g、旋覆花（包煎）15g、丹参15g；气虚者加黄芪12g；胸痛者加延胡索10g、黄药子12g。水煎服，每日一剂。
食管癌属祖国医学“噎膈”范畴。中医认为，食管癌的病因病机归纳为气、痰、瘀、热之变，七情郁结、饮食不节、脾胃受伤、痰湿凝结、血气亏损、先天禀赋不足等，诸因素与本病有关，情志抑郁、肝失疏泄、肝气郁结、气滞血瘀、阻于谷道或饮酒过频、喜食辛辣香热之物,燥热伤津、咽管干涩，日久瘀热停滞，瘀毒内结，食管狭窄，气机失畅，胃失和降，而成“噎膈”之证。该病根据本虚标实之不同，古代医家多责之于虚、郁、痰、毒、瘀五端。中医药在治疗食管癌方面，紧扣病因病机，围绕补虚、解郁、祛痰、解毒、逐瘀五法。以行气、活血、软坚化痰为主。本方根据中医理论和临床实践，精心配伍，组成治疗食管癌的新处方启膈化痰汤。
本发明配方中，瓜蒌，甘、微苦、寒，归肺胃大肠经，清热化痰、宽胸散结、润肠通便；浙贝母苦寒，清热化痰、开郁散结；清半夏性凉，清化热痰；合为君药。白术苦甘温，补气健脾、燥湿利水；生薏苡仁，甘淡微寒，利水渗湿，健脾，清热；砂仁，气味清淡，行气开胃，醒脾消食；橘红理气宽中、早燥湿化痰；丹参味苦微寒，入心肝二经，有活血祛、清心除烦之效；胆南星，清热化痰；以上诸药共奏理气开郁、活血祛瘀之功，合为臣药。半枝莲、蚤休、黄连清热解毒；露蜂房解毒，归胃经；共为佐药；旋覆花降逆化痰、降逆止呕；酒大黄活血祛瘀为使药。
本发明诸药配伍具有润燥降气、开郁化痰、活血祛瘀之功效，治疗食管癌、反流性食管炎，切中病理，药效直接，效果显著。
具体实施方式
下面结合实施例对本发明作进一步说明。
实施例：启膈化痰汤，由以下原料药制成，瓜蒌20g、浙贝15g、清半夏12g、橘红15g、半枝莲20g、蚤休20g、白术20g、生薏苡仁10g、露蜂房10g、砂仁10g、酒大黄10g、黄连6g、胆南星15g、旋覆花（包煎）15g、丹参15g；气虚者加黄芪12g；胸痛者加延胡索10g、黄药子12g。水煎服，每日一剂。
临床实践资料
1、资料与方法
1.1一般资料
观察病例为2010年1月-2013年12月间收治病例，共201例。治疗组108例，男69例，女39例；年龄49~71岁，平均61.57岁；鳞癌87例，腺癌15例，未分化癌6例；肿瘤部位：颈段21例，胸上段36例，胸中段33例，胸下段18例；中期72例，晚期36例。对照组93例，男57例，女36例，年龄50~68岁，平均59.23岁，鳞癌75例，腺癌15例，未分化癌3例；颈段15例，胸上段33例，胸中段27例，胸下段18例；中期57例，晚期36例。两组病例在性别、年龄、病情及组织学分型诸方面经统计学处理差异无显著性，具有可比性(p>0.05)。
 1.2诊断标准
参照《中国常见恶性肿瘤诊治规范》（1）中介绍的中晚期食管癌临床诊断标准：（1）患者均有不同程度的进食困难，时轻时重，但能进流质饮食；（2）全部病例均经X线检查证实；（3）纤维食管镜检查并经组织学活检分类诊断。
 1.3排除标准
(1)食管完全阻塞者;(2)患者出现恶液质;(3)食管X线检查有穿孔者;(4)有远处转移征象者。
 1.4治疗方法
对照组：放疗先采用 60 Co外照射，常规三野或颈段患者采用两野加楔型板，每周5次，每次剂量 (DT) 2Gy，总量为DT60~70Gy，外照射2周后配合后装 192 铱腔内照射，每周1次，共4次。化疗采用(1) FD方案：氟尿嘧啶500mg/m 2 ，静脉滴注，第1-5天；顺铂50mg/m 2 ，静脉滴注，第1、8天 3周为1个周期，连用3-4个周期为1个疗程。(2)PPV方案：顺铂100mg/m 2 ，静脉滴注，第1天；平阳霉素6 mg/m 2 ，肌内注射，第3、6、10、13天；长春新碱1.4mg/ m 2 ，静脉注射，第3、10天。2l天为1个周期，连用2-3个周期为1 个疗程。
治疗组：在以上放化疗基础上,同时予中药启膈化痰汤，方药组成: 瓜蒌20g 浙贝15g 清半夏12g 橘红15g 半枝莲20g 蚤休20g 白术20g 生薏苡仁10g 露蜂房10g 砂仁10g 酒大黄10g 黄连6g 胆南星15g 旋覆花（包煎）15g 丹参15g  水煎服，日1剂，并在停止放化疗后，继续服用0.5个月。两组患者治疗前后均查血常规、肝肾功能、X线钡餐造影测量实体瘤大小,并注意观察全身及局部症状变化。
 1.5统计学方法
采用采用χ 2 检验。
 2、治疗结果
2.1近期疗效
按国际通用近期客观疗效标准 [1] ，以X线食管钡餐造影测得结果判断疗效，分完全缓解 (CR)，部分缓解(PR)，无变化(NC)，进展(PD)4个等级。治疗组CR15例(13.9%)，PR 48例(44.4%)，NC42例(38.9%)，PD 3例(2.8%)；对照组CR 12例(12.9%)，PR 36例(38.7%)，NC 39例(41.9%)，PD6例(6.5%)；治疗组CR+PR率58.3%，对照组CR+PR率为51.6%，经统计学处理两组差异无显著性(P>0.05)。提示在放化疗同时服用启膈化痰汤不能明显提高近期客观疗效。
 2.2毒副反应
毒副反应主要有骨髓抑制、肝肾功能变化及放射性食管炎。治疗组108例中血红蛋白下降至<80g/L 有27例，白细胞下降至<3×10 9 /L 15例，血小板下降至<80×10 9 /L 12例，肝功能异常9例，肾功能异常6例，出现放射性食管炎9例；而对照组93例中血红蛋白下降至<80g/L 57例，白细胞下降至<3×10 9 /L 39例，血小板下降至<80×10 9 /L 33例，肝功能异常30例，肾功能异常24例，出现放射性食管炎33例。两组经统计学处理，血红蛋白、白细胞计数、血小板计数、肝、肾功能异常及放射性食管炎各项毒副反应差异均有显著性(均P<0.01)。
 2.3转移情况
判断标准是原无转移的出现转移，原有邻近转移的出现新转移灶或远行转移。0.5年内转移情况：治疗组转移率为11.1%(12/108例)，对照组为22.6%(27/93例)。1年内转移情况：治疗组为36.1%(39/108例)，对照组为67.7%(63/93例)。对照组0.5年转移率高于治疗组，但差异无显著性(X 2 =3.42，P>0.05)，1年转移率对照组明显高于治疗组，且经统计学处理差异有显著性(X 2 =6.66，P<0.01)。治疗组明显优于对照组。
 2.4远期疗效
对两组患者追踪随访，病情复发者采用后装 192 铱腔内照射，照射方法同上，剂量略减，并配合化疗，方案同上，治疗组仍在此基础上继续服用启膈化痰汤，并采用Kapan-Meier法计算远期生存率。治疗组1、2、3年生存率分别为88.9%(96/108例)、52.8%(57/108例)、27.8%(30/108例)；对照组1、2、3年生存率分别为58.1%(54/93例)、22.6% (27/93例)、6.5%(6/93例)。经统计学处理比较，两组1、2、3年生存率差异有显著性(均P<0.05)。治疗组明显优于治疗组。
 3、结论
经临床观察比较，采用中西医结合疗法，不仅能发挥自身作用，且可相互协同，提高疗效，采用中药启膈化痰汤能降低消除放化疗引起的毒副反应，提高机体免疫力，并有助于骨髓功能恢复,防治放射性食管炎，减缓癌转移，从而改善患者带瘤生存质量，并能提高患者远期生存率。治疗组治疗效果明显优于对照组，本发明启膈化痰汤治疗食管癌、反流性食管炎效果显著。

Claims (3)

1.启膈化痰汤，其特征在于，由以下原料药制成，瓜蒌20g、浙贝15g、清半夏12g、橘红15g、半枝莲20g、蚤休20g、白术20g、生薏苡仁10g、露蜂房10g、砂仁10g、酒大黄10g、黄连6g、胆南星15g、旋覆花15g、丹参15g。
2.启膈化痰汤，其特征在于，由以下原料药制成，瓜蒌20g、浙贝15g、清半夏12g、橘红15g、半枝莲20g、蚤休20g、白术20g、生薏苡仁10g、露蜂房10g、砂仁10g、酒大黄10g、黄连6g、胆南星15g、旋覆花15g、丹参15g、黄芪12g。
3.启膈化痰汤，其特征在于，由以下原料药制成，瓜蒌20g、浙贝15g、清半夏12g、橘红15g、半枝莲20g、蚤休20g、白术20g、生薏苡仁10g、露蜂房10g、砂仁10g、酒大黄10g、黄连6g、胆南星15g、旋覆花15g、丹参15g、延胡索10g、黄药子12g。
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