CN108434420A - 一种用于治疗结直肠癌术后泄泻的中药制剂 - Google Patents
一种用于治疗结直肠癌术后泄泻的中药制剂 Download PDFInfo
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Abstract
本发明提供了一种用于治疗结直肠癌术后泄泻的中药制剂,是以补骨脂、仙鹤草、党参、炒白术、肉豆蔻、五味子、鸡血藤、干姜、吴茱萸、桂枝、炙甘草为原料,按中药药剂学的常规工艺和辅料制备而成的各种内服制剂和外用制剂。本发明方剂温阳补肾,化湿祛瘀兼施,标本兼顾,补不滞中,涩不留邪,共成温肾固摄,健脾止泻,活血通络之功,可有效改善结直肠癌术后泄泻症状,疗效明显且无毒副作用。
Description
技术领域
本发明属于中药领域,涉及一种用于治疗结直肠癌术后泄泻的中药制剂。
背景技术
我国结直肠癌(colorectal cancer,CRC)的发病率和病死率均保持上升趋势。2011 年,结直肠癌的发病率和病死率分别为23.03/10 万和11.11/10 万。其中,城市地区远高于农村,且结肠癌的发病率上升显著。多数病人发现时已属于中晚期。结直肠癌的病因非常复杂,其病因及发病机理尚未完全阐明,目前认为是环境因素与遗传因素综合作用的结果,治疗以外科手术为主,近年来临床实践表明,多数直结肠癌切除术后泄泻为主要常见症状之一,其典型症状为反复发作的泄泻、腹痛及肛门下坠。经用抗生素治疗可以缓解,停药后容易反复。长期反复的使用抗生素容易导致肠道菌群失调,易出现多种并发症。中医理论认为,该病属于中医泄泻范畴,多因手术损伤肠络,导致肠道气机紊乱,伤及脾肾所致。大量的动物实验和临床研究发现,中医中药在治疗结直肠癌术后腹泻方面有着自身的优势,具有多环节、多途径、多靶点的作用,疗效较为显著。
发明内容
本发明的目的在于针对现有技术存在的问题,提供一种用于治疗结直肠癌术后泄泻的中药制剂,该中药制剂在治疗结直肠癌术后泄泻方面效果显著且无毒副作用。
为此,本发明采用如下技术方案:
一种用于治疗结直肠癌术后泄泻的中药制剂,是以补骨脂、仙鹤草、党参、炒白术、肉豆蔻、五味子、鸡血藤、干姜、吴茱萸、桂枝、炙甘草为原料,按中药药剂学的常规工艺和辅料制备而成的各种内服制剂和外用制剂。
进一步地,所述原料按如下重量份进行配比:补骨脂6-20份,仙鹤草15-30份,党参10-20份,炒白术10-20份,肉豆蔻3-10份,五味子5-10份,鸡血藤10-20份,干姜9-20份,吴茱萸2-5份,桂枝3-10份,炙甘草6-10份。
进一步地,所述原料药材还包括:赤芍10-20份,红花3-10份。赤芍和红花可在本发明病证基础上遇血瘀之证较重,见肛门肿胀等症时予以加味。
进一步地,所述原料药材还包括:黄连3-12份。黄连可在本发明病证基础上遇湿热之象明显,见脓血便、舌苔黄腻时予以加味。
进一步地,所述内服制剂为胶囊剂、片剂、丸剂、颗粒剂、茶剂或口服液。
进一步地,所述外用制剂为栓剂或贴剂。
一、中医结直肠癌术后泄泻病理基础分析
祖国医学将结直肠癌术后泄泻归属于“泄泻”“肠风”“脏毒”“便血”等范畴。其主要病变在于大肠与脾肾,且本病多属本虚标实。肿瘤为慢性消耗性疾病,患者正气亏虚,感受癌毒,多为本虚标实之证。放化疗后脾胃更加虚弱,运化失司,致脾不能升清,水谷精微不化,生湿成滞,流注大肠,泄泻遂生。肿瘤患者久病,由脾及肾,肾失温煦,命口火衰,脾胃失于温养,运化失司,终脾肾阳虚,泄泻不止。此外,肿瘤病患者通常容易发生精神紧张、心情不舒畅等,致肝气郁结,横逆犯脾而发泄泻。又因手术损伤肠络,导致肠道气机紊乱,伤及脾肾,再加手术后大量输液导致湿自内生,阻滞气机而致腹泻、腹痛等症状。是故脾肾阳虚,血瘀阻络是本病的基本病理特点,并贯穿于疾病的始终。而升降失常、清浊不分、湿滞气阻、湿郁化热等皆由此演化而成,这也是患者产生便溏腹泻,腹痛胀满,便次增多,粘液便诸症的几大原因。故在临床上除采用健脾、温肾等外,还须用活血通络,理气之品,标本同治,才能取得较好的治疗效果。结直肠癌术后泄泻的病位主要在大肠,涉及肝、脾、肾等脏腑,病机当属本虚标实之证,湿邪停滞脾胃、大小肠、气血瘀滞为标,脾肾两虚为本,尤其脾肾阳虚是结直肠癌术后泄泻的最主要的病机之一。
二、本发明方剂原料药材药性药理分析
补骨脂,治肾泄,通命门,暖丹田。《本草蒙筌》:“补骨脂即破故纸,味苦、辛,气大温”。《景岳全书》:“味苦辛,气大温,性燥而降。能固下元,暖水脏,治下焦无火,精滑带浊,诸冷顽痹,脾肾虚寒而为溏泄下痢。以其暖肾固精,所以能疗腰膝酸疼,阴冷囊湿,缩小便,暖命门小腹,止腹中疼痛肾泄”。《本草备要》:“破故纸一名补骨脂,燥,补命火。辛苦大温。入心包、命门,补相火以通君火,暖丹田,壮元阳,缩小便。亦治遗尿。治五劳七伤,五脏之劳,七情之伤。腰膝冷痛,肾冷精流,肾虚泄泻”。《本草经疏》曰:“补骨脂,能暖水脏,阴中生阳,壮火益土之要药也。其主五劳七伤,盖缘劳伤之病,多起于脾肾两虚,以其能暖水脏、补火以生土,则肾中真阳之气得补而上升,则能腐熟水谷、蒸糟粕而化精微,脾气散精上归于肺,以荣养乎五脏,故主五脏之劳,七情之伤所生病”。
仙鹤草:又名脱力草,《百草镜》:“下气活血,理百病,散痞满;跌扑吐血,血崩,痢,肠风下血”。《生草药性备要》:“理跌打伤,止血,散疮毒”。仙鹤草具有活血祛瘀,抗肿瘤的功效,用于治疗各种类型的肿瘤,具有较好的作用,在应用时可在辨证的基础上加入复方中使用。
党参:味甘, 性平、入脾、肺经。功效补中,益气,生津。党参对胃肠运动具有重要的调节作用。《本草纲目》言其“能补中益气,和脾胃,除烦渴。中气微弱,用以调补,甚为平妥”。《得配本草》:“甘,平。入手足太阴经气分。补养中气,调和脾胃”。
炒白术,味苦、甘,性温。功能为健脾益气、燥湿利水,尤擅补脾燥湿以治脾虚,益气扶脾以和中。《日华子本草》:“治一切风疾,五劳七伤,冷气腹胀,补腰膝,消痰,治水气,利小便,止反胃呕逆,及筋骨弱软,痰癖气块,妇人冷,症瘕,温疾,山岚瘴气,除烦,长肌”。肉豆蔻,味苦,辛。《日华子本草》:“调中下气,止泻痢,开胃,消食”。《本草纲目》:“土爱暧而喜芳香,故肉蔻之辛温,理脾胃而止吐利。暖脾胃,固大肠”。
五味子:《药性赋》:“味酸,性温,无毒。降也,阴也。其用有四:滋肾经不足之水,收肺气耗散之金,除烦热生津止渴,补虚劳益气强阴”。《日华子本草》:“明目,暖水藏,治风、下气、消食、霍乱转筋,痃癖,贲豚,冷气,消水肿,反胃,心腹气胀,止渴,除烦热,解酒毒,壮筋骨”。
鸡血藤:去瘀血,生新血,流利经脉。治老人气血虚弱,手足麻木瘫痪等症。《滇志》:“统治百病,能生血、和血、补血、破血,又能通七孔,走五脏,宣筋络”。
吴茱萸:味辛,温。《日华子本草》:“健脾,通关节,治霍乱泻痢,消痰,破症癖,逐风,治腹痛,肾气,脚气,水肿,下产后余血”。《本草纲目》:“茱萸辛热,能散能温。苦热,能燥能坚。故其所治之症,皆取其散寒温中,燥湿解郁之功而已”。
干姜,其性味辛,热。归脾,胃,心,肺经。开五脏六腑,通四肢关节,宣诸络脉,治冷痹寒痞,反胃下利。所以干姜用于阴寒内盛,阳衰欲脱,或脾胃虚寒,呕吐泄泻,脘腹冷痛,以及寒饮犯肺之喘咳、痰多清稀、形寒背冷之症。临床上主要治疗用于肠炎、腹泻、呕吐。
桂枝:味辛,温。《珍珠囊》:“主九种心疼,补劳伤,通九窍,暖水脏,续筋骨,杀三虫,散结气,破瘀血,下胎衣,除咳逆,疗腹痛,止泻痢,善发汗”。《别录》云:“桂通血脉是矣”。
炙甘草:《神农本草经》:“味甘,平。主治五脏六腑寒热邪气,坚筋骨,长肌肉,倍力,金疮肿,解毒”。《日华子本草》:“安魂定魂,补五劳七伤,一切虚损,惊悸烦闷、健忘,通九窍,利百脉,益精养气,壮筋骨,解冷热。入药久用”。《药性赋》:“味甘,平,无毒。生之则寒,炙之则温。生则分身梢而泻火,炙则健脾胃而和中。解百毒而有效,协诸药而无争,以其甘能缓急,故有国老之称”。
红花:味辛,性温,无毒。阳也。逐腹中恶血而补血虚之虚。活血润燥,止痛散肿,通经。又能入心经,生新血。
赤芍:气味苦平无毒,主治邪气腹痛,除血痹,破坚积寒热,疝瘕止痛,利小便,益气。《日华子本草》:“芍药治风、补劳,主女人一切病,并产前后诸疾,通月水,退热,除烦,益气,天行热疾,瘟瘴,惊狂,妇人血运,及肠风,泻血,痔瘘。发背,疮疥,头痛,明目,目赤努肉。赤色者多补气,白者治血”。
黄连:味苦,寒。主治热气,目痛,眦伤,泣出,明目,肠澼,腹痛,下痢。《名医别录》:“微寒,无毒。主治五藏冷热,久下泄澼、脓血,止消渴、大惊,除水,利骨,调胃,厚肠,益胆,治口疮”。《本草纲目》:“黄连大苦大寒,用之降火燥湿,中病即当止”。
三、本发明方剂组方分析
发明人认为,脾肾阳虚是结直肠癌术后泄泻的最主要的病机之一,故本方以苦辛、大温之补骨脂固下元,暖水脏,治下焦无火,脾肾虚寒而致的溏泄下痢。仙鹤草又名脱力草,本方中用于收敛止痢,止血,解毒,脱力劳伤。现代药理研究还证实仙鹤草具有活血祛瘀,抗肿瘤的功效,用于治疗各种类型的肿瘤,具有较好的作用。二者合用以温肾健脾、扶助正气共为君药;党参、炒白术益气补脾,以恢复中焦斡旋之能;鸡血藤活血通络,去术后肠络瘀血,生新血,流利经脉;肉豆蔻辛温入脾、大肠经,温中行气,涩肠止泻;五味子收敛止泻,以上共为臣药。干姜、吴茱萸、桂枝温化寒湿,助君药温补之力而共为佐药;甘草调和诸药而为使。
在本发明结直肠癌术后泄泻基础病证基础上,如遇血瘀之证较重,见肛门肿胀等症时可加味赤芍和红花,以强化活血化瘀;如遇湿热之象明显,见脓血便、舌苔黄腻时可加味黄连,以清利湿热。此三味药材在加味时可作为臣药。
纵观全方,诸药配伍,温阳补肾,化湿祛瘀兼施,标本兼顾,补不滞中,涩不留邪,共成温肾固摄,健脾止泻,活血通络之功。组方配伍严谨合理,既符合中医理论,又符合现代药理研究的科学依据,全方选药精炼,结构严谨,共奏温肾固摄,健脾止泻,活血通络之功。此外,已有的大量现代药理学研究还表明本复方中所用药物具有抗炎抗菌、解痉镇痛、改善血液微循环、调整胃肠植物神经功能和机体免疫功能作用,是防治结直肠癌术后泄泻性疾病很有价值的复方制剂。
四、本发明方剂治疗结直肠癌术后泄泻临床资料
1.病例选择:共收集甘肃省中医药大学附属医院2014-2016年结直肠癌术后泄泻病例50例,其中男性32例,女性18例,年龄在15-50岁之间。
2.诊断标准:
术前所有病例均经结肠镜检查,病理诊断证实为结直肠癌,术后临床表现均为不同程度的间断性下腹部坠胀,泄泻8 ~10 次/天,为稀水样便,伴肛周坠痛。所选择病例多有失治误治病史,迁延不愈,导致症状加重,舌质淡,苔薄白,脉虚。两组病例在性别、年龄、病程等方面经统计学分析差异无统计学意义,具有可比性。所有病例诊断均参照《中药新药临床研究指导原则》中泄泻的诊断标准进行诊断。
3.治疗方法:口服本发明浓缩丸剂药物,规格:0.2克/丸,用法:每次12丸,一日两次,7天为一疗程,连续服用三个疗程。
4.疗效判断:
痊愈:临床症状、体征消失,随访期间未复发。
显效:临床症状、体征基本消失或明显改善,每日大便最多2 ~3 次,便质正常或糊状,随访期间未加重。
有效:临床症状、体征有改善,腹泻次数减少,每日大便3 ~5 次,便质较原来改善。
无效:症状、体征、便次、便质无明显变化。
5.治疗结果统计:
治疗结果见表1。
表1 疗效观察与结果统计
疗效 | 治愈 | 显效 | 有效 | 无效 |
例数 | 26 | 21 | 2 | 1 |
经统计,本发明药物治疗结直肠癌术后泄泻的临床应用中,总有效率为98%,其中显愈率为94%。
具体实施方式
下面通过具体实施例对本发明中药制剂的原料配比、制备及用法作进一步的说明。
实施例1:胶囊剂药物的制备
原料配方:补骨脂10份,仙鹤草20份,党参10份,炒白术15份,肉豆蔻3份,五味子8份,鸡血藤15份,干姜9份,吴茱萸3份,桂枝5份,炙甘草10份;
制备工艺:按中药药剂学制备胶囊剂药物的常规工艺和辅料制备而成,规格:0.4克/粒;
用法用量:每次4粒,一日三次,7天为一疗程,一般服用2-4个疗程。
实施例2:片剂药物的制备
原料配方:补骨脂8份,仙鹤草25份,党参15份,炒白术20份,肉豆蔻5份,五味子8份,鸡血藤15份,干姜10份,吴茱萸5份,桂枝8份,炙甘草8份;
制备工艺:按中药药剂学制备片剂药物的常规工艺和辅料制备而成,规格:0.5克/片;
用法用量:每次4片,一日三次,7天为一疗程,一般服用2-4个疗程。
实施例3:颗粒剂药物的制备
原料配方:补骨脂6份,仙鹤草15份,党参12份,炒白术12份,肉豆蔻8份,五味子10份,鸡血藤15份,干姜20份,吴茱萸3份,桂枝10份,炙甘草6份,赤芍15份,红花8份;
制备工艺:按中药药剂学制备颗粒剂药物的常规工艺和辅料制备而成,规格:6克/袋;
用法用量:每次一袋,一日两次,7天为一疗程,一般服用2-4个疗程。
实施例4:茶剂药物的制备
原料配方:补骨脂12份,仙鹤草30份,党参18份,炒白术18份,肉豆蔻10份,五味子5份,鸡血藤18份,干姜15份,吴茱萸5份,桂枝8份,炙甘草8份,赤芍10份,红花3份;
制备工艺:按中药药剂学制备茶剂药物的常规工艺和辅料制备而成,规格:8克/袋;
用法用量:一日两袋,泡水饮用,7天为一疗程,一般服用2-4个疗程。
实施例5:浓缩丸剂药物的制备
原料配方:补骨脂15份,仙鹤草18份,党参20份,炒白术20份,肉豆蔻10份,五味子6份,鸡血藤20份,干姜12份,吴茱萸2份,桂枝3份,炙甘草8份,赤芍20份,红花10份;
制备工艺:按中药药剂学制备浓缩丸剂药物的常规工艺和辅料制备而成,规格:0.2克/丸;
用法用量:每次12丸,一日两次,7天为一疗程,一般服用2-4个疗程。
实施例6:口服液的制备
原料配方:补骨脂20份,仙鹤草20份,党参15份,炒白术10份,肉豆蔻6份,五味子8份,鸡血藤15份,干姜18份,吴茱萸5份,桂枝5份,炙甘草6份,黄连8份;
制备工艺:按中药药剂学制备口服液的常规工艺和辅料制备而成,规格:10ml/瓶;
用法用量:每次2瓶,一日两次,7天为一疗程,一般服用2-4个疗程。
实施例7:外用栓剂的制备
原料配方:补骨脂15份,仙鹤草25份,党参10份,炒白术15份,肉豆蔻5份,五味子8份,鸡血藤12份,干姜15份,吴茱萸3份,桂枝6份,炙甘草10份,黄连12份;
制备工艺:按中药药剂学制备外用栓剂的常规工艺和辅料制备而成,规格:15g/管;
用法用量:每次1管,一日两次,排便后或晚上睡觉前挤入肛门内;7天为一疗程,一般使用2-3个疗程。
实施例8:外用贴剂的制备
原料配方:补骨脂12份,仙鹤草15份,党参15份,炒白术12份,肉豆蔻8份,五味子10份,鸡血藤10份,干姜20份,吴茱萸2份,桂枝10份,炙甘草10份,黄连3份;
制备工艺:按中药药剂学制备外用贴剂的常规工艺和辅料制备而成,规格:10g/贴;
用法用量:每次1贴,一日一贴,贴敷于患者肚脐处,7天为一疗程,一般使用2-3个疗程。
上述各实施例中,原料配比均以重量份计算。
Claims (6)
1.一种用于治疗结直肠癌术后泄泻的中药制剂,其特征在于,是以补骨脂、仙鹤草、党参、炒白术、肉豆蔻、五味子、鸡血藤、干姜、吴茱萸、桂枝、炙甘草为原料,按中药药剂学的常规工艺和辅料制备而成的各种内服制剂和外用制剂。
2.根据权利要求1所述的一种用于治疗结直肠癌术后泄泻的中药制剂,其特征在于,所述原料按如下重量份进行配比:补骨脂6-20份,仙鹤草15-30份,党参10-20份,炒白术10-20份,肉豆蔻3-10份,五味子5-10份,鸡血藤10-20份,干姜9-20份,吴茱萸2-5份,桂枝3-10份,炙甘草6-10份。
3.根据权利要求2所述的一种用于治疗结直肠癌术后泄泻的中药制剂,其特征在于,还包括如下重量份的原料药材:赤芍10-20份,红花3-10份。
4.根据权利要求2所述的一种用于治疗结直肠癌术后泄泻的中药制剂,其特征在于,还包括如下重量份的原料药材:黄连3-12份。
5.根据权利要求1所述的一种用于治疗结直肠癌术后泄泻的中药制剂,其特征在于,所述内服制剂为胶囊剂、片剂、丸剂、颗粒剂、茶剂或口服液。
6.根据权利要求1所述的一种用于治疗结直肠癌术后泄泻的中药制剂,其特征在于,所述外用制剂为栓剂或贴剂。
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