tcm肿瘤-.ppt

,单击此处编辑母版标题样式,*,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Traditional Chinese Medicine,in the Clinical Oncology,中医药,防治,恶性肿瘤 的现状和研究进展,Pro.Rongyao Zhou,Oncology Department of Shuguang Hospital Affiliated Shanghai University of TCM,上海中医药大学附属曙光医院肿瘤科,周 荣 耀,TCM,Oncology,1,What is the current situation?,中医药在肿瘤临床中的现状,2,Why?,原因,3,The review of TCM oncology in history,中医肿瘤学的发展,*,4,TCM basic theory on the clinical oncology,中医基础理论在肿瘤临床上应用,*,5,How to differentiate syndromes/diseases to decide treatment,临床常用辨证分型,辨证,/,辨病施治,*,6,TCM oncology combined with western medicine,与现代医学结合,(,中西医结合,),7,Laboratory research of TCM,中药抗肿瘤的实验研究,8,，,Diet therapy in TCM clinical oncology,食疗,理论在,肿瘤临床上应用,situation,1 What is the current situation,in the TCM clinical oncology?,中医药在肿瘤临床中的现状,situation,Many patients with malignant tumor in China,as well as all over the word,are treated mainly by operation,chemotherapy,radiotherapy,target treating,and etc.,But as you know,in China,especially in the mainland,a lot of patients have got TCM for their treatment.,目前肿瘤临床治疗上除了手术，放化疗,靶向治疗等措施以外，许多病人接受中医药治疗。特别是中晚期患者中，其比率更高。,Situation,According the datum from the 2nd international oncology seminar combined western and Chinese medicine.We found over 50%of them,（,56,85%,）,received TCM in their whole process.,The rate might be more high in patients of advantage stage and the older persons,。,根据,第二届国际中西医结合肿瘤研讨会,资料。国内一半以上的患者（,56,85%,），在整个治疗过程中接受过中医中药。,TCM at abroad(,国外,):,There were several traditional medicine in the world.Most of them were different with TCM since they had not such complete and systemic theory as TCM.So they were all decayed while modern scientific developing.Now,we believe only a few historian,who might familiar with them.,世界上有许多传统医学（例如古埃及，古希腊，古印度等），与中国传统医学不同的，其他传统医学基本都没有像中医一样如此完整的系统理论体系，随着现代医学的发展，这些传统医学基本已经消亡，目前仅有少数历史学家对此有所了解和研究。,Situation,In mainland(,国外,),Traditional culture,传统和文化背景影响,.,The effective of TCM,中医的,疗效,（,CR+PR,约,8%,SD,较高）,CR,disappear,1M,完全缓解,:,瘤体完全消失,1,月,PR,1M,部分缓解,:,瘤体缩小到治疗前的,50,以下,1,月,SD,50%-125%of original size,进展,:,瘤体大于治疗前的,125,Less by-side,中医较小的副反应,The law and ruler from the authority,国内的相关政策和法规。,Why,Abroad(,国外,),The over seas chinese affected with traditional culture,华人受到传统和文化背景影响,.,Relatively welcomed in South-East Asia,东南亚较普遍,.,International co-operation in over 60 countries,(Agreements and memorandum),目前已与,17,个国家签订政府间中医合作协定，,50,多个国家签订中医合作备忘录。,Why,Problems(,存在问题和误区也不少）,Advertisment,（各类宣传很多,广告）,Egaggrate,盲目扩大疗效（,2,98,）,Confused between food and drug,（混淆药品和食品的概念）,举例,:,国药准字,Z-,国药准字,B-,健字,-,专利号,-,Why,Different opinions and criticize from internet,关于互联网上批评中医的问题,有些指责和意见并非完全没有道理,（除去商业炒作，人身攻击等过激言论等）,要用历史的眼光，实事求是看待中医。,它是在特定的历史条件下形成、发展。,是中国传统文化一个重要组成部分。,中医是科学还是伪科学的问题。,Why,History,3,The review of TCM oncology,in history.,中医肿瘤学的发展,History,TCM theory and practice have been used on the clinical for 2000 or 3000 years.We can find lots of record in TCM history.,“Liu(,瘤,)”,was found in the incription bones or tortoise shells of the Shang Dynasty(16-17th century B.C.).,Those were all distributive in TCM books.,Neijing lingshu,the cause of“Liu(,瘤,)”is devil in the body for long time.,“Liu(,瘤,)”could be divided into,fasciaoma(,筋瘤,),intestine(,肠瘤,),spine(,脊瘤,),myoma(,肉瘤,),Some disease were not belonged to be,tumour.(TB,goiter,etc),Many kinds of tumors were not included(liver cancer,lung cancer,etc),These experience for treating cancer were not only used in ancient time,but also used in 21th.,中医对肿瘤的观察和认识，最早可以追溯到殷商时期。,如殷墟甲骨文中就“瘤”的病名记载。,现存最早的医书,灵枢,认为“瘤”是“邪气居其间，久而内着”。根据临床症候将“瘤”分为筋瘤、肠瘤、脊瘤、肉瘤等。,尽管由于受当时历史条件的限制,以及认识方法和认识手段的局限，当时所谓“瘤”的概念与现代的肿瘤概念并不完全一致（举例甲状腺肿大，结核，肺癌，直肠癌）。,Tumor has never been different from other subjects,such as internal medicine,gynecology pediatrics and etc.,There was not any monogragh on oncology in history.,Actually,there was no oncology in TCM history,although the TCM doctors have treated patients ill with tumor for many years.,It has no progress in later Ming dynasty to 1949,有许多古代医学家根据临床实践，对某些肿瘤进行了尽可能仔细的观察，作出了比较详尽的记载。有些医学家还根据中医学的基本理论，从宏观的角度，对肿瘤的病因、症状和治疗手方法进行分析和研究。这些研究对当时临床治疗肿瘤及其一类的疾病起到了重要的指导作用。同时也已经成为目前肿瘤临床实践中的一个不可缺少的重要组成部分,.,现存医书对各种肿瘤记载很多。但大多散在历代医学书籍或医案中。传统的中医学并没有将肿瘤学从内、外、妇、儿等学科中分出而成为独立的学科，也没有形成一个完整而独立的体系。,故现存医学文献虽然极多，却找不到肿瘤学的专著。只见于各种散在的临床观察和研究资料中,明清以后,-1949,年，基本没有发展,.,History,History,After1949(,建国以后,),The government has done a lot for researching TCM oncology.,Legislation,Shuguang Hospital started it since 1955 for gynaecology tumor.,Combinine TCM with western medicine was originalized from,.,国家投入大量的人力和物力,对中医药抗肿瘤的作用和机理作了大量的研究工作,上海在全国是较早进行中医抗肿瘤应用研究的城市（,1955,年）。,根据,1950,年卫生工作的四大方针,（面向工农兵，预防为主，,团结中西医,(unit western and TCM),，卫生运动卫生工作与群众工作相结合）,立法：,中华人民共和国中医药管理条例,),Achievement after 1949,建国以后的主要成绩：,Train the TCM scientists and techincians,培养了一批研究肿瘤人才（包括传统中医，双学历等）。,Basic and frame of TCM oncology,形成中医肿瘤学科的框架,Researching work,both in clinic and laboratory,对中药进行研究和开发。曾对,2000,多个单药和几百个复方进行筛选（主要是动物实验）,确定,190,多个单药和,30,多个复方有效。,Made criterion of TCM oncology,which is the same as international standard,(1993,1997-2003).,制定中医肿瘤学各种国内通用标准，并尽可能符合国际标准,。,History,*4,TCM basic theory on the clinical oncology,4,，中医基础理论在肿瘤临床上应用,TCM basic theory,Basic theory,Essence and qi,精气学说,Yin and yang,阴阳学说,Five elements,五行学说,Viscera(Zang and Fu),脏腑学说,Meridian and colleterals,经络学说,Qi,blood,body fluid,气血津液学说,TCM basic theory,Essence and qi,精气学说,The basic materal is Qi,世界一切事物均由气组成,Any thing and material contains Qi,“,气,”,是一切事物的最基本构成,.,The marrow of Qi is called essence and vital energy,“,气,”,的精华部分称之为,“,精气,”,.,TCM basic theory,Yin-yang Theory,(,阴阳学说,),It is most important in clinic.(,是中医学最重要的的理论基础,),Neijin(,内经）,Following the principles of yinyang ensures life,while breaking them may lead to death.Conforming to the principles of yinyang guarantees health,while violating them may result in disease.,The movement from conformity to violation is known as interior rejection.,从阴阳则生,逆之则死,.,Yin-yang theory(,阴阳学说的基本内容,),Interdependent(,相互依存,),Interrestraint(,相互制约,),Mutual transformation(,相互转化,),Mutual opposite(,相互对立,).,TCM basic theory,Five Elements Theory,五行学说,It means anything in the world made by these five elements.There are some special relations in them.They ar,generate(,生,),restrict(,克,),subjugate/over restrict(,乘,),and reverse restriction(,侮,).,helpIt is very useful to explain most things that exist in the nature and human body.,But sometimes it looks unreasonable or farfetched(four season).,They are really too difficulty to remember.The next star may give us some,Here is the relationship among the five elements.,世界一切事物均由五种物质组成,联系它们之间存在,生克乘侮的关系,.,五行学说可广泛用于解释自然界和人体之间联系,.,五行学说有时侯难以理解,有时后显得比较牵强,(,四季,).,五行学说可以用下图解释,five elements,五行学说,wood,木,fire,火,water,水,earth,土,matal,金,TCM basic theory,five elements,五行学说,Generate(,生,),over restrict(,乘,),wood,木,reverse restriction,fire,火,water,水,Restrict,earth,土,matal,金,TCM basic theory,-,-,Wood,木,Fire,火,Earth,土,Metal,金,Water,水,-,Liver,肝,heart,心,spleen,脾,lung,肺,kidney,肾,Gall,胆囊,smal,小肠,stomach,胃,large,大肠,urine,膀胱,bladder intestine intestine bladder,Eye,眼,tongue,舌,mouth,口,nose,鼻,ear,耳,Fascia,筋,pulse,脉,muscle,肌,skin,皮,bone,骨,Acid,辛,bitter,苦,sweet,甘,acrid,酸,salt,咸,green,绿,red,赤,yellow,黄,white,白,black,黑,Wind,风,(summer)-heat,暑,wetness,湿,dryness,燥,cold,寒,East,东,south,南,middle,中,west,西,north,北,Spring,春,summer,夏,long-summer,长夏,autumn,秋,winter,冬,anger,怒,happy,喜,think,思,grief,悲,terrify,恐,-,TCM basic theory,TCM oncology in the clinical,临床应用特点,Holism(,整体观念,),Humen being and nature(,人与自然,),in body of human being (,人体内部）,Differentiating syndromes to decide treatment,(,辨证施治为主,),Differentiating disease to decide treatment,(,辨病施治为辅,),TCM basic theory,“,瘤”的,概念（,Conception,）：,1,，,Tumor,（瘤,体表生长的赘生物,),。,abnormal mass in the body.which is not only seen on animal or/and humun being,but also on plants.2,Liu(,瘤,不,等同于现代医学的肿瘤，它包括了许多非肿瘤的疾病,)is differente from Zhong Liu,though both can be translated into“tumor”.Goite,Stamochace,Jaundice,Tuberclusis.etc,TCM basic theory,“,瘤”的,概念（,Conception,）：,3,有些现代医学的“肿瘤”没包括在瘤的范畴内,Some tomors were not included.(,积聚,噎膈，,乳岩（癌）,),4,瘤,(Liu)can be divided into five types.They are Qi,Bone,Blood,Muscle,Tendon,according to the 5 elements.(,气瘤,qi(metal),肉瘤,myoma(earth),血瘤,angioma(fire),骨瘤,osteoma(water),筋瘤,fasciaoma(wood)hemoreology,5,五积：心之积为伏梁，肺之积为息贲，肝之积为肥气，脾之积为痞气，肾之积为奔豚。,Effective,bi-sides,and QOL standard are all as same as western medicine,目前中医肿瘤临床在疗效,毒副反应,生活质量等指标的观察与评价与现代医学一样,参照世界统一的标准,.,疗效评判标准,Effective standard(WHO):,完全缓解,:,瘤体完全消失,1,月,CR,disappear 1M,部分缓解,:,瘤体缩小到治疗前的,50,以下,1,月,PR,1M,稳定,:,瘤体在治疗前的,50-125,之间,SD,50%-125%of original size,Cell growth,肿瘤增长估计数值表 ,倍增 癌 细 胞 数 重量 直径 临床所见次数,(,个,),假定,10,9,1,克）（假定为球形）,0 2,0,(1 )0.001,微克 不能触知,10 2,10,(1,千,)1,微克 不能触知,20 2,20,(,1,百万,)1,毫克,1,毫米 不能触知,30 2,30,(,10,亿,)1,克,10,毫米 人癌可触知，,小鼠可致死,10,10,10,11,10,100,克,22,47,大部分人癌,(,百亿千亿,),毫米 可临床诊断,40 2,40,10,12,(,万亿,)1,公斤,100,毫米 人癌可致死,Cell dynamics,细胞周期,G0,期，静止期，休眠，凋亡 时间不定,G1,期，,gap1,DNA,合成前期（占,1/2,），几小时到几天,S,期，,synthesis,DNA,合成期（占,1/3,1/4,）,5,30,，个别,60,小时,G2,期，,gap2,DNA,合成后期，丝状分裂准备期（占,1/5,）,1,2,。,5,小时,M,期，,mitosis,丝状分裂期,0,。,5,1,。,5,小时,D,期，,division,很短,Cell cycle,细胞周期,The standard of acue and sub-acute bi-sides,（,WHO),化疗急性和亚急性毒副反应的表现和分度标准,-,0,度 ,度 ,度 ,度 ,度肠,Hb,血红蛋白,g,、,L,110 95-109 80-94 65-79 ,65 ,血,WBC,白细胞,(,千,),4,0 3-3,9 2,0-2,9 1,0-1,9 1,0 ,液,N,中性白细胞 ,2,0 1,5-1,9 1,0-1,4 0,5-0,9 0,5 ,系,PLT,血小板报,(,万,),100 75-99 50-74 25-49 25,Bleed,出血 无 瘀点 轻度出血 严重出血 出血致衰 ,胆红素,TBil ,1,25N 1,26-2,5N 2,6-5N 5,1-10N ,10N ,AST,谷丙 ,1,25N 1,26-2,5N 2,6-5N 5,1-10N ,10N ,胃,ALP,谷草案 ,1,25 1,26-2,5N 2,6-5N 5,1-10N ,10N ,肠口腔,Oral cavity,无 红斑、疼痛 红斑、溃疡、可进食 溃疡、只进流汁 不能进食 ,恶心呕吐,Vomity,无 恶心 暂时性呕吐 呕吐、需治疗 难控制的呕吐 ,道 ,腹泻,Diarhea ,无 短暂性,(,2,天,),能耐受,(,2,天,),不能耐受、需治疗血性腹 ,注：,N,为正常值上限,The standard of acue and sub-acute bi-sides,（,WHO),化疗急性和亚急性毒副反应的表现和分度标准,0,度,度 ,度 ,度 ,度,BUN 1,25N 1,26-2,5N 2,6-5N 5,1-10N ,10N ,肾 尿素氮肥 ,Cr warm even cool cold,“,温次与热”“凉次于寒”,Yang asthenia Yin asthenia,阳虚 阴虚,Syndromes syndromes,症侯,:,症侯,:,TCM,Oncology,(3),五味,内经,(,与五行学说,脏腑学说有关,),F,our character and five taste,辛，苦，咸，酸，甘,acid,bitter,sweet,acrid,salt,辛入肺,(,金,),acid to lung,苦入心,(,火,),bitter to heart,甘入脾,(,土,),sweet to spleen,酸入肝,(,木,),acrid to liver,咸入肾,(,水,),salt to kidney,可作为补的基础,但,过,与,不足,均可致病,No more,no less is the best.,TCM,Oncology,(4),经络,周礼,和升降沉浮,药物的归经,十二经络,奇经八脉,TCM,Oncology,(5),关于,“忌口”的问题,What is avoid certain food,不要道听途说，随意,“忌口”。,It is unrequired,现代医学的营养学,(,最佳营养支持,BNS),Best nutrition surpote,中医的食疗理论,TCM basic theory of diet therapy,(,根据个人的体质，从四气，五味阴阳学说，脏腑学说，五行学说，经络学说等等,),临床实践证明,Clinical practice and experience,TCM,Oncology,(7),部分常用药物和食物,药物,:,人参,灵芝,冬虫夏草,虫草菌丝体,霍山石斛（枫斗）,黄芪等,食物,:,鸡,鸭,羊肉,鳖,海参等,药物不分,(,药食同源,):,大枣,枸杞子,菊花等,人参,神草，地精，天狗，玉精，百草王,世界上人参有四大家族，中国的,吉林人参,，朝鲜的,高丽人参,，日本的,东洋参,和加拿大，美国的,西洋参,我国人参又有三个分支，天然产于吉林长百山,-,野山参,，野山参的种子用人工栽培,-,园参,，幼小的园参再移植到山野成长,-,移山参,人参：,野山参十分稀少，需要几十到一二百年，所以价格昂贵，野山参一般都不大，“七两为参，八两为宝（旧式老称）”九两以上为“稀世珍宝”。人工栽培的园参和移山参，量较大，生长周期短（,6,7,年）药力相对较弱。价格也便宜，新鲜园参晒干叫,生晒参,，其中有效的叫,皮尾参,，用冰糖浸制加工的叫,白参,，蒸制加工成暗红色叫,红参,，将须根加工的有白直须，红直须，白弯须，红弯须等等。朝鲜的高丽人参，因加工不同，分为朝,鲜红参和朝鲜白参,，日本东洋参,（红参）,形似竹节又称,竹节参,，加拿大，美国的西洋参，又称,花旗参，洋参，,其中去皮叫,去皮参,或,粉光参,，未去皮叫,原皮参或面参,。,人参：,性味：甘 微苦归经：肝、肾功效：补肾滋阴，养肝明目治疗：阴虚内热，头晕目花，耳鸣腰酸,须发早白,如果服人参过量，会引起中毒，称之为“人参综合症”（精神亢奋、头痛、烦燥、饱胀、汗出等）,冬虫夏草（蝙蝠蛾，虫草菌,）,虫草真菌的子囊孢子，于冬季前后侵入虫草蝙蝠蛾的幼虫体内，吸收养分而发展菌丝，待菌丝充满虫体，虫即僵死。到了夏季，从死虫的头顶长出菌座，露出土面，故名夏草。,冬虫夏草含虫草酸（即甘露醇）约，蛋白质约，脂肪，多种氨基酸及铅、锶、钾、钠、胆甾醇、软酸、麦角甾醇过氧化物。尤以生长在海拔,4500,米以上的西藏那曲地区的虫草为虫草中的佳品,.,虫草蝙蝠蛾的耐寒性强，在一,3,低温下冻不死，而至,0,时即复苏，幼虫受虫草孢子囊菌感染后，喜蛰居于向阳湿润、土质松软肥沃的山坡。一般生长在海拔,4000,米左右。,冬虫夏草（蝙蝠蛾，虫草菌,）,1578,年明李时珍的,本草纲目,记载药物,1892,种，无,冬虫夏草,记录，,本草纲目,出版后,10,余年，,1765,年清朝赵学敏,本草拾遗,补充,872,味药物。历代其它文献论述有,本草备要,、,药性考,、,本草正义,、,本草拾遗,等。,性味：甘、平（温）归经：肺、肾作用：补肺益肾，止血化痰,治疗：病后或年老虚损，或劳嗽咳痰血不已。,补肾助阳、益精起痿之功，用于肾虚精亏,导致的腰膝酸痛、软弱无力、梦遗滑精、,阳痿早泄、耳鸣健忘及神思恍惚等。,古代和现代民间常用，属阴阳平补药物。,中国藏药,1996,版报道：冬虫夏草具有十大功能作用,:,1.,抗菌作用,2.,免疫调节作用,3.,抗癌作用,4.,抗炎作用,5.,滋肾作用,6.,提高肾上腺胆固醇含量,7.,抗心律失常作用,8.,抗疲劳作用,9.,祛痰平喘作用,10.,镇静催眠作用,以人工发酵培养虫草菌丝体代替天然虫草已获成功，但二者,并不能完全等同,据国家中药品种保护及国家食品药品监督管理部门等发布的有关资料介绍，“至灵胶囊”的生产菌为被孢霉属，“宁心宝胶囊”的生产菌为虫草头孢，“心肝宝胶囊”的生产菌为粉红胶霉，“百奥牌奇滋宝菌丝胶囊”，“金水宝胶囊”的生产菌均为蝙蝠蛾拟青霉。这些菌种均不同于冬虫夏草菌中国被毛孢。而,“百令胶囊”,的生产菌为中华束丝孢，有学者采用分子生物学方法证实，中华束丝孢与中国被毛孢属同物异名，均是冬虫夏草菌的无性型。虽然如此，但采用发酵法生产的百令胶囊，其活性成分与药理功效仍然有别于青藏高原出产的冬虫夏草。,蛹虫草并不是冬虫夏草,蛹虫草，又称北虫草，采用米饭及奶粉培养基人工培养，如今已实现规模生产，现代研究表明，蛹虫草与冬虫夏草的亲缘关系相差甚远，其药用价值与冬虫夏草相比更是有天壤之别。,黄芪,(,耆,),性味：甘、微温,归经：脾、肺,功效：大补元气 固托生津 安神,治疗：劳伤虚损，一切气血津液不足,石斛,性味,甘，淡,微咸,寒功能主治：生津益胃，清热养阴治疗：热病伤阴，口干烦渴,.,铁皮石斛：清热生津作用强金石斛：清热生津作用较强川石斛：清热生津作用较弱,（安徽）霍山石斛（枫斗）,：较适合老人既要补阴，又不能太寒,灵芝,灵芝，历史上,属于安神药,分清医学文献与文学作品的不同记载,最早记载于,神农本草经,，本草纲目有详细记载：,紫芝，赤芝,，青芝，黄芝，白芝，黑芝等六种。,性味，甘，平，无毒。有些记载（温）,功能主治：,治虚劳，咳嗽，气喘，,失眠,，消化不良。,成份，主要是酸性,葡聚糖,灵芝孢子有一层难被人体胃酸消化的几丁质构成的外壁。,破壁后人体对灵芝孢子粉的吸收率可提高,45,倍之多。目前灵芝孢子破壁的技术有生物酶解法、化学法等多种方法,肿瘤患者调理和养生的原则：运用整体观念，辨证施治原则，中医基本理论指导，阴阳学说，脏腑学说，五行学说，经络学说等根据个人的体质，从四气，五味决定饮食种类，进行调理。同病可以异治,(,调理,),，异病可以同治,(,调理,),不要道听途说，随意,“忌口”。,肿瘤患者的调理和养生包括食疗和冬令进补,THANK YOU,谢 谢,