TCM肿瘤

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 ZhouOncology 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 situationin 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 （5685%）, 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（5685%），在整个治疗过程中接受过中医中药。,In the mainland of China, more than 50% of patients with malignant tumur, has been received TCM for treatment in their whole process. 。,Situation,Why,2, Why?产生上述现状的原因？,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（298）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.LegislationShuguang 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 (19931997-2003). 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 oncology4，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 someHere 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 Restrictearth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)hemoreology5, 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1091克） （假定为球形） 0 20 ( 1 ) 0.001微克 不能触知10 210 ( 1千 ) 1微克 不能触知20 220 ( 1百万) 1毫克 1毫米 不能触知30 230 ( 10亿) 1克 10毫米 人癌可触知， 小鼠可致死10101011 10100克 2247 大部分人癌 (百亿千亿) 毫米 可临床诊断40 2401012 (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1/31/4）530，个别60小时G2期，gap2,DNA合成后期，丝状分裂准备期（占1/5）12。5小时M期，mitosis,丝状分裂期0。51。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、L110 95-109 80-94 65-79 65 血WBC白细胞 (千) 40 3-39 20-29 10-19 10 液N中性白细胞 20 15-19 10-14 05-09 05 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 125N 126-25N 26-5N 51-10N 10N AST 谷丙 125N 126-25N 26-5N 51-10N 10N 胃ALP 谷草案 125 126-25N 26-5N 51-10N 10N