叶霈智 冯利 秦子舒 杨宏丽 殷玉琨

[摘要] “窠囊理论”在痰瘀相关理论基础上发展形成，顽痰死血胶结化毒、凝滞不化，结成窠囊，兼具病位、病性、病势等特点。恶性肿瘤治疗周期长、难度大，多属久病难愈、重病难治者。依据窠囊理论从“痰”“瘀”角度论治恶性肿瘤，有助于深入认识恶性肿瘤的病因病机，为开拓新的治疗思路和方法提供理论根据。本文对窠囊理论的形成与发展、临床特点及症状、治则治法和常用药物，结合典型病例加以阐述。

[关键词] 窠囊理论；恶性肿瘤；痰；瘀

[中图分类号] R730.5 [文献标识码] A [文章编号] 1673-7210（2018）08（a）-0115-04

[Abstract] Ke-nang theory is developed and formed on the basis of the phlegm and blood stasis. Chronic phlegm and static blood are cemented as toxic， stagnant and stale， thus formed ke-nang， which has its own characteristics of disease position， disease nature， disease status， etc. The treatment period of malignant tumor is long and difficult. Most of them are long-term and difficult to be cured. According to the ke-nang theory， treating malignant tumor from "phlegm" and "stasis" is helpful to deeply understand the pathogenesis of malignant tumor， and it provides theoretical basis for developing new treatment ideas and methods. In this paper， the formation and development， clinical features and symptoms， therapeutic methods and commonly used drugs of ke-nang are described combined with typical cases.

[Key words] Ke-nang theory； Malignant tumor； Phlegm； Stasis

惡性肿瘤是我国居民死亡的主要原因，严重威胁人民生命健康。近年来，手术、放疗、化疗、靶向治疗、免疫治疗等治疗方法不断完善丰富，但恶性肿瘤死亡率并未得到改善。针对目前恶性肿瘤治疗有效率的“瓶颈”问题，如何深入挖掘中医药理论精髓、拓展中医治疗思路、发挥其特色和优势，是需要不断思考和努力践行的问题。笔者结合个人临床实践，分析中医“窠囊”理论在恶性肿瘤治疗中的应用，现简介如下：

1 窠囊学说的形成与发展

“窠囊”一词，首见于宋代许叔微《普济本事方》，书中作者记述了以单药苍术治疗自身“膈中停饮”宿疾的经历。其年少之时夜间喜左侧伏案，饮食多坠向左侧，且深夜饮酒后左侧卧睡，久而久之，“觉酒止从左边下，漉漉有声，胁痛，饮食殊减，十数日必呕数升酸苦水，暑月只是右边身有汗，常润，左边病处绝燥”之症，遍访名医治疗无效。……