杨婧妍 张钟玥 王苏晋 宋清雅 吴煜

〔摘要〕 骨髓抑制是肿瘤化疗患者常见的并发症。结合中医古籍知识与现代医家观点，从中医“虚劳病”角度论述骨髓抑制，总结骨髓抑制病因病机。强调药毒为主要病因，瘀血为重要环节。结合临床实际，論述疾病证候，指出脾肾两虚为基本病机、血瘀证广泛存在;并强调“虚劳干血”应治以“缓中补虚”，虫类药的运用十分重要，食养调护必不可少。

〔关键词〕 骨髓抑制;恶性肿瘤;虚劳;血瘀;化疗;缓中补虚;大黄[[[庶][虫]]]虫丸

〔中图分类号〕R273       〔文献标志码〕A       〔文章编号〕doi：10.3969/j.issn.1674-070X.2021.05.024

Treatment of Myelosuppression After Tumor Chemotherapy From the

Perspective of Consumptive Disease

YANG Jingyan1，2， ZHANG Zhongyue1，2， WANG Sujin1，2， SONG Qingya2， WU Yu2*

（1. Graduate School of Beijing University of Chinese Medicine， Beijing 100029， China; 2. Xiyuan Hospital，

China Academy of Chinese Medical Sciences， Beijing 100091， China）

〔Abstract〕 Myelosuppression is a common complication in patients receiving chemotherapy for tumors. Myelosuppression was discussed from the perspective of “consumptive disease” in traditional Chinese medicine， incorporating opinions from ancient works and of modern practitioners; the etiology and pathogenesis of myelosuppression was summarized. This paper emphasized the main cause is the herbal toxicity and the important link is the static blood. The symptoms were discussed combination with clinical practice. This paper pointed out that deficiency of both spleen and kidney is the basic syndrome， and blood stasis syndrome is widespread， and stressed that "consumptive blood-stasis" should be treated with "relaxing middle Jiao and supplementing deficiency". The use of insecticides in the treatment is very important， and it is also essential to maintain food.

〔Keywords〕 myelosuppression; malignant tumor; consumptive disease; blood stasis; chemotherapy; relaxing middle Jiao and supplementing deficiency; Dahuang Zhechong Pill

骨髓抑制是化疗常见毒性反应，发生率约为80%[1]。化疗药诱导骨髓中分裂旺盛的造血细胞凋亡，致使成熟红细胞、白细胞和血小板减少，反过来又阻碍患者的化疗进程、影响化疗疗效。患者白细胞减少导致机体防御功能下降、感染风险增加，出现食欲降低、发热等症状;红细胞与血红蛋白减少则加重贫血，加重面色苍白、体倦乏力等症状;血小板减少导致皮肤、黏膜、胃肠、泌尿系统出血，严重者甚至颅内出血，多器官组织衰竭[2]。临床常输入成分血，应用重组人促血小板生成素（thermoplastic polyolefin， TPO）、重组人粒细胞集落刺激因子（recombinant human

granulocyte colony stimulating factor， rhG-CSF）等手段治疗骨髓抑制。但有研究证实，反复多次注射rhG-CSF可能导致中性粒细胞“疲惫”，从而加重骨髓衰竭[3]。并且，rhG-CSF对于血小板减少效果差，有反跳现象。

中医无“骨髓抑制”病名，中医“血”的概念与西医“血液”的概念亦有区别。临床观察及研究证实了中医药治疗骨髓抑制的有效性[4]。患者因骨髓抑制而出现的各种症状，与中医“虚劳”这一疾病的证候相符，因此，骨髓抑制在中医治疗中常被划分为虚劳病范畴。……