中医临床研究2025，Vol.17Issue(27)：9-13,5.DOI:10.3969/j.issn.1674-7860.2025.27.002
基于"络以通为用"论治癌性疼痛
The treatment of cancer pain based on the theory of"collaterals should be unobstructed"
摘要
Abstract
Cancer pain is one of the most common complications in malignant tumor patients,severely affecting quality of life of patients.Western medicine primarily relies on opioids to treat this disease,yet long-term use may lead to medicine tolerance,addiction,and various adverse effects.The theory of"collaterals should be unobstructed"originated from YE Gui's work Linzheng Zhinan Yi'an(《临证指南医案》),providing a critical theoretical foundation and clinical guidance for the syndrome differentiation and treatment of cancer pain.Based on the theories of"long-term diseases entering collaterals"and"long-term pain entering collaterals,the pathogenesis of cancer pain follows a progressive evolution process from Qi(气)stagnation to blood stasis,from excess to deficiency,and from meridians to collaterals.The pathogenesis at each stage is interrelated,ultimately forming a pathological transformation pattern of"Qi stagnation-phlegm stasis-toxin damage".In the early stage,liver Qi stagnation leads to collateral obstruction,manifesting as migratory distending pain that travel and worsen with emotional fluctuations.In the intermediate stage,Qi stagnation progresses into the blood,with phlegm and blood stasis mutually binding,and the collaterals are blocked,resulting in fixed stabbing pain which is worsened at night.In the late stage,phlegm and blood stasis transform into toxins,and the collaterals become deficient and lack nourishment,resulting in intractable persistent pain accompanied by emaciation.Stage-specific treatment strategies are proposed as follows:early-stage therapy focuses on the method of soothing liver and regulating Qi,and harmonizing collaterals to relieve pain,primarily selecting soothing liver and regulating Qi medicines such as Chaihu(Radix Bupleuri)and Xiangfu(Rhizoma Cyperi)combined with invigorating blood circulation and alleviating pain medicines such as Yanhusuo(Rhizoma Corydalis)and Yujin(Radix Curcumae);the treatment in the intermediate stage emphasizes the therapy of resolving phlegm to dispel stasis,and unblocking collaterals to dissipate masses,mainly employing resolving phlegm medicines such as Banxia(Rhizoma Pinelliae)and Baijiezi(Semen Sinapis)alongside insect medicines such as Quanxie(Scorpio)and Wugong(Scolopendra)as well as vine herbs such as Jixueteng(Caulis Spatholobi);the treatment of the late stage prioritizes the method of reinforcing healthy Qi to unblock collaterals,and detoxifying and removing stasis,mainly selecting reinforcing medicines such as Huangqi(Radix Astragali)and Renshen(Radix Ginseng)supplemented by activating blood medicines such as Sanleng(Rhizoma Sparganii)and Ezhu(Rhizoma Curcumae),along with detoxifying medicines such as Banzhilian(Herba Scutellariae Barbatae).Clinical practice demonstrates that syndrome differentiation and treatment guided by this theoretical framework can effectively alleviate cancer pain and improve patients'quality of life.Future research should further explore the application and development of collateral disease theory in the management of cancer pain,promoting the innovation and refinement of collateral disease theory of traditional Chinese medicine.关键词
癌性疼痛/络病/络以通为用/通络Key words
Cancer pain/Collateral disease/Collaterals should be unobstructed/Unblocking collaterals分类
医药卫生引用本文复制引用
王凌云,郑广达,任娟霞,尚璐,李长林,李东滔,刘海啸,鲍艳举..基于"络以通为用"论治癌性疼痛[J].中医临床研究,2025,17(27):9-13,5.基金项目
中央高水平中医医院临床研究和成果转化能力提升项目—医疗机构制剂研发与新药转化专项(HLCMHPP2023078). （HLCMHPP2023078）
