中国药物滥用防治杂志

鼻咽恶性肿瘤（NPC）是一种具有显著地域聚集性的头颈部肿瘤，在我国南方及东南亚地区高发，其发病与EB病毒感染、遗传易感性及环境因素密切相关。由于鼻咽部位解剖结构复杂，邻近重要神经血管，传统西医治疗（如放疗、化疗）虽能控制肿瘤进展，但常伴随放射性黏膜炎、唾液腺损伤等并发症，导致患者咽干、吞咽困难及生活质量下降，临床治疗难度较大。朱镇华教授基于多年临床实践，提出中西医结合治疗模式，强调“本虚标实”的核心病机，即放疗前以“脾虚痰瘀”为主，放疗后转为“阴虚痰热”，通过动态辨证施治改善症状，延缓病情。本文报道1例72岁女性鼻咽恶性肿瘤患者，西医确诊为低分化鳞状细胞癌，中医辨为“鼻岩”（痰瘀互结，脾胃虚弱），放疗后采用参苓通窍散加减治疗，基础方以党参、茯苓、白术等健脾益气，配伍皂角刺、石菖蒲化痰散结，并根据咽干、纳差等症动态调整，加入麦冬、石斛滋阴润燥。治疗后患者咳嗽、痰中带血等症状减轻，黏膜损伤改善，生活质量显著提升。朱教授注重脾胃虚弱之本与痰毒瘀结之标的平衡，通过扶正祛邪、标本兼治，为鼻咽恶性肿瘤的个体化治疗提供了重要参考。

Nasopharyngeal malignant tumor(NPC) is a head and neck tumor with significant regional aggregation, which is highly prevalent in southern China and SOutheast Asia. The incidence of NPC is closely related to EB virus infection, genetic susceptibility and environmental factors. Due to the complex anatomical structure of the nasopharynx and the proximity to important nerves and blood vessels, traditional western medicine treatment(such as radiotherapy and chemotherapy) can control tumor progression, but it is often accompanied by complications such as radioactive mucositis and salivary gland injury, resulting in patients with dry throat, dysphagia and decreased quality of life, and clinical treatment is difficult. Based on years of clinical practice, Professor ZHU Zhenhua put forward the treatment mode of integrated traditional Chinese and Western medicine, emphasizing the core pathogenesis of “deficiency in origin and excess in superficiality”, that is, before radiotherapy, “spleen deficiency and phlegm stasis” was the main pathogenesis, and after radiotherapy, “yin deficiency and phlegm heat” was transformed into “yin deficiency and phlegm heat”. Through dynamic syndrome differentiation and treatment, symptoms were improved and the condition was delayed.This paper reported a 72-year-old female patient with nasopharyngeal malignant tumor. The patient was diagnosed as poorly differentiated squamous cell carcinoma by Western medicine and identified as “biyan”(phlegm and blood stasis, spleen and stomach weakness) by traditional Chinese medicine. After radiotherapy, shenlingtongqiao powder was used for treatment. The basic prescription was to invigorate the spleen and replenish qi such as dangshen, poria cocos and atractylodesmacrocephala, combined with Zaojiao thorn and Shichangpu to resolve phlegm and disperse knots, and dynamically adjusted according to symptoms such as dry throat and anorexia. After treatment, the symptoms of cough and bloody sputum were alleviated, mucosal injury was improved, and the quality of life was significantly improved. Professor Zhu pays attention to the balance between the root of spleen and stomach weakness and the target of phlegm, toxin and blood stasis. By strengthening the body resistance to eliminate pathogenic factors and treating both the symptoms and root causes, he provides an important reference for the individualized treatment of nasopharyngeal malignant tumors.