胃淋巴癌的中西醫理與治療的整合思維

The Integration of Gastric Lymphatic Carcinoma About Its Treatment and the Principles of Traditional Chinese Medicine and Western Medicine

根據WHO淋巴癌分類系統，具MALT（mucosa-associated lymphoid tissue lymphoma）組織的瀰漫性大B細胞淋巴瘤（diffuse large B cell lymphoma，DLBCL （MALT）），與幽門螺旋桿菌（H.pylori）有密切關係。因此，根除治療幽門螺旋桿菌是有助於避免DLBCL的復發；就中醫而言，本病案的病機主軸為胃濕熱實證，因幽門螺旋桿菌（屬熱毒）的侵入，而長期反覆的胃發炎、黏膜充血、血熱壅滯，甚至在化放療後因濕熱下注的腸道發炎，故有腹痛、腹瀉、胃悶脹痛的症狀。然而，對應於西醫的淋巴癌分類系統，在治療過程中考慮幽門桿菌（熱毒）的因素，及腫瘤的病理變化，處方以散腫潰堅湯，可消堅散腫，符合中醫的微觀辨證。同時，因研究結果指出“陰虛證候與癌症預後有正相關”，故搭配中醫辨證系統，改善胃陰虛證候、期望提高預後機率。況且，在治療過程中發現，長期使用清熱解毒藥物，反而有助於偏低的白血球數目回復正常。因此，藉此病案分享討論，期望以中西醫整合思維提升治療癌症的療效。 According to classification system of World Health Organization, it is a close relationship between mucosa-associated lymphoid tissue of diffuse large B cell lymphoma and Helicobacter pylori. Thus, eradication therapy of Helicobacter pylori contributes to prevent from relapse of diffuse large B cell lymphoma. For traditional medicine, the main pathogenesis of this medical case is demp heat and empirical sympton of stomach. By the invasion of Helicobacter pylori, a heat toxin, that resulted demp heat of stomach to become the long term repeatedly gastric inflammation and mucosal hyperemia, blood stasis. Even that, the hot and humid of stomach flows down to the intestinal tract, and resulting the tract in inflammation. Therefore, there are abdominal pain, diarrhea, stomach ache and bloating symptoms. However, corresponding to classification system of medicine, we consider that the reason of Helicobacter pylori, a heat toxin, is and that pathological changes of tumors is at the process of treatment. That is why we prescribe the SAN ZHONG KWZI JIEN TANG for eliminating the mass and relieving swelling becouse it is in line with microscorpic syndrome differentiation of traditional chinese medicine. At the same time, according to the previous study, Yin-deficiency syndrome is positive correlation to prognosis of cancer. Therefore, we prescribe drugs by using syndrome differentiation to improve Yin-deficiency syndrome of stomach, and to enhance prognostic probability. Besides, we find that taking medicine of clearing heat toxin for long term contributes to make the numbers of leukocyte return to normal. In short, sharing this medical case offers us to discuss how to enhance curing effect of cancer by using integrated thinking of traditional medicine and western medicine.

According to classification system of World Health Organization, it is a close relationship between mucosa-associated lymphoid tissue of diffuse large B cell lymphoma and Helicobacter pylori. Thus, eradication therapy of Helicobacter pylori contributes to prevent from relapse of diffuse large B cell lymphoma. For traditional medicine, the main pathogenesis of this medical case is demp heat and empirical sympton of stomach. By the invasion of Helicobacter pylori, a heat toxin, that resulted demp heat of stomach to become the long term repeatedly gastric inflammation and mucosal hyperemia, blood stasis. Even that, the hot and humid of stomach flows down to the intestinal tract, and resulting the tract in inflammation. Therefore, there are abdominal pain, diarrhea, stomach ache and bloating symptoms. However, corresponding to classification system of medicine, we consider that the reason of Helicobacter pylori, a heat toxin, is and that pathological changes of tumors is at the process of treatment. That is why we prescribe the SAN ZHONG KWZI JIEN TANG for eliminating the mass and relieving swelling becouse it is in line with microscorpic syndrome differentiation of traditional chinese medicine. At the same time, according to the previous study, Yin-deficiency syndrome is positive correlation to prognosis of cancer. Therefore, we prescribe drugs by using syndrome differentiation to improve Yin-deficiency syndrome of stomach, and to enhance prognostic probability. Besides, we find that taking medicine of clearing heat toxin for long term contributes to make the numbers of leukocyte return to normal. In short, sharing this medical case offers us to discuss how to enhance curing effect of cancer by using integrated thinking of traditional medicine and western medicine.