愛(ài)華網(wǎng)北京中日友好醫(yī)院有學(xué)者統(tǒng)計(jì)了300例肝癌患者，發(fā)現(xiàn)經(jīng)常服用中藥達(dá)3個(gè)月以上者，其疼痛發(fā)生明顯輕于不用中藥者。研究認(rèn)為，中藥對(duì)疼痛的預(yù)防機(jī)制在于兩個(gè)方面：一是中藥的雙向調(diào)節(jié)作用，機(jī)體的某些不平衡可使疼痛加劇，而中藥可使之平衡；二是中醫(yī)有“不通則痛”之說(shuō)，活血化瘀、理氣通絡(luò)之藥能起到“通則不痛”的作用。對(duì)腫瘤患者來(lái)說(shuō)，應(yīng)早服中藥，防患于未然，不能等到嗎啡、杜冷丁也止不住痛時(shí)再求助中藥。
第二、止痛效果明顯
中藥外用及口服對(duì)已發(fā)生的癌痛有止痛作用，效果持久而緩和，副作用小。常用止痛中藥如元胡、細(xì)辛、米殼、白屈菜等，取材方便。乳香、沒(méi)藥、血竭、紅花、姜黃、冰片等還是易溶于酒精、易于配制的外用止痛藥。如將冰片溶于適量的酒中，配制成20%～50%的溶液，治療肝癌后期劇痛，往往能在10～15分鐘內(nèi)收效?，F(xiàn)重點(diǎn)介紹幾則癌痛外治法：
(1)中藥涂擦劑
藥物組成為元胡、丹參、臺(tái)烏藥、蚤休、地鱉蟲(chóng)、血竭、冰片等，前4味藥與地鱉蟲(chóng)以4：1比例配方，血竭、冰片各按10%比例加入。以上藥物加75%酒精浸泡1周(酒精用量以沒(méi)過(guò)中藥為度)，過(guò)濾后將藥物濃度調(diào)至每毫升含中藥1g即可。用法：洗凈疼痛部位皮膚，棉簽蘸涂，用藥面積應(yīng)大于疼痛周邊2～3cm，每日3～4次。據(jù)觀察，治胸部疼痛緩解率為90.1%，腹部疼痛緩解率為75.5%，脊柱、四肢骨疼痛緩解率為50%。疼痛緩解持續(xù)時(shí)間較強(qiáng)痛定為優(yōu)。
(2)祛痛噴霧酊
由延胡索、烏藥、土鱉蟲(chóng)、丹參、紅花、血竭、冰片等組成。先以75%酒精2000ml浸泡延胡索等前五味中藥，1周后濾取藥汁；再于藥液中加入血竭、冰片，溶解后過(guò)濾，裝入50ml塑料噴霧瓶中備用，每毫升含生藥0.1g。癌痛時(shí)可均勻噴涂于癌痛處的體表。功能止痛、消炎、消腫，適用于各種癌痛，對(duì)胸痛、脅肋痛效果最佳，而對(duì)脊柱四肢等處的骨腫瘤疼痛效果較差。
(3)肝痛外敷方
雄黃、明礬、青黛、皮硝、乳香、沒(méi)藥各60g，冰片10g，血竭30g，共研細(xì)末，分成7包。每次1包，用醋和豬膽汁各半調(diào)成糊狀外敷，每日1次，每次敷8小時(shí)，藥干后蘸醋及豬膽汁。對(duì)晚期肝癌劇痛有良效。
(4)博生癌寧透皮藥貼
藥物成分包括馬錢子堿、木鱉堿、藤黃素、蟾毒靈、大戟二烯醇、月桂氮卓酮等。透皮貼貼于癌痛局部或肚臍處、胸腹部、上臂或大腿內(nèi)側(cè)以及其它毛細(xì)血管豐富的部位。每次選1～2個(gè)部位貼敷，每日2～4貼，每貼可連續(xù)貼敷12～16小時(shí)。該貼具有抗癌化瘤、鎮(zhèn)痛消腫、破瘀逐水、扶正固本功能，對(duì)各種腫瘤的癌性疼痛均有顯效。
(5)穴位敷貼法
山柰、乳香、沒(méi)藥、大黃、姜黃、梔子、白芷、黃芩各20g，小茴香、公丁香、赤芍、木香、黃柏各15g，蓖麻仁20粒。上藥共研細(xì)末，取雞蛋清(或蜂蜜)適量，混合拌勻成糊狀。肺癌敷乳根穴，肝癌敷期門穴。痛劇者6小時(shí)換藥1次，痛輕者12小時(shí)更換1次?？沙掷m(xù)使用至疼痛緩解或消失。
(6)癌痛藥酒方
松香、制乳香、制沒(méi)藥、莪術(shù)各15g，冰片10g。以白酒500ml浸泡1周。用數(shù)層紗布浸濕藥酒，敷于痛處，外用塑料薄膜覆蓋，待紗布快干時(shí)，再以藥酒濕潤(rùn)，間斷或連續(xù)使用。一般敷10～20分鐘即感局部清涼舒適，疼痛逐漸緩解。
(7)化瘤發(fā)熱袋
藤黃、川芎、皮硝、生南星、川烏、草烏、冰片、大黃、雄黃、細(xì)辛、白芨、制乳沒(méi)、茴香、山柰等，研末，過(guò)60目篩，裝入一面似100目篩小孔的特制清潔袋，加干性發(fā)熱劑后封閉，再套入厚塑料袋中密封。用時(shí)取出內(nèi)袋，將有微孔的一面接觸疼痛部位，定時(shí)拍打藥袋，使發(fā)熱劑與空氣及藥物接觸面發(fā)熱，維持溫度在40～43℃左右，24小時(shí)換藥1次。適用于惡性腫瘤或其他良性包塊等所引起的疼痛。
(8)穴位封閉法
在用止痛藥無(wú)效時(shí)可使用本方法。取穴：足三里(雙側(cè))，讓患者正坐垂足，從外膝眼下量3寸，脛骨外側(cè)1寸處取穴。在無(wú)菌操作下用5ml注射器，7號(hào)針頭抽吸維生素K3注射液8ml、654-2 10ml；讓患者取坐位(或抑臥位)，選準(zhǔn)穴位，局部皮膚常規(guī)用碘酒、酒精消毒后，直刺進(jìn)針；待患者有酸、麻、脹感時(shí)，快速將藥液注入，兩側(cè)穴各一半，每日1次。3次為1療程，間隔2天，再進(jìn)行下一療程。經(jīng)觀察30例中(未使用其他止痛藥)，總有效率60%。另外在疼痛充分緩解的8例中，有3例無(wú)痛持續(xù)2個(gè)月以上，2例持續(xù)時(shí)間在20天以上，3例持續(xù)時(shí)間在5天以上。
(9)中藥離子導(dǎo)入
延胡索、乳香、沒(méi)藥、丹參各100g，徐長(zhǎng)卿150g。用75%酒精浸1月以上，取藥液加少量冰片及二甲基亞砜即成。導(dǎo)入穴位：胸痛取內(nèi)關(guān)、膻中、阿是穴；腰腿痛取腎俞、環(huán)跳、陽(yáng)陵泉、昆侖等穴；肩背痛取天宗、肩髃、阿是穴等；內(nèi)臟病取相應(yīng)臟腑的俞、募、原穴。氣滯配行間或太沖；血瘀配血海、膈俞；痰瘀配豐隆。
第三、協(xié)同止痛作用
中藥與西藥止痛藥配合，既可增強(qiáng)其療效，又可減少西藥副作用。例如芍藥甘草湯加米殼水煎服對(duì)腹部癌痛有效，并可增加鹽酸二氫埃托啡含服的鎮(zhèn)痛效果。透骨草、骨碎補(bǔ)、補(bǔ)骨脂三味中藥對(duì)骨痛有效，也可加強(qiáng)解熱鎮(zhèn)痛藥及放射治療對(duì)骨轉(zhuǎn)移癌的止痛效果。再如肝癌劇痛?？慷爬涠≈雇矗缬皿杆?、元胡、山甲、青皮煎濃汁外敷肝區(qū)，會(huì)加強(qiáng)止痛效果。
綜上所述，中藥應(yīng)用于癌痛，既可定位于癌癥止痛的第一、二階梯，亦可作為癌痛第三階梯聯(lián)合用藥的優(yōu)選，以減少阿片類藥物的劑量追加，避免阿片的過(guò)量危險(xiǎn)。
===== 翻譯 =====
First, the prevention of pain and seizures
Beijing Sino-Japan Friendship Hospital, some scholars and Statistics of the 300 cases of liver cancer patients and found that regular use of Chinese medicine over more than 3 months, their pain occurred significantly lighter than those who do not have medicine. Studies suggest that traditional Chinese medicine for pain prevention mechanism is two aspects: First, the bi-directional regulation of traditional Chinese medicine, body pain can exacerbate some of the imbalances, while the traditional Chinese medicine allows the balance; Second, Chinese medicine is "not General pain" of the that the blood stasis, qi and meridians of the drug can play, "General non-pain" effect. For cancer patients, it should serve as early Chinese medicine, take preventive measures, can not wait until morphine, pethidine also not stop the pain medicine again for help.
Second, the analgesic effect of significantly
Topical and oral medicine for pain that have occurred have analgesic effect, the effect lasting and ease the side effects. Commonly used pain medicine, such as Yuan Hu, Asarum, rice shell, Chelidonium dishes, drawing convenience. Frankincense, myrrh, Dragon Blood, safflower, turmeric, borneol, etc., or soluble in alcohol, easy-to-formulated topical analgesics. Borneol dissolved if the appropriate amount of alcohol in the preparation of 20% ~ 50% of the solution, post-treatment of liver cancer pain, often in 10 to 15 minutes effective. Now focuses on cancer pain Ikunori External:
(1) traditional Chinese medicine erasure agent
Drug composition Yuan Hu, Salvia, Taiwan Lindera aggregata, Paris polyphylla, land turtle worms, Dragon's blood, borneol, etc., the former four Herbs and the earth worms to 4:1 ratio of soft-shelled turtle recipe Xuejie, borneol according to 10% the proportion of each加入. More than 75% of drug plus alcohol soaked 1 week (alcohol consumption in order to not over Chinese-medicine degrees), filter will be transferred to drug concentration in traditional Chinese medicine 1g per ml can. Usage: Wash the pain site skin, cotton swabs dipped coating, medication pain surrounding area should be larger than 2 ~ 3cm, day 3 to 4 times. It was observed that governance chest pain remission rate of 90.1%, abdominal pain remission rate of 75.5%, spine, limb bone pain relief rate was 50%. A strong pain relief duration of pain as a priority.
(2) Spray tincture Qutong
From Corydalis, Lindera aggregata, Eupolyphaga worms, red sage root, safflower, Dragon's blood, composed of borneol. First soaked in 75% ethanol 2000ml fumarate wait for the previous five flavors of Chinese medicine, 1 week after leaching concoction; again in liquid added to Dragon Blood, borneol, dissolved, after filtration, into 50ml plastic spray bottle, spare, each ml containing crude drug 0.1g. Pain may evenly sprayed on the surface of cancer pain Agency. Functional pain, inflammation, swelling, apply a variety of cancer pain, right chest pain and pain Xielei best results, while the right spine of bone cancer pain in the limbs, etc. less effective.
(3) liver pain for external parties
Realgar, alum, indigo, leather NOx, frankincense, myrrh each 60g, borneol 10g, Xuejie 30g, joint research to fine, divided into seven packages. Every time a package, half and half with vinegar and pig bile tune into a paste topical, daily one time, each 8-hour deposition, medicine dry dip in vinegar and pig bile. Pain in advanced liver cancer have good effect.
(4) Berson cancer ning transdermal paste
Medicines, including strychnine, wood turtle base, rattan Flavin, Bufalin, euphorbia-ol, laurel diazepam ketones. Transdermal pain partial or affixed to the navel Office, the chest and abdomen, upper arms or inner thighs and other parts of the rich capillaries. Every election a ~ 2 parts Sticking day 2 ~ 4, each affixed to a continuous patching 12 ~ 16 hours. The paste has a cancer of tumor, pain swelling, Po Yu-by-water, righting the strengths of features, a variety of tumors were markedly effective cancer pain.
(5) Point Application Method
Kaempferia galanga, frankincense, myrrh, rhubarb, turmeric, gardenia, Angelica, baicalin the 20g, cumin, public clove, red peony, costas, Phellodendron the 15g, castor-jen 20. Joint research to fine on the drug, take egg white (or honey) amount, mixed into a paste mix well. Milk Kan lung deposition hole, liver deposition period of the door hole. Pain drama by dressing a sub-six hours, the pain 12 hours of light were replaced 1. The sustainable use of to pain relief or disappeared.
(6) pain Liquor Square
Rosin, system of frankincense, myrrh system, Zedoary the 15g, borneol 10g. With white wine 500ml immersion for 1 week. Several layers of gauze soaked with the tincture, Fuyu raw nerves, external plastic film covered with gauze to be quick-drying, the longer Liquor wet, intermittent or continuous use. Generally deposited 10 to 20 minutes to partially cool sense of comfort, pain and gradually ease.
(7) of tumor heating bag
Garcinia, Chuanxiong, skin saltpetre, raw Southern Star, Chuanwu, Aconitum, borneol, rhubarb, realgar, Asarum, Baiji, dairy did not, fennel, kaempferol and so on, Yan Mo, more than 60 mesh sieve, into one side may 100 mesh sieve pores of the special cleaning bags, plus dry closed after heating agent, and then set into the thick plastic bag, sealed. Within the time out with the bag, there will be contact with porous side pain location, timing beat Irazu, so that heating agent and heating the air and drug contact surface to maintain the temperature around 40 ~ 43 ℃, 24 hours dressing 1. Applied to other benign or malignant tumor mass, etc. caused by pain.
(8) Point closure France
When using painkillers can use this method is invalid. Acupoints: Zusanli (both sides), to enable patients to riding a pedal, from the moment the amount of 3-inch outside the knee, tibia lateral one inch at point selection. Used in aseptic operation under 5ml syringe, needle aspiration on the 7th of Vitamin K3 Injection 8ml ,654-2 10ml; to enable patients to take sitting (or suppression supine), selecting the right points, local skin routine with tincture of iodine, alcohol after disinfection pierce straight into the needle; when patients have acid, hemp, swelling and flu, quickly liquid injection, both sides of the hole of one half a day a time. Three times for a course of treatment, interval of 2 days, and then proceed to the next course of treatment. 30 cases were observed (without the use of other analgesics), the total effective rate 60%. Also in adequate pain relief in 8 cases, there are three cases of pain for 2 months or more, two cases of the duration of 20 days or more, three cases of the duration of 5 days.
(9) Chinese medicine iontophoresis
Corydalis, frankincense, myrrh, red sage root of 100g, Xu Changqing 150g. With 75% alcohol for more than dip in January, take a small amount of liquid added branding for borneol and DMSO. Import Point: chest pain, taking in Guan, Negative, the A is the point; low back pain to take Shenshu, ring jump, Yang Ling-chuen, Kunlun, and other points; the shoulders and back pain to take days were, shoulder Yu, Ah is a cave, etc.; offal patients take the appropriate organs of the Yu, enlistment, the original points. Qi stagnation with lines from time to time Taichong; blood stasis with sea of blood, Geshu; phlegm and blood stasis with Hong Leong.
Third, the synergistic analgesic effect
Traditional Chinese medicine and western medicine with painkillers, can enhance its efficacy and reduce side effects of western medicine. For example, Peony Decoction gami shell Shuijianbi right abdominal pain and effective, and may increase the hydrochloric acid-containing clothes dihydroetorphine analgesic effect. Speranskia tuberculata, Drynaria, psoralen shamisen, traditional Chinese medicine effective against pain, but also enhance the anti-inflammatory drugs and radiation treatment on the analgesic effect of bone metastasis. Another example is liver pain often rely on dolantin pain, such as using Toad, Yuan Hu, Shan Jia, Qingpi fried liver gravy topical areas, will strengthen the analgesic effect.
To sum up, traditional Chinese medicine used in cancer pain, cancer pain both located in the first and second step, third step can be combined as a pain medication of choice in order to reduce the dose of additional opioids to avoid opioid excessive risk.
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