乳癌之中西醫病機與預防

Pathogenesis and Prevention of Breast Cancer in Chinese Medicine and Western Medicine

林健蓉(Chien-Jung Lin) ； 謝宗運(Tsung-Yun Hsieh) ； 張慈文(Tzu-Wen Chang)

《中醫藥雜誌》 28卷2期 (2017/12) Pp. 11-27

https://doi.org/10.3966/241139642017122802002

摘要

本文探討古代醫家與現代研究對於乳癌的病機理論。古代醫家認為情志內傷為最主要病因，而現代研究對於情緒與乳癌之相關性仍無一致的看法。現代醫學認為年紀與遺傳特性為不可調控之因素，荷爾蒙補充、輻射暴露、體重、飲酒為可調控因素，飲食方面，古代文獻提及膏粱厚味之病因，現代研究認為乳癌發生與飲食組成無相關。中醫病位方面，乳房之病位為胃、肝經與膽經，衝脈、任脈也直接影響乳房氣血，病性上，乳癌為經絡氣滯而形成痰核。統整文獻，乳癌之中醫病機為情志不遂，肝氣不疏，經絡氣停滯，聚成痰核為主要病機，另外，營衛氣血化生來源不足，經絡氣虛易加重經絡氣滯之病機。在降低乳癌發生率及預防復發上，最重要是體重控制與運動，包括中醫養生運動，其它如停經後減少荷爾蒙補充，儘量少暴露於輻射，限制飲酒量，少食用酸類及甜味過重之食物，多食用辛甘及淡味之品，減少易怒、愁憂與思慮及過度勞累之狀況，保持樂觀豁達，也是重要的事項。

關鍵字

中醫 ； 乳癌 ； 病因 ； 病機 ； 預防

並列摘要

This paper is an attempt to explore the pathogenesis of breast cancer from the viewpoint of both traditional Chinese medicine (TCM) and Western medicine (WM), comparing the similarities and differences. TCM believes that the most important cause of breast cancer is of emotional origins, whereas there is no consensus from the WM perspective on whether there is a correlation between emotions and breast cancer. WM believes that the factors that contribute to breast cancer include uncontrollable ones, such as age and genetic characteristics, and also controllable ones, such as hormonal supplementation, radiation exposure, body weight, and alcohol consumption. As for whether diets are related to breast cancer, a few TCM literature do mention that fatty diet is one of the causes of breast cancer, but the number of such literature is limited. Most of the WM research shows that the occurrence of breast cancer does not correlate with dietary compositions. In terms of TCM location of the disease, the direct disease locations of breast cancer are the stomach, liver, and gall bladder meridians. Both thoroughfare vessels and conception vessels also have direct impacts on the qi and blood flow of breasts. In terms of TCM characterization of the disease, breast cancer is considered to be the formation of phlegm nodes resulted from meridian qi stagnation. Synthesizing ancient and modern literature, the main TCM pathogenesis of breast cancer comprises emotional issues, liver qi obstruction, meridian qi stagnation, and the formation of phlegm nodes. In addition, the inadequate engendering and transformation of nutrient qi and defense qi would lead to meridian qi deficiency, which would then worsen the pathogenesis of meridian qi stagnation. In terms of reducing the occurrence and preventing the recurrence of breast cancer, weight management and exercising, including common exercises and TCM health regimen exercises, are of great importance. Additional ways for breast cancer reduction and prevention include reducing post-menopausal hormone supplementation, minimizing radiation exposure, regulating alcohol intake, minimizing the consumption of acidic and overly-surgery foods, and choosing more pungent, sweet foods and lightly-flavored foods. Minimizing anger, melancholy, anxiety, and defatigation as well as maintaining an optimistic and open-minded outlook are also influential considerations.

並列關鍵字

traditional Chinese medicine ； breast cancer ； etiology ； pathogenesis ； prevention

參考文獻

衛生福利部國民健康署：乳癌與子宮頸癌防治，http://www.hpa.gov.tw/BHPNet/web/index/index.aspx

賴榮年、吳建東、王榮德(2013)。台灣乳癌婦女1998-2008 年間的中藥使用率及模式分析。中醫藥雜誌。24(1)，13-23。

陳婉伶、蔡嘉一、黃怡嘉(2015)。比較中醫期刊文獻與臺灣健保資料庫乳癌研究之用藥差異。中西整合醫學雜誌。17(3)，17-24。

PDQ® Screening and Prevention Editorial Board. PDQ Breast Cancer Prevention. Bethesda, MD: National Cancer Institute. Updated <12/16/2015>. Available at: http://www.cancer.gov/types/breast/hp/breast-prevention-pdq. Accessed <06/22/2016>.[PMID: 26389323]

Callari, A,Mauri, M,Miniati, M,Mancino, M,Bracci, G,Dell'Osso, L,Greco, C(2013).Treatment of depression in patients with breast cancer: a critical review.Tumori..99(5),623-33.