探討中醫學對腫瘤性糖尿病的診療

Cancer-associated Diabetes Mellitus

鄭淑鎂(Shu-Mei Zheng)

《中國鍼灸學雜誌》 2卷1期 (2014/12) Pp. 145-154

https://doi.org/10.6528/CAMS.2014.0009

摘要

身體各部位組織的損傷變異，都可能誘發高血糖。惡性腫瘤併發糖尿病，可能是腫瘤細胞的毒邪特性，或腫瘤誘發自體免疫攻擊，或腫瘤併發症，或化放療副作用。腫瘤性糖尿病易發生在癌症病程各階段。初中期，多表現口乾舌燥、煩熱、焦躁、睡臥不安、便秘、脉象弦滑或弦數，屬瘀熱症；中期以後發炎或水腫慢性化，即西醫介入後，或中醫以苦寒退熱治療一段時日後，病人血色素低，或低蛋白血症，或Cr、BUN升高，且腫瘤標記仍持續升高，血糖仍升高，即進入陰虛或氣虛血虛期；晚期細胞萎縮退化，以補氣補血養陰仍無法改善時，進入寒瘀陽虛。治療方面，第一階以清熱解毒、活血化瘀爲主；第二階段以補氣補血養陰爲主；第三階段以補腎陽爲主。各階段治療皆須考慮加入清熱解毒、或清熱養陰藥反制，若需加入補氣補陽藥，如黃耆、附子、玉桂等，需少量慢慢加入，並以良薑易乾薑。

關鍵字

糖尿病 ； 惡性腫瘤 ； 腫瘤性糖尿病

並列摘要

Hyperglycemia can be the consequence of tissue injuries or mutation in different systems. The causes of cancer-associated diabetes mellitus include the direct toxicity of malignancies, cancer-triggered immune response, complications of cancer or the side effects of chemotherapy or radiotherapy. The onset of cancer-associated diabetes mellitus can be at any stage during the duration of the cancer. In early-stage and interim cancer, the manifestations of cancer-associated diabetes mellitus include thirst and dry mouth, irritation and anxiety, restlessness and insomnia, constipation, rapid and slippery or rapid and wiry pulse. Thus it is categorized as a heat stasis disease. The differential diagnosis pertains to Yin deficiency or blood and Qi deficiency when the patient manifests low levels of hemoglobin, hypoproteinemia, elevation of creatinine and BUN, sustained elevation of tumor markers and blood sugar resulting from inflammation in post interim cancer, chronic edema, interventions of conventional medicine or prolonged treatment with cold,bitter and heat clearing herbs. As the disease progresses into terminal stage, with signs and symptoms of cellular atrophy not rectified by tonifiying qi and blood method, the differential diagnosis is soon changed to cold obstruction with yang deficiency. Treatment of cancer-associated diabetes mellitus can also be categorized into three different stages. In the first stage, the treatment focuses on clearing heat-toxin and dissipating bloods stasis. The treatment in the second stage emphasizes on tonifying qi and blood in conjunction with nourishing Yin. The therapeutic principle and method in the third stage are nourishing kidney Yang. Despite the stages, all the formulas need to incorporate the herbs that clear the heat toxin or clear heat and nourish yin. The addition of Qi tonifying and Yang tonifying herbs , such as Huang Qi (Astragalus membranaceus), Fu Zi (Aconitum carmichaeli Debx), Yu Gui (Cinnamomum cassia), if needed ,must be slow and gradual in a small amount. Gou Liang Jiang (Galangal) is widely used to replace Gan jiang (ginger).

並列關鍵字

diabetes mellitus ； manglinant tumor ； cancer-associated diabetes mellitus