| 摘要: |
| 目的：总结中医临证医案中治疗不同阶段进展期胃癌的经验与辨治规律。方法： 系统检索中国知网、维普中文科技期刊数据库、中国生物医学文献数据库收录的进展期胃癌中医临证医案相关文献，检索时间限定为2000年1月1日至2025年6月30日，按纳入与排除标准筛选后提取关键信息，构建中医治疗数据库，采用R-4.1.1软件进行关联规则分析和聚类分析。结果：共纳入文献240篇，围手术期、康复期、姑息治疗期医案分别为96篇（占40.13%）、79篇（占32.89%）、65篇（占26.98%），涉及临床症状296条、病机225条、药物300种。进展期胃癌不同阶段存在特征性关联规则：围手术期神疲倦怠、疲乏无力等正气损伤症状关联紧密，病机以气血不足、脾胃虚弱为核心，配伍茯苓、白术健脾益气;康复期胃脘疼痛、纳差等脾胃失调症状显著，核心药物新增陈皮理气，白花蛇舌草清余毒;姑息治疗期烧心、反酸等邪实症状与正虚并存，毒瘀交结证凸显，白术配甘草扶正，半夏、茯苓祛邪，攻补兼施。结论：进展期胃癌属本虚标实之证，不同阶段病机与治法各具特点，围手术期侧重扶正健脾以修复正气，康复期注重扶正与清余毒并举，姑息治疗期强调攻补兼施以平衡正邪。本研究揭示的“症-机-药”规律可为中医药分阶段辅助治疗进展期胃癌提供参考。 |
| 关键词: 胃癌 进展期 中医药辅助治疗 关联规则 临床症状 病机 |
| DOI： |
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| “Syndrome-mechanism-medicine” rules in traditional Chinese medicine clinical medical records for different stages of advanced gastric cancer |
| SONG Jiajie,CAO Ying,WANG Wenping |
| (Liaoning University of Traditional Chinese Medicine，Shenyang 110847，Liaoning，China;The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine，Shenyang 110032，Liaoning，China;Liaoning Cancer Hospital，Shenyang 110042，Liaoning，China) |
| Abstract: |
| Objective：To summarize the experience and syndrome differentiation-based treatment rules for different stages of advanced gastric cancer in traditional Chinese medicine (TCM) clinical medical records.Methods：CNKI，VIP，and SinoMed were searched for articles on TCM clinical medical records for advanced gastric cancer published from January 1，2000 to June 30，2025.The articles were screened based on inclusion and exclusion criteria，and then key data were extracted to establish a TCM treatment database.R-4.1.1 was used to perform association rule analysis and clustering analysis.Results：A total of 240 articles were included，including 96 medical records (40.13%) for perioperative period，79 medical records (32.89%) for convalescence stage，and 65 medical records (26.98%) for the stage of palliative care，and these articles involved 296 clinical symptoms，225 pathogeneses，and 300 drugs.There were characteristic association rules in different stages of advanced gastric cancer：in the perioperative period，there was a close association between vital Qi injury-related symptoms such as fatigue and lassitude，with Qi and blood deficiency along with weakness of spleen and stomach as the core pathogenesis，and Poria cocos and Atractylodes macrocephala Koidz.were used in combination for strengthening the spleen and benefiting Qi;in the convalescence stage，there were significant symptoms of spleen and stomach disorders such as epigastric pain and anorexia，and the core drugs tangerine peel and Hedyotis diffusa were added for regulating Qi and clearing residual toxin，respective;in the stage of palliative care，the symptoms of excess pathogen such as heartburn and acid reflux coexisted with weakened body resistance，with a prominent intermingled toxin-stasis syndrome，and Atractylodes macrocephala Koidz.combined with Radix Glycyrrhizae was used for strengthening vital Qi，while Pinellia ternata and Poria cocos were used for eliminating pathogens，achieving the effect of tonification and purgation in combination.Conclusion：Advanced gastric cancer is a syndrome of deficiency in origin and excess in superficiality.There are different pathogeneses and treatment methods for the different stages of advanced gastric cancer，i.e.，strengthening vital Qi and invigorating the spleen to repair vital Qi in the perioperative period，strengthening vital Qi and eliminating residual toxin in the convalescence stage，and emphasizing tonification and purgation in combination to balance vital Qi and pathogens in the stage of palliative care.The “syndrome-mechanism-drug” rules revealed in this study can provide a reference for staged TCM adjuvant therapy for advanced gastric cancer. |
| Key words: advanced gastric cancer adjuvant therapy with traditional Chinese medicine association rule clinical symptoms pathogenesis |
