王清任活血化瘀法在肿瘤治疗中的应用

卢泰成 许博文 李杰

摘要 活血化瘀法作为中医药治疗肿瘤病的核心治法之一，临证效果颇佳，但也需与益气、化痰、祛湿、解毒等治法相伍为用，方能不失偏颇。通过简述王清任活血化瘀法的学术思想，并基于王清任对积聚病的认识，总结其运用活血化瘀法在肿瘤治疗过程中的经验，探讨王清任活血化瘀法在肿瘤辨治过程中的具体应用，以丰富中医肿瘤病机学说，为肿瘤临证辨治提供一定的借鉴。

关键词 活血化瘀法;肿瘤病;分阶段;应用; @ 王清任;《医林改错》;五逐瘀汤;补阳还五汤

Abstract As one of the core cures of traditional Chinese medicine（TCM）for the treatment of cancer diseases，the method of promoting blood circulation and removing blood stasis is very effective，but it also needs to be used with the treatment of benefiting qi，dissipating phlegm，eliminating dampness，detoxification，etc.，so as not to be partial.This paper summarizes WANG Qingren′s experience in the tumor treatment process by briefly describing WANG′s academic thought of promoting blood circulation and removing blood stasis method，and summarizes his experience in the process of tumor treatment using such method.It also discusses the specific application of WANG Qingren′s promoting blood circulation and removing blood stasis method in the tumor treatment process，so as to enrich the theory of pathogenesis of oncology disease in TCM，and provide a certain reference for the pro-evidence of tumor disease.

Keywords Method of promoting blood circulation and removing blood stasis; Oncology; Different stages; Application; @ WANG Qingren; Correction on Errors in Medical Classics，Five Zhuyu Decoction，Buyang Huanwu Decoction

中圖分类号：R273文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.10.023

中医学认为，肿瘤的病因病机多因外感邪毒、内伤七情、阴阳失调、脏腑受损，或致痰湿凝聚，阻滞脉络，气机运行不畅，病理产物易于停聚，结于体表发为瘿瘤，结于内脏则为癥瘕积聚;亦或致气机郁闭，郁而发热，热毒内蕴，久则发为癌瘤、痈疽[1];亦或导致气滞血瘀，血瘀成块，久则成为“癥瘕”“积聚”。在肿瘤的发生发展过程中，血瘀证始终贯穿于其中[2]，所以一般认为“瘀血内阻”为肿瘤的核心病机，治疗也多从活血化瘀论治。而王清任为善用活血化瘀法的大家，其所创“逐瘀汤”在现代临床治疗中应用广泛，近年来在肿瘤的治疗中的应用尤为突出，其重视活血化瘀的思想值得我们借鉴和学习。现基于王清任对活血化瘀法的认识及其在肿瘤中的治疗应用作初步探讨。

1 王清任对肿瘤的认识

1.1 食自胸右下 此语出自血府逐瘀汤所治之症目，“食自胃管而下，宜从正中。……