直接灸治疗肿瘤化疗毒副反应的临床研究
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摘要
研究背景恶性肿瘤是临床上常见的疾病之一,也是目前导致人类死亡的原因。肿瘤的治疗目前主要有三种方法：手术切除、放射治疗(放疗)和药物治疗(化疗)。其中化疗是一种全身治疗,是运用化学药物进行肿瘤治疗,抗癌药物进入体内后很快分布到全身,既可杀灭局部的肿瘤也可杀灭远处转移的肿瘤,化疗的优势在于可以治疗手术和放疗无能为力的造血系统肿瘤、全身扩散的转移性肿瘤、手术及放疗难以彻底消灭的亚临床肿瘤。对于手术和放疗后的患者,辅助以化疗,可以提高其治愈率。但由于用于化疗的药物缺乏特异性选择作用,在杀伤肿瘤细胞的同时,又杀伤正常组织的细胞,尤其是杀伤人体中生长发育旺盛的血液、淋巴组织细胞等,从而产生了如骨髓抑制、免疫抑制、消化障碍、全身反应、脱发等一系列毒副作用,而这些毒副作用严重影响化疗患者的生活质量和长期治疗计划的实施。因此减少化疗药物的毒副作用的研究是众多医疗工作者研究的重要研究方向之一。化疗在中医属于攻邪范畴,而化疗毒副作用的临床表现,可以认为是化疗致使脏腑元气耗损,精血亏虚而产生虚劳证。近年来,中医药治疗和针灸治疗在改善化疗毒副作用等方面发挥了积极作用,取得了很好的进展。中医药对化疗产生的局部反应,骨髓抑制,心脏、周围神经毒性都能起到明显防治作用,对消化、泌尿、呼吸系统副反应的防治也有明显疗效。
研究目的通过对恶性肿瘤化疗后毒副反应的前瞻性临床对照研究,观察直接灸对恶性肿瘤化疗毒副反应的减毒效应影响程度以及对患者情绪、生活质量的影响,并为针灸防治肿瘤提供科学依据。
研究方法把来自台湾大学医院斗六分院进行的化疗患者经过严格筛选,并有2名主治或以上级别专业医师共同认可后,成为合格的受试病例。62例合格的受试病例,均在化疗同时常规应用预防化疗毒副反应的西药地塞米松(抗过敏)、昂丹司琼(止呕)等处理,采用简单随机对照的方法,设立Ⅱ组为对照组,只接受化疗和常规应用预防化疗毒副反应的西药,共30例；Ⅰ组为治疗组,在化疗和常规应用预防化疗毒副反应的西药基础上,进行直接灸法处理,共32例。直接灸组取穴：膈俞、胆俞,膏肓俞、足三里,均取双侧。直接灸法操作：穴位定位按照国家技术监督局发布的《中华人民共和国国家标准·经穴部位》取穴。依次在穴位上涂一层薄薄的跌打万花油,将艾绒制成0.5×0.8cm2的艾炷,置于穴位上点燃,等艾炷烧至约剩1／3患者感觉灼热感时,撤去艾炷,连续3次,1次／天。对照组采用化疗方案与常规西药预防化疗毒副反应根据不同恶性肿瘤和病理分型,分别采用顺铂、多烯紫杉醇、吉西他滨、奥沙利铂、环磷酰胺、长春新碱、5—氟尿嘧啶等为主的联合化疗方案,进行为期约1周的1疗程治疗。同时应用预防化疗毒副反应的西药地塞米松(抗过敏)、昂丹司琼(止呕)。观察周期：由化疗第一天开始,7天为1疗程,开始治疗前后分别进行疗效评定1次,随访时间为两周。观察指标包括：血液学表现(血红蛋白、白细胞、粒细胞、血小板的变化)、消化道毒性表现(恶心、呕吐症状分度[WHO抗癌药急性及亚急性毒性反应分度标准,分0-Ⅳ度进行评价])、体力状况Karnofasky和ZPS体力状况评分、汉密尔顿焦虑、抑郁状况评分以及生活质量评分。将收集到的临床研究数据录入电脑,建立数据库,采用SPSS13.0、Epitable统计软件包进行分析。组间构成比较用x2检验；血液学检查结果、KPS评分,组间比较采用独立样本t检验；组内治疗前后比较采用配对t检验；血液系统毒性、恶心呕吐症状分度等级资料,采用Ridit分析。
研究结果化疗前两组患者血液毒性HGB、WBC、NEU、PLT分度及水平、恶心呕吐分度、Karnofsky体力状况评分及体力状况ZPS分级、焦虑和抑郁状况、生活质量,经统计学比较,差异无统计学意义(P>0.05),说明两组间具有可比性；两组患者化疗后血液毒性HGB分度均有升高,HGB水平下降,但差异无统计学意义(P>0.05),说明观察期间患者HGB下降不明显,且化疗后两组比较差异也无统计学意义(P>0.05),说明化疗后治疗组和对照组血红蛋白水平相当；两组患者化疗后血液毒性WBC、NEU分度均有升高,WBC、NEU、PLT水平下降,且两组比较差异有统计学意义(P<0.05),化疗后两组患者PLT分度差异无统计学意义(P>0.05),说明治疗组抑制化疗降低WBC、NEU、PLT的作用优于对照组,且两组患者PLT分度相当；化疗后两组恶心呕吐分度均有升高,且两组比较差异有统计学意义(P<0.05),说明治疗组抑制化疗患者恶心呕吐程度的作用优于对照组；两组患者化疗后Karnofsky体力状况评分下降(P<0.05),体力状况ZPS分级也有所下降,且两组间比较差异有统计学意义(P<0.05,P<0.01),说明治疗组对化疗所致患者体力状况的下降影响较对照组小；两组患者化疗后,焦虑、抑郁状况评分均有升高(P<0.05,P<0.01),且两组间比较差异有统计学意义(P<0.05),说明患者化疗后焦虑、抑郁状况均有所加重,且对照组患者焦虑、抑郁状况严重程度较治疗组重；两组患者化疗后生活质量评分均有下降(P<0.05),且两组比较差异有统计学意义(P<0.05),说明治疗组改善化疗患者生活质量下降的作用优于对照组。
研究结论直接灸能降低化疗药物引起的骨髓抑制,可以抑制化疗后血WBC、NEU、PLT的下降,对HGB作用不明显；直接灸可以减轻化疗患者恶心呕吐症状的胃肠道症状；.直接灸对因化疗引起的体力下降,有一定的改善作用；直接灸对因化疗引起的情绪障碍及生活质量下降,有一定的改善作用。总之,直接灸可以减轻化疗引起的毒副反应,改善患者生活质量,为恶性肿瘤的进一步治疗方案的实施创造更好的条件。
Background:Malignant tumor, a commonly seen fetal disease in clinical work is mainly treated with surgery, radiotherapy or chemotherapy now, of which, chemotherapy refers to using chemical drugs which can instantly distribute all over the body to treat both localized tumor and distant metastasis. Chemotherapy stands out from the other two treatments by effectively treating hematopoietic tumors, diffuse metastasis and sub-clinical tumor, which show little or no response to radiotherapy and are hard to be eradicated by surgery. Besides, chemotherapy can also be supplemental to radiotherapy or surgery to improve the therapeutic effects. However, it lacks target specificity, and kills healthy cells in normal tissues as well, especially vigorously growing cells in blood and lymphoid tissues. In this way it induces toxicity and side effects that can destroy patients'life quality and restrain it from long term use, for example, marrow suppression, immune suppression, digestive disorder, general reactions and alopecia ect. Thus, how to reduce the above mentioned toxicity and side effects is the focus of many researches in medical field.
From TCM aspect, chemotherapy is actually to eliminating pathogenic factors, the induced toxicity and side effects are the manifestations of consumptive disease, which is resulted from damaged primordial qi and deficient essence and blood. In the recent years, TCM therapy, especially acupuncture and moxibution has shown great improvements in reducing toxicity and side effects including marrow depression, heart or peripheral nerve toxicity as well as side effects of digestive, urinary and respiratory systems. Objective:To observe effects of direct contact moxibustion on the toxicity and side effects of chemotherapy and its influences to patients'emotion and life quality by designing the prospective controlled clinical trial.
Methods:A total of 62 eligible cases that underwent chemotherapy in the douliu part of the Taiwan University Hospital were chosen and enrolled in this study after consent was obtained from two physicians with medium or senior professional title. All cases were randomized divided into treatment group (groupⅠ,32 cases) and control group (groupⅡ,30 cases), and were given chemotherapy and conventional treatment of dexamethasone (Anti-allergic agents) and ondansetron (Controlling nausea and vomiting) to reduce side and toxicity effects, while the treatment group was also given an extra treatment of direct contact moxibustion on bilateral Geshu (BL17), Danshu(BL19), Gaohuang(BL43), and Zusanli (ST36). The specific manipulations are:Spread a thin layer of Die Da Wan Hua Oil (activating blood flow) around the points which are located according to the descriptions in National Standard of the People's Republic of China:acupuncture points, then lay and light a moxa cone (0.5×0.8 cm2) made of moxa wool. Remove the moxa cone when it's burnt to the last 1/3 height and the patient feels slight scorching pain, repeat it for three times each day.
Chemotherapy regimen applied to the patients were selected according to the type of tumor and its pathological stages, and were mainly consists of cisplatin (DDP), docetaxel (Taxotere), gemcitabine (Gemcitabine), oxaliplatin, cyclophosphamide (CTX), vincristine (VCR) or 5-fluorouracil (5-FU) separately. Dexamethasone (Anti-allergic agents) and ondansetron (Controlling nausea and vomiting) were also used for preventing or reducing toxicity and side effects. Started from the first day of chemotherapy,7 days makes a treatment course. Observe the effects according to 2 weeks follow up. Therapeutic effects were evaluated before and after the treatment and counted parameters include hematological changes (hemoglobin, white blood cell, granulocyte and platelet counts), gastrointestinal toxicity reactions (nausea and vomiting degree which is categorized as 0-Ⅳaccording to WHO criteria for acute and sub-acute toxicity of anti-cancer agents, Karnofsky and ZPS scores, scores of Hamilton anxiety scale and Hamilton depression scale, and life quality. All the collected data were analyzed with SPSS13.0 and Epitable software. Structural difference between groups were analyzed by x2 test, blood test results and KPS scores were processed with one sample t-test, Differences before and after the treatment in the same group were analyzed with paired sample t-test, data of blood system toxicity, and nausea and vomiting degree were analyzed using Ridit analysis.
Results:No significant difference of the observed parameters was shown between the two groups before chemotherapy (P＞0.05) indicating they were comparable. After chemotherapy, hemoglobin (HGB) levels was lower while degree of HGB hematotoxicity was greater for both groups comparing with that of before the treatment though no significant difference was observed in any of the two groups (P＞0.05), besides, HGB levels of both groups were not significant different from each other neither after the treatment (P＞0.05).
After treatment, hematotoxicity degree of white blood cells (WBC), neutrophils (NEU) and platelet count (PLT) were greater than that before treatment, while WBC, NEU and PLT levels were lower for both groups with significant differences between the two (P＜0.05) indicating better effects of preventing WBC, NEU and PLT levels from decreasing in the treatment group. Nausea and vomiting scores were higher than that before treatment for both groups after chemotherapy, but more obvious in the control group indicating better therapeutic effects on nausea and vomiting for the treatment group. Karnofasky and ZPS scores declined in both groups after chemotherapy but more obvious in the control group (P＜0.05, P＜0.01) indicating physical condition of the treatment group was better than that of the control. After chemotherapy, scores of Hamilton anxiety and depression scale were both raised compared with that before treatment (P＜0.05, P＜0.01) with significant differences between the two groups (P＜0.05), indicating emotional disorders of anxiety and depression in the control group was more serious than that of the treatment group. Life quality scores of both groups were both lower than that before treatment, but more obvious for the control group (P<0.05) showing better effects of improving patients'life quality in the treatment group.
Conclusions:Direct contact moxibustion can alleviate toxicity and side effects resulted from chemotherapy including marrow suppression, gastrointestinal reactions, fatigue, and emotional disorder; particularly, it can significantly prevent blood cell levels of WBC, NEU, and PLT from dropping, thus improve patients'life quality and create a better physical condition for further treatment.
研究目的通过对恶性肿瘤化疗后毒副反应的前瞻性临床对照研究,观察直接灸对恶性肿瘤化疗毒副反应的减毒效应影响程度以及对患者情绪、生活质量的影响,并为针灸防治肿瘤提供科学依据。
研究方法把来自台湾大学医院斗六分院进行的化疗患者经过严格筛选,并有2名主治或以上级别专业医师共同认可后,成为合格的受试病例。62例合格的受试病例,均在化疗同时常规应用预防化疗毒副反应的西药地塞米松(抗过敏)、昂丹司琼(止呕)等处理,采用简单随机对照的方法,设立Ⅱ组为对照组,只接受化疗和常规应用预防化疗毒副反应的西药,共30例；Ⅰ组为治疗组,在化疗和常规应用预防化疗毒副反应的西药基础上,进行直接灸法处理,共32例。直接灸组取穴：膈俞、胆俞,膏肓俞、足三里,均取双侧。直接灸法操作：穴位定位按照国家技术监督局发布的《中华人民共和国国家标准·经穴部位》取穴。依次在穴位上涂一层薄薄的跌打万花油,将艾绒制成0.5×0.8cm2的艾炷,置于穴位上点燃,等艾炷烧至约剩1／3患者感觉灼热感时,撤去艾炷,连续3次,1次／天。对照组采用化疗方案与常规西药预防化疗毒副反应根据不同恶性肿瘤和病理分型,分别采用顺铂、多烯紫杉醇、吉西他滨、奥沙利铂、环磷酰胺、长春新碱、5—氟尿嘧啶等为主的联合化疗方案,进行为期约1周的1疗程治疗。同时应用预防化疗毒副反应的西药地塞米松(抗过敏)、昂丹司琼(止呕)。观察周期：由化疗第一天开始,7天为1疗程,开始治疗前后分别进行疗效评定1次,随访时间为两周。观察指标包括：血液学表现(血红蛋白、白细胞、粒细胞、血小板的变化)、消化道毒性表现(恶心、呕吐症状分度[WHO抗癌药急性及亚急性毒性反应分度标准,分0-Ⅳ度进行评价])、体力状况Karnofasky和ZPS体力状况评分、汉密尔顿焦虑、抑郁状况评分以及生活质量评分。将收集到的临床研究数据录入电脑,建立数据库,采用SPSS13.0、Epitable统计软件包进行分析。组间构成比较用x2检验；血液学检查结果、KPS评分,组间比较采用独立样本t检验；组内治疗前后比较采用配对t检验；血液系统毒性、恶心呕吐症状分度等级资料,采用Ridit分析。
研究结果化疗前两组患者血液毒性HGB、WBC、NEU、PLT分度及水平、恶心呕吐分度、Karnofsky体力状况评分及体力状况ZPS分级、焦虑和抑郁状况、生活质量,经统计学比较,差异无统计学意义(P>0.05),说明两组间具有可比性；两组患者化疗后血液毒性HGB分度均有升高,HGB水平下降,但差异无统计学意义(P>0.05),说明观察期间患者HGB下降不明显,且化疗后两组比较差异也无统计学意义(P>0.05),说明化疗后治疗组和对照组血红蛋白水平相当；两组患者化疗后血液毒性WBC、NEU分度均有升高,WBC、NEU、PLT水平下降,且两组比较差异有统计学意义(P<0.05),化疗后两组患者PLT分度差异无统计学意义(P>0.05),说明治疗组抑制化疗降低WBC、NEU、PLT的作用优于对照组,且两组患者PLT分度相当；化疗后两组恶心呕吐分度均有升高,且两组比较差异有统计学意义(P<0.05),说明治疗组抑制化疗患者恶心呕吐程度的作用优于对照组；两组患者化疗后Karnofsky体力状况评分下降(P<0.05),体力状况ZPS分级也有所下降,且两组间比较差异有统计学意义(P<0.05,P<0.01),说明治疗组对化疗所致患者体力状况的下降影响较对照组小；两组患者化疗后,焦虑、抑郁状况评分均有升高(P<0.05,P<0.01),且两组间比较差异有统计学意义(P<0.05),说明患者化疗后焦虑、抑郁状况均有所加重,且对照组患者焦虑、抑郁状况严重程度较治疗组重；两组患者化疗后生活质量评分均有下降(P<0.05),且两组比较差异有统计学意义(P<0.05),说明治疗组改善化疗患者生活质量下降的作用优于对照组。
研究结论直接灸能降低化疗药物引起的骨髓抑制,可以抑制化疗后血WBC、NEU、PLT的下降,对HGB作用不明显；直接灸可以减轻化疗患者恶心呕吐症状的胃肠道症状；.直接灸对因化疗引起的体力下降,有一定的改善作用；直接灸对因化疗引起的情绪障碍及生活质量下降,有一定的改善作用。总之,直接灸可以减轻化疗引起的毒副反应,改善患者生活质量,为恶性肿瘤的进一步治疗方案的实施创造更好的条件。
Background:Malignant tumor, a commonly seen fetal disease in clinical work is mainly treated with surgery, radiotherapy or chemotherapy now, of which, chemotherapy refers to using chemical drugs which can instantly distribute all over the body to treat both localized tumor and distant metastasis. Chemotherapy stands out from the other two treatments by effectively treating hematopoietic tumors, diffuse metastasis and sub-clinical tumor, which show little or no response to radiotherapy and are hard to be eradicated by surgery. Besides, chemotherapy can also be supplemental to radiotherapy or surgery to improve the therapeutic effects. However, it lacks target specificity, and kills healthy cells in normal tissues as well, especially vigorously growing cells in blood and lymphoid tissues. In this way it induces toxicity and side effects that can destroy patients'life quality and restrain it from long term use, for example, marrow suppression, immune suppression, digestive disorder, general reactions and alopecia ect. Thus, how to reduce the above mentioned toxicity and side effects is the focus of many researches in medical field.
From TCM aspect, chemotherapy is actually to eliminating pathogenic factors, the induced toxicity and side effects are the manifestations of consumptive disease, which is resulted from damaged primordial qi and deficient essence and blood. In the recent years, TCM therapy, especially acupuncture and moxibution has shown great improvements in reducing toxicity and side effects including marrow depression, heart or peripheral nerve toxicity as well as side effects of digestive, urinary and respiratory systems. Objective:To observe effects of direct contact moxibustion on the toxicity and side effects of chemotherapy and its influences to patients'emotion and life quality by designing the prospective controlled clinical trial.
Methods:A total of 62 eligible cases that underwent chemotherapy in the douliu part of the Taiwan University Hospital were chosen and enrolled in this study after consent was obtained from two physicians with medium or senior professional title. All cases were randomized divided into treatment group (groupⅠ,32 cases) and control group (groupⅡ,30 cases), and were given chemotherapy and conventional treatment of dexamethasone (Anti-allergic agents) and ondansetron (Controlling nausea and vomiting) to reduce side and toxicity effects, while the treatment group was also given an extra treatment of direct contact moxibustion on bilateral Geshu (BL17), Danshu(BL19), Gaohuang(BL43), and Zusanli (ST36). The specific manipulations are:Spread a thin layer of Die Da Wan Hua Oil (activating blood flow) around the points which are located according to the descriptions in National Standard of the People's Republic of China:acupuncture points, then lay and light a moxa cone (0.5×0.8 cm2) made of moxa wool. Remove the moxa cone when it's burnt to the last 1/3 height and the patient feels slight scorching pain, repeat it for three times each day.
Chemotherapy regimen applied to the patients were selected according to the type of tumor and its pathological stages, and were mainly consists of cisplatin (DDP), docetaxel (Taxotere), gemcitabine (Gemcitabine), oxaliplatin, cyclophosphamide (CTX), vincristine (VCR) or 5-fluorouracil (5-FU) separately. Dexamethasone (Anti-allergic agents) and ondansetron (Controlling nausea and vomiting) were also used for preventing or reducing toxicity and side effects. Started from the first day of chemotherapy,7 days makes a treatment course. Observe the effects according to 2 weeks follow up. Therapeutic effects were evaluated before and after the treatment and counted parameters include hematological changes (hemoglobin, white blood cell, granulocyte and platelet counts), gastrointestinal toxicity reactions (nausea and vomiting degree which is categorized as 0-Ⅳaccording to WHO criteria for acute and sub-acute toxicity of anti-cancer agents, Karnofsky and ZPS scores, scores of Hamilton anxiety scale and Hamilton depression scale, and life quality. All the collected data were analyzed with SPSS13.0 and Epitable software. Structural difference between groups were analyzed by x2 test, blood test results and KPS scores were processed with one sample t-test, Differences before and after the treatment in the same group were analyzed with paired sample t-test, data of blood system toxicity, and nausea and vomiting degree were analyzed using Ridit analysis.
Results:No significant difference of the observed parameters was shown between the two groups before chemotherapy (P＞0.05) indicating they were comparable. After chemotherapy, hemoglobin (HGB) levels was lower while degree of HGB hematotoxicity was greater for both groups comparing with that of before the treatment though no significant difference was observed in any of the two groups (P＞0.05), besides, HGB levels of both groups were not significant different from each other neither after the treatment (P＞0.05).
After treatment, hematotoxicity degree of white blood cells (WBC), neutrophils (NEU) and platelet count (PLT) were greater than that before treatment, while WBC, NEU and PLT levels were lower for both groups with significant differences between the two (P＜0.05) indicating better effects of preventing WBC, NEU and PLT levels from decreasing in the treatment group. Nausea and vomiting scores were higher than that before treatment for both groups after chemotherapy, but more obvious in the control group indicating better therapeutic effects on nausea and vomiting for the treatment group. Karnofasky and ZPS scores declined in both groups after chemotherapy but more obvious in the control group (P＜0.05, P＜0.01) indicating physical condition of the treatment group was better than that of the control. After chemotherapy, scores of Hamilton anxiety and depression scale were both raised compared with that before treatment (P＜0.05, P＜0.01) with significant differences between the two groups (P＜0.05), indicating emotional disorders of anxiety and depression in the control group was more serious than that of the treatment group. Life quality scores of both groups were both lower than that before treatment, but more obvious for the control group (P<0.05) showing better effects of improving patients'life quality in the treatment group.
Conclusions:Direct contact moxibustion can alleviate toxicity and side effects resulted from chemotherapy including marrow suppression, gastrointestinal reactions, fatigue, and emotional disorder; particularly, it can significantly prevent blood cell levels of WBC, NEU, and PLT from dropping, thus improve patients'life quality and create a better physical condition for further treatment.
引文
[1]Ferlay J, Bray F, Piasni P, etal. GLOBOCAN 2002:Cancer Incidenee, Mortality and Prevalence Worldwide, Version 2.0. IARC CancerBase No 5. Lyon, IARCPress, 2004.
[2]李连弟,鲁风珠,张思维等.中国恶性肿瘤死亡率20年变化趋势和近期预测分析.中华肿瘤杂志,1997,19(1)：3-9。
[3]中华人民共和国卫生部.全国第三次死因回顾抽样调查报告.北京：中国协和医科大学出版社.2008：10.
[4]张志义,孙燕主编.恶性肿瘤化学治疗学.第1版.上海科学技术出版社,1981,117.
[5]岛田安博,下山正德,田村友秀,等.Japan Clinicaal Oncology(JCOG)临床安全性情报操作.药理治疗,1998,7.
[6]张新龙,王根发.半夏泻心汤防治顺铂联合化疗所致恶心呕吐90例[J].江西中医,2007,5：28.
[7]许树才.四逆散与格拉司琼联合应用预防化疗所致呕84例报告[J].贵阳中医学院学报,2006,(28)1：16.
[8]阙铁生,吕军影,黄耀全,等.针刺防治顺铂化疗所致呕吐的临床观察.上海针灸杂志,2003,(4)：8-9.
[9]周俊青,徐天舒,钱雷.针灸对肿瘤患者化疗后血细胞和消化道反应的影响.中国针灸,2004,(11)：741-743.
[10]黄喜梅.电针足三里穴对癌症化疗中胃肠功能影响的临床及实验研究.上海针灸杂志,1996,(3)：11-13.
[11]王守章,杨学峰.针刺控制化疗所致胃肠反应临床研究.中国针灸,1997,(1)：17-18.
[12]陈桂平,杨金洪,郁美娟,等.针刺治疗放化疗胃肠反应44例.中国针灸,1996,(7)：9-10.
[13]李爱华.针刺治疗肝癌介入化疗栓塞术后顽固性呃逆疗效观察.湖北中医杂志,2005,(7)：38.
[14]邓力.针刺治疗肝癌介入化疗后呃逆.山西中医,1997,(2)：48-49.
[15]王绪红,钱春艳,陈剑波.针刺治疗肿瘤病人并发呃逆89例.针灸临床杂志,2003,(1)：17.
[16]沈国伟,等.针灸足三里对抗化疗呕吐反应临床研究.中国针灸,2001,(3)：158-159.
[17]沈国伟,等.针灸对化疗呕吐患者胃电频谱分布和波形的影响.中国针灸,2001, (9)：7-8.
[18]沈国伟,赵京生.针灸对化疗呕吐患者的胃动力学影响.上海针灸杂志,2003,(3)：18-21.
[19]景华,刘华,凌贞.胃复安穴位注射治疗化疗性胃肠反应疗效分析.上海针灸杂志,2002,(2)：12-14.
[20]马东兴,等.胃复安与维生素B6足三里注射治疗化疗后消化道反应的疗效分析.中国针灸,2001,(2)：75-76.
[21]王作胜,刘超英,王克杰.胃复安双足三里穴位封闭防治化疗所致呕吐的疗效观察.肿瘤防治杂志,2001,8(2)：219-220.
[22]毕宏达.耳穴贴压对化疗病人枢复宁使用剂量的影响.上海针灸杂志,2005,(1)：17-18.
[23]李佩文.凉气补血治则并用化疗对肿瘤患者化疗血象的影响[J].中日友好医院学报1989,6,3(2)100-101.
[24]李佩文.化疗中中药升血的再认识[M].肿瘤基础与临床,1.1：12-13.
[25]董海涛,赵炜等.金龙胶囊并肝动脉介入治疗原发性肝癌133例临床观察[J].中国肿瘤临床,2008,35,7：378—379.
[26]黄智芬,韦劲松,黎汉忠等.参芪扶正注射液联合化疗治疗晚期乳腺癌30例临床观察[J],中国中西医结合杂志,2008,28(2)：152—153.
[27]张跃强,蒋士卿.八珍汤加减防治化疗后骨髓抑制135例[J].河南中医,2007,(27)7：66—67.
[28]路玫.针灸治疗肿瘤患者化疗致白细胞减少症疗效及机理研究.中国针灸,1997,(10)：583.
[29]黎治平.针灸治疗中晚期恶性肿瘤患者放化疗后白细胞降低症65例.江西医药,1995,(6)：335.
[30]王晓.艾灸治疗化疗后白细胞下降的疗效观察.中国针灸,1997,(1)：13.
[31]沈雪勇,费伦,吴耀持,等.特定波段红外灸对放化疗肿瘤患者升白细胞作用观察.上海针灸杂志,2005,(4)：1-3.
[32]杜昭琳,孙迎红,康红梅,等.穴位注射治疗化疗后白细胞减少的疗效观察.上海针灸杂志,2005,(5)：9-10.
[33]谢玲,赵遴,李明众.足三里穴位注射治疗放、化疗所致白细胞减少症90例.陕西中医,2002,(1)：59.
[34]陈新,史静.鸡血藤与针灸联合治疗化疗后白细胞减少症185例.河北中西医结合杂志,1998,(11)：1782.
[35]路玫.针穴位敷贴治疗癌症化疗患者白细胞减少的临床观察.针刺研究,1998,(2)：115.
[36]窭健卿,张辉,高文斌,等.针刺加穴位注射治疗化疗药物致骨髓抑制的临床观察与研究.中国针灸,2002,(5)：301-303.
[37]徐琳.针灸配合中药治疗白细胞减少症46例.针灸临床杂志,2003,(6)：17.
[38]隋胜莲,刘秀珍.针灸治疗白细胞减少症84例.中国民间疗法.2004,(2)：16-17.
[39]刘萍,刘艳,唐强,等.穴位注射配合艾灸治疗化疗后白细胞减少症的临床研究.辽宁中医杂志.2003,(3)：213.
[40]郁美娟,杨金洪,陈桂萍,等.针刺治疗放化疗所致造血功能损害的临床观察.中国针灸,1994,(5)：4-5.
[41]袁红香,喻志冲,成慧贞,等.艾灸对宫颈癌放疗患者血红蛋白的影响.上海针灸杂志,2003,(7)：33-34.
[42]杜煦电,郭勇,陈沉,等.不同时机针刺对缓解化疗药物所致血象损害作用的比较研究.中国针灸,1994,14(3)：113.
[43]宁莉.中药治疗奥沙利铂神经毒性16例[J].辽宁中医杂志,2006,33(1)：63.
[44]王玲,焦智民,李平.中药内服外洗治疗希罗达所致中重度手足综合征8例[J].中医研究,2006,19(4)：41-43.
[45]杨金洪,赵蓉,袁纪阁,等.针刺防治化疗副反应的实验研究.针刺研究.1995,19(1)：75.
[46]汪军,姜建伟,蔡三军,等.电针对消化道肿瘤患者围手术及围化疗期T淋巴细胞亚群和淋巴细胞转化功能的影响.上海针灸杂志,2004,(11)：5-7.
[47]叶芳,刘德山,王淑丽,等.电针疗法对化疗患者T细胞亚群、NK细胞活性、体液免疫及白细胞计数的影响.南京中医药大学学报,2004,20(4)：212—216.
[48]陈少宗,叶芳,刘美芹,等.电针疗法抑制化疗药物破坏肿瘤患者T细胞NK细胞作用的初步观察.针灸临床杂志,2000,16(1)：21.
[49]赵蓉,杨金洪,郁美娟,等.针刺对放、化疗患者免疫功能的调节作用.中国针灸,1994,(3)：38-39.
[50]田菲,贾英杰,陈军,等.温针灸对于恶性肿瘤患者的免疫生物调控.针灸临床杂志,1999,15(5)：48.
[51]范钰,杨兆民,万铭,等.不同针灸方法防治恶性肿瘤化疗毒副反应临床比较研究.中国针灸,2001,21(5)：259.
[52]杨金洪,郁美娟,赵蓉,等.放化疗对恶性肿瘤患者内分泌功能的影响及针刺调节作用.针刺研究,1995,20(1)1.
[53]李佩文.化疗药外漏引起局部损伤的中医治疗[J].中日友好医院学报,2004,2,18(1)：39-40.
[54]陆宁,郭勇,阮善明.癌性发热中西医结合治疗模式探讨[J].实用中西医结合临床.2008,2,8(1)：66.
[55]方志军.保肝降酶汤治疗化疗所致药物性肝损害例[J].辽宁中医杂志,1995,6,22(6)：260.
[56]李宁鸿,费阿佩.健脾清肝汤治疗肝动脉化疗所致肝37例临床研究[J].长春中医学院学报.1996,9,12(9)：16.
[57]张微微,陈越,钱义明.参附注射液对含阿霉素类化疗方案减毒增效作用的临床观察[J].河南中医,2007,4,27(4)：70—71.
[58]宁莉.生脉注射液治疗阿霉素引起的心肌损害疗效观察[J].中国中医急症,2006,6,15(6)：617.
[59]张霆,马胜林,岳建华等.一贯煎对非小细胞肺癌NP方案化疗减毒作用的Ⅰ临床研究[J].中国中西医结合杂志2007。5,27(5)：396.
[60]廖威,裴景春.针刺不同穴位防治顺铂致家免消化道反应的实验研究.上海针灸杂志,2000,19(6)：35-36.
[61]黄喜梅.电针足三里穴对癌症化疗中胃肠功能影响的临床及实验研究.上海针灸杂志,1996,(3)：11-13.
[62]李英,冯明秀,黄喜梅.电针对化疗大鼠胃肠功能影响的实验研究.中国针灸,1996,146,(3)：31-32.
[63]尚明华,孙亦农.针灸对CTX化疗小鼠NK细胞活力的影响.江苏中医,1998,19(4)：45.
[64]刘宏伟,庞波,冯晓东,等.针灸对荷瘤动物若干免疫学指标的影响.中医研究,1995,8(4)：51-53.
[65]施茵,张安莉.针灸调节U14荷瘤小鼠红细胞免疫功能的实验研究.江西中医学院学报,2000,12(3)：111-113.
[66]付静宜,马振亚.针灸对IL2-IFN-NKC调节网与其相关网络Mφ-IL1-Th的效应---针灸并施对荷瘤(S37)小鼠相关网络的效应.西安医科大学学,2001,22(1)：7-10.
[67]刘宏伟,冯晓东,庞波.针灸对小白鼠移植瘤活血化瘀作用实验研究.中国针灸,1997,(11)：659.
[68]崔瑾,申定珠,熊芳丽.针刺、艾灸膈俞穴对低白细胞模型大鼠白细胞及骨髓造血功能的调节作用.上海针灸杂志,2005,(6)：41-43
[69]闫杜海.针灸对荷瘤小鼠环磷酰胺化疗后白细胞及骨髓有核细胞总数的影响.河南中医,1997,(3)：154.
[70]孙德利,皇甫宏,郑东升,等.天灸调节环磷酸胺小鼠造血功能的研究.浙江中医学院学报,2002,26,(3)：55-57.
[71]杨金洪,赵蓉,袁纪阁,等.针刺防治化疗副反应的实验研究——不同穴位的针刺效应比较.针刺研究,1994,75.
[72]查炜,孙亦农,尚明华.不同针灸刺激方法对荷瘤CTX化疗小鼠抗氧化系统的影 响.针灸临床杂志,2000,16,(3)：59-60.
[73]施茵,张安莉.针灸调节U14荷瘤小鼠红细胞超氧化物歧化酶的实验研究.江西中医药,2002,33(1)：43-44.
[74]王学新,张丹,叶向荣,等.不同针灸方法对小鼠实体瘤(H22)抑制作用的比较.山东中医药大学学报,1999,23(5)：389-390.
[75]陈天安,李运峰.针灸治疗顽固性呃逆80例.河南中医,2001,(6)：62.
[76]刘景玲,张建平.膈俞埋针治疗顽固性呃逆.山西中医,2002,(5)：51.
[77]赵喜新,路玫,王民集,项晓人,常明.针灸对化疗所致小鼠骨髓神经损伤的修复作用.河南中医学院学报,2003：18：24-25
[78]赵喜新,黄喜梅,王和平,路玫,田开宇.针灸抗化疗骨髓抑制提升白细胞机制.上海针灸杂志2003；22：29-33
[79]阎杜海,赵喜新.针灸对环磷酰胺小鼠骨髓粒-单祖细胞集落形成单位的影响.中国针灸,1998,(5)：295-296.
[80]阎杜海.针灸对CY小鼠血清CSF含量及活性的影响.针刺研究,1997,(4)：304-306.
[81]姚俊青.隔姜灸治疗化疗所致门细胞减少症的临床观察[J]针刺研究,1997,22(3)：209.
[82]孙德利,皇甫宏,郑东升,等.天灸调节环磷酸胺小鼠造血功能的研究.浙江中医学院学报,2002,26,(3)：55-57.
[83]孙燕.内科肿瘤学[M].北京：人民卫生出版社,2001：57-58.
[84]石学敏.针灸推拿学[M].北京：中国中医药出版社,2002：349.
[85]李晓军,李秀华,刘亚书.隔姜灸法配合耳穴贴压治疗放化疗所致不良反应32例[J].中国针灸,2001,21(9)：523-524
[86]许玉萍,张立春,林乃龙.针刺穴位防治癌症患者化疗呕吐的临床观察[J].辽宁中医药大学学报,2008,10(3)：109.
[87]南京中医学院·针灸学,第1版,上海：科学技术出版社,1979：289~291
[88]Fulton C. The prevalence and detection of psychiatric morbidity inpatientswith metastatic breast cancer[J]. European Journal ofCancer Care.1998,7(4):232-239b
[89]reast cancer:two case studies [J]. Oncol Nurs Fo-rum,2003,30(3):473-478
[90]杨燕艳,郑红薇,孙大志.重组人粒细胞集落刺激因子联针灸治疗消化道肿瘤化疗后骨髓抑制的疗效.世界华人消化杂志.2006.14(36)：3525-352
[2]李连弟,鲁风珠,张思维等.中国恶性肿瘤死亡率20年变化趋势和近期预测分析.中华肿瘤杂志,1997,19(1)：3-9。
[3]中华人民共和国卫生部.全国第三次死因回顾抽样调查报告.北京：中国协和医科大学出版社.2008：10.
[4]张志义,孙燕主编.恶性肿瘤化学治疗学.第1版.上海科学技术出版社,1981,117.
[5]岛田安博,下山正德,田村友秀,等.Japan Clinicaal Oncology(JCOG)临床安全性情报操作.药理治疗,1998,7.
[6]张新龙,王根发.半夏泻心汤防治顺铂联合化疗所致恶心呕吐90例[J].江西中医,2007,5：28.
[7]许树才.四逆散与格拉司琼联合应用预防化疗所致呕84例报告[J].贵阳中医学院学报,2006,(28)1：16.
[8]阙铁生,吕军影,黄耀全,等.针刺防治顺铂化疗所致呕吐的临床观察.上海针灸杂志,2003,(4)：8-9.
[9]周俊青,徐天舒,钱雷.针灸对肿瘤患者化疗后血细胞和消化道反应的影响.中国针灸,2004,(11)：741-743.
[10]黄喜梅.电针足三里穴对癌症化疗中胃肠功能影响的临床及实验研究.上海针灸杂志,1996,(3)：11-13.
[11]王守章,杨学峰.针刺控制化疗所致胃肠反应临床研究.中国针灸,1997,(1)：17-18.
[12]陈桂平,杨金洪,郁美娟,等.针刺治疗放化疗胃肠反应44例.中国针灸,1996,(7)：9-10.
[13]李爱华.针刺治疗肝癌介入化疗栓塞术后顽固性呃逆疗效观察.湖北中医杂志,2005,(7)：38.
[14]邓力.针刺治疗肝癌介入化疗后呃逆.山西中医,1997,(2)：48-49.
[15]王绪红,钱春艳,陈剑波.针刺治疗肿瘤病人并发呃逆89例.针灸临床杂志,2003,(1)：17.
[16]沈国伟,等.针灸足三里对抗化疗呕吐反应临床研究.中国针灸,2001,(3)：158-159.
[17]沈国伟,等.针灸对化疗呕吐患者胃电频谱分布和波形的影响.中国针灸,2001, (9)：7-8.
[18]沈国伟,赵京生.针灸对化疗呕吐患者的胃动力学影响.上海针灸杂志,2003,(3)：18-21.
[19]景华,刘华,凌贞.胃复安穴位注射治疗化疗性胃肠反应疗效分析.上海针灸杂志,2002,(2)：12-14.
[20]马东兴,等.胃复安与维生素B6足三里注射治疗化疗后消化道反应的疗效分析.中国针灸,2001,(2)：75-76.
[21]王作胜,刘超英,王克杰.胃复安双足三里穴位封闭防治化疗所致呕吐的疗效观察.肿瘤防治杂志,2001,8(2)：219-220.
[22]毕宏达.耳穴贴压对化疗病人枢复宁使用剂量的影响.上海针灸杂志,2005,(1)：17-18.
[23]李佩文.凉气补血治则并用化疗对肿瘤患者化疗血象的影响[J].中日友好医院学报1989,6,3(2)100-101.
[24]李佩文.化疗中中药升血的再认识[M].肿瘤基础与临床,1.1：12-13.
[25]董海涛,赵炜等.金龙胶囊并肝动脉介入治疗原发性肝癌133例临床观察[J].中国肿瘤临床,2008,35,7：378—379.
[26]黄智芬,韦劲松,黎汉忠等.参芪扶正注射液联合化疗治疗晚期乳腺癌30例临床观察[J],中国中西医结合杂志,2008,28(2)：152—153.
[27]张跃强,蒋士卿.八珍汤加减防治化疗后骨髓抑制135例[J].河南中医,2007,(27)7：66—67.
[28]路玫.针灸治疗肿瘤患者化疗致白细胞减少症疗效及机理研究.中国针灸,1997,(10)：583.
[29]黎治平.针灸治疗中晚期恶性肿瘤患者放化疗后白细胞降低症65例.江西医药,1995,(6)：335.
[30]王晓.艾灸治疗化疗后白细胞下降的疗效观察.中国针灸,1997,(1)：13.
[31]沈雪勇,费伦,吴耀持,等.特定波段红外灸对放化疗肿瘤患者升白细胞作用观察.上海针灸杂志,2005,(4)：1-3.
[32]杜昭琳,孙迎红,康红梅,等.穴位注射治疗化疗后白细胞减少的疗效观察.上海针灸杂志,2005,(5)：9-10.
[33]谢玲,赵遴,李明众.足三里穴位注射治疗放、化疗所致白细胞减少症90例.陕西中医,2002,(1)：59.
[34]陈新,史静.鸡血藤与针灸联合治疗化疗后白细胞减少症185例.河北中西医结合杂志,1998,(11)：1782.
[35]路玫.针穴位敷贴治疗癌症化疗患者白细胞减少的临床观察.针刺研究,1998,(2)：115.
[36]窭健卿,张辉,高文斌,等.针刺加穴位注射治疗化疗药物致骨髓抑制的临床观察与研究.中国针灸,2002,(5)：301-303.
[37]徐琳.针灸配合中药治疗白细胞减少症46例.针灸临床杂志,2003,(6)：17.
[38]隋胜莲,刘秀珍.针灸治疗白细胞减少症84例.中国民间疗法.2004,(2)：16-17.
[39]刘萍,刘艳,唐强,等.穴位注射配合艾灸治疗化疗后白细胞减少症的临床研究.辽宁中医杂志.2003,(3)：213.
[40]郁美娟,杨金洪,陈桂萍,等.针刺治疗放化疗所致造血功能损害的临床观察.中国针灸,1994,(5)：4-5.
[41]袁红香,喻志冲,成慧贞,等.艾灸对宫颈癌放疗患者血红蛋白的影响.上海针灸杂志,2003,(7)：33-34.
[42]杜煦电,郭勇,陈沉,等.不同时机针刺对缓解化疗药物所致血象损害作用的比较研究.中国针灸,1994,14(3)：113.
[43]宁莉.中药治疗奥沙利铂神经毒性16例[J].辽宁中医杂志,2006,33(1)：63.
[44]王玲,焦智民,李平.中药内服外洗治疗希罗达所致中重度手足综合征8例[J].中医研究,2006,19(4)：41-43.
[45]杨金洪,赵蓉,袁纪阁,等.针刺防治化疗副反应的实验研究.针刺研究.1995,19(1)：75.
[46]汪军,姜建伟,蔡三军,等.电针对消化道肿瘤患者围手术及围化疗期T淋巴细胞亚群和淋巴细胞转化功能的影响.上海针灸杂志,2004,(11)：5-7.
[47]叶芳,刘德山,王淑丽,等.电针疗法对化疗患者T细胞亚群、NK细胞活性、体液免疫及白细胞计数的影响.南京中医药大学学报,2004,20(4)：212—216.
[48]陈少宗,叶芳,刘美芹,等.电针疗法抑制化疗药物破坏肿瘤患者T细胞NK细胞作用的初步观察.针灸临床杂志,2000,16(1)：21.
[49]赵蓉,杨金洪,郁美娟,等.针刺对放、化疗患者免疫功能的调节作用.中国针灸,1994,(3)：38-39.
[50]田菲,贾英杰,陈军,等.温针灸对于恶性肿瘤患者的免疫生物调控.针灸临床杂志,1999,15(5)：48.
[51]范钰,杨兆民,万铭,等.不同针灸方法防治恶性肿瘤化疗毒副反应临床比较研究.中国针灸,2001,21(5)：259.
[52]杨金洪,郁美娟,赵蓉,等.放化疗对恶性肿瘤患者内分泌功能的影响及针刺调节作用.针刺研究,1995,20(1)1.
[53]李佩文.化疗药外漏引起局部损伤的中医治疗[J].中日友好医院学报,2004,2,18(1)：39-40.
[54]陆宁,郭勇,阮善明.癌性发热中西医结合治疗模式探讨[J].实用中西医结合临床.2008,2,8(1)：66.
[55]方志军.保肝降酶汤治疗化疗所致药物性肝损害例[J].辽宁中医杂志,1995,6,22(6)：260.
[56]李宁鸿,费阿佩.健脾清肝汤治疗肝动脉化疗所致肝37例临床研究[J].长春中医学院学报.1996,9,12(9)：16.
[57]张微微,陈越,钱义明.参附注射液对含阿霉素类化疗方案减毒增效作用的临床观察[J].河南中医,2007,4,27(4)：70—71.
[58]宁莉.生脉注射液治疗阿霉素引起的心肌损害疗效观察[J].中国中医急症,2006,6,15(6)：617.
[59]张霆,马胜林,岳建华等.一贯煎对非小细胞肺癌NP方案化疗减毒作用的Ⅰ临床研究[J].中国中西医结合杂志2007。5,27(5)：396.
[60]廖威,裴景春.针刺不同穴位防治顺铂致家免消化道反应的实验研究.上海针灸杂志,2000,19(6)：35-36.
[61]黄喜梅.电针足三里穴对癌症化疗中胃肠功能影响的临床及实验研究.上海针灸杂志,1996,(3)：11-13.
[62]李英,冯明秀,黄喜梅.电针对化疗大鼠胃肠功能影响的实验研究.中国针灸,1996,146,(3)：31-32.
[63]尚明华,孙亦农.针灸对CTX化疗小鼠NK细胞活力的影响.江苏中医,1998,19(4)：45.
[64]刘宏伟,庞波,冯晓东,等.针灸对荷瘤动物若干免疫学指标的影响.中医研究,1995,8(4)：51-53.
[65]施茵,张安莉.针灸调节U14荷瘤小鼠红细胞免疫功能的实验研究.江西中医学院学报,2000,12(3)：111-113.
[66]付静宜,马振亚.针灸对IL2-IFN-NKC调节网与其相关网络Mφ-IL1-Th的效应---针灸并施对荷瘤(S37)小鼠相关网络的效应.西安医科大学学,2001,22(1)：7-10.
[67]刘宏伟,冯晓东,庞波.针灸对小白鼠移植瘤活血化瘀作用实验研究.中国针灸,1997,(11)：659.
[68]崔瑾,申定珠,熊芳丽.针刺、艾灸膈俞穴对低白细胞模型大鼠白细胞及骨髓造血功能的调节作用.上海针灸杂志,2005,(6)：41-43
[69]闫杜海.针灸对荷瘤小鼠环磷酰胺化疗后白细胞及骨髓有核细胞总数的影响.河南中医,1997,(3)：154.
[70]孙德利,皇甫宏,郑东升,等.天灸调节环磷酸胺小鼠造血功能的研究.浙江中医学院学报,2002,26,(3)：55-57.
[71]杨金洪,赵蓉,袁纪阁,等.针刺防治化疗副反应的实验研究——不同穴位的针刺效应比较.针刺研究,1994,75.
[72]查炜,孙亦农,尚明华.不同针灸刺激方法对荷瘤CTX化疗小鼠抗氧化系统的影 响.针灸临床杂志,2000,16,(3)：59-60.
[73]施茵,张安莉.针灸调节U14荷瘤小鼠红细胞超氧化物歧化酶的实验研究.江西中医药,2002,33(1)：43-44.
[74]王学新,张丹,叶向荣,等.不同针灸方法对小鼠实体瘤(H22)抑制作用的比较.山东中医药大学学报,1999,23(5)：389-390.
[75]陈天安,李运峰.针灸治疗顽固性呃逆80例.河南中医,2001,(6)：62.
[76]刘景玲,张建平.膈俞埋针治疗顽固性呃逆.山西中医,2002,(5)：51.
[77]赵喜新,路玫,王民集,项晓人,常明.针灸对化疗所致小鼠骨髓神经损伤的修复作用.河南中医学院学报,2003：18：24-25
[78]赵喜新,黄喜梅,王和平,路玫,田开宇.针灸抗化疗骨髓抑制提升白细胞机制.上海针灸杂志2003；22：29-33
[79]阎杜海,赵喜新.针灸对环磷酰胺小鼠骨髓粒-单祖细胞集落形成单位的影响.中国针灸,1998,(5)：295-296.
[80]阎杜海.针灸对CY小鼠血清CSF含量及活性的影响.针刺研究,1997,(4)：304-306.
[81]姚俊青.隔姜灸治疗化疗所致门细胞减少症的临床观察[J]针刺研究,1997,22(3)：209.
[82]孙德利,皇甫宏,郑东升,等.天灸调节环磷酸胺小鼠造血功能的研究.浙江中医学院学报,2002,26,(3)：55-57.
[83]孙燕.内科肿瘤学[M].北京：人民卫生出版社,2001：57-58.
[84]石学敏.针灸推拿学[M].北京：中国中医药出版社,2002：349.
[85]李晓军,李秀华,刘亚书.隔姜灸法配合耳穴贴压治疗放化疗所致不良反应32例[J].中国针灸,2001,21(9)：523-524
[86]许玉萍,张立春,林乃龙.针刺穴位防治癌症患者化疗呕吐的临床观察[J].辽宁中医药大学学报,2008,10(3)：109.
[87]南京中医学院·针灸学,第1版,上海：科学技术出版社,1979：289~291
[88]Fulton C. The prevalence and detection of psychiatric morbidity inpatientswith metastatic breast cancer[J]. European Journal ofCancer Care.1998,7(4):232-239b
[89]reast cancer:two case studies [J]. Oncol Nurs Fo-rum,2003,30(3):473-478
[90]杨燕艳,郑红薇,孙大志.重组人粒细胞集落刺激因子联针灸治疗消化道肿瘤化疗后骨髓抑制的疗效.世界华人消化杂志.2006.14(36)：3525-352