鄭淑鎂
培真中醫診所院長
中華中西結合神經醫學會監事．世界中醫藥聯合會糖尿病分會理事
遼寧中醫藥大學客座教授．遼寧中醫藥大學博士
通訊作者：鄭淑鎂
連絡地址：新北市中和區新生街220巷5號
Tel：02-2225-6618
E-Mail：mg6618 @hotmail.com
2014年08月28日受理; 2014年12月14日刊載
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、?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?主；第二階段以補氣補血養陰?主；第三階段以
補腎陽?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。
關鍵詞：
糖尿病、惡性腫瘤、腫瘤性糖尿病
Cancer-associated diabetes mellitus
Zheng Shu-Mei
Chief of Pei-Zhen Chinese Medical Clinic
Supervisor of the Taiwan Chinese-Western Medicine Association
Visiting Professor at Liaoning University of Traditional Chinese Medicine
Ph.D. Liaoning University of Traditional Chinese Medicine Naturopathic
Doctor, USA.
Director of the International Federation Chinese Medicine Professional
Commitee
Authors：Chang Wen-Huai
Address：No.5, Ln. 220, Xinsheng St., Zhonghe Dist., New Taipei City,
Taiwan (R.O.C.)
Tel：886-3-284-0723
E-Mail：whchang7@yahoo.com.tw
Received：2014.08.28; Accepted：2014.12.14
Abstract
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).
Key Words :
diabetes mellitus, manglinant tumor,cancer-associated
diabetes mellitus.