Art of Alleviating Pain in Final Days of Cancer缓和癌症晚期疼痛的艺术

“To cure sometimes， to relieve often， to comfort always” is a famous inscription on the gravestone of American doctor Edward Livingston Trudeau.

美国医生爱德华·利文斯顿·特鲁多的墓碑上刻着一句名言：“偶尔治愈，常常缓解，总去安慰。”

That mantra has been adopted by many doctors around the world， including Shanghainese doctor Cheng Wenwu， director of the Department of Integrated Therapy at Fudan University Shanghai Cancer Center， who in 2006 established the first palliative treatment and care department in a Chinese grade III， class A hospital—the country’s best.

世界各地的许多医生都信奉这句口号，其中就包括上海的成文武医生。他是复旦大学附属肿瘤医院综合治疗科主任，于2006年在一家三甲医院（中国的一流医院）成立了中国第一个姑息治疗与护理专科。

In 2008， a couple walked into Cheng’s office. The husband， a surgeon， suffered from advanced intestinal cancer with metastasizing tumors. He came to Cheng not to be cured but to deal with the pain of dying， as his days seemed to be numbered. Cheng promised to do his best， using painkillers to relieve the surgeon’s pain. When he died two months later， his wife found a letter of thanks left for Cheng， which said “Thank you Dr Cheng for letting me live my final days almost pain-free， and helping me walk to the end of my life peacefully and with dignity.”

2008年，一对夫妇走进成医生的诊室，其中的丈夫是一名外科医生，患有晚期肠癌伴肿瘤转移。他来找成医生并非为了治愈，而是为了应对垂死之痛，因为他似乎已经时日无多。成医生承诺会尽最大努力，他用止痛药来缓解这位外科医生的疼痛。两个月后，患者去世，他的妻子发现了他留给成医生的感谢信。信中写道：“谢谢成医生让我几乎没有痛苦地度过了最后时日，也谢谢成医生帮助我安宁地、有尊严地走到生命尽头。”

“One distinguishing feature of palliative care is a greater focus on mental health and pain management than on curing patients’ illnesses，” said Cheng. “Actually， most cancers can’t be cured， but what I can do is try to alleviate their symptoms and improve their quality of life.”

“姑息关怀的一个显著特点是，比起治好患者的病，更注重患者的心理健康和疼痛管理。”成医生说，“事实上，大多数癌症都无法治愈，但我能做的就是尽力缓和他们的症状，提高他们的生活质量。”

According to official statistics in 2008–2009， 28，000 cancer patients die every year in Shanghai， but there are only 60 palliative care beds in the entire city， including 12 in Cheng’s department. In 2004， after 14 years spent treating advanced liver cancer， Cheng enrolled at The University of Texas MD Anderson Cancer Center in the United States—one of the largest cancer centers in the world. A graduate of the Shanghai University of Traditional Chinese Medicine， Cheng witnessed how much his patients suffered during the final stages of their lives. He decided to study palliative care and rehabilitation in the US to learn how to alleviate some of that suffering.

根据2008年至2009年的官方统计，上海每年有28000名癌症患者死亡，但整个城市只有60个姑息关怀床位，其中包括成医生所在科室的12个床位。2004年，在治疗了14年晚期肝癌后，成医生进入全球最大的癌症中心之一——美国得克萨斯大学MD安德森癌症中心学习。毕业于上海中医药大学的成医生，曾目睹自己的患者在生命最后阶段所遭受的痛苦。因此，他决定到美国进修姑息关怀和康复医学，学习如何缓和这种痛苦。

“I had a really eye-opening experience at MD Anderson， which introduced me to a brand-new concept of providing support systems to advanced cancer patients， such as setting different levels of care for different patients and providing tailor-made treatment plans，” Cheng said.

“在MD安德森癌症中心学习的经历让我大开眼界，我了解到了为晚期癌症患者提供支持体系的新理念，比如为不同的患者安排不同级别的护理，提供量身定制的治疗计划。”成医生说。

Following his studies in the US， Cheng returned to Shanghai to practice and promote what he learned， including a proposal to the center’s director to create a palliative care department. Two years later， that proposal became a reality. The integrated therapy department accepts all patients suffering from malignant tumors， including those have been turned away by other doctors.

在美国完成进修后，成医生回到上海，实践并推广他所学的知识，包括向医院领导提议成立姑息关怀科。两年后，这一提议成为现实。综合治疗科接收患有各类恶性肿瘤的患者，包括被其他医生拒之门外的患者。

Incorporating new concepts and basic guidelines from overseas， Cheng also localized the department by applying Chinese traditional medicine to patients’ care. “We didn’t simply copy the Western model，” he said. “We enhanced it with traditional Chinese medicine， which can alleviate many symptoms Western medicine can’t. My process is to take the first step and then reassess a patient’s condition before proceeding further. Some are cured， which I think is the essence of palliative care. Miracles happen here sometimes.”

除了吸收国外的新理念和基本方针，成医生还将中医应用于患者护理，从而实现了科室的本地化。“我们不是简单地照搬西方模式。”他说，“我们用中医来强化西方模式，这样就能够缓和西医无法缓和的许多症状。我的做法是先迈出第一步，然后重新评估患者的病情，再采取下一步行动。有些患者已经治愈了，我认为这是姑息关怀的精髓。奇迹有时会在这里发生。”

Xu Haiquan from Suzhou， Jiangsu Province， is one of those miracles. Two years ago， Cheng treated Xu who suffered from malignant mesothelioma. When the patient arrived， one of his symptoms was pleural effusion， or water on the lungs. To make Xu more comfortable， Cheng began by draining the fluid from his lungs. After draining more than 10，000 milliliters of fluid， he applied traditional Chinese medicine to strengthen his vital qi （energy flow） and body resistance. Amazingly， his condition greatly improved. “Even I did not expect that amazing outcome， because Xu had previously tried many Western treatments，” Cheng said. “It seems traditional Chinese medicine helped his immune system destroy cancerous cells.”

来自江苏省苏州市的徐海全（音译）就是其中一个奇迹。两年前，成医生接诊了这位患有恶性间皮瘤的患者。初诊时，他的症状之一是胸腔积液，也称肺积水。为了让他舒服，成医生先从他的肺部引流积液。排出超过10000毫升积液后，成医生又用中医来增强他的正气（能量流）和身体抵抗力。令人惊讶的是，患者的病情大大好转。“我也没想到会有如此惊人的效果，因为患者之前曾尝试过许多西医疗法。” 成医生说，“看来中医帮助他的免疫系统消灭了癌细胞。”