从“中焦如衡”论治胃癌前病变

Discussion on Precancerous Lesions of Gastric Cancer from Balancing Middle Energizer

“中焦如衡”是清代医家吴鞠通基于脾胃的生理特点,提出的脾胃病治疗大法。后世医家在此论点基础上,结合大量临床实践不断深化,形成了以“中焦如衡”为切入点的论治脾胃病病因病机与治疗大法为一体的理论体系。胃癌前病变(PLGC)是具有较高癌变风险的病理改变。从“中焦如衡”理论探讨PLGC的病因病机,立足于脾胃的生理病理特点,以“中焦如衡,以平为期”为切入点,认为本病由多种因素叠加导致胃黏膜遭受持续损害,而在正邪交争中,胃黏膜的保护和防御机制被激活,动态平衡机制被打破,出现以脾胃虚损为本、毒瘀损络为要、升降失衡为主要表现的病机特点,随之而出现病理改变和临床表现。通过调和气血、虚实、气机等多种因素,以调和中焦为手段,以恢复脾胃平衡、气机升降为目的,从而防治PLGC。

Balancing middle energizer is a general method for treating spleen and stomach diseases proposed by Wu Jutong,a doctor of the Qing Dynasty,based on the physiological characteristics of the spleen and stomach.Later doctors,on the basis of this method and clinical practices,created a theoretical system involving the etiology,pathogenesis,and treatment of spleen and stomach diseases with balancing middle energizer as the breakthrough point.Precancerous lesions of gastric cancer(PLGC)are a pathological state with a high risk of canceration.We explored the etiology and pathogenesis of PLGC from the theory of balancing middle energizer.Considering the physiological and pathological characteristics of the spleen and stomach,we believe that this disease is caused by multiple factors that cause continuous damage to the gastric mucosa.In the battle between pathogenic and healthy qi,the protection and defense mechanism of the gastric mucosa is activated,which disturbs the dynamic balance and leads to spleen-stomach deficiency,collateral damage due to stasis,and imbalance of ascending and descending,followed by pathological changes and clinical manifestations.Regulating various factors such as qi and blood,deficiency and excess,and qi movement by means of harmonizing the middle energizer can restore the balance of spleen and stomach and the normal ascending and descending of qi movement,thereby treating PLGC.