从三焦论治幽门螺杆菌感染的六维辨证观

Enhanced Six-dimensional dialectical approach to the management of helicobacter pylori infection based onthe Triple energizer Theory

六维辨证观强调从病因、病位、病期、病势、病理、病性六个不同维度对病证进行辨析,有利于中医临床思维的锻炼和形成。基于六维辨证观,可以更全面地认知从三焦论治幽门螺杆菌(Helicobacter pylori,H.pylori)感染。辨病因,应综合考虑H.pylori致病因素的外感兼内伤属性,要注重三焦疾病“总在一经不移为辨”的病理特点;辨病性,应关注H.pylori作为病原微生物的致病规律,不能简单归结为湿热致病,其“粘附致炎”的病理属性需结合三焦气化的“通透性网状效应”从而表现出不同的证型;辨病位,H.pylori留滞部位在中焦胃腑膜层,胃黏膜分布规则的集合小静脉是反映中焦气化“通透性网状效应”的重要标志;辨病理,H.pylori粘附致炎的病理产物以气滞、湿、热、虚、瘀多见,影响三焦气化功能而呈现气机阻滞、湿热中阻、虚瘀共存等不同的病理状态;辨病期,H.pylori感染造成三焦“通透性网状效应”变差,日久生变,毒瘀虚互结,从而衍变经典的Correa模式。临床应注重H.pylori的根治治疗与胃黏膜癌前状态和癌前病变的共同处理策略;辨病势,根据H.pylori感染的不同阶段,注重对比正邪态势、病理因素态势的不同,叶天士针对“邪留三焦”提出的“分消上下之势”是很重要的治疗原则。

The six-dimension syndrome differentiation emphasizes the differentiation of disease from six different dimensions of etiology,disease location,disease stage,disease tendency,pathology and disease nature,which is conducive to the exercise and formation of TCM clinical mode of thought.Based on the six-dimensional dialectical view,we can understand more comprehensively the treatment of H.pylori from the Triple energizer theory.To identify the etiology of H.pylori,we should comprehensively consider the attributes of external and internal injury of pathogenic factors,and pay attention to the pathological characteristics of“always in the first place”;In terms of disease differentiation,we should pay attention to the pathogenic law of H.pylori as a pathogenic microorganism,which can not be simply attributed to damp-heat disease.Its pathological attribute of“adhesion causing inflammation”should be combined with the“permeability network effect”of Triple energizer gasification to show different syndrome types;Identifying the location of the disease,the retention site of H.pylori is located in the gastric membrane layer of the middle energizer,and the collection of small veins in the gastric mucosa(RAC)is an important marker reflecting the“permeability network effect”of middle energizer gasification;The pathological manifestations of H.pylori-induced inflammation include Qi stagnation,dampness,heat,deficiency,and stasis,which impact the function of Triple energizer gasification and give rise to various pathological conditions such as Qi stagnation,damp-heat obstruction,and deficiency-stasis coexistence;During the differentiation stage,H.pylori infection leads to the impairment of the“permeability network effect”of Triple energizer,temporal alterations,and deficiencies in poison and blood stasis inter-junction,ultimately giving rise to the classic Correa model.The focus is on radical treatment of H.pylori and a co-management strategy for precancerous states and lesions of gastric mucosa;According to the different stages of H.pylori infection,it is important to focus on comparing the positive and negative trends and the various pathological factors.The concept of“separating the upper and lower trends”proposed by Ye Tianshi is a crucial treatment principle for addressing“Triple energizer of evil retention.”