基于癌毒理论探讨胃癌前病变的辨治思路

Discussion on the Idea of Differentiation and Treatment of Precancerous Lesions of Gastric Cancer Based on Cancer Toxin Theory

胃癌前病变是一类具有明显癌变危险的胃部慢性疾病,早期干预胃癌前病变,是胃癌二级预防的重要手段。吴勉华教授基于脾胃功能特点和癌毒理论,认为情志不畅是胃癌前病变的诱发因素,脾胃虚弱是基本病机,痰瘀互结是关键病机,癌毒蓄积是病理特征;辨证以辨病位、辨病理因素、辨病性为要点;治疗以疏肝利胆为先,运脾和胃为本,化痰祛瘀为治疗核心,抗癌解毒贯穿始终;注重病机的兼夹转化;遣方用药以理气不伤阴、滋阴不碍脾、化瘀不伤正、补益不助邪为主要原则,从而发挥中医药优势与特色,为胃癌前病变的临床诊治提供思路与借鉴。

Precancerous lesions of gastric cancer are a category of chronic diseases of the stomach with a clear risk of becoming cancerous.Early intervention of precancerous lesions of gastric cancer is an essential way of secondary prevention of gastric cancer.Based on the functional characteristics of the spleen and stomach and the theory of cancer toxin,Professor Wu Mianhua believes that emotional distress is the triggering cause of precancerous lesions of gastric cancer;weakness of the spleen and stomach is the basic pathogenesis;phlegm and stagnation is the key pathogenesis;and accumulation of cancer toxin is the pathological feature.Syndrome differentiation should focus on identifying the location,pathological factors,and the nature of the disease;treatment should prioritize soothing the liver and gallbladder and be based on regulating and harmonizing the spleen and stomach,with resolving phlegm and blood stasis as the core and anti-cancer and detoxification throughout the entire process;attention should be paid to the transformation of the pathogenesis;prescriptions and medications should be based on the main principles of regulating qi without damaging yin,nourishing yin without hindering the spleen,removing blood stasis without damaging the healthy qi,and replenishing without aiding evil,so as to give full play to the advantages and characteristics of traditional Chinese medicine and provide ideas and references for the clinical diagnosis and treatment of gastric precancerous lesions.