基于“邪伏肠络”理论探讨结直肠“炎癌转化”的动态演变机制及治疗思路

Dynamic evolution mechanism and treatment ideas of colorectal"inflammation-mediated carcinogenesis"based on the"latent pathogens trapped in the intestinal collaterals"theory

结直肠炎症患者罹患结直肠癌的风险较普通人群明显升高。迁延日久的炎症是诱发结直肠癌变的重要因素,结直肠炎症→异型增生→结直肠癌是常见的结直肠“炎癌转化”的动态病理演变过程。中医学对于结直肠“炎癌转化”的病机尚缺乏系统共识,本文提出“邪伏肠络”理论,用以阐释结直肠“炎癌转化”动态演变过程中的病机发展规律,邪气伏藏于肠络而正气无法驱邪外出,待内外因素触发,伏邪内动,损伤肠道组织;病程迁延使得正气愈衰,邪气伏藏于肠络,与痰湿、瘀血互结,加速形成积聚,最终导致癌变。“邪伏肠络”是贯穿结直肠“炎癌转化”全过程的核心病机,应以透邪通络为治疗原则,透达伏邪,扶助正气,通畅肠络,从而截断“炎癌转化”进程。阐释“邪伏肠络”理论有助于完善结直肠“炎癌转化”的辨证论治体系,为临床治疗本病提供新思路。

The risk of colorectal cancer is substantially higher in patients with long-term colorectal inflammation than in the general population.Prolonged inflammation is an essential factor that triggers colorectal cancer.The dynamic pathological evolution process of the classic"inflammation-mediated carcinogenesis"in the colorectum is proctocolitis→dysplasia→cancer.Traditional Chinese medicine lacks a systematic consensus on the pathogenesis of colorectal"inflammation-mediated carcinogenesis".This article proposes the theory of"pathogenic factors lurk intestinal collaterals"to explain the development law of pathogenesis in the dynamic evolution of colorectal"inflammation-mediated carcinogenesis".Internal and external factors can trigger the movement of the latent pathogenic factors,thereby damaging the intestinal tissues,when latent pathogenic factors are hidden in the intestinal collaterals,and the healthy qi is unable to expel them.The prolonged course of the disease further weakens the healthy qi,allowing the latent pathogenic factors to accumulate in the intestinal collaterals,intertwine with phlegm-dampness and blood stasis,accelerate accumulation,and lead to cancer."Latent pathogens trapped in the intestinal collaterals"is the core pathogenesis during inflammation-mediated carcinogenesis.Thus,to prevent colorectal inflammation-mediated carcinogenesis,consideration should be given to the principle of driving away pathogenic factors and dredging the collaterals in clinical practice.The theory regarding"latent pathogens trapped in the intestinal collaterals"can provide a theoretical reference for syndrome differentiation and treating colorectal inflammation-mediated carcinogenesis and offer novel ideas for clinical treatment.