摘要
胃癌前病变(Gastric Precancerous Lesion,GPL)作为胃癌发生的关键癌前阶段,其演进与胃“炎-癌转化”过程密切相关。基于黄元御“一气周流”理论,人体气机以中气为枢轴,通过脾升胃降带动全身气血循环。GPL则被认为是中气虚衰,枢转不利,阴阳升降失调,中土日久累积湿、痰、瘀、毒等病理产物的结果。现代医家基于该理论辨治胃“炎-癌链”进程中的不同病理阶段,临床效果显著。细胞焦亡作为一种促炎性的程序性死亡方式,在GPL演进中发挥着双重调控作用,适度的细胞焦亡在免疫功能方面与“一气周流”的防御循环机制有一定相关性,而过度的细胞焦亡则通过相关信号通路介导炎症因子大量释放,所形成的炎症微环境类似于中医湿、痰、瘀、毒蕴结的病机特点。治疗重在运中焦、复周流,强调以健脾益气为核心,配合燥湿化痰、消瘀解毒等祛邪之法。现代研究表明,健脾类中医药可多靶点调控焦亡通路,抑制核苷酸结合寡聚化结构域样受体蛋白3(Nucleotide-binding Oligomerization Domain-like Receptor Protein 3,NLRP3)炎症小体的异常激活,减轻炎性反应,改善胃黏膜病理状态,体现“扶正祛邪、斡旋中气”治法的现代医学内涵。基于“一气周流”理论探讨细胞焦亡与GPL的关联机制,不仅为诠释中医经典理论提供现代医学依据,也为中医药靶向调控细胞焦亡、逆转癌前病变提供创新性理论支撑。
Gastric precancerous lesions(GPL)represent a critical phase in gastric carcinogenesis,closely linked to the inflammationcancer transformation.In traditional Chinese medicine(TCM),HUANG Yuanyu’s circumfluence theory describes a dynamic Qi(气)movement mechanism centered on the middle Jiao(焦),supported by spleen-stomach coordination that regulates systemic Qi and blood circulation.Within this framework,GPL pathogenesis is attributed to middle Qi deficiency and pivot dysfunction,leading to imbalance in ascent-descent movement and the accumulation of dampness,phlegm,stasis,and toxins.Clinically,this theory has shown significant efficacy across the inflammation-cancer continuum.Pyroptosis,a pro-inflammatory programmed cell death process,exhibits a dual role in GPL progression:moderate activation aids immune clearance consistent with the defensive function in circumfluence,while excessive pyroptosis drives inflammatory factor release via pathways,forming a microenvironment similar to TCM’s“dampness-phlegm-stasis-toxin”accumulation.Therapeutic strategies emphasize regulating the middle Jiao and restoring Qi flow,focusing on spleen reinforcement and Qi supplementation,complemented by dampness resolution and toxin removal.Modern studies indicate that spleen-strengthening herbal formulas multitarget pyroptosis pathways,inhibit NLRP3 activation,alleviate inflammation,and ameliorate gastric mucosal pathology,supporting the TCM principle of“Beinforcing healthy Qi and eliminating pathogenic factors,regulating the Qi of spleen and stomach”.Investigating pyroptosis through the circumfluence theory provides a basis for TCM mechanisms and facilitates targeted interventions to reverse precancerous lesions.
出处
《中医临床研究》
2025年第30期21-26,共6页
Clinical Journal Of Chinese Medicine
基金
国家自然科学基金项目(81973601)
黑龙江省自然科学基金项目(LH2023H059)。
关键词
“一气周流”理论
细胞焦亡
胃癌前病变
炎-癌转化
中气
脾虚
Circumfluence theory
Pyroptosis
Gastric precancerous lesions
Inflammation-cancer transformation
Middle Qi
Spleen deficiency
