摘要
恶性胸腔积液(MPE)是癌症晚期常见并发症,西医姑息疗法治疗存在高复发率及不良反应等局限。中医将本病归属于悬饮范畴,认为病机为阳气虚衰、三焦气化失司、水饮停聚,但存在病机阐释离散化、治法碎片化的局限。基于《素问·阴阳应象大论》中“阳化气,阴成形”理论,笔者创新性构建MPE“虚-瘀-毒”闭环病机模型:核心在于阳气虚衰致三焦气化失司,水饮从无形之气逆转为有形之阴浊,并与瘀血、癌毒互结形成窠囊,呈现因虚致瘀、因瘀酿毒、因毒损虚的恶性循环。据此确立温阳化饮的根本治则,并构建温阳复气化以治本与化饮消阴浊以治标的分层论治体系:前者通过温振上、中、下三焦阳气,重启气化动力;后者针对水饮从无形到有形的病理演进过程,分层采用化气行水、破瘀消癥、软坚散结之法消解阴浊标实。该体系融合经典理论与现代机制,突破了传统治疗局限,为MPE的中西医协同治疗提供了系统的理论支撑与实践路径。
Malignant pleural effusion(MPE)is a common complication of advanced cancer.Western palliative treatments face limitations such as high recurrence rates and obvious adverse reactions.In traditional Chinese medicine(TCM),MPE is categorized as suspended fluid,and its pathogenesis lies in yang-qi deficiency,dysfunctional qi transformation of triple energizer,and pathological fluid retention.But this interpretations often suffer from fragmented pathomechanism explanations and disjointed therapeutic approaches.Based on the theory of"yang transforms qi,yin shapes form"from the chapter Grand Discussion of Yin-Yang in Response to the Nature and Body in Su Wen(Basic Questions),this study innovatively constructs a"deficiency-stasis-toxin"closed-loop pathomechanism model for MPE.The core of this model lies in yang-qi deficiency leading to dysfunctional qi transformation of triple energizer,causing a pathological reversion of fluids from an immaterial functional state into a substantial pathological yin turbidity.This turbidity further coalesces with blood stasis and cancer toxin to form encysted pathological aggregates.These three pathogens of deficiency,stasis,and toxin engage in a vicious cycle characterized by deficiency begetting stasis,stasis brewing toxin,and toxin damaging deficiency.Accordingly,the fundamental therapeutic principle of warming yang to resolve fluid retention is established.A stratified therapeutic system is further constructed,integrating warming yang to restore qi transformation targeting the root by revitalizing the dynamic source of qi transformation by warming yang qi in the upper,middle,and lower energizer,and resolving fluid and dispersing yin turbidity targeting the branch by employing stage-specific methods to dissipate the substantial yin turbidity based on its pathological progression from formless to formed.These methods include transforming qi and moving water,breaking stasis and dispersing aggregations,and softening hardness and scattering nodules.This integrated system synthesizes classical TCM theory with modern mechanistic understanding,transcending the limitations of traditional therapeutic approaches,and providing a systematic theoretical foundation and practical pathway for the integrated traditional Chinese and western medicine management of MPE.
作者
马锦程
邵化敏
王帅
MA Jincheng;SHAO Huamin;WANG Shuai(The First Affiliated Hospital of Henan University,Kaifeng Henan 475000,China;People's Hospital of Zhengzhou,Zhengzhou Henan 450000,China)
出处
《新中医》
2026年第4期140-145,共6页
New Chinese Medicine
关键词
恶性胸腔积液
阳化气
阴成形
温阳化饮法
病机模型
论治体系
Malignant pleural effusion
Yang transforms qi
Yin shapes form
Wenyang Huayin method
Pathogenesis model
Treatment system
