从辨证论治探析胃癌前病变的临床治疗  

Clinical Treatment of Precancerous Lesions of Gastric Cancer Based on Syndrome Differentiation and Treatment

作　　者：左昕 李吉彦[3] 朱炜楷 沈会[1,2] 张靖源[1,2] 赵妍妍 郝长浩[1,2] 张玉书 ZUO Xin;LI Jiyan;ZHU Weikai;SHEN Hui;ZHANG Jingyuan;ZHAO Yanyan;HAO Changhao;ZHANG Yushu(The First Affiliated Hospital of Dalian Medical University,Dalian 116011,Liaoning,China;Dalian Medical University,Dalian 116044,Liaoning,China;Dalian Hospital of Traditional Chinese Medicine,Dalian 116013,Liaoning,China)

机构地区：[1]大连医科大学附属第一医院,辽宁大连116011 [2]大连医科大学,辽宁大连116044 [3]大连市中医医院,辽宁大连116013

出　　处：《辽宁中医药大学学报》2023年第2期205-209,共5页Journal of Liaoning University of Traditional Chinese Medicine

基　　金：国家中医药管理局关于第五批全国中医临床优秀人才研修项目(国中医药人教函{2022}1号);全国中医药创新骨干人才项目(国中医药人教函{2019}128号);辽宁省中医优秀人才项目(辽卫办发{2021}29号)。

摘　　要：胃癌前病变是慢性萎缩性胃炎向胃癌进展的重要阶段,中医药治疗该病常常病证结合,辨证施治。辨证论治是中医的特色和优势。文章从古代、现代中医医家对该病的认识等方面进行阐述,分析其病机特点为本虚标实,虚实夹杂。脾虚为发病基础,湿热、阴虚、瘀毒是其危险因素,并以此为线索,论述中医辨证治疗胃癌前病变4个分型的相关基础及临床试验研究进展,探讨慢性萎缩性胃炎伴上皮内瘤变的组织病理学改变过程与中医证型分布、结构变化的关系。再结合各证素变化,探讨癌变发展及虚实互生理论的关系,提出PLGC以扶正祛邪为基本治则,临床根据其病理演变过程,辨证结合益气健脾、清热化湿、养阴益胃、化瘀解毒等治法动态调节人体内环境的平衡,为相关防治提供新思路。Precancerous lesion of gastric cancer(PLGC)is an important stage of the progression from chronic atrophic gastritis to gastric cancer.Traditional Chinese medicine(TCM)treatment of this disease is often combined with disease and syndrome differentiation.Syndrome differentiation and treatment is the characteristic and advantage of traditional Chinese medicine.This paper expounds the ancient and modern Chinese medicine doctors'understanding of this disease,and analyzes its pathogenesis characteristics as the deficiency of this disease and the excess of deficiency and excess.Spleen deficiency is the basis of the disease,and damp heat,Yin deficiency,blood stasis and toxin are the risk factors.Taking this as a clue,this paper discusses the relevant basis and clinical experimental research progress of the four types of PLGC treated by TCM syndrome differentiation and treatment,and discusses the relationship between the histopathological change process of chronic atrophic gastritis with intraepithelial neoplasia and the distribution and structural changes of TCM syndrome types.Combined with the changes of various syndrome elements,this paper discusses the relationship between the development of cancer and the theory of interaction between deficiency and excess,and puts forward that PLGC is based on the principle of supporting the right and expelling evil.According to its pathological evolution,PLGC dynamically adjusts the balance of the internal environment of the human body by syndrome differentiation combined with the treatment methods of supplementing Qi and strengthening the spleen,clearing away heat and removing dampness,nourishing Yin and benefiting the stomach,removing blood stasis and detoxification,so as to provide new ideas for related prevention and treatment.

关 键 词：胃癌前病变 中医药 辨证论治 虚实相关 

分 类 号：R735.2[医药卫生—肿瘤]