基于“气血水”理论探讨十二指肠神经内分泌肿瘤与胃及胆囊息肉的相关性

Exploring the Correlation between Duodenal Neuroendocrine Neoplasms and Gastric Polyps and Gallbladder Polyps Based on the “Qi-Blood-Fluid” Theory

摘要: 十二指肠神经内分泌肿瘤是一种来源于神经内分泌细胞的异常增生而产生的一类可以分泌多种激素和肽类神经递质的较为罕见的肿瘤。但近年来随着健康体检的普及，其检出率也在逐年提高，临床上约九成的患者都是因为体检发现。现代医学对于十二指肠神经内分泌肿瘤的治疗仅限于内镜下切除、外科手术切除、药物及放化疗，少有提及中医药治疗。本文试从“气血水”理论出发探析十二指肠神经内分泌肿瘤与胃息肉和胆囊息肉之间的相关性；认为外邪、饮食、情志及内虚等因素引动中焦的“气血水”稳态失衡，产生胃息肉和/或胆囊息肉，两者进一步使“气血水”失衡，造成气机失养、血水运行不畅，互结于十二指肠发为神经内分泌肿瘤。可见，十二指肠神经内分泌肿瘤的发生与胃息肉和/或胆囊息肉具有一定的相关性，在中药治疗上可从调摄“气血水”的角度入手整体辨治。

Abstract: Duodenal neuroendocrine neoplasms (D-NENs) are a rare category of neoplasms arising from abnormal proliferation of neuroendocrine cells, capable of secreting various hormones and peptidergic neurotransmitters. However, with the increasing prevalence of health checkups in recent years, their detection rate has been rising annually, and clinically about 90% of patients are diagnosed incidentally during routine physical examinations. Modern medical treatments for D-NENs are predominantly confined to endoscopic resection, surgical excision, pharmacotherapy, and chemoradiotherapy, with traditional Chinese medicine (TCM) being rarely addressed. This article explores the correlation among D-NENs, gastric polyps, and gallbladder polyps from the perspective of the “Qi-Blood-Fluid” theory. It posits that exogenous pathogens, dietary irregularities, emotional disturbances, and internal deficiencies perturb the homeostatic balance of “Qi-Blood-Fluid” in the middle Jiao (the digestive system), thereby giving rise to gastric polyps and/or gallbladder polyps. These polyps, in turn, further exacerbate the dysregulation of “Qi-Blood-Fluid”, leading to malnourishment of Qi activity, impeded circulation of Blood and Fluid, and their mutual aggregation in the duodenum, ultimately culminating in neuroendocrine neoplasms. Thus, the development of duodenal neuroendocrine neoplasms appears to be correlated with the presence of gastric polyps and/or gallbladder polyps. In terms of TCM treatment, a holistic differentiation-based approach that regulates and harmonizes “Qi-Blood-Fluid” may be adopted.