基于元气“生成–输布–达络”探讨针灸治疗化疗相关周围神经病变

Exploring Acupuncture Treatment for Chemotherapy-Induced Peripheral Neuropathy Based on the “Generation, Distribution, and Distal Arrival” of Yuanqi

摘要: 化疗相关周围神经病变(Chemotherapy-Induced Peripheral Neuropathy, CIPN)是铂类、紫杉类等化疗药物常见的剂量限制性毒性反应，临床上常以四肢末端麻木、刺痛、感觉异常为主要表现，严重影响肿瘤患者的生活质量与依从性。文章基于元气生成、输布与达络的生理特点，提出CIPN可概括为“药毒伤正，元气生成不足；三焦失司，元气输布不利；毒瘀痰寒痹络，元气不达四末”的病机。针灸治疗宜以培元、调焦、通络为纲，根据药毒壅络、中焦失运、脾肾亏虚等病机偏向，分别采用通络泄毒、健运中焦、温培元气之法，并重视局部辨经取穴及肿瘤治疗期的安全边界。该框架旨在将元气理论转化为可辨证、可操作、可验证的针灸证治路径，为CIPN针灸方案优化及后续临床研究提供理论参考。

Abstract: Chemotherapy-Induced Peripheral Neuropathy (CIPN) is a common dose-limiting toxic adverse reaction of chemotherapeutic agents such as platinum and taxane drugs. Clinically, it is predominantly manifested as numbness, stabbing pain, and paresthesia in the extremities, which severely impairs the quality of life and treatment adherence of cancer patients. Based on the physiological characteristics of yuanqi (primordial qi) in its generation, systemic distribution and perfusion to the collaterals, this paper proposes a three-layer pathological mechanism of CIPN “chemotherapeutic toxins damage healthy qi and lead to insufficient generation of primordial qi; dysfunction of the sanjiao obstructs the distribution of primordial qi; toxin, static blood, phlegm and cold bind and obstruct the collaterals, preventing primordial qi from reaching the distal extremities”. Acupuncture treatment takes replenishing primordial qi, regulating sanjiao, and unblocking collaterals as the core guiding principles. Corresponding targeted therapies are adopted according to different pathological predominances: unblocking collaterals and eliminating toxins for collateral stagnation by chemotoxicants, invigorating transportation of the middle jiao for dysfunctional spleen-stomach, and warming and tonifying primordial qi for spleen-kidney deficiency. Local meridian-differentiated acupoint selection and safety specifications during oncotherapy are also emphasized. This theoretical framework transforms the yuanqi doctrine into a syndrome-differentiable, operable, and verifiable acupuncture diagnosis and treatment pathway, providing theoretical references for optimizing acupuncture protocols against CIPN and subsequent clinical research.