基于“枢轴失和”理论探析慢性胆囊炎的辨治思路

Analysis of the Approach to Syndrome Differentiation and Treatment of Chronic Cholecystitis from the Perspective of “Pivot-Axis Disharmony” Theory

摘要: 慢性胆囊炎是临床常见的消化系统疾病，易反复发作，现代西医治疗存在局限性，难以有效阻断病情进展及规避复发风险，而中医药治疗本病具备整体调控、标本兼顾、副作用小的独特优势。当前中医临床多从湿热、气滞、肝郁等单一病机论治本病，辨证视角较为局限。本文结合中医典籍与临床实践，立足“少阳为枢”与“脾胃为轴”理论，提出“枢轴一体”的气机运动观。分析并阐述慢性胆囊炎病机本质为“枢轴失和”，即少阳枢机不利与脾胃中轴失运相互影响，其病理演变可分为枢机不利、胆腑通降失司，枢郁及轴、脾胃升降失常，轴虚枢涩、枢轴互损三个阶段，据此确立“调枢和轴”基本治则，以和法为纲，分期论治。该理论将六经气化、“一气周流”与脏腑辨证相结合，可为慢性胆囊炎的中医辨治提供新的理论视角与治疗思路。

Abstract: Chronic cholecystitis is a common digestive system disease in clinical practice and is prone to recurrent attacks. Modern Western medical treatment has limitations, making it difficult to effectively block disease progression and avoid the risk of recurrence. In contrast, traditional Chinese medicine (TCM) treatment of this disease has the unique advantages of holistic regulation, simultaneously addressing both the root and branch, and minimal side effects. Currently, TCM clinical practice mostly treats this disease based on a single pathogenesis such as damp-heat, qi stagnation, or liver depression, and the perspective of syndrome differentiation is relatively limited. By combining TCM classical texts with clinical practice, and grounded in the theories of “Shaoyang as the pivot” and “the spleen and stomach as the axis”, this article proposes the qi movement concept of “pivot-axis unity”. It analyzes and elaborates that the essential pathogenesis of chronic cholecystitis is “pivot-axis disharmony”, that is, the mutual influence between dysfunction of the Shaoyang pivot and failure of the spleen-stomach central axis. Its pathological evolution can be divided into three stages: pivot dysfunction with impaired free descent of the gallbladder; pivot depression affecting the axis with disorder of spleen-stomach ascending and descending; and axis deficiency with pivot stagnation and mutual damage between the pivot and axis. Accordingly, the basic therapeutic principle of “regulating the pivot and harmonizing the axis” is established, with the harmonizing method as the guiding principle and staged treatment. This theory integrates six-meridian qi transformation, “the circulation of one qi”, and zang-fu syndrome differentiation, and can provide a new theoretical perspective and treatment approach for TCM syndrome differentiation and treatment of chronic cholecystitis.