基于肝郁理论辨治慢性萎缩性胃炎及胃癌前病变的思路探讨

Exploration of the Approach to Differentiation and Treatment of Chronic Atrophic Gastritis and Precancerous Gastric Lesions Based on Liver Depression Theory

摘要: 慢性萎缩性胃炎及胃癌前病变是胃癌发生过程中的关键环节，中医药在其防治中具有独特优势。本文基于中医肝脾相关理论，围绕“肝郁”这一核心病机，从肝与胃的生理联系、肝郁导致胃病的病理机制、肝郁所致病理产物对疾病发展的影响等方面进行详细阐述。参考临床各家经验，认为肝郁气滞是CAG及GPL的启动病机，肝郁脾虚是疾病进展的枢纽，肝郁化热、酿生浊毒、久病入络是疾病恶化的关键环节。临证治疗当以疏肝解郁为基本大法，并根据兼夹病机分别采用疏肝理气、疏肝健脾、疏肝活血、疏肝解毒等治法，以期为从肝郁论治CAG及GPL提供系统的辨治思路。

Abstract: Chronic atrophic gastritis and precancerous lesions of the stomach are key stages in the development of gastric cancer, and traditional Chinese medicine has unique advantages in their prevention and treatment. Based on the TCM theories related to the liver and spleen, this article focuses on the core pathogenic mechanism of ‘liver depression,’ detailing aspects such as the physiological relationship between the liver and stomach, the pathological mechanisms by which liver depression causes gastric disease, and the impact of pathological products resulting from liver depression on disease progression. Drawing on the clinical experiences of various practitioners, it is believed that liver depression with Qi stagnation is the initiating mechanism of CAG and GPL, liver depression with spleen deficiency is the pivotal factor in disease progression, and liver depression transforming into heat, generating turbid toxins, and chronic pathological invasion into the collaterals are key links in disease deterioration. Clinical treatment should primarily aim to soothe the liver and relieve depression, while adopting specific methods according to accompanying pathogenic mechanisms, including soothing the liver and regulating Qi, soothing the liver and strengthening the spleen, soothing the liver and activating blood circulation, and soothing the liver and detoxifying, in order to provide a systematic differentiation and treatment approach for managing CAG and GPL from the perspective of liver depression.