基于伏邪理论探讨炎症记忆的中西医结合认识

An Integrative Chinese and Western Medicine Perspective on Inflammatory Memory Based on the Theory of Latent Pathogenic Factors (Fuxie)

摘要: 炎症记忆是指机体在经历感染、组织损伤或无菌性炎症之后，通过表观遗传重塑、代谢重编程以及组织微环境改变，在固有免疫细胞、组织实质细胞和局部干细胞中留下的长期功能印记。有了这些印记，机体再次遇到相同或不同刺激时会产生更快、更强的炎症反应，因此被认为与炎症性肠病、银屑病、类风湿关节炎、动脉粥样硬化等多种慢性炎症性疾病的反复发作和持续进展有关。伏邪理论认为，外感六淫和体内生成的痰、瘀、毒等病理因素都可能藏伏于体内，等正气亏虚或内外诱因出现时才发病。这种先藏伏后发病的过程，在潜伏、易感、复发和动态变化等方面，和炎症记忆引起的缓解与复发规律大体对应。炎症记忆是可以观察和测量的生物学机制，伏邪则是以正气和病邪相互消长为核心的整体病机认识。本文首先介绍炎症记忆的概念、形成机制和临床证据，再从潜伏、易感、复发和动态四个角度分析伏邪同炎症记忆的对应。炎症记忆可能是伏邪长期潜伏、反复发作的重要生物学基础，单核巨噬细胞和组织驻留细胞上的表观及代谢印记可能为判断伏邪潜伏程度提供潜在的参考指标。同时，伏邪理论重视整体调节和治未病，为慢性炎症性疾病的复发预警和中西医结合防治提供新的参考。

Abstract: Inflammatory memory refers to the long-lasting functional imprints left in innate immune cells, tissue parenchymal cells, and local stem cells after infection, tissue injury, or sterile inflammation through epigenetic remodeling, metabolic reprogramming, and changes in the tissue microenvironment. With these imprints, the body can mount faster and stronger inflammatory responses when it meets the same or different stimuli again. Inflammatory memory is therefore regarded as associated with the recurrence and continued progression of chronic inflammatory diseases such as inflammatory bowel disease, psoriasis, rheumatoid arthritis, and atherosclerosis. The theory of Fuxie (latent pathogenic factors) holds that the six exogenous pathogenic factors and pathological products generated inside the body, such as phlegm, blood stasis, and toxin, can hide in the body and cause disease when healthy qi (zheng qi) is weak or when internal or external triggers appear. This pattern, from latency to onset, broadly corresponds in terms of latency, susceptibility, recurrence, and dynamic changes to the remission and relapse dynamics produced by inflammatory memory. Inflammatory memory is a biological mechanism that can be observed and measured, whereas Fuxie is a holistic view of pathogenesis built on the waxing and waning of zheng qi and pathogenic factors. This article first reviews the concept, mechanisms, and clinical evidence of inflammatory memory, then analyzes its correspondence with Fuxie theory in four aspects, namely latency, susceptibility, recurrence, and dynamism. Inflammatory memory may be an important biological basis for the long-term latency and repeated recurrence of Fuxie. The epigenetic and metabolic imprints of monocytes, macrophages, and tissue-resident cells may be used as potential reference indicators for assessing the degree of Fuxie latency. At the same time, the emphasis on holistic regulation and the idea of preventive treatment in Fuxie theory can offer new guidance for relapse warning and for preventing and treating chronic inflammatory diseases with integrative medicine.