| 引用本文: |
刘沛恬, 黄贵华, 邓澳林, 聂峰, 陈竣桦, 张子晨, 朱明源.基于“痞坚之处，必有伏阳”理论探讨慢性萎缩性胃炎“炎癌转化”与防治[J].湖南中医药大学学报,2026,46(6):1165-1170[点击复制] |
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| 基于“痞坚之处，必有伏阳”理论探讨慢性萎缩性胃炎“炎癌转化”与防治 |
| 刘沛恬,黄贵华,邓澳林,聂峰,陈竣桦,张子晨,朱明源 |
| (广西中医药大学, 广西 南宁 530200;广西中医药大学第一附属医院, 广西 南宁 530022) |
| 摘要: |
| 慢性萎缩性胃炎作为常见的胃癌前疾病，其“炎癌转化”的病理机制尚未完全阐明，是现代医学面临的重大挑战。“痞坚之处，必有伏阳”理论源自尤在泾《金匮要略心典·痰饮咳嗽病脉证并治第十二》，该理论指出有形阴邪聚集形成“痞坚”，阻滞气机，郁遏阳气，形成“伏阳”，继而进一步加重“痞坚”的病理状态。本文基于“痞坚之处，必有伏阳”理论，结合慢性萎缩性胃炎“炎癌转化”的病理机制，深入探讨其动态病机，并提出分期论治思路：伏阳失固、脾虚卫弱、邪毒内侵者，治以温阳建中、培元固本，方选黄芪建中汤加减；伏阳化浊、阳不化气、痰瘀胶结者，治以助阳化气、涤痰消萎，方选苓桂术甘汤加减；伏阳郁火、气郁化火、灼伤胃络者，治以疏阳散郁、泻火化瘀，方选半夏泻心汤合失笑散加减；伏阳化毒、痰瘀毒聚、正虚毒发者，治以扶阳解毒、养阴散结，方选益胃汤加减。 |
| 关键词: 慢性萎缩性胃炎 炎癌转化 胃癌 痞坚之处，必有伏阳 辨证论治 |
| DOI：10.3969/j.issn.1674-070X.2026.06.010 |
| 投稿时间：2025-12-12 |
| 基金项目:广西科技基地和人才专项（桂科AD19245168）；黄贵华桂派中医大师培养项目（桂中医药科教发〔2024〕1号）；国医大师黄瑾明学术思想与临床诊疗传承发展推广中心建设项目（桂中医大党〔2022〕24号）；黄贵华广西名中医传承工作室项目（桂卫中医发〔2017〕2号）。 |
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| Prevention and treatment of “inflammation-cancer transformation” in chronic atrophic gastritis base on the theory of “Where there is a painful hard mass, there must be latent yang” |
| LIU Peitian, HUANG Guihua, DENG Aolin, NIE Feng, CHEN Junhua, ZHANG Zichen, ZHU Mingyuan |
| (Guangxi University of Chinese Medicine, Nanning, Guangxi 530200, China;The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi 530022, China) |
| Abstract: |
| Chronic atrophic gastritis (CAG) is a common precancerous condition that can progress to gastric cancer. However, the pathological mechanisms underlying its "inflammation-cancer transformation" remain not fully elucidated and constitute a major challenge in modern medicine. The TCM theory of "Where there is a painful hard mass, there must be latent yang" originated from the chapter "Phlegm-Fluid and Cough" in YOU Zaijing's Jin Gui Yao Lue Xin Dian (Personal Standards for the "Essentials from the Golden Cabinet"). This theory posits that the accumulation of tangible yin pathogens forms a "painful hard mass," which obstructs qi movement and suppresses yang qi, thereby generating "latent yang," and this in turn further aggravates the pathological state of the painful hard mass. Based on the theory of "Where there is a painful hard mass, there must be latent yang," and in conjunction with the pathological mechanism of "inflammation-cancer transformation" in CAG, this article deeply explores the dynamic pathogenesis and proposes a stage-based treatment approach: for cases with insecure latent yang, spleen deficiency with weak defensive qi, and invasion of pathogenic toxins, the treatment is to warm yang and strengthen the spleen, consolidate the primordial foundation and strengthen the body, with the modified Huangqi Jianzhong Decoction as the formula of choice. For cases with latent yang transforming into turbidity, yang failing to transform qi, and intermingling of phlegm and blood stasis, the treatment is to assist yang in transforming qi, eliminate phlegm and reduce atrophic lesions, with the modified Linggui Zhugan Decoction. For cases with latent yang stagnated and transforming into fire, qi stagnation evolving into fire that burns the stomach collaterals, the treatment is to disperse yang and relieve stagnation, reduce fire and resolve stasis, with the modified Banxia Xiexin Decoction combined with Shixiao Powder. For cases with latent yang transforming into toxin, accumulation of phlegm, stasis and toxin, and healthy qi deficiency initiating toxin outburst, the treatment is to support yang and remove toxin, nourish yin and dissipate masses, with the modified Yiwei Decoction. |
| Key words: chronic atrophic gastritis inflammation-cancer transformation gastric cancer Where there is a painful hard mass,there must be latent yang pattern differentiation and treatment |
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