| 引用本文: |
徐晓颖, 石琦, 王裕颐, 赵峻.基于“水精四布”理论从肝脾肾论治食管癌的思路探析[J].湖南中医药大学学报,2026,46(7):1502-1506[点击复制] |
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| 基于“水精四布”理论从肝脾肾论治食管癌的思路探析 |
| 徐晓颖,石琦,王裕颐,赵峻 |
| (山西省中医药研究院(山西省中医院), 山西 太原 030012;中国医学科学院肿瘤医院, 北京 100021) |
| 摘要: |
| 食管癌（EC）属中医学“噎膈”范畴，其病位在食管，病机根本在于肝、脾、肾三脏功能失调，导致水液与精微物质输布失常，即水津不布。本应濡养周身之津液，反聚而为痰、为瘀、为毒，结于食管，日久成癌。本文基于《素问·经脉别论篇》“水精四布”理论，系统阐释肝失疏泄为始动因素，脾失健运为关键环节，肾精亏虚为终末根源，三脏功能失常层层递进，共同导致EC水津不布的核心病机演变。痰、瘀、毒互结阻于食管，与肿瘤微环境炎症、水液代谢紊乱及免疫失调等现代病理过程相契合。据此提出EC分期论治：初期疏肝调气以通水道，中期健脾助运以绝痰源，晚期温肾化气以布水精，三脏同治、攻补兼施，旨在恢复“水精四布”之常。 |
| 关键词: 食管癌|噎膈|水精四布|肝脾肾同调|药对 |
| DOI：10.3969/j.issn.1674-070X.2026.07.026 |
| 投稿时间：2026-01-09 |
| 基金项目:山西省中医药管理局项目（2022ZYYC003，2025ZYYA001）。 |
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| Therapeutic approach for esophageal cancer from the liver, spleen, and kidney based on the "fluid-essence distribution" theory |
| XU Xiaoying, SHI Qi, WANG Yuyi, ZHAO Jun |
| (Shanxi Academy of Traditional Chinese Medicine (Shanxi Provincial Hospital of Traditional Chinese Medicine), Taiyuan, Shanxi 030012, China;Cancer Hospital of Chinese Academy of Medical Sciences, Beijing 100021, China) |
| Abstract: |
| Esophageal cancer (EC) falls under the category of "dysphagia" in TCM. Although the disease is located in the esophagus, its fundamental pathogenesis lies in the dysfunction of the liver, spleen, and kidney, which leads to abnormal distribution of body fluids and essential substances—that is, the failure of fluid-essence to spread properly. The body fluids that should have nourished the whole body instead accumulate to form phlegm, stasis, and toxin, which coalesce in the esophagus and over time develop into cancer. Based on the theory of "fluid-essence distribution" from the chapter of Special Discussion on Meridians and Vessels in Su Wen (Plain Questions), this paper systematically elucidates the progressive core pathogenesis of dysfunction in the liver, spleen, and kidney—with liver failing in governing the free flow of qi as the starting factor, spleen failing in transportation and transformation as the critical link, and kidney essence deficiency as the ultimate root—collectively leading to the failure of fluid-essence distribution. The intermingling of phlegm, stasis, and toxins obstructing the esophagus aligns with modern pathological processes such as tumor microenvironment inflammation, fluid metabolism disorders, and immune dysregulation. Accordingly, a stage-based treatment strategy is proposed: in the early stage, soothe the liver and regulate qi to unblock the waterways; in the middle stage, strengthen the spleen and promote transportation to eliminate the source of phlegm; in the late stage, warm the kidney and promote qi transformation to distribute fluid and essence. By treating the three zang-organs in coordination and reinforcing healthy qi and removing pathogenic factors simultaneously, the aim is to restore the normal state of "fluid-essence distribution." |
| Key words: esophageal cancer|dysphagia|fluid-essence distribution|simultaneous regulation of liver, spleen, and kidney|medicinal pair |
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