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甘润濡养法治疗食管癌的中医新思路理论构建及现代诠释

A NovelTraditional Chinese Medicine Approach for Esophageal Cancer: Theoretical Construction and Modern Interpretation of the Sweet-Moistening and Nourishing Therapy

  • 摘要: 本文基于李晶教授对中医经典溯源以及数十年的临床经验总结,创新性地提出“胃脘干槁,血液俱耗”是贯穿食管癌全程的核心病机。该理论认为,食管癌始于津伤所致的胃脘干槁,形成津伤-液损-血亏-精耗的动态演变特征并最终导致恶病质。据此创立了甘润濡养治疗法则及分期方药体系,涵盖了甘凉生津到补髓填精,并配以相应的方药。并从现代生物学视角对该理论进行系统诠释,胃脘干槁对应肿瘤微环境局部稳态破坏,包括细胞间隙连接减弱、微丝骨架重排、上皮间质化、巨噬细胞极化及肠道菌群失调;血液俱耗对应全身性代谢紊乱与免疫抑制,涉及糖代谢重编程、体液比例下降、氨基酸代谢异常、系统性炎症与营养耗竭;甘润濡养法通过稳定细胞连接、阻断Gas6/Axl-NF-κB轴、改善免疫抑制、纠正代谢紊乱及调控菌群-代谢物-免疫轴等多靶点途径,实现清热润燥以治标、养血填精以固本的标本同治,为食管癌中西医结合治疗提供了理论依据。

     

    Abstract: Based on Professor Li Jing's exploration of traditional Chinese medicine (TCM) classics and decades of clinical experience, this paper innovatively proposes that "dryness and depletion of the stomach and esophagus with concurrent consumption of blood and essence" constitutes the core pathogenesis throughout the entire course of esophageal cancer. According to this theory, esophageal cancer originates from stomach-esophageal dryness and depletion caused by fluid damage, subsequently evolving through a dynamic progression of fluid impairment-humor depletion-blood deficiency-essence exhaustion, ultimately leading to cachexia. On this basis, the Sweet-Moistening and Nourishing (Ganrun Ruyang) therapeutic principle and a staged prescription system were established, encompassing strategies from producing fluids with sweet-cool medicinals to supplementing the marrow and replenishing essence, matched with corresponding formulas. This theory is further systematically interpreted from the perspective of modern biology: "stomach-esophageal dryness and depletion" corresponds to local homeostatic disruption in the tumor microenvironment (TME), including weakened gap junctions, microfilament cytoskeleton rearrangement, epithelial-mesenchymal transition (EMT), macrophage polarization, and gut microbiota dysbiosis; "concurrent consumption of blood and essence" corresponds to systemic metabolic disorder and immunosuppression, involving glycolytic reprogramming, decreased body fluid proportion, abnormal amino acid metabolism, systemic inflammation, and nutritional depletion. The Sweet-Moistening and Nourishing therapy achieves the principle of simultaneously treating the symptoms by clearing heat and moistening dryness while consolidating the root by nourishing blood and replenishing essence, through multi-target approaches such as stabilizing cell junctions, blocking the Gas6/Axl-NF-κB axis, ameliorating immunosuppression, rectifying metabolic disturbances, and modulating the microbiota-metabolite-immune axis. This provides a theoretical foundation for the integrated traditional Chinese and Western medicine treatment of esophageal cancer.

     

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