| 摘要: |
| 放射性口腔黏膜炎是严重影响头颈部肿瘤放疗患者生存质量及治疗进程的常见并发症，现代医学暂无特效治疗手段。中医学辨治多从“热毒伤阴”立论，但未系统阐述中焦脾胃及气机升降过程在该疾病中的重要性。文章以肺、肝、脾胃为代表的“左升右降”理论为切入点，系统剖析放射性口腔黏膜炎的深层病机并拓展其辨治思路。提出“中焦脾胃虚损为本，气机升降逆乱为标”的核心病机：放疗火热毒邪不仅直接灼伤阴津，更致脾胃虚弱；中轴失运，则肝气左升不及，影响情志疏泄，肺气右降无权，携热上逆，故见口咽燥渴，红肿热痛，终致气滞血瘀、黏膜失养溃烂。因此，治疗关键在于以健运脾胃、斡旋中焦为枢轴，辅以轻宣升散助肝气条达，肃降敛肺引火热下行。基于对古今验方与当代肿瘤名家辨治思路的梳理分析，该研究旨在构建一个以恢复“左升右降”为核心的中医辨治理论框架，从而为提升中医药防治放射性口腔黏膜炎的临床疗效提供理论参考。 |
| 关键词: 放射性口腔黏膜炎 左升右降 病因病机 辨治思路 |
| DOI： |
|
|
| Syndrome differentiation and treatment of radiation-induced oral mucositis based on the theory of “left ascending and right descending” |
| TAN Kexin,CHEN Jiaming,HAN Chen,CHEN Jian,LIANG Hui,TAN Ying |
| (Hunan Cancer Hospital，Changsha 410003，Hunan，China;Hunan University of Chinese Medicine，Changsha 410208，Hunan，China;Hunan Academy of Chinese Medicine，Changsha 410003，Hunan，China) |
| Abstract: |
| Radiation-induced oral mucositis is a common complication that severely affects the quality of life and treatment process of patients undergoing radiotherapy for head and neck tumors，and there is still a lack of effective treatment measures in modern medicine. Traditional Chinese medicine （TCM） syndrome differentiation and treatment are often based on the theory of “heat toxin damaging Yin”，without systematically elaborating on the importance of the middle Jiao spleen-stomach system and the process of ascending and descending of Qi movement in this disease. Starting from the theory of “left ascending and right descending” represented by the lung，liver，and spleen-stomach，this article explores the deep pathogenesis of radiation-induced oral mucositis，expands the thinking of syndrome differentiation and treatment，and proposes the core pathogenesis of “deficiency of the middle Jiao spleen-stomach as the root cause and reversal and disorder of the ascending and descending of Qi movement as the manifestation”. The key to treatment lies in strengthening the spleen and stomach and regulating the middle Jiao as the pivot，supplemented by mildly dispersing and promoting herbs to help liver Qi flow smoothly and clearing and descending the lung to guide fire-heat downward. Based on the analysis of ancient and modern empirical prescriptions and the syndrome differentiation and treatment methods of contemporary famous TCM oncologists，this study constructs a theoretical framework of TCM syndrome differentiation and treatment centered on restoring “left ascending and right descending”，in order to provide a theoretical reference for improving the clinical efficacy of TCM in the prevention and treatment of radiation-induced oral mucositis. |
| Key words: radiation-induced oral mucositis left ascending and right descending etiology and pathogenesis syndrome differentiation and treatment approaches |
