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立足少阳少阴主枢理论，结合气火转变、阴阳更迭、正邪消长规律及免疫检查点抑制剂（ICIs）作用特性，系统阐释少阳少阴枢机动态演变规律，构建胃癌免疫治疗分期分阶段辨治框架。新辅助治疗期以少阳枢机不利、气火转枢失司为核心，兼见中焦虚寒邪滞；术后辅助治疗期以少阴之火亏虚、阴液亦损为主导，伴少阳余邪羁留、痰瘀阻络；晚期则以少阴枢机衰惫、浊毒闭窍、阴阳离决为危候，致邪毒炽盛、变证丛生。治疗当以调畅双枢为纲，新辅助治疗期枢启少阳、温运中焦；术后辅助治疗期枢清余邪，枢养少阴；晚期枢救少阴，启闭化浊。同时，在分期辨治基础上动态观察机体免疫状态及阶段变化，以促进免疫激活，防治免疫过激及耐药。
Abstract：Based on the theory that Shaoyang (少阳) and Shaoyin (少阴) function as the principal pivots, and integrating the laws of qi-fire transformation, yin-yang alternation, and the waxing and waning of healthy qi and patho-genic factors, as well as the action characteristics of immune checkpoint inhibitors(ICIs), this study systematically expounds the dynamic evolution laws of the Shaoyang and Shaoyin pivots and constructs a stage-and phase-based dif-ferentiation and treatment framework for gastric cancer immunotherapy. In the neoadjuvant treatment stage, the core pathogenesis is the dysfunction of the Shaoyang pivot and the disorder of qi and fire transformation, often accompa-nied by stagnation of cold-deficiency in the middle jiao (焦). In the postoperative adjuvant treatment stage, the domi-nant factors are the depletion of Shaoyin fire and the damage of yin fluid, accompanied by the lingering of residual pathogen in the Shaoyang level and the obstruction of collaterals by phlegm and stasis. In the advanced stage, the critical conditions are the exhaustion of the Shaoyin pivot, the blockage of orifices by turbid toxins, and the separation of yin and yang, leading to the rampant of pathogenic toxins and the emergence of various complicated syndromes. The treatment should be guided by the principle of regulating the double pivot. In the neoadjuvant treatment stage, it is recommended to activate the Shaoyang pivot and warm and promote the qi movement in the middle jiao. In the post-operative adjuvant treatment stage, clearing the residual pathogenic factors from the pivot and nourishing the Shaoyin. In the advanced stage, rescuing the Shaoyin pivot and opening the orifices to transform turbidity. Furthermore, stagebased treatment should serve as the foundation for dynamically assessing the patient's immune status and phase-specific changes in immunity, thereby promoting immune activation while preventing and managing immune overactivation and drug resistance.
[1]AJANI JA, D'AMICO TA, BENTREM DJ, et al. Gastric cancer, version 2. 2025, NCCN clinical practice guidelines in oncology[J]. J Natl Compr Canc Netw, 2025, 23(5):169-191.
[2]TAKEI S, KAWAZOE A, SHITARA K. The new era of immunotherapy in gastric cancer[J]. Cancers(Basel),2022, 14(4):1054.
[3]SHEN L, BAI Y, LIN X, et al. First-line(1L)nivolumab(NIVO)plus chemotherapy(chemo)vs chemo in patients(pts)with advanced gastric cancer, gastroesophageal junction cancer, and esophageal adenocarcinoma(GC/GEJC/EAC):5-year(y)follow-up of Chinese pts from CheckMate 649[J]. J Clin Oncol, 2025, 43:392. doi:10. 1200/JCO. 2025. 43. 4_suppl. 392.
[4]JING Y, YANG J, JOHNSON DB, et al. Harnessing big data to characterize immune-related adverse events[J].Nat Rev Clin Oncol, 2022, 19(4):269-280.
[5]SUN Q, LI S, LOU J, et al. Recent advances in tumour microenvironment impact immunotherapy resistance in gastric cancer[J]. Crit Rev Oncol Hematol, 2025, 215:104837. doi:10. 1016/j. critrevonc. 2025. 104837.
[6]陈希琦，解广东，荣宝海，等.中医药调控胃癌免疫细胞的研究进展[J].中国中西医结合外科杂志，2022,28(3):425-428.
[7]李杰，许博文，朱广辉，等.基于五期演变探讨扶正五法在肿瘤防治中的实践与创新[J].北京中医药大学学报，2023,46(3):321-325.
[8]谭滢，朱广辉，李杰，等.基于五期演变规律探讨“气阳郁闭”在肿瘤发生发展中的核心作用与临床辨治[J].北京中医药大学学报，2022,45(9):960-964.
[9]吴静远，朱潇雨，王新苗，等.从气火并治探讨恶性肿瘤免疫相关不良反应的防治[J].中医杂志，2024,65(16):1667-1672.
[10]邢艺萦，胡建鹏，李净.基于“胆气春升”理论探讨从胆论治慢性泄泻[J].环球中医药，2025,18(10):2158-2161.
[11]胡圣涓，冯利，孙韬，等.从朱丹溪“相火理论”探讨结直肠癌免疫治疗相关不良反应的辨治[J].环球中医药，2025,18(11):2387-2391.
[12]欧阳欢，程发峰，王雪茜，等.从少阳少阴主枢探讨郁证证治[J].北京中医药大学学报，2023,46(12):1637-1640.
[13]OLSZANSKI AJ. Principles of immunotherapy[J]. J Natl Compr Canc Netw, 2015, 13(5 Suppl):670-672.
[14]匡子禹，闫宁哲，刘可心，等.从免疫编辑角度探讨恶性肿瘤“虚-毒”互作病机及其辨治[J].中华中医药杂志，2024,39(12):6404-6408.
[15]徐泽宽，李沣员，吴昊.胃癌免疫治疗研究进展[J].中国实用外科杂志，2024,44(10):1109-1114.
[16]ANDRÉT, TOUGERON D, PIESSEN G, et al. Neoadjuvant nivolumab plus ipilimumab and adjuvant nivolumab in localized deficient mismatch repair/microsatellite instability-high gastric or esophagogastric junction adenocarcinoma:the GERCOR NEONIPIGA phaseⅡstudy[J]. J Clin Oncol, 2023, 41(2):255-265.
[17]RACHED L, LAPARRA A, SAKKAL M, et al. Toxicity of immunotherapy combinations with chemotherapy across tumor indications:current knowledge and practical recommendations[J]. Cancer Treat Rev, 2024, 127:102751.doi:10. 1016/j. ctrv. 2024. 102751.
[18]ADHIKARY S, PATHAK S, PALANI V, et al. Current technologies and future perspectives in immunotherapy towards a clinical oncology approach[J]. Biomedicines,2024, 12(1):217.
[19]李杭洲，肖相如.《伤寒论》中少阳与少阴主枢的关系[J].安徽中医学院学报，2011,30(1):1-2.
[20]夏超，段培蓓，杨丽萍，等. 463例胃癌化疗患者消化道症状群内前哨症状的多中心调查研究[J].实用临床医药杂志，2025,29(2):124-128,137.
[21]谭可欣.基于细胞间对话探究“滋燥养荣汤”治疗靶向药皮肤干燥的机制研究[D].北京：北京中医药大学，2024.
[22]中国抗癌协会胃癌专业委员会.免疫检查点抑制剂用于进展期胃癌围手术期治疗的中国专家共识（2024版）[J].中华消化外科杂志，2024,23(3):309-322.
[23]EMILOJU O, MIAO R, ALESE O. The evolving role of immunotherapy for gastroesophageal malignancies[J].Ann Surg Oncol,2025, 32(9):6884-6901.
[24]赵若含，李慧杰，李秀荣.基于“阳化气，阴成形”理论探讨晚期胃癌的中医辨治[J].中国中西医结合消化杂志，2022,30(8):595-597,607.
[25]MA H, ZHANG S, JIAO P, et al. Serum IL-6 predicts immunotherapy-related adverse and outcome in advanced gastric and esophageal cancer patients with Anti-PD-1treatment[J]. Front Immunol,2025,16:1553882. doi:10. 3389/fimmu. 2025. 1553882.
[26]李明，唐华勇，杨毅，等.中西医结合治疗慢性肝炎疗效观察[J].山西中医，2020,36(4):19-20.
[27]姜翠红，吕雨桐，赵志正.升陷汤对肺癌化疗所致肺脾气虚型癌因性疲乏患者生活质量和免疫功能的影响[J].中国医药导报，2022,19(25):10-14.
[28]陈雨乐，王颖.《黄帝内经》“气薄则发泄”新探[J].浙江中医药大学学报，2023,47(4):347-352.
[29]洪文文.香砂六君子汤对进展期胃癌化疗患者免疫功能的影响[D].南京：南京中医药大学，2018.
[30]CAI K, CAO XY, CHEN F, et al. Xianlian Jiedu Decoction alleviates colorectal cancer by regulating metabolic profiles, intestinal microbiota and metabolites[J].Phytomedicine, 2024, 128:155385. doi:10. 1016/j.phymed. 2024. 155385.
[31]许琦.中药防治皮肤免疫相关不良反应的疗效观察[J].中国实用医药，2022,17(5):177-179.
[32]葛媛莎，许博文，李杰.基于“五观辨治”体系论治胃“炎-癌”转化[J].中医杂志，2024,65(19):1988-1993.
[33]周红.继发于造血干细胞移植后的免疫缺陷与小柴胡汤的免疫调控[J].中医药研究，1999(1):4-6.
[34]FENG X, XUE F, HE G, et al. Banxia Xiexin Decoction inhibits the expression of pd-l1 through multi-target and multi-pathway regulation of major oncogenes in gastric cancer[J]. Onco Targets Ther, 2021,14:3297-3307.doi:10. 2147/OTT. S288442.
[35]宋晓彤.益气温阳解毒方调控肠道菌群-肿瘤微环境防治胃癌术后复发的机制研究[D].北京：中国中医科学院，2024.
[36]WANG Z, WU X. Study and analysis of antitumor resistance mechanism of PD1/PD-L1 immune checkpoint blocker[J]. Cancer Med, 2020, 9(21):8086-8121.
[37]ZHANG W, LU C, CAI S, et al. Aconiti lateralis radix praeparata as potential anticancer herb:bioactive compounds and molecular mechanisms[J]. Front Pharmacol,2022,13:870282. doi:10. 3389/fphar. 2022. 87028.
[38]余达，黄立萍，邵莉莉，等.升阳益胃汤化裁联合化疗治疗晚期胃癌的疗效观察及其对免疫功能的影响[J].中国中医药科技，2019,26(4):556-557.
[39]田津，叶佐玉，付丹丹，等.升阳益胃汤对慢性阻塞性肺疾病肺脾气虚证模型大鼠组织病理学及血清炎症因子、外周血Th17/Treg平衡的影响[J].中医杂志，2023,64(1):62-70.
基本信息:
DOI：10.13288/j.11-2166/r.2026.07.006
中图分类号:R273
引用信息:
[1]张文康,葛媛莎,刘可心,等.基于少阳少阴主枢理论探讨胃癌免疫治疗分期分阶段辨治思路[J].中医杂志,2026,67(07):730-735.DOI:10.13288/j.11-2166/r.2026.07.006.
基金信息:
国家重点研发计划（2023YFC3503300,2023YFC3503301,2023YFC3503302,2023YFC3503303,2023YFC3503304）; 中国中医科学院科技创新工程重大攻关项目（CI2021A01802）; 中央高水平中医医院临床科研业务费（HLCMHPP2023001,HLCMHPP2023097）; 福建省第三批柔性引进医疗卫生高层次人才团队
2026-04-02
2026-04-02