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OA

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,stage-based 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.