中医药学报

基于“承制自稳”探讨调枢治脘法辨治难治性胃食管反流病及Glu/GABA能神经元失衡机制

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张楠 ¹ , 王宏伟 ¹ , 方霜霜 ¹ , 韩明 ¹ , 郑沁薇 ¹ , 徐亭亭 ¹ , 朱生樑 ¹ , 倪红梅 ² , 方盛泉 ¹^,^*

中医药学报 | 临证体会 2026,54(10): 47-53

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中医药学报 |临证体会 2026 , 54 (10) : 47 -53

基于“承制自稳”探讨调枢治脘法辨治难治性胃食管反流病及Glu/GABA能神经元失衡机制

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张楠¹, 王宏伟¹, 方霜霜¹, 韩明¹, 郑沁薇¹, 徐亭亭¹, 朱生樑¹, 倪红梅², 方盛泉¹^,^*

作者信息

^1.上海中医药大学附属岳阳中西医结合医院消化内科，上海　200437

^2.上海中医药大学，上海　201203

通讯作者:

^* 方盛泉（1970-），男，博士，主任医师，教授，博士生导师，研究方向：中西医结合防治脾胃病。

作者简介:

张楠（1997-），男，博士研究生，研究方向：中西医结合防治脾胃病。

Discussion on the Imbalance of Glu/GABAergic Neurons in Refractory Gastroesophageal Reflux Disease and the Treatment Principle of “Regulating the Pivot and Treating the Epigastric Region” Based on the “Self-stabilization Function of Rehabilitation Mechanism”

Nan ZHANG¹, Hongwei WANG¹, Shuangshaung FANG¹, Ming HAN¹, Qinwei ZHENG¹, Tingting XU¹, Shengliang ZHU¹, Hongmei NI², Shengquan FANG¹^,^*

Affiliations

^1.Department of Gastroenterology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China

^2.Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China

出版时间: 2026-10-20 doi: 10.19664/j.cnki.1002-2392.260201

文章导航

摘要

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“承制自稳”是机体顺应生化和克制并存的运行规律，以及平衡-失衡-复衡的动态调整过程和维稳机制，可指导扭转亢害、防治疾病。内脏高敏感和精神心理问题在难治性胃食管反流病（rGERD）中发挥着重要作用，并受Glu/GABA能神经元失衡的调控。生理情况下，Glu与GABA能神经元相反相成，当二者之间生克制约及调控机制失常时，出现“承制失稳”，导致神经元微环境紊乱并促进内脏高敏感及本病的发生。基于此理论，本文探讨Glu/GABA能神经元失衡与rGERD“枢机不利，气机失调，郁虚犯脘”核心病机的内在联系，提出治疗rGERD的本质为协调枢机制衡关系，重在调枢、调气。临证以调枢治脘为治则，调肝胃枢机以降浊逆、调神明枢机以解郁结、益阳滋阴以助通润，使机体回归“承制自稳”状态，以期为rGERD临床治疗提供思路。

关键词

承制自稳 / 调枢治脘 / 难治性胃食管反流病 / Glu/GABA能神经元失衡 / E/I失衡

Abstract

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“Self-stabilization Function of Rehabilitation Mechanism” is the body's compliance with the operating law of biochemistry and restraint, as well as the dynamic adjustment process of balance-imbalance-rebalance and stabilizing mechanism, which can guide the reversal of hyperactivity and the prevention of disease. Psychosomatic problems and visceral hypersensitivity play an important role in refractory gastroesophageal reflux disease (rGERD) and are regulated by a key mechanism of Glu/GABAergic neuronal imbalance. Physiologically, Glu and GABAergic neurons are opposite and interact with each other, and when the birth-control and regulatory mechanisms between the two are malfunctioning, “Loss of Self-stabilization Function of Rehabilitation Mechanism” occurs, leading to neuronal micro-environmental disorders and promoting visceral hypersensitivity and the development of the disease. Based on this theory, this paper discusses the intrinsic connection between the imbalance of Glu/GABAergic neurons and the core mechanism of rGERD, which is “disorder of the pivot, dysregulation of qi, and stagnation and deficiency against the gastroesophageal”, and proposes that the essence of treating rGERD is to harmonize the balance relationship of pivot, with emphasis on regulating the pivot and qi. The treatment principle of “regulating the pivot and treating the epigastric region” is to adjust the pivot of the liver and stomach in order to lower the turbidity and rebelliousness, adjust the pivot of mind in order to resolve the depression, and benefit the yang and nourish the yin in order to help the smoothing and moisturizing as the treatment method, so as to make the body return to the state of “Self-stabilization”. We also summarize the relevant studies of TCM intervening in the imbalance of Glu/GABAergic neurons and restoring the E/I balance, which will provide new ideas for the clinical research and mechanism exploration of the combination of TCM and Western medicine in the prevention and treatment of rGERD.

Key words

Self-stabilization function of rehabilitation mechanism / Regulating pivot and treating the gastroesophageal / Refractory gastroesophageal reflux disease / Glu/GABAergic Imbalance / E/I imbalance

引用本文

张楠, 王宏伟, 方霜霜, 韩明, 郑沁薇, 徐亭亭, 朱生樑, 倪红梅, 方盛泉. 基于“承制自稳”探讨调枢治脘法辨治难治性胃食管反流病及Glu/GABA能神经元失衡机制. 中医药学报, 2026 , 54 (10) : 47 -53 . DOI: 10.19664/j.cnki.1002-2392.260201

Nan ZHANG, Hongwei WANG, Shuangshaung FANG, Ming HAN, Qinwei ZHENG, Tingting XU, Shengliang ZHU, Hongmei NI, Shengquan FANG. Discussion on the Imbalance of Glu/GABAergic Neurons in Refractory Gastroesophageal Reflux Disease and the Treatment Principle of “Regulating the Pivot and Treating the Epigastric Region” Based on the “Self-stabilization Function of Rehabilitation Mechanism”[J]. Acta Chinese Medicine and Pharmacology, 2026 , 54 (10) : 47 -53 . DOI: 10.19664/j.cnki.1002-2392.260201

基金

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国家重点研发计划项目(2024YFC3505303)
国家中医药管理局中西医协同旗舰科室建设项目
上海市进一步加快中医药传承创新发展三年行动计划（2025年-2027年）(1-1-2)
全国名老中医药专家传承工作室建设项目(国中医药人教函〔2022〕75号)
上海市中医药三年行动计划重点项目(ZY〔2021-2023〕-0302)
上海市级医院消化内科临床能力促进与提升专科联盟资助项目(SHDC22021311)
上海中医药大学附属岳阳中西医结合医院转化医学研究基金(2024YJJB14)
国家自然基金青年基金项目(82405248)

参考文献

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2026年第54卷第10期

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文章信息

doi: 10.19664/j.cnki.1002-2392.260201

接收时间：2025-04-08
首发时间：2026-10-14
出版时间：2026-10-20

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出版历史

收稿日期：2025-04-08
修回日期：2025-12-17

基金

国家重点研发计划项目(2024YFC3505303)

国家中医药管理局中西医协同旗舰科室建设项目

上海市进一步加快中医药传承创新发展三年行动计划（2025年-2027年）(1-1-2)

全国名老中医药专家传承工作室建设项目(国中医药人教函〔2022〕75号)

上海市中医药三年行动计划重点项目(ZY〔2021-2023〕-0302)

上海市级医院消化内科临床能力促进与提升专科联盟资助项目(SHDC22021311)

上海中医药大学附属岳阳中西医结合医院转化医学研究基金(2024YJJB14)

国家自然基金青年基金项目(82405248)

作者信息

^1.上海中医药大学附属岳阳中西医结合医院消化内科，上海　200437

^2.上海中医药大学，上海　201203

通讯作者:

^* 方盛泉（1970-），男，博士，主任医师，教授，博士生导师，研究方向：中西医结合防治脾胃病。

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2种不同金属材料的力学参数

科 Family	属数 Number of genus	种数 Number of species	占总种数比例 Percentage of total species (%)	属 Genus	种数 Number of species	占总种数比例 Percentage of total species (%)
鹅膏菌科Amanitaceae	2	11	5.26	鹅膏菌属 Amanita	10	4.78
小菇科 Mycenaceae	2	12	5.74	丝盖伞属 Inocybe	5	2.39
多孔菌科 Polyporaceae	8	14	6.70	蜡蘑属 Laccaria	5	2.39
红菇科 Russulaceae	3	23	11.00	小皮伞属 Marasmius	6	2.87
				小菇属 Mycena	11	5.26
				光柄菇属 Pluteus	5	2.39
				红菇属 Russula	17	8.13
				栓菌属 Trametes	5	2.39

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