古典医学洞察与现代癌症—慢性炎症模型的理论对接
王嘉驹 - Ka Kui Wong
值得注意的是，上述系统性疾病演化的认识，并非现代医学的全新发现。在出土于四川成都的《天回医简》中，《脉书·下经·病之变化篇》已对外源性致病因素所引发的长期病理演化作出高度概括性的描述：
“凡风者，百病之长也。虽已变化为它病，犹有风气之作也。此皆阴气之属也，同产而异分，故众人弗能别也。凡风之始产业，皆有大分，至其变化，则无常方矣。凡病久则变化，化则通，通则难辩也。”
若将此处之“风”限定为外风，并以现代医学视角重新诠释，其所指可合理对应来自外环境的生物性致病因子（病毒、细菌、真菌等）。扁鹊（或其医学传统）在此清楚指出：外源性致病因素在疾病初起阶段具有较高的可识别性，但随着时间推移，其病理影响会转化并渗透进机体的整体调控系统之中，形成跨系统、跨层级的慢性病理状态。
这一描述，与现代医学所提出的**“慢性炎症作为癌症及多种慢性疾病共同驱动力”的理论框架高度一致**。当急性感染转化为持续、低度、不可完全关闭的炎症反应时，疾病不再由单一病因主导，而是进入由免疫失衡、组织反复修复、基因损伤累积及微环境重塑共同推动的长期演化轨道。正是在这一阶段，疾病表现“同源异病、异病难辨”，其病因溯源亦变得极为困难。
从这一角度看，《天回医简》中《脉书》的相关论述，实可视为现代癌症—慢性炎症模型与系统医学疾病演化理论的早期思想原型，其价值不在于具体病名的对应，而在于对疾病时间维度与系统层级演化的深刻洞察。
现代科学所补上的，是分子机制；《天回医简》已经给出了疾病演化的系统框架。
一、胃癌：外风之“始有大分”，至久则“化而难辨”
在胃癌的发生机制中，幽门螺旋杆菌（Helicobacter pylori） 是最清楚体现《脉书》“风之始产业，皆有大分”这一阶段性特征的例子。
在感染早期，幽门螺旋杆菌作为明确的外源性生物致病因子，其病理作用具有高度可识别性：局限于胃黏膜，表现为急、慢性胃炎，病因、病位与病理过程相对清晰，正对应《脉书》所言“始有大分”。
然而，随着感染迁延，部分患者即便细菌负荷下降，甚至已不再检测到明显感染，其胃部仍持续处于低度、反复的炎症与修复状态之中。此时，疾病的驱动力已不再是单纯的细菌存在，而是由其长期激发的慢性炎症、免疫失衡、黏膜修复障碍及基因损伤累积所共同维持。
这一阶段，胃癌的发生已符合《脉书》所述“虽已变化为它病，犹有风气之作也”。病名由“感染”转化为“肿瘤”，但其系统病机仍深植于早期外风所留下的慢性病理轨迹之中。
二、结直肠癌：同产而异分的典型系统表达
结直肠癌最能体现《脉书》所说的**“同产而异分”**。
在现代研究中，多种肠道细菌（如梭状杆菌、脆弱拟杆菌、特定毒性大肠杆菌）可作为外源性或半外源性刺激因素，长期激活肠道免疫系统。这些刺激在初期多表现为肠道不适、腹泻、腹胀或炎症性肠病，病理过程仍具有相对明确的局部特征。
但随着时间推移，持续的免疫激活、炎症信号放大、氧化压力增加以及DNA损伤修复失败，使病理过程逐渐突破局部边界，进入系统层面的失衡状态。
此时，来自同一外源刺激起点的病理演化，可分化为多种临床表现：慢性肠炎、肠躁症、腺瘤形成，乃至结直肠癌本身。这正对应《脉书》所言“同产而异分，故众人弗能别也”——同一源头，在系统演化中分化为多种疾病形态，最终难以以单一病因重新归类。
三、乳癌：外风不在局部，而经系统“通而化之”
乳癌与前两者不同，其外风并非直接作用于乳腺局部，而是通过肠道—内分泌—免疫系统通路完成其病理演化，这正是《脉书》“化则通，通则难辩”的典型例证。
现代研究表明，肠道菌群深度参与雌激素代谢。当肠道菌相因外源性刺激（感染、抗生素、饮食失衡等）发生长期失调时，部分细菌可重新活化原本应被排出的雌激素，使其再次进入全身循环。
这种改变并不表现为明确的感染性疾病，却会在系统层面造成长期激素暴露增加、低度慢性炎症上调及组织增生信号偏移。最终，乳腺组织在这一系统性背景下，逐步进入癌变高风险状态。
在此过程中，“风”早已不见其形，却通过系统联通路径持续发挥作用，完全符合《脉书》对慢性病机演化的描述。
结语
从胃癌的局部感染起点，到结直肠癌的多路径分化，再到乳癌的系统性远程演化，《天回医简·脉书》所揭示的，并非具体病名，而是外风触发—系统转化—慢性病机锁定的普遍疾病动力学。
Classical Medical Insight as a Theoretical Prototype of the Modern Cancer–Chronic Inflammation Model
It is important to recognize that the systems-level understanding of disease evolution outlined above is not a purely modern construct. In the Tianhui Medical Bamboo Manuscripts (天回医简), specifically in Maishu · Lower Canon · On Disease Transformation, an early medical tradition articulated a remarkably prescient account of the long-term consequences of external pathogenic influences:
“Wind is the origin of many diseases.
Even when it has transformed into other diseases, the influence of wind still operates.
These all belong to the yin domain; they arise from the same source but diverge in manifestation,
which is why most people cannot distinguish them.
At the beginning of wind-induced disease, there are clear distinctions;
but once transformation occurs, there is no fixed pattern.
When disease persists over time, it transforms; once transformed, it becomes interconnected,
and when interconnected, it becomes difficult to differentiate.”
When “wind” in this passage is interpreted specifically as external wind, it can be reasonably mapped onto exogenous biological agents in modern medicine, including viruses, bacteria, and fungi. This text clearly recognizes that while external pathogenic factors are readily identifiable in the acute phase of disease, their pathological influence becomes increasingly embedded within the host’s regulatory systems over time.
This insight closely parallels the modern cancer–chronic inflammation paradigm, in which acute infection transitions into persistent, low-grade inflammatory signaling that is no longer pathogen-dependent but system-maintained. At this stage, disease progression is driven not by a single causal agent, but by prolonged immune dysregulation, repeated tissue repair, cumulative genomic damage, and microenvironmental remodeling.
Viewed through this lens, the discussion in the Maishu may be understood as an early theoretical prototype of contemporary systems medicine. Its significance lies not in naming specific diseases, but in recognizing that chronic illness—and cancer in particular—emerges from long-term, multi-system pathological evolution initiated by external biological disturbances.
Gastric Cancer Mapping
Gastric cancer provides one of the clearest modern parallels to the Maishu description that “wind initially presents with clear distinctions, but becomes difficult to differentiate after transformation.”
In the early phase, Helicobacter pylori infection represents a well-defined external pathogenic factor, with pathology localized to the gastric mucosa and presenting as acute or chronic gastritis. Etiology, disease location, and progression remain relatively distinct, corresponding to the Maishu notion of “clear differentiation at the beginning.”
As infection persists, however, the pathological driver gradually shifts. Even when bacterial load decreases or active infection is no longer detectable, chronic low-grade inflammation, impaired mucosal repair, immune dysregulation, and cumulative DNA damage continue to shape the gastric microenvironment. At this stage, carcinogenesis is sustained by system-level pathological memory rather than direct microbial presence.
This transition exemplifies the principle that “even after transformation into another disease, the influence of wind still operates,” with cancer emerging as a downstream manifestation of long-standing inflammatory imprinting.
Colorectal Cancer Mapping
Colorectal cancer exemplifies the Maishu principle of “common origin with divergent manifestations.”
Multiple gut bacteria—such as Fusobacterium nucleatum, Bacteroides fragilis, and toxin-producing Escherichia coli—serve as persistent immunological stimuli within the intestinal environment. In early stages, these stimuli often present as localized gastrointestinal symptoms or inflammatory bowel conditions with identifiable pathological features.
Over time, sustained immune activation, amplified inflammatory signaling, oxidative stress, and impaired DNA repair mechanisms drive disease progression beyond localized pathology. The same initiating stimulus can diverge into multiple clinical outcomes, including chronic enteritis, irritable bowel syndromes, adenomatous changes, and ultimately colorectal cancer.
This divergence reflects the phenomenon described in the Maishu: conditions arising from the same source become increasingly difficult to distinguish once systemic transformation has occurred.
Breast Cancer Mapping
Breast cancer illustrates a distinct yet fully consistent application of the Maishu concept that “once transformation occurs, processes become interconnected, and differentiation becomes difficult.”
Here, the external pathogenic influence does not act directly on breast tissue. Instead, long-term gut microbial dysbiosis—often initiated by external environmental factors—alters estrogen metabolism. Certain gut bacteria reactivate estrogens otherwise destined for excretion, increasing systemic hormonal exposure.
This shift does not present as an overt infectious disease, yet it induces persistent low-grade inflammation and proliferative signaling across multiple systems. Over time, breast tissue becomes embedded within this altered systemic regulatory environment, increasing carcinogenic risk.
Thus, the pathogenic “wind” no longer manifests locally, but continues to exert influence through interconnected metabolic and immune pathways, exemplifying the principle that disease becomes difficult to trace once systemic integration has occurred.
Conclusion
Across gastric, colorectal, and breast cancer, the Maishu does not describe specific diseases, but a universal disease dynamic: external pathogenic initiation, systemic transformation, and long-term pathological imprinting.
Reference Note
主要综述来源：
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Ramadan YN, Alatawi MN, Albalawi AS, et al. Bacterial contributions to cancer development: mechanisms, dysbiosis, and cross-cancer associations. Infectious Agents and Cancer. 2026; DOI: 10.1186/s13027-025-00722-7 (Open Access).
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