Etiology, pathogenesis, and syndrome differentiation and treatment of "pan-nodules" based on the "qi circular flow" theory

"Pan-nodules" refer to the comorbidity phenomenon in which multiple organ nodules, such as thyroid nodules, breast nodules, and uterine fibroids, occur simultaneously or successively, which is commonly observed in women of childbearing age. The specialized diagnostic and treatment model of Western medicine often fails to account for nodules across multiple systems, leading to treatment plans that are prone to conflict. Moreover, benign nodules still have the risk of malignancy, and long-term follow-up and surgical intervention can lead to increased physical and mental burdens on patients. The difficulty in its treatment lies in the widespread distribution of nodules, the complex pathogenesis, and the tendency to recur. Traditional Chinese medicine classifies them as distinct diseases and treats them separately in different specialties. Based on the "qi circular flow" theory of HUANG Yuanyu, a renowned physician of the Qing Dynasty, this study proposes that the core etiology and pathogenesis of "pan-nodules" are the deficiency and decline of the spleen earth in the middle jiao, the dysfunction of the pivot, the disorder of the ascending and descending of the liver and lungs, and the obstruction of the meridians with phlegm turbidity and blood stasis along with qi, resulting in visible nodules. The clinical classification of "pan-nodules" is primarily characterized by spleen deficiency with phlegm-dampness, liver depression with qi stagnation, and the interplay of phlegm and blood stasis. Based on this, a "different diseases treated in the same way" diagnosis and treatment system was proposed, with the fundamental principle of "turning the pivot and restoring its circulation." The priority is to increase the middle to eliminate the source of phlegm, then soothe the wood and consolidate the metal to smooth the flow of qi, and finally dissolve phlegm and remove blood stasis to disperse the nodules. Clinical practice should follow the menstrual cycle of women and carefully weigh the selection of blood-activating drugs for patients of childbearing age. It aims to systematically regulate the overall qi movement, improve the environment for the growth of nodules from the source, provide a systematic approach for preventing and treating "pan-nodules" in traditional Chinese medicine, avoid surgical intervention and recurrence risks, and achieve the clinical goal of "preventing the progression of existing diseases and preventing diseases before they occur."