Evolution of qi transformation and staged differentiation and treatment of radiation injury based on the opening-closing-pivoting theory

Radiation injury is a common complication of tumor radiotherapy (referred to as "radiotherapy"), and its pathogenesis is complex. The traditional approach based on heat-toxin damaging yin fails to fully encompass the dynamic process of its transformation from functional disorder to structural damage. Based on the opening-closing-pivoting theory from the Huangdi Neijing, this paper systematically explores the evolution of pathogenesis of radiation injury throughout its cycle. The invasion of radiation fire-toxin into the human body disrupts the qi transformation of the three yin and three yang, leading to a pathological state characterized by the "impaired opening and failed pivoting". In the early stage, the Taiyang fails to open and the Taiyin fails to distribute, treatment focuses on regulating the opening mechanism and expelling pathogens. In the middle stage, the Shaoyang pivot stagnates, and the Yangming fails to close, treatment aims to rotate the pivot and clear moistening to preserve fluids, emphasizing the combined use of moistening and unblocking to prevent dryness-transformation. In the late stage, the failure of the Shaoyin pivot and the Jueyin close mechanism leads to internal dry blood accumulation and substantial and structural damage, treatment focuses on nourishing essence and marrow while resolving stasis to restore the close function. By integrating the theoretical essence of the opening-closing-pivoting theory with the pathogenic characteristics of radiotherapy, this study explores the evolutionary patterns of radiation injury to provide novel insights for its precise differentiation and treatment.