| 引用本文: |
孙宝嵘, 侯爱画, 孟鹏, 李珊, 戴玲玲.基于叶天士“卫气营血”理论辨治肿瘤靶向药物相关毒性[J].湖南中医药大学学报,2026,46(3):569-575[点击复制] |
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| 基于叶天士“卫气营血”理论辨治肿瘤靶向药物相关毒性 |
| 孙宝嵘,侯爱画,孟鹏,李珊,戴玲玲 |
| (山东中医药大学, 山东 济南 250014;烟台市中医医院, 山东 烟台 264001) |
| 摘要: |
| 靶向药物在恶性肿瘤治疗中广泛应用，其引发的各类毒性作用已成为影响患者生活质量与治疗依从性的关键问题。本文基于清代医家叶天士“卫气营血”辨证理论体系，创新性地提出肿瘤靶向药物相关毒性当属“温热毒邪”致病的新观点。文章系统阐述该邪气沿卫、气、营、血分层次传变的病机规律：邪在卫分，郁闭肺卫，发为皮肤毒性；传入气分，壅滞中焦，表现为口腔黏膜与消化道毒性；深入营分，灼伤营阴，扰及心神，则见心脏毒性；陷于血分，耗竭肝肾精血，引动阴火，上灼下扰，乃成毛发与指甲毒性。据此构建相应的论治体系，以“分期辨治，扶正祛邪”为原则，分别立以辛凉透邪、清泻郁火、清瘀复脉、滋养肝肾等法，并附具体方药。 |
| 关键词: 肿瘤 靶向治疗 温热毒邪 卫气营血 药物毒性 分期辨治 |
| DOI：10.3969/j.issn.1674-070X.2026.03.018 |
| 投稿时间：2025-11-03 |
| 基金项目:国家中医药管理局科技司共建科技项目（GZY-KJS-SD-2023-017）；山东省名老中医药专家传承工作室（鲁卫函〔2019〕92号）；山东省中医药科技项目（M-2023096）；烟台市科技创新发展计划项目（2021MSGY050） 。 |
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| Differentiating and treating the toxicities of targeted tumor drugs based on YE Tianshi's "Wei-defense, qi, Ying-nutrients, and blood" Theory |
| SUN Baorong, HOU Aihua, MENG Peng, LI Shan, DAI Lingling |
| (Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250014, China;Yantai Hospital of Traditional Chinese Medicine, Yantai, Shandong 264001, China) |
| Abstract: |
| Targeted drugs are widely used in the treatment of malignant tumors, yet its induced toxicities have emerged as key issues affecting patients' quality of life and treatment adherence. Based on the "Wei-defense, Qi, Ying-nutrients, and Blood" pattern identification theory system of the Qing Dynasty physician YE Tianshi, this paper innovatively proposes that the toxicities associated with tumor-targeted drugs should be attributed to the "warm-heat toxic pathogens". The article systematically expounds the pathogenic mechanism of the pathogen's hierarchical transmission and transformation along the Wei-defense, qi, Ying-nutrients, and blood phases: When the pathogen is in the Wei-defense phase, it blocks the lung Wei-defense and manifests as skin toxicities; When the pathogen goes into the qi phase, it blocks the middle jiao, presenting as toxicities to the oral mucosa and digestive tract; If it penetrates in the Ying-nutrients phase, it consumes the yin part of Ying-nutrients, and disturbs the heart spirit, and the cardiotoxicity will be observed; Trapped in the blood phase, the pathogen depletes the essence and blood of the liver and kidneys, triggers yin fire, burns the upper part and disturbs the lower part, thus causing toxicities to the hair and nails. Based on the above, this article constructs a corresponding therapeutic system, adhering to the principle of "differentiating and treating in stages, reinforcing the healthy qi to eliminate the pathogenic factors", and respectively establishes therapies such as dispelling pathogenic factors with pungent and cool medicines, clearing and purging stagnant fire, resolving blood stasis and restoring vessel function, and nourishing the liver and kidneys, accompanied by specific formulas and medicines. |
| Key words: tumor targeted therapy warm-heat toxic pathogens Wei-defense, qi, Ying-nutrients, and blood drug toxicity differentiating and treating in stages |
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