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张敏, 陈尧, 马乐诗, 李萌, 谢壁元, 黄学武, 关洁珊.从“肝将脾卫”理论探讨原发性肝癌的病机演变规律及分期辨治[J].湖南中医药大学学报英文版,2026,46(8):1681-1685.[Click to copy
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| 从“肝将脾卫”理论探讨原发性肝癌的病机演变规律及分期辨治 |
| 张敏,陈尧,马乐诗,李萌,谢壁元,黄学武,关洁珊 |
| (广州中医药大学第一临床医学院, 广东 广州 510405;广州中医药大学第一附属医院, 广东 广州 510405;广东省中医临床研究院, 广东 广州 510405;深圳市中医肿瘤医学中心, 广东 深圳 518034;广州中医药大学深圳医院(福田)肿瘤科, 广东 深圳 518034;广东省第二中医院, 广东 广州 510095) |
| 摘要: |
| 原发性肝癌发病率高、起病隐匿、进展迅速，现代临床诊疗面临诸多局限。中医“肝将脾卫”理论强调肝主疏泄御邪、脾主运化固卫，二者协同护卫机体稳态，肝脾失调是原发性肝癌发生发展的核心病机。本文基于“肝将脾卫”理论阐释原发性肝癌之病机演变规律，结合肺脏宣降功能与卫气布散作用，提出本病病机呈现以肝郁脾弱、肺失宣发、癌毒暗生为始动之基，以肝旺脾败、灼肺生浊、癌毒成巢为演进之枢，以肝脾两虚、肺气衰败、癌毒留恋为终末之归的递进特征。据此确立肝脾肺同调、扶正祛邪、标本兼顾的核心治则，提出初期应疏肝健脾、宣肺固卫、御毒防变，中期宜泻肝扶脾、清肺化浊、散结消癌，晚期应补肝健脾、益气固肺、透邪托毒的分期辨治策略，以期为中医药防治原发性肝癌提供理论依据与临床新思路。 |
| 关键词: 原发性肝癌|肝将脾卫|癌毒|肺失宣降|肝脾肺同调 |
| DOI：10.3969/j.issn.1674-070X.2026.08.021 |
| Received:February 02, 2026 |
| 基金项目:广东省中医药局科研项目（20262017；20261419）；广州中医药大学校院联合科技创新基金（GZYFT2024Y10；GZYSE2024Y10）；广州中医药大学深圳医院（福田）科研专项（GZYSY2024016）。 |
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| Pathogenic progression and stage-based pattern differentiation and treatment of primary liver cancer based on the "liver as the general and spleen as the defender" theory |
| ZHANG Min, CHEN Yao, MA Leshi, LI Meng, XIE Biyuan, HUANG Xuewu, GUAN Jieshan |
| (First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510405, China;The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510405;Guangdong Clinical Research Academy of Chinese Medicine, Guangzhou, Guangdong 510405;Shenzhen Traditional Chinese Medicine Oncology Center, Shenzhen, Guangdong 518034;Department of Oncology, Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong 518034;Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou, Guangdong 510095) |
| Abstract: |
| Primary liver cancer is characterized by high incidence, insidious onset, and rapid progression, presenting considerable challenges to current clinical diagnosis and treatment. The theory of "liver as the general and spleen as the defender" in Chinese medicine emphasizes that the liver, which governs the free flow of qi, defends against pathogenic factors, while the spleen, which governs transformation and transportation, consolidates Wei-defensive qi. The two act synergistically to safeguard the body's homeostasis. Thus, the disharmony between the liver and spleen constitutes the core of the pathogenesis of primary liver cancer. Based on this theory, this paper elucidates the pathogenetic progression of primary liver cancer. Integrating the lung's functions of diffusing and descending with the distribution of Wei-defensive qi, this study proposes that the pathogenesis of this disease exhibits a progressive characteristic, unfolding in three sequential stages: the initial stage—characterized by liver qi stagnation and spleen weakness, failure of lung to diffuse upward and outward, and latent generation of cancer toxins as the initiating basis; the progressive stage—marked by liver hyperactivity and spleen decline, scorching lung involvement with turbidity formation, and the formation of cancer toxins as the pivotal transition; the terminal stage—defined by dual deficiency of the liver and spleen, deficiency of lung qi, and lingering cancer toxins as the final outcome. Accordingly, the core therapeutic principle of "harmonization of liver and spleen, reinforcing healthy qi to eliminate pathogenic factors, treating both the tip and root" is established. A stage-based pattern differentiation and treatment strategy is proposed: the initial stage involves soothing the liver and strengthening the spleen, dispersing the lung and consolidating Wei-defensive qi as well as warding off toxins and preventing transmission of the disease; the progressive stage involves clearing the liver fire and strengthening the spleen, clearing the lung heat and resolving turbidity as well as dissipating nodules and eliminating the cancerous growth; the terminal stage involves tonifying the liver and strengthening the spleen, tonifying qi and consolidating the lung as well as expelling pathogen and drawing out toxin. This study aims to provide a theoretical basis and novel clinical insights for the prevention and treatment of primary liver cancer with Chinese medicine. |
| Key words: primary liver cancer|liver as the general and spleen as the defender|cancer toxin|failure of lung to diffuse and descende|harmonization of liver, spleen, and lung |
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