摘要
在艾滋病诊疗领域,免疫重建不良(INR)仍是亟待破解的重大临床难题。其发病机制尚未完全阐明,中医对其病机的认识仍未形成统一共识,导致临床干预面临多重挑战。基于中医理论与临床实践,本文提出“邪伏肠络”理论,阐释其核心病机为人类免疫缺陷病毒、抗逆转录病毒治疗药物毒性,以及内生湿、痰、瘀等实邪,因正气亏虚(尤以脾虚为基)伏藏于肠络,引发“正虚邪实、络脉阻滞”的病理状态。针对“邪伏肠络”的致病特点,提出三大治疗策略。攻毒透邪,扶正补虚,针对伏邪核心的靶向干预;调肠固屏,减毒增效,发挥中医药调节肠道微生态与黏膜免疫的优势,减轻抗逆转录病毒治疗药物毒性,改善肠-免疫轴紊乱,增强免疫重建效率。健脾调肠,通络祛邪,实现“脏腑同治”。“邪伏肠络”理论整合中医伏邪学说、络病理论与现代肠道菌群-免疫调节研究,丰富INR的中医病机阐释,为INR的诊疗提供新思路。
Immunological non-responder(INR)is still a major clinical problem in the field of acquired immune deficiency syndrome diagnosis and treatment.The pathogenesis of INR has not been fully elucidated,there is no unanimous consensus on its pathogenesis in traditional Chinese medicine,which leads to multiple challenges in clinical intervention.Based on Chinese medicine theory and clinical practice,this article proposes the theory of“evil ambush in intestine collateral”,which explains that the core pathogenesis of INR is human immunodeficiency virus,drug toxicity of antiretroviral therapy,and internal dampness,phlegm,stasis and other solid evils,which are hidden in intestine collateral due to deficiency of vital qi(especially based on spleen deficiency),triggering pathological state of“deficiency of positive energy and excess of evil energy,blockage of collaterals”.In view of pathogenic characteristics of“evil ambush in intestine collateral”,three major treatment strategies are proposed.Attacking poison and penetrating evil,supporting body and tonifying deficiency,targeting intervention for the core of hidden pathogen;regulating intestines and fixing screen,reducing toxicity and increasing effectiveness,giving full play to the advantages of Chinese materia medica in regulating gut microbiota and mucosal immunity,reducing drug toxicity of antiretroviral therapy,improving the disorders of gut-immune axis,and enhancing the efficiency of immune reconstruction.Strengthening spleen and regulating intestines,dredging channels and eliminating evils,and realizing“simultaneous treatment of zang fu viscera”.The theory of“evil ambush in intestine collateral”integrates the theory of Chinese medicine hidden pathogen,the theory of collateral disease,and modern research on intestinal flora-immune regulation,which enriches the interpretation of Chinese medicine mechanism of INR,and provides new ideas for the diagnosis and treatment of INR.
作者
赵泰龙
陈守生
李鹏宇
郭会军
ZHAO Tailong;CHEN Shousheng;LI Pengyu;GUO Huijun(The First Clinical Medical College,Henan University of Chinese Medicine,Henan Province,Zhengzhou 450046,China;Ai Research Center,the First Affiliated Hospital of Henan University of Chinese Medicine,Henan Province,Zhengzhou 450000,China)
出处
《中国医药导报》
2025年第24期112-115,120,共5页
China Medical Herald
基金
国家自然科学基金资助项目(82274474)
河南省科技研发计划联合基金项目(232301420074)
河南省国家中医药传承创新中心科研专项项目(2023ZXZX1059)
河南省医学科技攻关计划项目(LHGJ20230678)。
关键词
艾滋病
免疫重建不良
伏邪
肠络
病机
治疗思路
Acquired immune deficiency syndrome
Immunological non-responders
Hidden pathogen
Intestine collateral
Pathogenesis
Treatment ideas
