摘要
肝细胞癌(hepatocellular carcinoma,HCC)是全球高发病率、高致死率的恶性肿瘤,其发生与慢性肝损伤、炎症微环境失衡及纤维化进展密切相关。基于中医学“痞坚之处,必有伏阳”与“肝体阴而用阳”理论,笔者提出HCC的核心病机为肝阴亏虚致疏泄失常,痰瘀湿浊结聚肝络形成“痞坚”,气机闭遏则阳气郁而化火成“伏阳”。伏阳初起驱动肝脏慢性炎症;伏阳炽盛加速痰瘀互结,促成肝纤维化及肝硬化;伏阳化毒终致癌毒内生,耗竭真阴而癌变。针对HCC发展的三阶段病理特征,提出分阶段防治策略,炎症期以“疏肝透热、护阴利湿”化伏阳,防郁热化火;纤维化期以“软坚散结、清热解毒”消痞坚,兼透热存阴;癌变期以“解毒消癥、扶正固本”解癌毒,调和阴阳。治疗全程贯穿“调气机、护肝阴、截传变”思路,为中医药防治HCC提供参考。
Hepatocellular carcinoma(HCC)is a highly prevalent and lethal malignant tumor globally,whose development is closely linked to chronic liver injury,imbalanced inflammatory microenvironment,and the progression of fibrosis.Based on traditional Chinese medicine(TCM)theories that“Where there is mass hardness,there must be latent yang”and“Liver as yin in substance and yang in function”,the core pathogenesis of HCC is proposed as liver yin deficiency leading to impaired dispersion function,congealment of phlegm,blood stasis,and turbid dampness within the liver collaterals forming“hard mass”,and the obstruction of qi activity causing yang qi stagnation and transforming into“latent yang”.Initially,the latent yang drives chronic liver inflammation.As it intensifies,the latent yang accelerates the interaction between phlegm and stasis,promoting liver fibrosis and cirrhosis.Ultimately,the latent yang transforms into toxin and generates endogenous cancer toxin that depletes genuine yin,leading to malignant transformation.Targeting the three-stage pathological progression of HCC,a staged prevention and treatment strategy is proposed:during the inflammation stage,“soothing liver and venting heat,preserving yin and draining dampness”is applied to transform the latent yang and prevent stagnant heat from intensifying;in the fibrosis stage,“softening hardness and dissipating nodule,clearing heat and resolving toxin”is employed to resolve the hard mass while simultaneously venting heat and preserving yin;at the cancerization stage,“counteracting toxin and resolving mass,supporting healthy qi and consolidating the root”is utilized to counteract the cancer toxin and harmonize yin and yang.The principles of“regulating qi activity,preserving liver yin,and intercepting pathological progression”are emphasized throughout all stages,providing a reference for TCM in the prevention and treatment of HCC.
作者
陈俊辉
汪鑫
杜思润
刘畅
李东东
马纯政
郑玉玲
郭军辉
CHEN Junhui;WANG Xin;DU Sirun;LIU Chang;LI Dongdong;MA Chunzheng;ZHENG Yuling;GUO Junhui(Second Clinical Medical College,Henan University of Chinese Medicine,Zhengzhou 450000 Henan,China;Department of Medical Oncology,The Second Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450011 Henan,China;Department of Hematology and Oncology,The First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450046 Henan,China)
出处
《中医肿瘤学杂志》
2025年第5期98-105,共8页
Journal of Oncology in Chinese Medicine
基金
国家自然科学基金资助项目(编号:82204981)
河南省中医院博士科研基金(编号:2022BSJJ07)
河南省中医药科研专项课题(编号:2025ZY3047)。
关键词
痞坚
伏阳
体阴而用阳
肝细胞癌
中医药
hard mass
latent yang
yin in substance and yang in function
hepatocellular carcinoma
traditional Chinese medicine
