摘要
瘀血是癥瘕积聚形成的核心病机与证候。《内经》注重外邪致病,寒邪凝涩、瘀血蕴里而成积;张仲景倡导五劳酿生瘀血而致癥瘕;朱丹溪独出心裁提出痰挟瘀血“窠囊”理论;“久病入络”理论至今仍为肿瘤治疗圭臬。气血交互于脉,气为血滞,正气不行,既是邪毒稽留日久形成癥瘕的根据,亦为癌邪流注走窜而发生传舍的根源。血脉迂曲渗漏、凝涩黏附导致具有肿瘤杀伤作用的免疫细胞浸润障碍,肿瘤微环境(tumor microenvironment,TME)中T细胞排斥致正气不行;组成抗肿瘤正气的T细胞和自然杀伤(natural kill,NK)细胞功能障碍诱导血管发育异常而致瘀血蕴里。癥瘕积聚内瘀血与正虚交互为患,正虚是促进癥瘕积聚为患的前提,治病求本,故宋代以来活血化瘀药逐渐成为癥积治法主流之一,祛瘀即是养正,养正则积自除。
Blood stasis is the core pathogenesis and syndrome in the formation of abdominal masses.Huangdi Neijing emphasizes exogenous pathogens,posing that cold congeals blood and blood stasis accumulates to form abdominal masses.Zhang Zhongjing advocated that chronic strain injuries generated blood stasis leading to abdominal masses.Zhu Danxi innovatively proposed the theory of“phlegm-blood stasis co-aggregation”forming nest-like lesions.The“protracted illness penetrates collaterals”theory remains pivotal in oncology therapy today.Qi-blood interaction within vessels is fundamental.Qi stagnation due to blood stasis impedes healthy qi,enabling pathogenic toxins to linger and form abdominal masses.This also underlies cancer metastasis.Tortuous and leaky vasculature with hypercoagulability disrupts the infiltration of immune cells with tumor-killing effects.T-cell repulsion within the tumor microenvironment(TME)leads to the failure of healthy qi.Dysfunction of T cells and natural killer(NK)cells,which constitute the anti-tumor healthy qi,induces abnormal vascular development,and exacerbates blood stasis.Within abdominal masses,blood stasis and deficiency of healthy qi interact pathogenically.Deficiency of healthy qi is the prerequisite promoting abdominal masses formation.Treating disease requires targeting the root cause.Therefore,since the Song Dynasty,blood activating and stasis resolving herbs have gradually become mainstream for abdominal masses.Resolving blood stasis is equivalent to nourishing healthy qi,and nourishing healthy qi will naturally dissipate accumulations.
作者
严心怡
姜谷蓉
郑烨韵
韩钦芮
陈修平
孙学刚
YAN Xinyi;JIANG Gurong;ZHENG Yeyun;HAN Qinrui;CHEN Xiuping;SUN Xuegang(School of Traditional Chinese Medicine,Southern Medical University,Guangzhou 510515 Guangdong,China;Institute of Chinese Medical Sciences,University of Macao,Macao 999078,China)
出处
《中医肿瘤学杂志》
2025年第6期19-27,共9页
Journal of Oncology in Chinese Medicine
基金
国家重点研发计划“中医药现代化”重点专项(编号:2023YFC3502802)
国家自然科学基金面上项目(编号:82274387)
国家自然科学基金面上项目(编号:82574892)
广东省基础与应用基础研究基金项目(编号:2022A1515011147)。
关键词
瘀血
正虚
癥瘕积聚
活血化瘀
免疫抑制性微环境
blood stasis
deficiency of healthy qi
abdominal mass
activating blood and resolving stasis
immunosuppressive tumor microenvironment
