现代中医临床2025，Vol.32Issue(5)：9-14,6.DOI:10.3969/j.issn.2095-6606.2025.05.002
从"壮火食气"探讨免疫检查点抑制剂相关心肌炎的病机及分期辨治
Exploring the pathogenesis and staged pattern differentiation and treatment of myocarditis associated with immune checkpoint inhibitors from the perspective of"exuberant fire consuming qi"
摘要
Abstract
Immune checkpoint inhibitors(ICIs)are widely used in clinical oncology,but ICI-related myocarditis is a major adverse cardiovascular event.In Traditional Chinese Medicine(TCM),balanced yang qi constitutes shaohuo(benign fire),which"generates qi";whereas excessive yang qi becomes zhuanghuo(exuberant fire),which"consumes qi".ICIs represent"immune-related drug-toxicity"possessing a strong warm-dispersing property.Their attribute of zhuanghuo is key to the occurrence of immune-related adverse events(irAEs).ICI-related myocarditis can be categorized under TCM patterns such as xinji(palpitations)and xiongbi(chest impediment).The primary pathogenesis involves toxins damaging the cardiac collaterals and imbalance of qi and fire.Treating ICI-related myocarditis by regulating both qi and fire simultaneously can be divided into the following stages.Initial Stage is characterized by disharmony of the cardiac collaterals and impeded qi-blood circulation.Treatment should focus on clearing,dispersing,and venting heat to dissipate the medicinal toxin.Acute Stage is characterized by intense heat toxin damage,stagnation of fire toxin,and constrained heart yang.Treatment should subdue the toxin and disperse the blockage simultaneously to intercept the medicinal toxin.Recovery Stage is characterized by yin deficiency leading to deficient fire and depletion of qi and fluids,impairing collateral nourishment.Treatment should nourish yin and downbear fire to eliminate residual toxin.Intermittent Stage is characterized by smoldering fire combined with phlegm,blood stasis,and toxin obstructing the collaterals.Treatment should support the healthy qi and unblock the collaterals to prevent recurrence.This approach,based on the principle of"exuberant fire consuming qi",for the staged pattern differentiation and treatment of ICI-related myocarditis is further elaborated combined with clinical cases.关键词
壮火食气/气火失衡/免疫检查点抑制剂/心肌炎Key words
exuberant fire consuming qi/imbalance of qi and fire/immune checkpoint inhibitors/myocarditis分类
医药卫生引用本文复制引用
胡圣涓,冯利,侯丽,孙韬,董青,沈洋..从"壮火食气"探讨免疫检查点抑制剂相关心肌炎的病机及分期辨治[J].现代中医临床,2025,32(5):9-14,6.基金项目
北京市重大疑难疾病中西医协同攻关项目(No.2023BJSZDYNJBXTGG-004) （No.2023BJSZDYNJBXTGG-004）
