祛瘀解毒中药在肝癌防治中的应用OA
Application of TCM for dispelling stasis and detoxification in prevention and treatment of liver cancer
肝癌为临床常见的高致死性恶性肿瘤,其发生多与肝气郁滞、血行不畅、久瘀酿毒密切相关,瘀毒为其关键癌毒.肝癌的核心病机为瘀毒互结,祛瘀解毒法以化瘀通滞、解毒清本为治则,通过行气祛瘀解毒、清热祛瘀解毒、软坚祛瘀解毒与益气祛瘀解毒等治法,在肝癌的防治中发挥了重要作用,为肝癌的治疗大法.行气祛瘀解毒注重疏肝行气、通利瘀阻,代表方剂有膈下逐瘀汤等,常配伍川芎、莪术、郁金等;清热祛瘀解毒注重清热解毒、散结消瘀,代表方剂有龙胆泻肝汤等,常配伍连翘、虎杖、牡丹皮等;软坚祛瘀解毒注重软坚散结、攻毒化瘀,代表方剂有鳖甲煎丸等,常配伍蜈蚣、皂角刺、夏枯草等;益气祛瘀解毒注重扶正固本、益气化瘀,代表方剂有益气化瘀解毒方等,常配伍黄芪、三七、仙鹤草等.现代药理研究表明,上述祛瘀解毒中药可通过阻滞细胞周期,增强线粒体依赖性凋亡,抑制肿瘤新生血管生成,抑制肿瘤细胞增殖、迁移与侵袭,并在一定程度上逆转化疗耐药表型.其作用机制涉及对多条核心信号网络的综合调控,主要包括抑制 STAT3、NF-κB、PI3K/Akt、TGF-β/Smad 等促癌通路,降低促炎因子及促增殖信号的激活水平;调节肿瘤免疫微环境、缓解慢性炎症;抑制 HIF-1α 与 VEGF 介导的血管生成;调控氧化应激反应,并影响组蛋白乙酰化等表观遗传调控环节.该文系统梳理了各类祛瘀解毒中药在肝癌中的多靶点、多层次作用特征及可能的调控机制,为理解和应用祛瘀抗癌解毒中药防治肝癌提供理论依据和治疗策略.
Liver cancer is a common malignancy with high lethality,and its development is closely associated with liver Qi stagnation,impaired blood circulation,and the long-term accumulation of stasis generating toxin,in which toxin arising from stasis represents a key pathogenic driver.The core mechanism of liver cancer is characterized by stasis-toxin interlocking,and the therapeutic approach of dispelling stasis and detoxifying-guided by the principle of promoting circulation to resolve stasis and clearing toxin at its root-has become a major strategy in prevention and treatment.Through distinct methods such as moving Qi to dispel stasis and remove toxin,clearing heat to eliminate stasis and remove toxin,softening hardness to resolve stasis and remove toxin,and tonifying Qi to dispel stasis and expel toxin,this approach exerts important benefits in liver cancer management.The approach of moving Qi focuses on soothing the liver,promoting Qi movement,and alleviating stasis obstruction,exemplified by formulas such as Gexia Zhuyu Decoction,with Chuanxiong Rhizoma,Curcumae Rhizoma,and Curcumae Radix commonly used.The heat-clearing strategy emphasizes clearing heat,detoxifying,dissipating mass,and dispersing stasis,represented by Longdan Xiegan Decoction,and often incorporates Forsythiae Fructus,Polygoni Cuspidati Rhizoma et Radix,and Moutan Cortex.The softening-hardness approach aims to soften hardness,dissipate mass,eliminate toxin,and resolve stasis,with representative formulas such as Biejiajian Pills and key TCMs including Scolopendra,Gleditsiae Spina,and Prunellae Spica.The Qi-tonifying approach highlights reinforcing healthy Qi,consolidating root,and promoting stasis resolution,represented by formulas such as the Yiqi Huayu Jiedu Prescription,commonly combining Astragali Radix,Notoginseng Radix et Rhizoma,and Agrimoniae Herba.Modern pharmacological studies demonstrate that these stasis-removing and detoxifying TCMs exert anti-liver cancer effects through mechanisms such as cell-cycle arrest,enhancement of mitochondrial-dependent apoptosis,inhibition of tumor angiogenesis,and suppression of proliferation,migration,and invasion of tumor cells,as well as partial reversal of chemoresistance.Their actions involve the coordinated regulation of multiple cancer-related signaling networks,including inhibition of STAT3,NF-κB,PI3K/Akt,TGF-β/Smad pathways,attenuation of pro-inflammatory and pro-proliferative signaling,modulation of the tumor immune microenvironment,alleviation of chronic inflammation,suppression of HIF-1α-mediated and VEGF-mediated angiogenesis,regulation of oxidative stress,and influence on epigenetic processes such as histone acetylation.By systematically summarizing the multi-target and multi-layered action characteristics and potential regulatory mechanisms of these TCM strategies,this study provides a theoretical foundation and therapeutic perspective for understanding and applying stasis-removing and detoxifying TCMs in the management of liver cancer.
陈慧;周丽萍;魏小曼;赖岳阳;闫秋莹;李柳;沈卫星;程海波;孙东东
南京中医药大学 中医学院,江苏 南京 210023南京中医药大学 中医学院,江苏 南京 210023南京中医药大学 第一临床医学院,江苏 南京 210023||江苏省中医药防治肿瘤协同创新中心,江苏 南京 210023||南京中医药大学附属医院,江苏 南京 210029南京中医药大学 第一临床医学院,江苏 南京 210023江苏省中医药防治肿瘤协同创新中心,江苏 南京 210023南京中医药大学 第一临床医学院,江苏 南京 210023||江苏省中医药防治肿瘤协同创新中心,江苏 南京 210023||南京中医药大学附属医院,江苏 南京 210029南京中医药大学 第一临床医学院,江苏 南京 210023||江苏省中医药防治肿瘤协同创新中心,江苏 南京 210023||南京中医药大学附属医院,江苏 南京 210029南京中医药大学 第一临床医学院,江苏 南京 210023||江苏省中医药防治肿瘤协同创新中心,江苏 南京 210023||南京中医药大学附属医院,江苏 南京 210029南京中医药大学 中医学院,江苏 南京 210023||南京中医药大学 第一临床医学院,江苏 南京 210023||江苏省中医药防治肿瘤协同创新中心,江苏 南京 210023||南京中医药大学附属医院,江苏 南京 210029
肝癌祛瘀解毒法瘀毒互结癌毒病机理论中西医结合
liver cancertherapeutic approach of dispelling stasis and detoxifyingstasis-toxin interlockingpathogenesis theory of cancer toxinintegrated traditional Chinese and western medicine
《中国中药杂志》 2026 (10)
2970-2982,13
国家重点研发计划"中医药现代化"重点专项(2022YFC3500201)江苏省中医药领军人才培养项目(SLJ0312)南京中医药大学中医肿瘤癌毒病机"揭榜挂帅"专项(AD202402)
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