国医大师王晞星基于“脏腑别通”理论从“药毒”论治化疗相关性腹泻

Chinese medicine master WANG Xixing treating chemotherapy-related diarrhoea from the perspective of “drug toxicity”based on the theory of “zang-fu extea-ordinary connection”

关键词:  化疗相关性腹泻  脏腑别通  药毒  名医经验

Key words:  chemotherapy-associated diarrhea  zang-fu extea-ordinary connection  drug poisons  famous doctor experience

摘要:

化疗相关性腹泻是化疗常见的不良反应之一，轻者影响患者的生活质量，干扰化疗进程，甚者威胁生命安全，目前西医以对症治疗为主，疗效有限。“脏腑别通”理论拓展了中医传统的脏腑关系理念，国医大师王晞星依据“脏腑别通”理论，结合化疗药物的寒热特性，创新地从脾-小肠、肾-三焦、肝-大肠、心-胆4个角度分析化疗相关性腹泻的病理机制。提出寒性化疗药早期直折脾阳以致小肠主液失常、后期损伤肾阳以致三焦水道不通，热性化疗药引动肝火以致大肠传导失司、心火炽盛以致胆热下移大肠。临床明辨病位、寒热，提出健脾升阳助小肠泌别、补肾助阳促三焦气化、清肝泻火助大肠疏利、清心泻火助胆火清顺之治法，并予自拟升阳止泻方、补肾利水汤、葛根芩连汤、柴胡清胆汤等方辨证加减，获效甚佳。

Abstract:

Chemotherapy-induced diarrhea（CID） is a common adverse reaction to chemotherapy. Mild cases impair patients’ quality of life and disrupt treatment schedules，while severe cases may be life-threatening. Current Western medicine primarily relies on symptomatic management with limited efficacy. Expanding the traditional concept of zang-fu relationships in traditional Chinese medicine（TCM），this study innovatively analyzes CID through the lens of the “zang-fu extea-ordinary connection” theory（viscera interconnection beyond conventional pairings）. By correlating the cold/heat nature of chemotherapeutic agents，the pathological mechanisms are explored via four pathways：spleen-small intestine，kidney-triple energizer，liver-large intestine，and heart-gallbladder. Specifically，cold-natured chemotherapeutics initially impair spleen yang，leading to dysfunction of the small intestine in regulating fluids；in later stages，they damage kidney yang，obstructing triple energizer’s water metabolism. Heat-natured agents trigger liver fire hyperactivity（causing large intestine dysmotility） and heart fire excess（resulting in gallbladder heat descending to the large intestine）. Clinically，targeted therapies are proposed：strengthening spleen yang to regulate small intestine function，tonifying kidney yang to promote triple energizer’s qi transformation，clearing liver fire to restore large intestine motility，and purging heart fire to normalize gallbladder heat. Modified formulas such as Shengyang Zhixie Formula，Bushen Lishui Decoction，Gegen Qinlian Decoction，and Chaihu Qingdan Decoction are applied with marked efficacy.