基于“劳者温之”探讨HPA轴在癌症相关性疲乏中的作用  

Role of HPA Axis Dysregulation in Cancer-related Fatigue Based on Principle of "Treating Overstrain with Warming"

作　　者：韩凤娟[1] 刘芳媛 张景欣[1] HAN Fengjuan;LIU Fangyuan;ZHANG Jingxin(The First Affiliated Hospital of Heilongjiang University of Chinese Medicine,Harbin 150040,China;Heilongjiang University of Chinese Medicine,Harbin 150040,China)

机构地区：[1]黑龙江中医药大学附属第一医院,哈尔滨150040 [2]黑龙江中医药大学,哈尔滨150040

出　　处：《中国实验方剂学杂志》2023年第5期216-222,共7页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：国家自然科学基金项目(82074484);国家中医临床研究基地业务建设第二批科研专项(JDZX2015055)。

摘　　要：该文基于《黄帝内经》中“劳者温之”理论,结合下丘脑-垂体-肾上腺(HPA)轴失调在癌症相关性疲乏的作用,探讨中医药治疗癌症相关性疲乏(CRF)的理论基础,为临床治疗CRF提供诊疗新思路。在HPA轴脉冲式的调控机制中,由肾上腺皮质合成并释放的皮质醇在人体生命活动中发挥重要作用。皮质醇的昼夜节律异常及血清含量降低是导致癌症相关性疲乏发生的重要机制,故提高皮质醇的血清含量,激发其生物学活性,平衡HPA轴的失调是治疗癌症相关性疲乏的重要靶点,也是中医药诊疗本病的关键。从中医经典基础理论“劳者温之”出发,通过解读“劳”在病因病机及临床表现上的不同含义,以“劳”为切入点,探讨CRF发生的病因病机,认为肾、脾、肝三脏之气血、阴阳、精液耗伤、形气衰少为其病要之所在,从而产生疲乏、劳倦等病理症状。基于此,阐述“温”的理论内涵,并以“温”法为治疗总则,总结出“温养”及“甘温除热”两大治疗原则。根据受邪脏腑的不同特点,提出温肾益精以培其本、温胃养脾以补其气、养肝补血以疏其机、甘温除热以抑其劳的治法,通过“温”法,增加CRF患者体内皮质醇含量,振奋其生物学功能,以此论治CRF,为癌症患者的临床治疗,提供改善症状、提高生存质量的新的理论依据。This paper discusses the theoretical basis of traditional Chinese medicine(TCM)for the treatment of cancer-related fatigue(CRF)based on the principle of treating overstrain with warming in the Huangdi's Internal Classic《黄帝内经》and the role of hypothalamic-pituitary-adrenal(HPA)axis dysregulation in CRF,aiming to provide new ideas for the clinical treatment of CRF.In the pulsatile regulation of the HPA axis,cortisol,which is synthesized and released by the adrenal cortex,plays an essential role in the life activities.The abnormal circadian rhythm and reduced serum level of cortisol are major factors leading to CRF.Therefore,increasing the serum level and stimulating the biological activity of cortisol and restoring the normal function of HPA axis are important targets for the treatment of CRF and also the key to the TCM treatment of this disease.According to the TCM principle of treating overstrain with warming,we interpreted the etiology and clinical manifestations of overstrain and further explored the causes of CRF.It is believed that the depletion of Qi and blood,Yin and Yang,and fluid in the kidney,spleen,and liver is the key of the disease,which results in symptoms such as fatigue.Further,we elaborated on the theoretical connotation of warming and summarized the two main treatment principles of tonifying with warm-natured herbs and relieving fever with sweet-and warmnatured herbs.According to the different characteristics of the organs affected by pathogen,we proposed the treatment method of warming kidney to cultivate essence,warming stomach and nourishing spleen to replenish Qi,nourishing liver and tonifying blood to promote Qi movement,and relieving fever with sweet-and warmnatured herbs to alleviate fatigue.The warming method can elevate the serum level and invigorate the biological functions of cortisol in CRF patients,which provides a new theoretical basis for alleviating the symptoms and improving the quality of life of cancer patients in clinical practice.

关 键 词：劳者温之 癌症 疲乏 下丘脑-垂体-肾上腺(HPA)轴 皮质醇 

分 类 号：R22[医药卫生—中医基础理论] R242[医药卫生—中医学] R2-031R287