从“脾-代谢”相关性探讨肿瘤代谢重编程的中医病机与干预策略  

Discussion on pathogenesis and intervention strategies of tumor metabolic reprogramming from the"spleen‑metabolism"correlation in traditional Chinese medicine

作　　者：戴义宁 孙钰涵 肖娇 原雅敏 李秀荣[2] 李慧杰[2] DAI Yining;SUN Yuhan;XIAO Jiao;YUAN Yamin;LI Xiurong;LI Huijie(First Clinical School,Shandong University of Traditional Chinese Medicine,Jinan,Shandong 250013,China;Department of Oncology,The Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan,Shandong 250014,China)

机构地区：[1]山东中医药大学第一临床医学院,山东济南250013 [2]山东中医药大学附属医院肿瘤科,山东济南250014

出　　处：《上海中医药杂志》2025年第5期20-24,共5页Shanghai Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(81503542)。

摘　　要：代谢重编程是恶性肿瘤的重要生物学特征之一,贯穿于癌症病程的始终,与疾病的发生发展以及转归密切相关。结合中医脾藏象理论,从线粒体、肠道菌群等角度阐述脾气散精与物质能量代谢的相关性,探讨“脾失散精-肿瘤代谢重编程”的病机关联,提出“脾失散精”乃是肿瘤代谢重编程的核心病机。通过探析“脾失散精”形成的病理过程,进而解构出脾虚失运、脾失升清、癌浊困脾皆可引发由“脾气散精”到“脾失散精”的病理转化,介导并推进肿瘤代谢重编程的发生。基于“助脾散精”的干预策略,施以益气、调气、化浊之法,达到补中健脾、和中运脾、清中醒脾之效。脾气充盛则水谷得以运化,健运有司则精微得以布散,浊邪清化则癌瘤难以成形,有助于全面恢复脾气散精的正常环节,为中医药重塑肿瘤代谢重编程提供新思路。Metabolic reprogramming is one of the key biological characteristics of malignant tumors,playing a crucial role throughout the course of cancer.It is closely associated with the development,progression,and prognosis of the disease.Based on traditional Chinese medicine(TCM)visceral manifestation theory of the spleen,this paper elaborates on the correlation between spleen qi dispersing essence and the metabolism of matter and energy from the perspectives of mitochondria,gut microbiota and other factors,explores the pathological connection between"spleen's failure to disperse essence"and tumor metabolic reprogramming,proposing that"spleen's failure to disperse essence"is the core pathogenesis of tumor metabolic reprogramming.By analyzing the pathological process underlying the"spleen's failure to disperse essence",this paper further deconstructs how the pathological transformation from"spleen qi dispersing essence"to"spleen's failure to disperse essence"is triggered by spleen deficiency and dysfunction,spleen's inability to raise clear fluids,and cancerous turbidity stagnating the spleen.This pathological transformation mediates and accelerates the tumor metabolic reprogramming.Based on the intervention strategy of"assisting the spleen to disperse essence",methods such as tonifying qi,regulating qi,and resolving turbidity should be applied to achieve the effects of nourishing the middle,strengthening the spleen,harmonizing the middle and promoting spleen function,and clearing the middle and reviving the spleen.When the spleen qi is abundant,water and grains can be transported and transformed;with healthy function of transportation and proper transformation,the subtle essence can be distributed and dispersed.The clearing of pathogenic turbidity prevents the formation of cancer,thereby helping to restore the normal processes of spleen qi dispersing essence.This paper offers a new approach for TCM to reshape tumor metabolic reprogramming.

关 键 词：肿瘤 代谢重编程 藏象理论 脾气散精 中医理论 病因病机 中医药疗法 

分 类 号：R273[医药卫生—中西医结合]