基于“正气化邪”理论辨治免疫相关不良反应*
作者：房立广1，高丹丹2，王 彤3，赵海军1，王玉芳1，王世军1,4，张亚楠1
单位：1.山东中医药大学中医学院，山东 济南 250355； 2.山东中医药大学第一临床医学院，山东 济南 250013； 3.山东中医药大学护理学院，山东 济南 250355； 4.山东省经典名方协同创新中心，山东 济南 250355
引用：引用：房立广，高丹丹，王彤，赵海军，王玉芳，王世军，张亚楠.基于“正气化邪”理论辨治免疫相关不良反应[J].中医药导报,2025,31(8):215-219.
DOI：10.13862/j.cn43-1446/r.2025.08.036
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摘要：
正邪理论是指导中医认识和辨治疾病的重要理论体系，正气、邪气是根据物质对机体健康的作用进行划分，“正气”是指能够维持机体平衡健康状态的物质，而“邪气”则相反。免疫治疗为许多肿瘤患者带来了希望，但免疫相关不良反应却极大地限制了免疫治疗的临床应用。免疫检查点抑制剂使原本发挥防御、修复作用的免疫系统过于亢进，从而破坏了健康组织，导致本病的发生。因此基于免疫系统由“正气”向“邪气”的转化过程，提出“正气化邪”的概念。结合《黄帝内经》对于正、邪的认识，认为正气“亢而为害”“过于本位”和“因加而发”是正气化邪的内在机制。结合临床治疗经验，提出使用“佐制正气”“拘囿正气”和“益彰正气”的治法治疗本病，以期为治疗免疫相关不良反应，促进免疫治疗的临床应用提供新思路。
关键词：免疫相关不良反应；免疫治疗；免疫检查点抑制剂；正气化邪；《黄帝内经》
Abstract：
The theory of healthy Qi and pathogenic Qi
is an important theoretical system to guide the understanding and
differentiation and treatment of diseases in traditional Chinese medicine.
Healthy Qi and Pathogenic Qi are divided according to the effect of substances
on the health of the body. "Healthy Qi" refers to substances that can
maintain the balance and health of the body, while "pathogenic Qi" is
the opposite. Immunotherapy has brought hope to many cancer patients, but
immune-related adverse reactions have greatly limited its clinical application.
Immune checkpoint inhibitors cause excessive hyperactivity of the immune
system, which originally functions in defense and repair, thereby damaging
healthy tissues and leading to the occurrence of this disease. Therefore, based
on the transformation process of the immune system from "healthy Qi"
to "pathogenic Qi", the concept of "transformation of healthy Qi
into pathogenic Qi" is proposed. Combined with the understanding of
healthy Qi and pathogenic Qi in Huangdi Neijing, the intrinsic mechanisms of
healthy Qi transforming into pathogenic Qi are identified as "excessive
hyperactivity causing harm", "exceeding its proper position",
and "manifestation due to external stimulation". Based on clinical
treatment experience, therapeutic methods including "assisting in regulating
healthy Qi", "confining healthy Qi within bounds", and
"enhancing and manifesting healthy Qi" are put forward for treating
this disease, aiming to provide new ideas for the management of immune-related
adverse reactions and the promotion of immunotherapy in clinical practice.
Key words：immune-related adverse reactions; immunotherapy; immune checkpoint inhibitors; transformation of healthy Qi into pathogenic Qi; Huangdi Neijing
发布时间：2026-01-07
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