“肝脾失和-癌毒传舍”视域下胰腺癌肝转移的生物学内涵及中医辨治思路*

作者：邹 毅，邓皖利

单位：上海中医药大学附属普陀医院，上海 200062

引用：引用：邹毅，邓皖利.“肝脾失和-癌毒传舍”视域下胰腺癌肝转移的生物学内涵及中医辨治思路[J].中医药导报,2025,31(10):195-199.

DOI：10.13862/j.cn43-1446/r.2025.10.035

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摘要：基于“肝脾失和，癌毒传舍”理论，创新性地阐释了肝脾藏象功能互损在胰腺癌肝转移病程各阶段中的核心作用。通过整合转移前微环境、肿瘤微环境、肠道微生态等多维度的现代研究成果，赋予“肝脾失和，癌毒传舍”在免疫逃逸、肿瘤细胞上皮-间质转化及微环境的免疫抑制作用方面的生物学内涵。发现胰腺癌肝转移的病机演变呈现出阶段性态势：始则于转移前龛，湿热蕴结，瘀毒内阻；继而至转移间期，脾虚肝郁，两虚相得；终至转移终末期，脾衰卫溃，正不胜邪。此三阶段之递变，实乃病邪传舍、正气盛衰之消长，肝脾失和、癌毒流窜之轨迹。揆诸病机演变之规律，遂拟“调和肝脾，以平为期”之治法，以健脾疏肝、化湿祛瘀诸法复肝脾和谐，冀挽病势于既发，旨在为建立胰腺癌肝转移“既病防变”中医干预方案提供新范式。

关键词：胰腺癌肝转移；转移前微环境；肿瘤微环境；上皮-间质转化；肝脾失和；调和肝脾

Abstract：

Based on the theory of "Liver-Spleen Disharmony and Cancer Toxin Transmission," this article innovatively explains the core role of the mutual impairment of Liver and Spleen Zang-organ functions in various stages of pancreatic cancer liver metastasis. By integrating modern research findings from multiple dimensions, including the pre-metastatic niche, tumor microenvironment, and gut microbiome, it assigns biological connotations to "Liver-Spleen Disharmony and Cancer Toxin Transmission" in terms of immune evasion, tumor cell epithelial-mesenchymal transition, and microenvironmental immunosuppression. The study finds that the pathogenesis evolution of pancreatic cancer liver metastasis exhibits a staged pattern: beginning in the pre-metastatic niche with dampness-heat accumulation and internal obstruction of stasis-toxins; progressing to the inter-metastatic period characterized by spleen deficiency and liver depression, where deficiency and pathogen interact; and culminating in the terminal metastatic stage marked by spleen failure and defensive Qi collapse, which leads to healthy Qi cannot overcome pathogens. This three-stage progression reflects the dynamic interplay between pathogen transmission and the rise and fall of healthy Qi, tracing the trajectory of Liver-Spleen disharmony and the spread of cancer toxins. Based on this pathogenesis pattern, the therapeutic principle of "Harmonizing the Liver and Spleen, Aiming for Balance" is proposed, employing methods such as fortifying the spleen, soothing the liver, resolving dampness, and dispelling stasis to restore Liver-Spleen harmony, aiming to curb disease progression upon its onset. This provides a new paradigm for establishing TCM intervention strategies for "preventing deterioration of existing diseases" in pancreatic cancer liver metastasis.

Key words：pancreatic cancer liver metastasis; pre-metastatic niche; tumor microenvironment; epithelial-mesenchymal transition; liver-spleen disharmony; harmonize the liver and spleen

发布时间：2026-01-08

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