从“癌毒–络脉”理论探讨中西医结合调控肠癌微环境的临床与机制进展

From the “Cancer Toxin-Collateral” Theory: Clinical and Mechanistic Advances of Integrated Chinese and Western Medicine in Regulating the Colorectal Cancer Microenvironment

摘要: 肠癌作为全球发病率和死亡率较高的恶性肿瘤，严重威胁人类健康。现代肿瘤微环境研究证实，低氧条件下HIF-1α的病理性高表达及其驱动的VEGF促血管生成级联反应，与中医“毒深陷络”理论在分子层面高度契合。HIF-1α作为低氧微环境中的核心转录调节因子，通过激活HIF-1α/VEGF等信号通路，促进大肠癌细胞增殖、侵袭、转移及血管生成。肿瘤外泌体作为癌毒的“微观载体”，通过递送miR-21、miR-210等miRNA远程调控血管内皮细胞功能，进一步印证了“毒邪深伏、暗中耗损络脉”的微观实质。临床上，中西医结合治疗大肠癌以“宏观破瘀通络，微观抑靶阻管”为核心策略，在化疗减毒增效、靶向/免疫治疗协同增效及维持治疗期防复发转移三个维度展现出独特优势。本文系统梳理“癌毒–络脉”理论指导下中西医结合调控大肠癌微环境的理论基础及临床研究进展，以期为大肠癌的中西医结合精准治疗提供理论依据与实践参考。

Abstract: Colorectal cancer, as a malignant tumor with high global incidence and mortality, poses a serious threat to human health. Modern tumor microenvironment research has confirmed that the pathological overexpression of HIF-1α under hypoxic conditions and its driven VEGF-mediated pro-angiogenic cascade are highly consistent at the molecular level with the traditional Chinese medicine theory of “deep-lying toxin in the collaterals.” As a core transcriptional regulator in the hypoxic microenvironment, HIF-1α promotes the proliferation, invasion, metastasis, and angiogenesis of colorectal cancer cells by activating signaling pathways such as HIF-1α/VEGF. Tumor exosomes, as “microscopic carriers” of cancer toxin, remotely regulate vascular endothelial cell function by delivering miRNAs such as miR-21 and miR-210, further corroborating the microscopic essence of “toxin pathogen hidden deep and secretly depleting the collaterals.” Clinically, integrated Chinese and Western medicine in the treatment of colorectal cancer takes “macro-level breaking blood stasis and dredging collaterals, micro-level inhibiting targets and blocking angiogenesis” as its core strategy, demonstrating unique advantages in three dimensions: reducing toxicity and enhancing the efficacy of chemotherapy, synergistic enhancement with targeted therapy/immunotherapy, and prevention of recurrence and metastasis during maintenance therapy. This article systematically reviews the theoretical basis and clinical research progress of integrated Chinese and Western medicine in regulating the colorectal cancer microenvironment under the guidance of the “cancer toxin-collateral” theory, aiming to provide a theoretical basis and practical reference for precision integrated Chinese and Western medicine treatment of colorectal cancer.