宋卓 杨宇飞 孙凌云 张彤 陈悦 闫韶花 闫蕴孜 许云

摘要 胃腸恶性肿瘤给我国人民的生命健康带来了严重的危害。中医学具有以人为本、整体调节的特点在我国胃肠肿瘤的防治体系中占据一席之地。当代中医形成了以健脾为核心的防治理念，但各医家对脾虚内涵的理解尚不统一，应用方药差异较大，制约中医药研究质量的提高和未来的发展。本团队多年来从脾虚论治结直肠癌的临床和科研工作取得了较好的成效，并与国内多家单位一起，围绕脾虚在胃肠肿瘤领域开展循证研究工作。现结合文献和团队多年来的实践，提出瘤之成因与治疗造就胃肠恶性肿瘤病机以脾虚为主，遵循以脾虚为本、邪实自内外而生、蕴化癌毒、病久及肾的病机演变规律，正虚、邪实、癌毒是中医认识其病机的3个层面，同时兼有胃癌易于阳化、肠癌易于寒化的特点。最后从证治规律、临床试验、生物机制3个方面列举当前已有的相关研究实践作为验证。对胃肠肿瘤脾虚理论的探索起到了抛砖引玉的作用，旨在促进中医肿瘤防治理论的创新，为更高质量的研究提供理论支撑。

关键词 胃癌;结直肠癌;中医药;核心病机;脾虚;证候;专家观点;述评

Abstract Gastrointestinal cancer has brought serious harm to the life and health of our people. Based on the characteristics of people-oriented and overall regulation， traditional Chinese medicine occupies a place in the prevention and treatment system of gastrointestinal tumors in China. Modern Chinese medicine has formed the concept of spleen strengthening as the core of prevention and treatment， but the understanding of spleen deficiency connotation is not unified among doctors. The application of prescriptions and medicines are quite different， which restricts the improvement of the quality of Chinese medicine research and the future development. Over the years， our team has achieved good results in the clinical and scientific research work of treating colorectal cancer from spleen deficiency， and has carried out evidence-based research on spleen deficiency in the field of gastrointestinal cancer with many domestic units. Based on the literature and the practice of the team for many years， this paper proposes that the pathogenesis of gastrointestinal malignant tumor is spleen deficiency. And we follows the evolution law of spleen deficiency， pathogenic excess from inside and outside， accumulation of cancer toxin， long-term disease leading to kidney， healthy qi deficiency， pathogenic excess， and cancer toxin， the 3 levels of TCM understanding of the pathogenesis. Meanwhile， it has the characteristics of gastric cancer easy to yang and colon cancer easy to cold . Finally， the paper lists the current relevant research practice from the rule of syndrome differentiation and treatment， clinical trials and biological mechanism. The paper has played an important role in exploring the theory of gastrointestinal tumors with spleen deficiency， and aims to promote the original innovation of the theory of TCM tumor prevention and treatment， and provide theoretical support for higher-quality research.

Keywords Gastric cancer; Colorectal cancer; Traditional Chinese medicine; Core pathogenesis; Spleen deficiency; Syndrome; Expert opinion; Review

中图分类号：R242;R273;R256文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.09.003

据全球最新癌症数据统计，胃肠恶性肿瘤发病率分别位于全部癌症病例的第5位和第3位，死亡率则更高居第2位和第4位[1]。近20年来，归因于对风险因素预防以及对高危人群筛查的重视，胃肠恶性肿瘤的5年生存率得到了一定的改善，但总体生存率仍显不足[2-3]。……