2026 年第 3 期 第 21 卷

基于《黄帝内经》“虚邪”理论的乳腺癌治未病策略

Disease prevention strategies for breast cancer based on the "pathogenic deficient evil" theory in Huangdi Neijing

作者：张维佳1常磊2卢雯平2

英文作者：Zhang Weijia1 Chang Lei2 Lu Wenping2

单位：1北京中医药大学，北京100029；2中国中医科学院广安门医院肿瘤科，北京100053

英文单位：1Beijing University of Chinese Medicine Beijing 100029 China; 2Department of Oncology Guang′anmen Hospital China Academy of Chinese Medical Sciences Beijing 100053 China

关键词：乳腺癌病机；《黄帝内经》；虚邪；治未病；肿瘤免疫

英文关键词：Pathogenesisofbreastcancer;HuangdiNeijing;Pathogenicdeficientevil;Diseaseprevention;Tumorimmunity

• 摘要：

• 乳腺癌是女性最常见的恶性肿瘤之一，尽管综合治疗显著提高了生存率，但如何前移防控关口、构建具有中医特色的治未病策略仍是临床难点和研究热点。《黄帝内经》“虚邪”理论认为，发病是机体正气不足以抵御病邪侵袭的过程，乳腺癌亦是正气与癌毒相互制约抗衡的结果，“虚邪”是其发生发展的重要病机之一，这与现代肿瘤免疫学中的免疫逃逸和免疫抑制微环境高度契合。本研究通过系统检索和梳理《黄帝内经》及历代医家关于“虚邪”与治未病的相关文献，结合国内外乳腺癌流行病学、分子分型、肿瘤免疫微环境及中医药干预等临床与基础研究资料，采用对读、归纳与理论整合的方法，将“以虚为本、因虚致邪、虚中夹实”等核心命题与免疫编辑、免疫逃逸过程进行同构对接。在此基础上，从未病先防、既病防变到瘥后防复3个层面系统论述乳腺癌治未病策略，提出以体质调控和高危人群干预为基础、以扶正祛邪改善全身及局部免疫微环境为核心的分层防控思路，并通过对黄芪、灵芝等代表性扶正中药相关研究的梳理，探讨其可能通过程序性细胞死亡受体1/程序性细胞死亡受体配体1、转化生长因子β等通路干预“虚邪-免疫逃逸”过程的作用机制。该研究旨在搭建“虚邪”理论与现代肿瘤免疫同构的乳腺癌防治框架，为构建可嵌入现有综合治疗路径的中西医结合治未病模式提供理论依据与思路。

• Breast cancer is one of the most common malignant tumors in women. Although comprehensive treatment has significantly improved the survival rate, how to advance the prevention and control threshold and construct a disease prevention strategy with traditional Chinese medicine (TCM) characteristics remains a clinical difficulty and research hotspot. The "pathogenic deficient evil" theory in Huangdi Neijing holds that the onset of disease is a process in which the body′s healthy Qi is insufficient to resist the invasion of pathogenic factors. Breast cancer is also the result of the mutual restriction and confrontation between healthy Qi and cancer toxin, and "pathogenic deficient evil" is one of the important pathogenesis of its occurrence and development, which is highly consistent with the immune escape and immunosuppressive microenvironment in modern tumor immunology. By systematically searching and sorting out the relevant literatures on "pathogenic deficient evil" and disease prevention in Huangdi Neijing and medical scholars of all dynasties, combined with clinical and basic research data on breast cancer epidemiology, molecular typing, tumor immune microenvironment and TCM intervention at home and abroad, this study adopted the methods of parallel reading, induction and theoretical integration to conduct isomorphic docking between the core propositions such as "deficiency as the root cause, pathogenic factors arising from deficiency, and deficiency complicated with excess" and the processes of immunoediting and immune escape. On this basis, the disease prevention strategies for breast cancer were systematically discussed from three levels: preventing disease before its onset, preventing disease progression after its onset, and preventing recurrence after recovery. A hierarchical prevention and control idea was proposed, which is based on constitution regulation and intervention of high-risk groups, and takes strengthening healthy Qi and eliminating pathogenic factors to improve the systemic and local immune microenvironment as the core. By sorting out the relevant studies on representative Qi-invigorating Chinese medicinal herbs such as Astragali Radix and Ganoderma, the possible mechanism by which they intervene in the "pathogenic deficient evil-immune escape" process through pathways such as programmed cell death protein 1/programmed cell death ligand 1 and transforming growth factor-β was explored. This study aims to construct a breast cancer prevention and treatment framework with isomorphic relationship between the "pathogenic deficient evil" theory and modern tumor immunology, and provide theoretical basis and ideas for building an integrated traditional Chinese and western medicine disease prevention model that can be embedded in the existing comprehensive treatment pathways.