Discuss the Preventive and Treatment for Immune-Related Adverse Events of Malignant Tumors Based on Simultaneous Treatment of Qi and Fire
Immune checkpoint inhibitors(ICIs)can activate anti-tumour-related immunity in the treatment of malignant tumours,but at the same time,they can also cause non-specific immune activation,leading to the occur-rence of immune-related adverse reactions(irAEs).It is believed that under physiological conditions,ICIs can be classified as tonic agents in traditional Chinese medicine,exerting the effect of warming yang and benefiting qi,but when the immune response become over-excited,ICIs evolve into pathogen of exuberant fire,which is destructive to the body.Combining the different periods of immunotherapy and the degree of symptoms,irAEs are divided into two phases:symptom onset phase(exuberant fire consuming qi and essence)and intermittent phase(latent fire dispersing healthy qi in critical condition),in which yang movement is excess fire leading to toxicity of the skin and oral mucous membranes,qi constraint transforming into fire leading to toxicity of gastrointestinal tract,qi block generating fire leading to cardiotoxicity,and qi and yin deficiencies leading to fire manifesting as ICIs-related diabetes.The general principle of"simultaneous treatment of qi and fire"is proposed to guide the treatment of irAEs.During the onset phase,draining fire,directing qi downward,and dispelling drug toxicity are used to remove excess fire;raising yang,dispersing fire,and dispelling drug toxicity are used to disperse fire constraint;promoting the flow of yang and qi and dispelling drug toxicity are used to close fire and smoothen the flow;cultivating qi,clearing fire,and dispelling drug toxicity are used to disperse the deficiency fire,so as to achieve the goal of clearing exuberant fire,eliminating drug toxicity,and alleviating acute symptoms.During the intermittent phase,the aim is to generate fire slightly to warm yang qi,block latent fire,and prevent recurrence,and ultimately restore the balance of qi and yang in human physiology to prevent and treat irAEs and improve the quality of life of patients.
malignant tumorsimmune-related adverse eventssimultaneous treatment of qi and fireexuberant fireimmune checkpoint inhibitors
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