通讯作者: 陈太全, 1312561827@qq.com

DOI：10.12201/bmr.202609.00009

Exploration of Diagnosis and Treatment Strategies for Immune Checkpoint Inhibitor-Related Myocarditis Based on the “Toxin-Deficiency-Blood Stasis” Pattern within the Framework of “Stagnation and Accumulation in Collaterals”

• 摘要：本文基于“络息成积”核心病机，结合“毒-虚-瘀”动态演变规律，系统阐述免疫检查点抑制剂相关性心肌炎（ICI-related myocarditis,irMyocarditis）的发病机制与诊疗策略。认为“药毒伤络”为发病之始，“因毒致虚”导致气阴两伤，“因虚生瘀”形成痰瘀阻络，最终形成“络息成积”的病理状态。并将“毒-虚-瘀”的疾病传变规律与irMyocarditis现代病理机制相结合。突破“一方统摄”的静态范式，提出“分期-分证”结合的时序分治策略，主张急性期清热解毒、凉营护心；损伤期益气养阴、兼清余毒；后遗症期化痰通络，破血消癥。为完善irMyocarditis的中西医结合诊疗提供新的理论视角与临床路径。

  关键词： 免疫检查点抑制剂；心肌炎；毒-虚-瘀；络息成积；时序分治; ; ; ; 

   

  Abstract: Grounded in the core pathogenesis of “Stagnation and Accumulation in Collaterals” (Luo Xi Cheng Ji) and integrating the dynamic evolution pattern of “Toxin-Deficiency-Blood Stasis” (Du-Xu-Yu), this study systematically elucidates the pathogenic mechanism and integrated diagnostic-therapeutic strategies for immune checkpoint inhibitor (ICI)-related myocarditis. We propose that “drug-induced toxin injuring collaterals” initiates the disease; “toxin-induced deficiency” leads to dual impairment of qi and yin; and “deficiency-generated blood stasis” results in phlegm-stasis obstruction of collaterals, culminating in the pathological state of “Stagnation and Accumulation in Collaterals.” The progression pattern of Toxin-Deficiency-Blood Stasis is correlated with the immunopathological mechanisms of ICI-related myocarditis. Moving beyond the static paradigm of “single formula for all stages,” we propose a sequential treatment strategy integrating disease staging and syndrome differentiation: (1) Acute phase: clear heat, detoxify, cool the nutrient (ying) level, and protect the heart; (2) Injury phase: tonify qi, nourish yin, and concurrently eliminate residual toxin; (3) Sequelae phase: resolve phlegm, unblock collaterals, activate blood circulation, and dissipate pathological masses. This framework offers a novel theoretical perspective and clinically actionable pathway for optimizing integrated Chinese-Western medicine management of ICI-related myocarditis.

  Key words: Immune checkpoint inhibitors; Myocarditis; Toxin-Deficiency-Blood Stasis; Stagnation and Accumulation in Collaterals; Sequential treatment based on staging and syndrome differentiation

  提交时间：2026-09-07

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• 序号	提交日期	编号	操作
  1	2026-08-16	10.12201/bmr.202609.00009V1	下载

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