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”

Corresponding author: chentaiquan, 1312561827@qq.com

DOI: 10.12201/bmr.202609.00009

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  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

  Submit time: 7 September 2026

  Copyright: The copyright holder for this preprint is the author/funder, who has granted biomedRxiv a license to display the preprint in perpetuity.
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