[TCM pathogenesis of adverse reactions to molecularly targeted anti-tumor drugs in light of collateral disease theory].

Toxic and adverse reactions associated with molecularly targeted anti-tumor drugs are highly prevalent and seriously affect the patients' quality of life. Drawing upon TCM meridian-collateral theory, this paper elucidated the essentials of TCM pathogenesis of toxic and adverse reactions associated with molecularly targeted anti-tumor drugs. It postulated a core pathological theory defined as " drug pathogens invade the meridians, resulting in disharmony of Qi and blood". The toxic and adverse reactions of molecularly targeted anti-tumor drugs are not isolated or disordered local injuries but display a well-defined and intrinsically interconnected pattern. Their dynamic progression follows a sequential transmission pattern of " skin and pores-collaterals-meridians-Zang-fu organs ". Pathologically, this manifests as an evolutionary process of wind-heat accumulation in the skin, heat-toxin congestion in the collaterals, Qi stagnation and blood stasis in the meridians, and imbalance of Yin and Yang, which is highly consistent with the pathogen transmission theory described in Miraculous Pivot: Treatise on Contralateral Puncture(Lingshu: Miuci Lun). Toxic and adverse reactions of different classes of molecularly targeted anti-tumor drugs also exhibit distinct affinity for meridians and collaterals. For example, anti-angiogenic drugs primarily affect the Shaoyin meridian system and are prone to inducing hand-foot syndrome, hypertension, and hypothyroidism. Epidermal growth factor receptor tyrosine kinase inhibitors predominantly involve the Yangming and Taiyang meridian systems, commonly leading to cutaneous rash, diarrhea, and interstitial pneumonia. Human epidermal growth factor receptor-2 inhibitors preferentially affect the heart and spleen meridian systems, with cardiac toxicity and anemia being the most frequently observed manifestations. Meridian-collateral theory offers a novel perspective for understanding the TCM pathogenesis of toxic and adverse reactions associated with molecularly targeted anti-tumor drugs, providing a theoretical basis for the clinical implementation of early intervention, meridian-based syndrome differentiation, and stage-specific treatment.