Construction of TCM syndrome differentiation and treatment system for antineoplastic drug-induced cardiotoxicity based on the dynamic pathogenesis of "toxin impairing heart collaterals"

Antineoplastic drug-induced cardiotoxicity is a critical issue faced in modern cancer treatment, presenting diverse clinical phenotypes and varying degrees of severity. It can progress from preclinical alterations to terminal fatal cardiovascular events. However, current traditional Chinese medicine (TCM) syndrome differentiation and treatment system for anticancer drug-induced cardiac toxicity-related diseases still requires refinement. This study grounded in the theories of "collateral disease" and "latent pathogens", elucidating the sequential progression pattern of toxic pathogens invading collaterals, mutual entanglement of toxins and stasis, collateral deficiency with latent toxins, integrating the hierarchical evolution of disease locations of qi, blood, substance, and spirit, reveals that "toxic stasis lurking in collaterals" constitute the core link in the disease chain transmission. A TCM diagnostic and therapeutic framework is systematically constructed under the dynamic pathogenesis of "toxin impairing heart collaterals". Accordingly, we advocate adhering to the therapeutic principles of sequential treatment and multidimensional meridian regulation in clinical practice. We emphasize promoting outward dispersion to provide an escape route for toxins, harmonizing both physical and mental aspects, and simultaneously differentiating between collaterals and zang-fu organs. Based on disease progression, a phased prevention and treatment strategy of fortifying the collaterals before disease onset, penetrating the collaterals during disease, and nourishing the collaterals after recovery should be adopted. Based on the disease location, a layered intervention plan of regulating qi to unblock collaterals, invigorating blood to harmonize collaterals, nourishing to support collateral substance, and calming the spirit to protect collaterals should be selected. This study aims to systematically elucidate the dynamic evolution of cardiac toxicity from anticancer drugs, characterized by "qi entering collaterals and simultaneous impairment of form and qi", along with corresponding diagnostic and therapeutic strategies. It provides theoretical underpinnings and actionable clinical pathways for traditional Chinese medicine in preventing and treating cardiac complications of cancer.