基于烟草烟雾致病研究进展刍议“烟毒”之外内因机

Progress of Research on the Cause of Tobacco Smoke is Based on the Discussion of the Endogenous Mechanism other than"Tobacco Poisoning"

在过去的几十年,大量化学分析研究已经鉴定出烟草烟雾中众多化合物,且数量不断增加,截至2013年,烟草烟雾中已发现化合物达9582种,其中包含尼古丁、烟草烟雾特异性亚硝胺、苯并[α]芘等物质,以及可替宁、4-(甲基亚硝胺)-1-(3-吡啶基)-1-丁醇等经体内代谢转化而成的产物,能够靶向心、肺等器官,诱发慢性阻塞性肺疾病、冠心病以及肺癌、食道癌等多种类型的癌症。中医对“毒性”的认识起源于《内经》,认为“毒邪”既可以作为外来致病因素,也可致五脏失和酿生痰瘀等病理产物蕴积成内毒。现代医学对烟草烟雾有毒物质及其代谢产物致病认识与中医“外毒”“内毒”的认识颇相一致,因此笔者从烟草烟雾有害物质及其代谢产物出发,拟深入探析其主要成分及致病机制,明确烟毒“内毒”“外毒”病因特点及病机转化特征,从而为中医探析“烟毒”致病现代化研究及烟草烟雾致病与中医理论相结合奠定理论基础。

In the past decades,numerous chemical analysis studies have identified numerous compounds in tobacco smoke,and the number is increasing,as of 2013,9582 compounds have been identified in tobacco smoke,including nicotine,tobacco smoke-specific nitrosamines,benzo[alpha]pyrene and other substances,as well as cotinine,4-(methylnitrosamine)-1-(3-pyridyl)-1-butanol and other products that are metabolized in the body.The products of metabolic transformation,such as cotinine and 4-(methylnitrosamine)-1-(3-pyridyl)-1-butanol,can target the heart,lungs and other organs,inducing chronic obstructive pulmonary disease,coronary heart disease,lung cancer,esophageal cancer and other types of cancer.Chinese medicine's understanding of"toxicity"originates from the Nei Jing,which believes that"poisonous evil"can be an external pathogenic factor,but can also cause the five organs to lose harmony and produce phlegm and stagnation and other pathological products that accumulate into internal toxicity.The modern medical understanding of tobacco smoke toxic substances and their metabolites is quite consistent with the understanding of"external toxicity"and"internal toxicity"in Chinese medicine,so the author intends to explore the main components and pathogenic mechanisms of tobacco smoke harmful substances and their metabolites.To clarify the etiological characteristics and pathogenic transformation characteristics of"internal"and"external"tobacco smoke toxicity,so as to explore the modernization of"tobacco smoke toxicity"and the combination of tobacco smoke pathogenesis and TCM theory for TCM.Theoretical foundation is laid.