结直肠癌恶液质是晚期结直肠癌患者常见的消耗性综合征，以进行性骨骼肌消耗、脂肪分解、系统性炎症反应及代谢免疫紊乱为主要特征，严重影响患者生活质量、治疗耐受性及预后。中医学认为本病多属“虚劳”范畴，其病机以“本虚标实”“虚实夹杂”为核心，扶正祛邪为主要治则。通过检索国内外相关文献，系统梳理结直肠癌恶液质发病机制、中医证治规律及方药应用特点，阐释中药活性成分与复方通过调控炎症网络、改善骨骼肌与脂肪代谢、保护线粒体功能、重塑免疫微环境干预恶液质的药理机制。明确“扶正”对应营养代谢改善、骨骼肌保护与免疫功能调节，“祛邪”对应炎症抑制、肿瘤微环境重塑与异常分解代谢阻断，构建中医治则与炎症-代谢-免疫调控网络关联。

Colorectal cancer (CRC) cachexia is a common wasting syndrome in patients with advanced CRC. It is mainly characterized by progressive skeletal muscle wasting, lipolysis, systemic inflammatory response, and metabolic and immune dysregulation, which seriously impair patients’quality of life, treatment tolerance, and prognosis. In traditional Chinese medicine (TCM), this disease is generally classified into the category of “consumptive disease”, with its core pathogenesis characterized by “deficiency in origin and excess in superficiality” and “deficiency and excess inclusiofuzhengquxie”. Reinforcing healthy qi and dispelling pathogen are regarded as the principal therapeutic principles. By retrieving relevant domestic and international literature, this review systematically summarizes the pathogenesis of CRC cachexia, the regularity of syndrome differentiation and treatment in TCM, and the characteristics of the Application of prescriptions and drugs. Furthermore, it elucidates the pharmacological mechanisms by which active ingredients and Chinese herbal formulas intervene in cachexia through regulating inflammatory networks, improving skeletal muscle and adipose tissue metabolism, protecting mitochondrial function, and reshaping the immune microenvironment. Specifically, “reinforcing healthy qi” corresponds to the improvement of nutritional metabolism, protection of skeletal muscle, and regulation of immune function, whereas “dispelling pathogen” corresponds to the inhibition of inflammation, remodeling of the tumor microenvironment, and blockade of abnormal catabolism, thereby constructing a correlation between TCM therapeutic principles and the inflammation-metabolism-immunity regulatory network.

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国家科技重大专项：四大慢病重大专项项目（2024ZD0521205）；国家自然科学基金资助项目（82274610，82260957，82460959）；贵州省临床重点专科“942计划”登峰计划（中医类）建设项目-肿瘤科（黔卫健函 [2025] 30号）；2025—2026年度贵州省基础研究计划重大项目（黔科合基础VZD [2026] 003）；贵州省科技厅2026年度基础研究计划（自然科学）青年引导项目（黔科合基础QN[2026] 004-28）；2026年贵州省基础研究计划面上项目（黔科合基础MS [2026] 713）；贵州中医药大学校级项目（贵中医科合-QNYFZK [2025] 20号）