基于肠道菌群失调探讨“升清降浊”理论在糖尿病周围神经病变中的作用

To Explore the Role of the Theory of“Ascending Lucidity and Descending Turbidity”in Diabetic Peripheral Neuropathy Based on Intestinal Microbiota Imbalance

饮食模式转变介导的肠道菌群失衡、糖脂代谢紊乱、宿主免疫失调被认为是引起糖尿病周围神经病变(Diabetic peripheral neuropathy,DPN)的重要因素,肠道微生态平衡成为改善糖脂代谢、调节宿主免疫、神经介质与减缓神经性疼痛进展的新切入点。肠道对饮食的消化、吸收、转运、排泄等功能与中医学脾胃的“升清降浊”功能相吻合,脾胃“升清降浊”是全身气机正常运行及维系气、血、津、液等精微物质吸收、转化、代谢的关键枢纽,其功能发挥的主要部位在肠道,而嗜食肥甘导致脾胃“升清降浊”失司,肠腑之气不得畅通,精微物质转化异常,从而引起肠道菌群失养,过剩的糖脂代谢物与炎性介质沉积于脉道,是引起DPN病变的始动之因,糖脂代谢紊乱与免疫炎症互作又进一步使得肠道菌群失衡,脾胃功能受损,清浊相干,精微难散,糟粕难排,随之产生的痰、瘀、毒成为推动DPN发展的重要病理环节。健脾益气升清,和胃通腑降浊为代表的中药通过对肠道菌群的调控有着减缓神经疼痛、修复受损神经、调节糖脂代谢和炎性介质等积极作用,为临床治疗DPN提供了新思路。

Intestinal microbiota imbalance,glucose and lipid metabolism disorders,and host immune disorders mediated by dietary pattern change are considered to be important factors causing diabetic peripheral neuropathy(DPN).Intestinal microecological balance has become a new breakthrough point to improve glucose and lipid metabolism,regulate neuromediators and slow down the progression of neuropathic pain.The intestinal functions of diet digestion,absorption,transport and excretion are consistent with the function of spleen and stomach in traditional Chinese medicine.Spleen and stomach material is normal operation and to maintain qi,blood and body subtle material such as Zimbabwe,liquid absorption and transformation,key hub of metabolism,the function of main parts in the gut,and mind you,fat lead to spleen and stomach"rose clear material department,bowel relieving qi can not open,subtle abnormalities,transforming alongwith causing intestinal flora,Sugar lipid metabolites and inflammatory mediators deposit on the pulse,is caused because of DPN lesions of,sugar,lipid metabolic disorder with immune inflammation and further makes the intestinal flora imbalance,the spleen and stomach function is impaired,QingZhuo coherent,subtle and dregs is row,the resulting flow of phlegm,blood stasis and toxin become important pathological link to promote the development of DPN.Traditional Chinese medicine,represented by invigorating spleen,invigorating qi,raising Qing,and weitongfu,lowering turbidity,has positive effects on alleviating nerve pain,repairing damaged nerves,regulating glucose and lipid metabolism and inflammatory mediators by regulating intestinal flora,which provides a new idea for clinical treatment of DPN.