从脾胃升降与肠道微生态相关性出发对动脉粥样硬化组方用药思路的探讨

Prescription for Atherosclerosis Based on Correlation Between Spleen-stomach’s Lifting and Lowering Theory and Intestinal Microecology

肠道微生态的平衡有益于宿主健康,这与中医从气机升降理论阐述人体生命活动的动态平衡有相似之处,而脾胃在其中起着重要的调衡作用。众多研究证实肠道失稳态可影响宿主糖脂代谢,从而促进动脉粥样硬化的发生发展,故肠道菌群及其代谢产物的调控成为干预动脉粥样硬化的新靶点。脾胃升降是维系气、血、津、液等精微物质以及药物吸收、转化、代谢的关键枢纽,其功能发挥的主要部位在肠道。脾胃升降失司,肠腑之气受阻,清浊不分进而衍生多种代谢紊乱,为动脉粥样硬化形成的始动因素。文章从脾胃升降与肠道微生态相关性出发,动态阐述了动脉粥样硬化的病机演变过程,并据此探讨了动脉粥样硬化的组方用药思路,即:健脾益气升清、和胃行气降浊为主导;化痰散瘀解毒孤立邪势、邪去正安为辅佐;旁及肠腑之通利、肝肺肾之气化,局部与整体相结合,助力脾胃升降。随着肠道微生态研究的不断深入,肠道菌群与中药的互作机制逐渐清晰,将进一步丰富从脾论治动脉粥样硬化的科学内涵。

The dynamic balance of intestinal microecology is of great significance to the normal operation of human body,similar to the theory of Qi lifting and lowering,where the spleen and stomach play an important regulating role.Multiple studies have confirmed that intestinal microecology imbalance can affect host glucose and lipid metabolism,then promoting the occurrence and development of atherosclerosis.Therefore,regulating intestinal flora and its metabolites has become a new target for the intervention of atherosclerosis.Spleen-stomach’s lifting and lowering is a key hub for maintaining cereal essence such as Qi,blood,fluid and so on,as well as drug absorption,transforming and metabolism,with its main functional place in the gut.If spleen-stomach’s lifting and lowering loss division and the gut’s Qi movement is blocked,turbidities are not divided then drives a variety of metabolic disorders,which is an initial factor of atherosclerosis formation.Starting from the correlation between spleen-stomach’s lifting/lowering and intestinal microecology,this paper dynamically elaborated the pathogenesis evolution process of atherosclerosis,so as to its prescription.Namely,invigorating spleen Qi and lifting clarity,while harmonizing stomach and lowering turbidity,is dominated in treatment of atherosclerosis.Moreover,removing phlegm,dispersing stasis and detoxifying pathogen is an assist.Finally,purgation together with gasification of liver,lung and kidney is an cooperation factor from part to whole for spleen-stomach’s lifting and lowering.With the deepening research on intestinal microecology,the interaction mechanism between intestinal flora and traditional Chinese medicine is gradually clear,which will further enrich the scientific connotation of treating atherosclerosis from spleen-stomach.