从“脾主运化”探讨中医药调节糖尿病胰岛细胞命运的作用机制

Exploring the Mechanism of Traditional Chinese Medicine in Regulating Diabetic Pancreatic Islet Cells Fate based on’Spleen Governing Transportation and Transformation’Theory

基于“脾主运化”探讨中医药助脾健运对糖尿病胰岛细胞命运的调节作用。胰岛内分泌细胞间命运转换是导致糖尿病胰岛功能下降的重要原因,以β细胞发生去分化和转分化改变为主,“改写”胰岛细胞命运在糖尿病治疗中具有广阔前景。“脾主运化”是脾脏参与机体精微物质运化布散的核心功能,而现代医学胰腺的功能可归属于中医“脾”功能范畴。认为“脾气郁遏-运化失司”和“脾气亏虚-运化无力”引起升降失常、精微不布是糖尿病胰岛功能障碍的基本病机,与β细胞“沉默”和身份“丢失”的核心机制关系密切。提出助脾健运是临证改善糖尿病胰岛功能的主要思路,可通过补脾气、滋脾阴、通脾络、化脾浊等治法全面恢复脾的运化功能,达到重塑胰岛细胞命运,维持β细胞身份,改善胰岛功能衰竭,恢复血糖稳态的作用,为阐释中医药从脾论治糖尿病、保护胰岛功能提供研究思路。

Based on the theory of‘spleen governing transportation and transformation’,this paper discussed the regulating effect of traditional Chinese medicine(TCM)on the fate of pancreatic islet cells in diabetes by assisting spleen and healthy transportation.The cell fate switching between pancreatic islet endocrine cells is an important reason for the decline of pancreatic function in diabetes,mainly manifested as dedifferentiation and transdifferentiation ofβcells,therefore,remodeling the pancreatic islet cells fate has open up broad prospects for the treatment of diabetes.The‘spleen governing transportation and transformation’is the core of the spleen to participate in the transportation,transformation and dissipation of the essence.And in modern medicine,the function of the pancreas belongs to that of the“spleen”in TCM.If the“spleen qi is constraint and obstructed leading to disordered transportation and transformation”,and if the“spleen qi is depleted causing powerless transportation and transformation”,the ascending and descending of the qi is abnormal,and the essence cannot be dispersed.This basic pathogenesis is closely related to the core mechanism ofβcell‘silencing’and identity‘loss’.The main idea of treating diabetic pancreatic islet failure is to assist the spleen's ability to transport nutrients.By supplementing spleen qi,enriching spleen yin,unblocking spleen collaterals,and removing spleen turbidity,the function of spleen governing transportation and transformation can be fully restored,so as to remodel islet cell fate,maintainβcell identity,improve the pancreatic islet function,and restore blood glucose homeostasis,which provides ideas for explaining that TCM treats the diabetes and protects the islet function from spleen.