基于“肝肠相通”理论对清热解毒类中药调控肠道微生态防治非酒精性脂肪性肝病的探讨

Discussion on the regulation of intestinal microecology by heat-clearing and toxin-resolving herbs to prevent and control non-alcoholic fatty liver disease based on the theory of"liver and intestine are connected"

非酒精性脂肪性肝病(NAFLD)是我国常见的代谢性疾病之一,患病率呈逐年上升的趋势。中医药“肝肠相通”的理论提出于明代,而历代本草记载均显示清热解毒药具有调控肠道的潜在作用。结合清热解毒药的不少活性成分生物利用度较低,我们推测,清热解毒药改善NAFLD的作用靶位可能在肠道。现有研究表明,清热解毒类中药,如黄连、黄芩、土茯苓、蒲公英、连翘、胆类动物药等,均能改善NAFLD的代谢障碍和炎症反应,同时又能调节肠道微生态及细菌来源的代谢物。本文从肠道菌群与NAFLD的相互作用出发,探讨了清热解毒药调控肠道菌群相关机制,挖掘中医“肝病治肠”理论的生物学证据,为靶向肠道菌群的NAFLD中药创新药物研发提供参考。

Non-alcoholic fatty liver disease(NAFLD)is one of the common metabolic diseases in China,and its prevalence is increasing year by year.The theory of"liver and intestine are connected"in Traditional Chinese Medicine was proposed in the Ming Dynasty,and successive herbal records have shown that herbs with heat-clearing and toxin-resolving functions have the potential to regulate the intestines.Many of the active ingredients have low bioavailability,and we speculate that the target of action of herbs with heat-clearing and toxin-resolving functions to improve NAFLD may be in the gut.Existing studies have shown that herbs with heat-clearing and toxin-resolving functions,such as Rhizoma Coptidis,Radix Scutellariae,Rhizoma Smilacis Glabrae,HerbaTaraxaci,Fructus Forsythiae and biliary drugs,can improve the metabolic disorders and inflammatory response of NAFLD,and at the same time regulate the intestinal microecology and bacteria-derived metabolites.Starting from the interaction between intestinal microbiota and NAFLD,this research discusses the mechanism of herbs with heat-clearing and toxin-resolving functions regulating intestinal microbiota,excavates the biological evidence of the theory of"regulating the intestines to treat liver diseases"in Traditional Chinese Medicine,and provides a reference for the development of innovative drugs in Traditional Chinese Medicine targeting intestinal microbiota.