基于“肺与大肠相表里”探讨中医药调控肠道菌群治疗慢性阻塞性肺疾病的内涵

Connotation of Traditional Chinese Medicine in Treatment of Chronic Obstructive Pulmonary Disease by Regulating Gut Microbiota Based on"Lung and Large Intestine Being Interior-exterior Related"

慢性阻塞性肺疾病(COPD)是一种异质性肺部状态,其特征是持续性、并通常是进行性的气流阻塞,包括支气管炎、细支气管炎在内的气道异常及呼吸困难、咳嗽、咳痰在内的慢性呼吸道症状等,是世界范围内的主要死亡原因之一。中医学提出“肺与大肠相表里”,认为肺脏和大肠在生理病理方面相互联系影响,可采用补益肺脾肾,以及祛痰、逐瘀等治法肺肠同治。肠道菌群在人体的免疫、神经和代谢等方面发挥着重要作用,并可能通过影响肺肠组织结构功能,调节肺部炎症和免疫等作用于COPD。中医药能够调控肠道菌群使其恢复平衡,从而有利于COPD的恢复,如以补益肺补肾为主的治法能够调控肠道菌群,改善肺肠组织损伤,调节肺部免疫;以祛痰、逐瘀为主的治法能够调控肠道菌群,降低肺部炎症反应。该文基于“肺与大肠相表里”,以肠道菌群为关键点,阐述了中医药调控肠道菌群治疗COPD的内涵,旨在为临床通过肠道菌群治疗COPD提供新思路。

Chronic obstructive pulmonary disease(COPD)is a heterogeneous lung condition characterized by persistent and often progressive airflow obstruction,including airway abnormalities(e.g.,bronchitis and bronchiolitis)and chronic respiratory symptoms(e.g.,dyspnea,cough,and expectoration).It is one of the leading causes of death worldwide.According to the theory of traditional Chinese medicine(TCM),the lung and large intestine are interior-exterior related.Therefore,COPD can be treated from both the lung and intestine by the methods of tonifying and invigorating lung,spleen,and kidney,dispelling phlegm,and expelling stasis.Gut microbiota plays a key role in human immunity,nerve,and metabolism and may act on COPD by affecting the structures and functions of lung and intestine tissue and regulating lung inflammation and immunity.TCM can restore the balance of gut microbiota,which is conducive to the recovery from COPD.For example,the treatment method of tonifying lung and invigorating kidney can regulate gut microbiota,alleviate pulmonary and intestinal injuries,and improve lung immunity.The treatment methods of dispelling phlegm and expelling stasis can regulate gut microbiota and reduce pulmonary inflammation.According to the TCM theory of lung and large intestine being interior-exterior related,this review elaborates on the connotation of TCM in the treatment of COPD by regulating gut microbiota,aiming to provide new ideas for the clinical treatment of COPD via gut microbiota.