基于肠道菌群紊乱与炎症反应从“脾虚失运、痰瘀阻滞”论治糖尿病前期

Treatment of Pre-diabetes from the Perspective of“Spleen Deficiency and Stagnation of Phlegm and Blood Stasis”Based on the Intestinal Flora Disorder and Inflammatory Reaction

糖尿病前期又称糖调节受损,是向糖尿病发生发展的重要病理过程,严重危害人民的身心健康,因此积极治疗糖尿病前期,延缓或防止其进展为糖尿病期至关重要。糖尿病前期归属于中医学“脾瘅”范畴,文章通过梳理古代经典医家典籍理论及现代医家临床经验总结等,分析探讨糖尿病前期的病机演变过程,将其总结概括为“脾虚失运,痰瘀阻滞”。结合现代临床与基础研究,发现肠道菌群的平衡稳定状态是脾主运化功能正常发挥的重要体现,脾虚可影响肠道菌群稳态。脾虚日久,引发水饮与血液的停聚,痰瘀互结,会进一步加重脾虚。研究表明,糖尿病前期患者体内存在轻微的炎症反应,且在病理、病机等方面痰瘀互结又与炎症反应存在着紧密联系。故基于以上理论,归纳出脾虚失运-肠道菌群紊乱为致病之本,痰瘀阻滞-炎症浸润为疾病迁延之由。在此病机基础上总结出健脾气助运化,化痰祛瘀并用的治法,以期为糖尿病前期的中医临床诊断与治疗提供新的方向与思考。

Pre-diabetes,also known as impaired glucose regulation,is an important pathological process to the development of diabetes,which seriously endangers the physical and mental health of the people.Therefore,active treatment of pre-diabetes,delay or prevent its progression to diabetes is essential.Pre-diabetes belongs to the category of“Pidan”in traditional Chinese medicine.This paper analyzes and discusses the pathogenesis evolution process of pre-diabetes by combing the classical theory of ancient classical doctors and the summary of clinical experience of modern doctors,and summarizes it as“spleen deficiency and stagnation of phlegm and blood stasis”.Combined with modern clinical and basic research,the balance and stability of intestinal flora is an important manifestation of the normal function of spleen in transportation and transformation.Spleen deficiency can affect the homeostasis of intestinal flora.Spleen deficiency for a long time,causing water and blood to stop gathering,phlegm and blood stasis,will further aggravate the spleen deficiency.Studies have shown that there is a slight inflammatory response in patients with pre-diabetes,and there is a close relationship between phlegm and blood stasis and inflammatory response in terms of pathology and pathogenesis.Therefore,based on the above theory,it is concluded that the spleen deficiency-intestinal flora disorder is the root of the disease,and the phlegm and blood stasis-inflammatory infiltration is the cause of the disease.On the basis of this pathogenesis summed up the spleen and aid transport,phlegm and blood stasis and treatment,in order to pre-diabetes clinical diagnosis and treatment of Chinese medicine to provide a new direction and thinking.