基于肠肝轴理论探讨治未病法在肝癌治疗中的应用

Discussion on the Method of Treating Disease before Its Onset in the Treatment of Hepatocellular Carcinoma Based on the Theory of Intestine-Liver Axis

肠道微生物群是生活在人体消化道中的细菌群,与宿主长期相互依存,维持动态平衡关系,与人体健康密切相关。失衡的微生态系统对疾病的发生发展具有一定的促进作用,随着疾病的发生,人体肠道菌群的组成结构、菌群多样化也会随之改变。肠道细菌及其代谢物一方面通过影响肠上皮功能障碍以及胆汁酸代谢影响相关信号通路从而引发肝癌,另一方面通过肠-肝轴循环进入肝脏激活炎症反应相关信号通路从而促进肝癌的进展。中医“治未病”理论提出“见肝之病,知肝传脾,当先实脾”。历代医家在此基础上用“肝病治脾”论治肝病成效显著。现对肠道菌群对肝癌的发生发展机制以及健脾益气方法调节肠道稳态在原发性肝癌治疗机理及运用规律进行总结,为临床治疗肝癌拓宽思路。从中医理论出发,进一步探讨肝-肠轴学说。

Gut microbiota is a group of bacteria living in the human digestive tract,which is closely related to human health as it is interdependent with the host for a long period of time and maintains a dynamic equilibrium relationship.An imbalanced micro-ecosystem contributes to the occurrence and development of diseases.With the occurrence of diseases,the composition structure and diversity of human intestinal flora change.On the one hand,intestinal bacteria and their metabolites affect the signaling pathways related to intestinal epithelial dysfunction and bile acid metabolism,and on the other hand,they enter the liver through the intestine-liver axis to activate the signaling pathways related to inflammatory response,thus promoting the progression of hepatocellular carcinoma.The theory of“treating disease before its onset”in traditional Chinese medicine suggests that“knowing liver disease will be transmitted to the spleen,strengthening the spleen”.Based on this theory,successive generations of doctors have used the“liver diseases treating spleen”and have achieved remarkable results.The mechanism of intestinal flora in the occurrence and development of hepatocellular carcinoma as well as the regulation of intestinal homeostasis by the method of invigorating spleen and reinforcing qi in the treatment mechanism and application rules of primary hepatocellular carcinoma are as follows,in order to broaden the thinking of treatment for hepatocellular carcinoma and further discuss liver-intestine axis from the theory of traditional Chinese medicine.