Understanding the viscera-related theory that the lung and large intestine are exterior-interiorly related

Pairing of the viscera and bowels is an important theory,which provides guidance to traditional Chinese medicine(TCM) clinical practice.Investigating this theory has been the focus of research on the basic theory of TCM.Recently,researchers have performed many studies on the theory that the lung and large intestine are exterior-interiorly related,which is a different point of view to that of previous literature,recent clinical studies and experimental studies,and these recent studies have enforced the theoretical connotation of the statement.However,there are problems in some of these studies including recent clinical studies and experimental studies.In the current article,literature on the viscera-related theory of the lung and large intestine are exterior-interiorly related is reviewed from physiological,pathological,and clinical views,and some opinions on the current research status are discussed.

Infrared Thermal Imaging-Based Research on the Intermediate Structures of the Lung and Large Intestine Exterior-Interior Relationship in Asthma Patients

Objective: By observing body surface temperature variation of the intermediate structures of the Lung(Fei) and Large Intestine(Dachang) exterior-interior relationship in asthmatic patients, to investigate the pathological response on the pathway of channels and to substantiate the objective existence of the intermediary structures. Methods: The study included 60 subjects meeting the bronchial asthma inclusion criteria(experimental group) and 60 healthy subjects(normal control group). ATIR-M301 infrared thermal imaging device was used for detecting body surface temperature of the subjects and collecting the infrared thermal images. The temperature values of the intermediate structures of Lung and Large Intestine exterior-interior relationship [throat, Quepen, elbow, nose, Lieque(LU 7), Pianli(LI 6)], control areas(0.2 cm lateral to the above structures) and Yintang(EX-HN 3) were measured on the infrared thermal image by infrared imaging system. Then, the above temperature values were compared and analyzed within and between two groups. Results: There were insignificant differences between the temperature on the left and right sides of the intermediate structures(Quepen, elbow, LU 7, LI 6) in normal control group(P>0.05). Except for that of Quepen, there were insignificant differences between the temperature of the intermediate structures and their corresponding control areas in normal control group(P>0.05). In the experimental group, the temperature on the left and right sides of the intermediate structures(Quepen, elbow, LU 7, LI 6) showed statistically significant differences(P<0.05 or P<0.01); the temperature difference between intermediate structure(throat, Quepen, elbow, nose, LI 6) and their respective control areas were also significant(P<0.05 or P<0.01). The temperature of the intermediate structures(throat, Quepen, elbow, LU7, LI 6) between the experimental group and normal control group showed significant differences(P<0.05 or P<0.01). Conclusions: This study is an initial step to validate the objective existence of Lung and Large Intestine exterior-interior relationship intermediate structures, as described in the Chinese classical medical literatures, through the functional imaging angle. The intermediate structures are the pathological reaction areas of the bronchial asthmatic patients.

The Association between Pulmonary Function Impairment and Colon Inflammation in Ulcerative Colitis Patients： A Scientific Basis for Exterior-Interior Correlation between Lung and Large Intestine

Objective： To investigate the involvement of pulmonary function impairment in ulcerative colitis（UC）, and explore a scientific basis for the Chinese medicine（CM） theory of exterior-interior correlation between Lung（Fei） and Large intestine（Dachang）. Methods： Totally 120 patients with a diagnosis of UC were recruited and the demographics, clinical data, and blood samples were collected. C-reactive protein（CRP） and erythrocyte sedimentation rate（ESR） concentrations were measured. Every patient accepted pulmonary function test and took chest radiograph（CXR）. Results： Pulmonary function abnormalities were present in 72 of 120 patients. The median（interquartile range） vital capacity（VC）, forced vital capacity（FVC）, forced expiratory volume in 1 s（FEV_1）, carbon monoxide diffusion capacity（DL_∞） of lung, total lung capacity（TLC） and functional residual volume（FRV） were decreased in distal UC and pancolitis compared with ulcerative prochitis（P〈0.0005）. Male patients had increased VC, FEV_1/FVC, and residual volume（RV）/TLC compared with female（P〈0.0005）, but decreased DLCO and carbon monoxide iffusion capacity（KCO） of lung/alveolar ventilation（P〈0.0005）. Age was strongly correlated with RV（Spearman rank correlation coefficient（rs）=–0.57, P〈0.0001）, and RV/TLC（rs=0.48, P〈0.0001）. Age was also correlated with FEV_1/FVC（rs=–0.29, P=0.001）, forced expiratory flow in 75% vital capacity（FEF75%, rs=–0.20, P=0.03）, DLCO（rs=–0.21, P=0.02）, TLC（rs=–0.25, P=0.006）, and FRV（rs=–0.28, P=0.002）. The course of disease was correlated with FEF75%（rs=–0.18, P=0.049） and KCO（rs=–0.19, P=0.036）. Chest radiograph abnormalities were presented in 38 of 120. Pulmonary symptoms were presented in 10 of 120. Other extraintestinal complications were presented in 21 of 120. Conclusions： Pulmonary function impairment was more frequently than other extraintestinal complications in UC patients, which may be affected by sex, age, extent and course of disease. These results may be a scientific basis for the theory of exterior-interior correlation between Lung and Large intestine.

Experimental Study on the Mechanism of Protective Effect of Free Fu on Gut-derived Endotoxin-Mediated Lung Damage

The effect of tumor necrosis factor-α (TNF-α) on endotoxin (ET)-mediated lung damage caused by incomplete ligation of large intestine and the influence of free Fu on the expression of TNF-α mRNA were explored. Forty SD rats were randomly divided into 4 groups: normal control group, model group, ligation group and treatment group (n=10 in each group). The models were made by the method of partly ligating the rectum outside the body. The plasma level of lipopolysaccaride was measured by dynamic nephelo metric method and the serum level of TNF-α was detected by the method of radioactive immunity. The expression of TNF-α mRNA in lung tissue was detected by RT-PCR method. The results were compared among the 4 groups. The results showed the plasma levels of ET and serum TNF-α in the model group and the expression of TNF-α mRNA in the lung tissues were remarkably higher than those in the normal control group (P<0.01). After the treatment of free Fu, all of the above indexes in the treatment group were all decreased as compared with model group (all P<0.01), and the damage to lung was alleviated. It was concluded that TNF-α might play a very important role in the ET-mediated lung damage caused by incomplete ligation of large intestine, free Fu could protect the lung from damage.

杨燕教授从肺论治儿童功能性便秘的临床经验

儿童功能性便秘约占小儿便秘的95%以上,是小儿消化系统的常见病,病程迁延易对儿童的身心健康产生严重影响。文章总结杨燕教授治疗儿童功能性便秘的临床经验。杨燕教授认为便秘的病机主要是大肠的传导功能失常,但与肺脏密切相关。肺与大肠相表里,肺气亏虚或肺气郁闭,宣肃失职,气机不畅,津液疏布失常,肺热移于大肠,肠失濡润,均可导致便秘发生。从肺论治,临证采用塞因塞用之法补气启闭治虚秘,提壶揭盖之法理肺通腑治实秘,同时重视良好的饮食结构及日常护理,临床疗效显著。附验案1则以佐证。

基于“肺与大肠相表里”探析血管内皮细胞与肠道菌群的关联

肠道菌群及其代谢物失调对内皮细胞损伤和功能障碍具有重要影响。中医“肺”与血管内皮细胞在结构、生理及病理方面具有相关性。中医学“肺与大肠相表里”理论是肺与肠在结构、生理及病理方面相关性的高度概括,可作为血管内皮细胞与肠道菌群相关联的理论基础。本文可为以肠道菌群为切入点、修复血管内皮细胞损伤干预心血管疾病的实验研究提供理论依据,并为中医药临床治疗相关疾病提供参考。

从“金郁泄之”论治溃疡性结肠炎

“金郁泄之”理论出自《黄帝内经》,“金”是肺与肠的基本属性,“郁”指郁滞,壅塞不通的异常状态,故“金郁”可理解为属金脏腑如肺、大肠所发壅滞、阻塞之证。“泄之”是五行属金脏腑郁滞的治疗方法,其具体含义应随“金郁”的病理产物、病位的不同而不同。溃疡性结肠炎多由邪蕴肠腑,气血瘀滞,肠道传导失司,湿、热、瘀于大肠相互搏结成郁,改变肠道属金肃降之性所致,其核心病机为湿热内蕴,气血瘀滞,属于“金郁”的范畴,病位虽在大肠,可波及于肺。故治疗应顺应“泄之”的法则,以祛除肺肠之郁为主,包括清泄与宣泄两种方法,同时补益肺、脾、肾三脏之气,以恢复肺肠之功能,达到扶正祛邪,标本兼顾的目的,促进溃疡性结肠炎的愈合。

A Comparative Study of The Regular Pattern of Syndrome and Treatment of Lung-intestine Related Diseases in Ancient and Modern Medical Cases Based on Data Mining

Objective: To analyze the similarities and differences of the applications of "the lung and large intestine being interior-exteriorly related"between the ancient and modern clinical practices, and to reveal the theory meaning.Method: Based on the ancient and modern medical cases database, 245 ancient medical records and 373 modern medical records were studied with the general statistical description and analysis of association rules, and the results were compared to summarize the similarities and differences of the regular pattern of syndrome and treatment on lung-large intestine related diseases in ancient and modern medical records.Results: In modern medical cases, intestinal diseases appeared with the main symptom of constipation due to deficiency of lung qi and qi stagnation of large intestine were always treated by purgation together with replenishing and restoring lung qi. In ancient medical cases, large intestine heat was always caused by lung heat and a variety of diarrhea symptoms appeared. They were always treated by clearing heat and moistening lungs. In addition, the symptom of bound stool caused by qi stagnation of large intestine due to lung qi stagnation was always treated by lowering lung qi to regulate and smooth large intestine qi. And Armeniae Amarum Semen was used by both as a core medicinal herb.Conclusion: Ascending-descending of qi movement is the core of the lung and large intestine relationship. In other words, the lung and the large intestine communicate through qi.

从肠论治脓毒症所致ALI/ARDS有效性的Meta分析

目的系统评价在中医“肺与大肠相表里”理论下指导下,从肠论治脓毒症所致急性肺损伤/急性呼吸迫综合征(ALI/ARDS)的临床疗效,为临床提供循证参考。方法通过计算机检索中国知网(CNKI)、万方数据库、维普中文期刊数据库、中国生物医学文献数据库(CBMdisc)荷兰医学文摘Embase数据库、美国国立医学图书馆PubMed数据库、Cochrane图书馆数据库中,从建库至2020年10月8日发表的将通腑法作为干预措施治疗脓毒症所致ALI/ARDS的随机对照试验(RCT)。对照组采用常规西医治疗,试验组在常规西医治疗基础上联合通腑法治疗。由2名研究者筛选文献并对符合纳入标准的文献进行数据提取,运用改良Jadad量表进行质量评价,采用RevMan5.4和Stata16.0软件对数据进行Meta分析。结果最终纳入13篇文献,均为单中心RCT,其中≥4分的文献7篇,<4分的文献6篇。共纳入579例患者,其中试验组290例,对照组289例。Meta分析显示,与对照组比较,联合通腑法治疗能明显提高脓毒症所致ALI/ARDS患者氧合指数[PaO_(2)/FiO_(2),均数差(MD)=62.55,95%可信区间(95%CI)为55.74~69.37,P<0.05],降低白细胞介素-6(IL-6,MD=-29.70,95%CI为-48.34~-11.06,P<0.05)、肿瘤坏死因子-α(TNF-α,MD=-2.94,95%CI为-5.28~-0.59,P<0.05)降钙素原(PCT,MD=-1.34,95%CI为-2.17~-0.51,P<0.05)和C-反应蛋白(CRP,MD=-22.41,95%CI为-36.52~-8.29,P<0.05)水平,缩短机械通气时间(MD=-2.26,95%CI为-2.86~-1.66,P<0.05)和重症监护病房(ICU)住院时间(MD=-4.15,95%CI为-7.47~-0.84,P<0.05),降低28d病死率[相对危险度(RR)=0.43,95%CI为0.24~0.76,P<0.05]和急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ,MD=-3.53,95%CI为-5.41~-1.64,P<0.05)。结论从肠论治对减轻脓毒症所致ALI/ARDS患者病情及改善预后有一定价值,但仍需进一步开展高质量的RCT以验证其疗效,为临床治疗提供更准确的循证医学证据。

从“肺-肠”轴角度探讨肠道菌群与过敏性鼻炎的关系

过敏性鼻炎属于全球高发的气道变应性疾病,较多人群深受其影响,关于其更安全有效的治疗方式仍不断被探寻与挖掘。近年来关于肠道微生态与肺部疾病的相互关系被深入研究,文章基于肺肠关系,结合中医“肺与大肠相表里”理论,并从西医胚胎发育、菌群微环境、内分泌代谢、黏膜免疫等角度探讨肺-肠关系,在此基础上,认为肠道菌群可从细胞因子免疫平衡、机体黏膜等方面影响过敏性鼻炎的发生发展,以期为临床治疗过敏性鼻炎提供更多思路。

中医学对肠道菌群与非酒精性脂肪性肝病的理论认识

近年来,非酒精性脂肪性肝病全球流行率逐年升高,但发病机制至今尚未明确。中医学将非酒精性脂肪性肝病归属于“臌胀”“肝癖”“痰浊”“积聚”等,认为肝体用失调、脾肾亏虚是本病主要特点,痰、湿、浊、瘀、热为本病主要病理因素。随着对肠道菌群研究的不断深入,肠道菌群及其代谢产物有改善胰岛素抵抗、减少氧化应激、调节脂质代谢和调节免疫等多种作用,与肝脏功能及非酒精性脂肪性肝病之间的关系也受到广泛关注。许多研究揭示了肠-肝轴与非酒精性脂肪性肝病发生发展相关,饮食、抗生素、益生菌及益生元、粪菌移植、微生态制剂、噬菌体等干预措施均可以通过改变肠道菌群来缓解非酒精性脂肪性肝病。从现代医学对肠道菌群生理功能的研究中,我们发现现代医学“肠”的消化吸收、调节代谢、改善免疫等功能可属于中医“脾主运化”“脾主升清”功能的范畴。文章从中医“肝脾相关”“肝与大肠相通”“肝从左升,肺从右降,肺与大肠相表里”等理论视角出发,就中医学对肠道菌群与非酒精性脂肪性肝病关系的认识及相关治疗作一综述,阐述中医学治疗本病的理论基础,结合现代医学理念,以期为非酒精性脂肪性肝病的中医治疗提供新思路、新方法。

“肺与大肠相表里”物质相关性的研究进展

中医药文化历史源远流长,作为中医药藏象理论的重要组成部分,“肺与大肠相表里”阐述了肺-肠来源相同,生理上相互协作,病理上和治疗上相互影响。现基于“肺与大肠相表里”理论,分别从经络、津液代谢、黏膜免疫及肠道运动等方面探讨肺-肠物质相关性,为临床治疗肺肠相关疾病提供参考。

试用肺-肠轴学说探讨内异症痛经从肺肠论治思路

痛经为子宫内膜异位症的最常见临床表现之一,血瘀为子宫内膜异位症的公认病机,“通则不痛,不通则痛”,“气行则血行,气滞则血滞”,气机不畅与血行瘀滞往往相互夹杂、相互作用,促进子宫内膜异位症的进展和加重子宫内膜异位症的痛经症状。海派中医蔡氏妇科提出女性月经以血为基础,气为动力,以往理气多重在理肝胃之气。肺为一身气之主,肺与大肠相表里,肺气宣发肃降功能正常,调畅下焦气机,不仅通腑助大便顺利排出,亦可通畅胞宫气机,使子宫藏泻功能恢复正常,排出瘀血浊液,缓解痛经。作者尝试从肺与大肠相表里的角度联系肠道微生态探讨从肺论治子宫内膜异位症痛经的可行性,为临床子宫内膜异位症的治疗提供新思路。

《黄帝内经》肺与大肠相表里理论临床体会

脏腑表里理论历史悠久,源远流长,是中医藏象学说的重要组成部分。此文通过医案举例,介绍肺与大肠相表里理论,强调该理论在临床中的治疗作用,得出应用此理论在辨证论治肺系、肠系相关疾病时,脏腑同治较脏病治脏、腑病治腑收效更佳。总之,运用肺与大肠相表里理论,为临床疾病治疗肺系、肠系疾病扩宽了思路,值得临床推广。

基于“肺肠相表里”理论探讨痴呆的病机及治疗

随着全球经济的快速发展,认知障碍疾病发病率逐年升高。中医学对老年呆病有长久的认识,有一定的辨证论治经验。中医基于整体观、脏腑论治,临床多从肝、脾、肾三脏入手,但从娇嫩之肺脏论述较少,文章基于中医脏腑表里相通理论及现代研究,从理论探讨、病机、临床研究三方面分析“肺肠相表里”理论与痴呆病的病因病机、治则治法的关联。肺的主要生理功能是主纳水谷之精气与肺吸入之气,专司呼吸调节,将清气津液输布全身温润肌肤,将上焦之水下输膀胱,百脉得肺气充盈,血液运行畅通,脑清神明。大肠的主要生理功能是吸收肠腑水气,形成排泄糟粕之物。五脏水谷精微有赖肺的宣发输布,助行六腑之大肠排泄糟粕之物;六腑之大肠承担排泄之功能,肠腑洁净有助于肺气宣降,通调水道便于利行。肺与大肠相表里,生理上自发育开始紧密相连,二者来源相同,存在相同的黏膜防御活性肽;肺部疾病以及肠道炎症,共有活性肽表达失常,免疫紊乱,疾病易生。肺肠同治:一者通腑能增进肠道蠕动,使腹压降低,改善肺功能;二者通腑能清肠,促进机体新陈代谢,肺肃降畅通,清气易摄,脑腑清灵,记忆新生。文章基于“肺肠相表里”理论治疗痴呆,为认知障碍的中医药遣方用药提供理论依据。

肠道菌群与儿童呼吸系统疾病

近年来,随着呼吸系统疾病与肠道菌群相关性研究的增多,中医“肺与大肠相表里”理论和现代医学“肺-肠”轴概念逐渐受到国内外学者的重视。对感染性肺炎、哮喘、过敏性鼻炎等儿童呼吸系统常见病与肠道菌群的相互影响进行了归纳总结,并结合中医药诊治理念及方法为中医理论“肺与大肠相表里”的科学阐释提供参考。

调补肺肾三法对慢性阻塞性肺疾病稳定期大鼠肺与肠道炎症指标的影响

目的探讨调补肺肾三法对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)稳定期大鼠肺与肠道IL-6、IL-33和IFN-γ的调控。方法将60只SD大鼠随机分为空白(Control)组、COPD模型(Model)组、补肺健脾(Bufei Jianpi,BJ)组、补肺益肾(Bufei Yishen,BY)组、益气滋肾(Yiqi Zishen,ZS)组和氨茶碱(aminophylline,Am)组。第1-8周,采用香烟烟雾暴露联合脂多糖(lipopolysaccharide,LPS)滴注法制备稳定期COPD大鼠模型,对应给予生理盐水、补肺健脾方、补肺益肾方、益气滋肾方、氨茶碱灌胃4周,于第13周灌胃周期结束后取材。光镜下观察肺与结肠组织形态学改变,采用免疫组化法(IHC)对肺与结肠组织中白细胞介素(interleukin,IL)-6、IL-33、干扰素(interferon,IFN)-γ蛋白进行定位与半定量观察。结果与Control组相比,Model组大鼠不仅支气管周围与肺泡腔出现大量炎症细胞及炎性渗出,结肠黏膜也出现了大量炎症细胞浸润,肺和结肠IL-6、IL-33和IFN-γ水平明显升高(P<0.05,P<0.01);与Model组相比,各治疗组不仅支气管和肺泡炎症细胞浸润减少,而且结肠黏膜炎症细胞也出现减少,肺与结肠中IL-33和IFN-γ、结肠IL-6水平均明显降低(P<0.05,P<0.01),BY、ZS、Am组肺IL-6水平显著降低(P<0.01)。肺IL-6与结肠IL-6水平呈正相关,肺IL-33与结肠IL-33水平呈正相关,肺IFN-γ和结肠IFN-γ水平呈正相关。结论调补肺肾三法均可以改善慢性阻塞性肺疾病稳定期大鼠肠道功能障碍,其机制可能与抑制肺与结肠中IL-6、IL-33和IFN-γ的释放,降低肺与肠道炎症反应有关。

基于肺与大肠相表里探讨肺肠共治

现代医学认为肺脏与肠道分属2个不同的生理系统,临床治疗上也多以孤立的角度看待,而单独论治其一往往疗效欠佳。中医藏象学则认为五脏六腑互为表里、密不可分,由此延伸出的“脏腑合治”思想得到广泛应用。笔者基于“肺与大肠相表里”理论探讨肺肠在生理及病理上的密切联系,并根据肺肠在三焦体系中的位置关系和对气津运行的联动作用,结合现代医学微观研究下肺肠菌群的相关性,从中医整体思维的角度对“肺肠共治法”的理论内涵进行阐述,其义理精髓,内涵丰富,可广泛应用于许多肺肠相关疾病的临床诊疗思路中。

基于“肺与大肠相表里”探讨肺-肠-重症肺炎关联性

重症肺炎是呼吸系统常见的急危重症之一,是肺部炎症进展后出现全身中毒表现及器官功能障碍。传统中医理论认为肺与大肠相表里,临床实践中也证实肺肠同治更有利于重症肺炎患者康复,但对于其中关联性尚不明晰。肠道菌群是近年的研究热点,研究表明肠道菌群与重症肺炎相关,基于“肺与大肠相表里”理论,阐述肺-肠-重症肺炎的关联性,探讨中西医结合治疗重症肺炎的思路。

近20年中医“肺肠同治”临床应用可视化分析

目的分析总结“肺肠同治”理论的研究现状、研究热点及发展趋势,从而为该领域后期的研究提供参考。方法检索中国知网(CNKI)、万方数据库(Wanfang)和维普(VIP)中文数据库,自2004年1月1日-2023年4月30日期间收录的相关文献,利用CiteSpace、VOSviewer及Microsoft Excel软件对文献的发文年度、作者、研究机构及关键词进行可视化分析,并绘制知识图谱。结果共获得944篇文献,其中学术期刊751篇,硕博论文193篇。该领域论文共涉及作者2118名,其中发文量超过10篇的作者有23位,涉及的研究机构大部分是中医院校。近年来研究热点集中在肺与大肠的临床应用上,包括该理论指导下的疾病类型、治法、方药等。结论肺肠同治理论研究正处在上升阶段,对肠道菌群、代谢组学的研究可能是未来的研究趋势。