从“五脏之气”探讨代谢综合征的发病机制

代谢综合征(MS)是一组因机体多种物质代谢紊乱而产生的证候群,以血脂紊乱、中心性肥胖、血压升高、糖耐量异常及胰岛素抵抗为主要临床表现。随着人们饮食结构、生活习惯等方面的改变,MS的发病率日益增高,患病人群亦趋于年轻化,是糖尿病、动脉粥样硬化、冠心病、高脂血症、肝硬化及某些癌症等多种疾病发病的重要因素。中心性肥胖和胰岛素抵抗是被公认的重要致病因素,目前关于MS及其各个组分的发病机制尚未被充分认识。代谢综合征其临床表现复杂多样,中医认为本病的发生与饮食适宜、情志失调、过逸少动、年老体虚等因素有关。中医学者从痰瘀等病理因素、肝脾肾等脏腑功能、气血作用、情志因素等多角度研究了MS的发病机制。而气作为构成机体的基本物质,气化作用与机体新陈代谢的过程密切相关。MS的发生与机体内气机的升降出入及伴随而发生的形气转化的气化功能失常关系密切。气归于五脏分别称之为心气、肝气、脾气、肺气、肾气,"五脏之气"与参与机体水谷精微的生成、输布及排泄的全过程。该文从"五脏之气"出发,以产生的痰浊、瘀血、水饮等为病理因素探讨MS的发病机制,以冀对该病的临床治疗及预防提供理论支持。

Pathogenesis of Metabolic Syndrome from "Qi of five Internal Organs"

Metabolic syndrome (MS) is a group of syndromes caused by the disorder of metabolism of various substances in the body. The main clinical manifestations are dyslipidemia, central obesity, hypertension, abnormal glucose tolerance and insulin resistance. With the changes of diet structure and habits, the incidence rate of MS is increasing, and the patients are younger. It is an important factor in many diseases, such as diabetes, atherosclerosis, coronary heart disease, hyperlipidemia, cirrhosis and some cancers. MS has seriously affected people''s lives and health. Central obesity and insulin resistance are recognized as important pathogenic factors. At present, the pathogenesis of MS and its components has not been fully understood. The clinical manifestations of metabolic syndrome are complex and diverse. Traditional Chinese medicine (TCM) believes that the occurrence of metabolic syndrome is related to such factors as proper diet, emotional disorders, excessive escape and little movement, old age and physical deficiency. TCM scholars have studied the pathogenesis of MS in such pathological factors as phlegm and blood stasis, such visceral functions as liver, spleen and kidney, roles of Qi and blood, and emotional factors. As the basic substance of organism, Qi is closely related to the process of metabolism. The occurrence of MS is closely related to the rise and fall of Qi moving to and from the body as well as the abnormal gasification function of the transformation of Qi. Qi is derived from the five internal organs, which are respectively called Heart Qi, liver Qi, spleen Qi, lung Qi and kidney Qi. The "Qi of the five internal organs" is involved in the whole process of the generation, transportation and excretion of the essence of the body. Based on the "Qi of five internal organs", this paper discusses the pathogenesis of MS with phlegm, blood stasis and water drink as pathological factors.