基于肠道菌群从气机升降理论探析糖尿病发病机制

肠道菌群及其代谢产物之间的稳态对维持宿主的正常代谢和生理功能起着关键作用,这也与中医认为"气机升降"运动维持着人体脏腑气血津液等功能作用的发挥,使机体实现动态平衡的观点有许多相似之处。越来越多研究证实肠道微生物功能失调可影响宿主信号传导途径,从而导致糖尿病及其并发症的发生发展,而肠道关键菌的调控已逐渐成为糖尿病及其并发症防治的重要新靶点。气机升降理论立足于"动态平衡",将气机升降与各脏腑组织的功能活动、精微物质的输布、能量的代谢等环节紧密渗透连贯,高度概括了机体生理活动及病理变化的基本表现形式。气机升降障碍是导致机体各系统内环境失衡的主要原因。本文藉气机升降理论,动态阐释肠道微生态失衡在糖尿病的病理生理机制中的病机演变规律。笔者认为气机升降有序是维持肠道微生态平衡及物质代谢"内稳态"的必要条件。若气机升降失权,金失敛降,土不散精,木郁不疏,元阳虚损,则清阳不升、浊阴下陷,肠腑受盛、传道功能失常;这种失衡状态进一步发展会加剧气血津液代谢障碍,使精不归正化,郁滞化火而变生糖尿病。因此,在气机升降理论指导下,探讨肠道菌群及其代谢产物对糖尿病的调节机制,将有助于揭示中医药通过调节肠道菌群,维持机体物质代谢"内稳态"的科学内涵。

Analysis on Pathogenesis of Diabetes Mellitus Based on Theory of Ascending and Descending of Qi Movement of Gut Microbiota

The gut microbiota and its metabolites play a critical role on health maintenance, because they are involved in the absorption and metabolism of nutrients in the human bodies. This is also similar to traditional Chinese medicine (TCM) view that the ascending and descending of Qi movement affects Yin-Yang, Qi-blood, pneuma and body fluid, viscera and meridians of our bodies. More and more studies have demonstrated that gut microbiota is closely related to the development and progression of diabetes and its complications. Gut microbiota disorder could affect host metabolic signaling pathways, thereby promoting the formation and development of diabetes. The smooth ascending and descending of Qi movement is the basic form of maintaining host metabolic homeostasis, whose dysfunction however can lead to internal environment disturbance. Based on the theory of ascending and descending of Qi movement, this paper focuses on the pathogenesis of imbalanced intestinal flora in the process of the induction of diabetes mellitus from a dynamic perspective. It is assumed that the imbalance of Qi ascending and descending may act as a trigger for such symptoms as lung Qi impairment, spleen deficiency to dissipating essence, liver Qi stagnation and kidney Yang deficiency. Under this circumstance, gut microbiota will be out of balance, which will further lead to the nutrient substance metabolic disturbance in the body, and thus induce diabetes. Thus, it is significant to explore the regulatory mechanism of gut microbiota and its metabolites on diabetes based on the theory of ascending and descending of Qi movement, so as to reveal the scientific connotation of TCM in regulating substance metabolism homeostasis in the body.