基于“脾主为卫”的黄芽汤治疗溃疡性结肠炎机制探讨

[目的]丰富中医“脾主为卫”理论的现代科学内涵，为实验研究及临床治疗溃疡性结肠炎(ulcerative colitis，UC)提供思路借鉴。[方法]自 UC中医治则治法与“脾主为卫”理论相契合出发，结合黄芽汤中各药物治疗 UC的作用，通过阐释“脾主为卫”的理论内涵及免疫学外延，同时结合现代药理学研究，初步探讨“健脾益气”经典方黄芽汤治疗 UC的潜在作用机制。[结果]尽管黄芽汤治疗 UC的研究尚缺乏，然黄芽汤自中医“脾主为卫”理论出发，通过“健脾益气”治疗 UC具有可行性，其潜在机制包括调节免疫细胞、保护肠上皮屏障功能、调节肠道菌群、抑制或减轻炎症反应、调节自噬通路表达 5个方面。[结论]中医“脾主为卫”理论内涵与现代医学中机体免疫功能的发挥具有同质生理效应，是脾、胃肠道等多器官协同作用的结果，采用“健脾益气”经典方黄芽汤通过多靶点、多环节治疗 UC，不仅具有可行性，亦将为 UC的治疗提供新思路，为中医基础理论及经典名方的系统研究和开发利用奠定基础。

Discussion on the Mechanism of Treating Ulcerative Colitis with Huangya Decoction Based on“Spleen Being in Charge of the Defensive Function”

[Objective] To enrich the modern scientific connotation of the theory“spleen being in charge of the defensive function”in traditional Chinese medicine，and provide ideas for experimental research and clinical treatment of ulcerative colitis(UC). [Methods]Starting from the congruency between the therapeutic principle and method for UC in traditional Chinese medicine and the theory“spleen being in charge of the defensive function”，and taking into account the fact that various components of Huangya Decoction werescientifically proven to effectively alleviate UC symptoms，this article discussed the potential mechanism of classic formula of Huangya Decoction in treating UC via“strengthening the spleen and enriching Qi”by explaining the theoretical connotation and immunological extension of“spleen being in charge of the defensive function”，and combining with modern pharmacological research. [Results] Althoughstudies on the treatment of UC by Huangya Decoction are still lacking，Huangya Decoction is feasible to treat UC by strengthening the spleen and enriching Qi based on the theory“spleen being in charge of the defensive function”in traditional Chinese medicine. The potential mechanisms include regulating immune cells，protecting intestinal epithelial barrier function，regulating intestinal flora， inhibiting or alleviating inflammatory response and regulating autophagy pathway expression. [Conclusion] The theoretical connotation of“spleen being in charge of the defensive function”in traditional Chinese medicine exhibits homologous physiological effects with the immune function in modern medicine，resulting from the synergistic action of multiple organs such as the spleen and gastrointestinal tract. The application of Huangya Decoction，a classic formula of strengthening the spleen and enriching Qi，for the treatment of UC throughmulti-target and multi-link approaches is not only feasible but also provides new insights for UC therapy. It lays a foundation for thesystematic research，development and utilization of basic theories in traditional Chinese medicine and classic formulas.