从肠道微生态理论浅析仲景胃气理论的科学内涵与临床应用  

Based on Intestinal Microecology Theory to Analyze Scientific Connotation and Clinical Application in ZHANG Zhongjing’s Stomach Qi Theory

作　　者：刘婉婷 林树元[1] 吝盼洁 林妙 瞿溢谦 曹灵勇[1] 王磊 LIU Wanting;LIN Shuyuan;LIN Panjie(School of Basic Medical Sciences,Zhejiang Chinese Medi-cal University,Hangzhou(310053),China)

机构地区：[1]浙江中医药大学基础医学院,杭州310053 [2]浙江中医药大学附属第二医院

出　　处：《浙江中医药大学学报》2025年第3期376-381,390,共7页Journal of Zhejiang Chinese Medical University

基　　金：国家自然科学基金项目(82104803);浙江中医药大学校级科研基金项目(2022RCZXZK17)。

摘　　要：[目的]运用肠道微生态理论探讨仲景胃气理论的科学内涵,为其临床应用提供依据。[方法]整理《黄帝内经》《伤寒论》《金匮要略》等中医古籍中对脾胃及其功能的相关记载。基于肠道菌群及肠道微生态理论,分别从生理和病理角度探讨仲景胃气理论的科学内涵,并以此为基础,浅析该理论在临床上防病传变及预测愈后的科学依据。[结果]仲景胃气理论的现代内涵,可用肠道菌群及肠道微生态环境在人体生理中的作用及病理过程中的影响来解释。在生理功能层面,肠道菌群转化食物,维持正常代谢的机制可相应于胃气生化津液的作用;其促进肠黏膜免疫屏障的发育和成熟,抑制致病菌的作用机制可相应于胃气抗御邪气的作用;其维护肠黏膜屏障完整的作用可相应于胃气制摄下焦的作用;其通过肠-脑轴影响神志的作用可相应于胃气调神安志的作用。在病理状态层面,以肠道菌群紊乱为主的肠道微生态环境失衡可分别体现仲景体系中胃虚寒之太阴病、胃实热之阳明病,及寒热虚实错杂之厥阴病的病理特点。在胃气防病传变及预测愈后层面,肠道微生态环境失衡既是病因又是疾病的结果,且能加剧疾病的发展,体现了胃气病理状态对疾病性质、病传及愈后的影响,进一步证明仲景“保胃气”学术思想的重要性。[结论]以肠道微生态理论为切入点,探讨胃气理论的科学内涵,符合现代生物学认识。肠道菌群及肠道微生态理论可以作为仲景“保胃气”学术思想与现代医学之间的桥梁,能为提高经方临床疗效及可解释性提供理论依据与研究新思路。[ObjectiveObjective]To explore the scientific connotation of ZHANG Zhongjing’s stomach Qi theory with gut microbiota theory and to provide a basis for its clinical application.[MethodsMethods]Relevant records on the spleen and stomach,and their functions were collected from traditional Chinese medical classics such as Huangdi Neijing,Shanghan Lun and Jingui Yaolue.Based on the theory of gut microbiota and gut microecology,the scientific connotation of ZHANG Zhongjing’s stomach Qi theory was explored from both physiological and pathological perspectives.Furthermore,the scientific basis of this theory in preventing disease transmission and predicting prognosis in clinical practice was preliminarily analyzed.[ResultsResults]The modern connotation of ZHANG Zhongjing’s theory of stomach Qi can be explained from the roles of gut microbiota and the gut microecological environment in human physiology and their mechanisms of influence in pathological processes.The gut microbiota converts food and maintains normal metabolism,corresponding to stomach Qi’s role in generating biochemical fluids.It also promotes the development of the intestinal mucosal immune barrier and inhibits pathogenic bacteria,reflecting stomach Qi’s defensive role.Furthermore,the microbiota maintains intestinal barrier integrity,aligning with stomach Qi’s regulation in the lower-Jiao,and influences cognition through the gut-brain axis,which corresponds to the calming aspects of stomach Qi.At the level of pathological states,gut microecological imbalance,primarily characterized by dysbiosis,exemplifies the pathological features of Taiyin disease related to stomach deficiency and cold,Yangming disease associated with stomach excess and heat,and Jueyin disease marked by mixed cold,heat,deficiency and excess,as described in the Zhongjing system.It is acknowledged that gut microbial imbalance is both a cause of diseases,which can further exacerbate disease progression,and a consequence of diseases.This highlights the impact of the pathological s

关 键 词：张仲景 胃气 肠道菌群 肠道微生态 《伤寒论》 《金匮要略》 《黄帝内经》 科学内涵 

分 类 号：R574[医药卫生—消化系统]