基于“脏腑相关”探讨“肺-肠-脑轴”在慢性阻塞性肺疾病合并神志异常诊疗中的应用  

Application of"lung-gut-brain axis"in the diagnosis and treatment of COPD combined with abnormal consciousness based on"zang-fu correlation"

作　　者：王琦[1] 李雁[1] 陈一凡[2] 张思碧 贾子龙[3] WANG Qi;LI Yan;CHEN Yifan;ZHANG Sibi;JIA Zilong(Emergency Department,Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China;Beijing University of Chinese Medicine,Beijing 100029;Tuina Department,Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700)

机构地区：[1]北京中医药大学东直门医院急诊科,北京100700 [2]北京中医药大学,北京100029 [3]北京中医药大学东直门医院推拿科,北京100700

出　　处：《北京中医药》2025年第3期371-376,共6页Beijing Journal of Traditional Chinese Medicine

基　　金：中央高水平中医医院临床科研业务费资助项目(DZMG-MLZY-23004);北京市中医药“薪火传承3+3工程”项目(2020-SZ-A-47)。

摘　　要：慢性阻塞性肺疾病(COPD)患者常伴焦虑、抑郁、认知功能受损甚至意识障碍等神志异常,其病变与肺、脑关系密切。现代研究发现,肺与肠道、肠道与大脑在生理上密切关联,提出“肺-肠轴”“脑-肠轴”,这与中医学“脏腑相关”视角下的“肺与大肠相表里”“脑肠相关”理论相似。COPD患者在疾病进展过程中,肺部气道炎症改变,通过“肺-肠轴”可引起肠道菌群紊乱、肠道屏障受损,造成肠神经与内分泌系统稳态紊乱,使脑肠肽分泌异常;通过“脑-肠轴”引起脑肠互动失衡,间接对神经中枢、大脑功能产生影响,从而可能导致神志改变发生。因此,治疗需兼顾肺肠同治、脑肠同治,应用宣肺化痰、通腑泄浊、醒脑开窍之法,通过中药、针灸及导引功法等调节“肺-肠-脑轴”,改善及预防COPD患者神志异常表现。肠道菌群亦成为疾病治疗的新靶点,未来有广阔的研究及应用前景。Chronic obstructive pulmonary disease(COPD)patients are often accompanied by abnormal consciousness such as anxiety,depression,impaired cognitive function,and even disturbances in consciousness,which are closely related to the lung and brain.Modern research has found that the lung and gut,as well as the gut and brain,are closely connected physiologically.The concepts of the“lung-gut axis”and the“brain-gut axis”have been proposed,which align with the traditional Chinese medicine(TCM)theory of“Zang-Fu correlation”,specifically the“interior-exterior relationship between the lung and large intestine”and“brain-gut correlation”perspectives.In the progression of COPD,lung airway inflammation changes through the“lung-gut axis”,causing gut flora imbalances,intestinal barrier damage,and disruption of the homeostasis of the enteric nervous and endocrine systems,leading to abnormal secretion of brain-gut peptides.Through the“brain-gut axis”,this imbalance of brain-gut interaction indirectly affects the nerve center and brain function,which may lead to changes in consciousness.Therefore,treatment should focus on both lung and gut,as well as brain and gut,using methods such as ventilating the lung,resolving phlegm,regulating the Fuorgans to remove turbidity,and awakening the brain and opening the orifices.These approaches,utilizing Chinese medicine,acupuncture,moxibustion,and conduction exercise,can adjust the“lung-gut-brain axis”to improve and prevent abnormal consciousness in COPD patients.Additionally,intestinal flora has become a new target for disease treatment,with promising research and application prospects in the future.

关 键 词：“肺-肠-脑轴” 慢性阻塞性肺疾病 神志异常 

分 类 号：R563[医药卫生—呼吸系统]