从肠道菌群探讨中医助脾散精法治疗糖尿病的思考
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摘要
肠道菌群是目前医学研究的热点话题,其与糖尿病的相关性已在基因、分子层面进行了揭示。中医典籍无关于"肠道菌群"的记载,其功能的论述散见于脾的相关章节。笔者通过多年临证探索,提出针对糖尿病治疗的助脾散精法,并发现助脾散精与肠道菌群有着密切联系,对于糖尿病治疗有其实际的临床意义。
Gut microbiota is a hot topic in medical research at present, and its correlation with diabetes has been revealed at the genetic and molecular levels. There is no clear record about "gut microbiota" in classics of Chinese medicine. The discussions of its functions can be found in the chapters of Pi. Through years of clinical research, authors put forward reinforcing Pi to disperse essence method for treating diabetes. They also found a close relationship between the therapeutic method and gut microbiota, which had practical clinical significance for treating diabetes.
Gut microbiota is a hot topic in medical research at present, and its correlation with diabetes has been revealed at the genetic and molecular levels. There is no clear record about "gut microbiota" in classics of Chinese medicine. The discussions of its functions can be found in the chapters of Pi. Through years of clinical research, authors put forward reinforcing Pi to disperse essence method for treating diabetes. They also found a close relationship between the therapeutic method and gut microbiota, which had practical clinical significance for treating diabetes.
引文
[1] 岳仁宋,陈源,王帅,等.试论助脾散精法治疗糖尿病[J].新中医,2011,43(2):155-156.
[2] 张爱霞,岳仁宋,杨彩虹.助脾散精法治疗2型糖尿病胃强脾弱证46例疗效观察[J].四川中医,2012,30(10):96-97.
[3] Everard A,Cani PD.Diabetes,obesity and gut microbiota[J].Best Pract Res Clin Gastroenterol,2013,27(1):73-83.
[4] Nagpal R,Kumar M,Yadav AK,et al.Gut microbiota in health and disease:an overview focused on metabolic inflammation[J].Benefit Micro,2015,7(2):181-194.
[5] Larsen N,Vogensen FK,van den Berg FW,et al.Gut microbiota in human adults with type 2 diabetes differs from non-diabetic adults[J].PLoS One,2010,5(2):e9085.
[6] Karlsson FH,Tremaroli V,Nookaew I,et al.Gut metagenome in European women with normal,impaired and diabetic glucose control[J].Nature,2013,498(7452):99-103.
[7] Qin J,Li Y,Cai Z,et al.A metagenome-wide association study of gut microbiota in type 2 diabetes[J].Nature,2015,490(7418):55-60.
[8] Tan J,Mckenzie C,Potamitis M,et al.The role of short-chain fatty acids in health and disease[J].Adv Immunol,2014,121(1):91-119.
[9] Fang S,Suh JM,Reilly SM,et al.Intestinal FXR agonism promotes adipose tissue browning and reduces obesity and insulin resistance[J].Nature Med,2015,21(2):159-165.
[10] Su B,Liu H,Li J,et al.Acarbose treatment affects the serum levels of inflammatory cytokines and the gut content ofbifidobacteria in Chinese patients with type 2 diabetes mellitus[J].J Diabetes,2015,7(5):729-739.
[11] Shin NR,Lee JC,Lee HY,et al.An increase in the Akkermansia spp. population induced by metformin treatment improves glucose homeostasis in diet-induced obese mice[J].Gut,2014,63(5):727-735.
[12] Shan CY,Yang JH,Kong Y,et al.Alteration of the intestinal barrier and GLP2 secretion inberberine-treated type 2 diabetic rats[J].J Endocrinol,2013,218(3):255-262.
[13] Xu J,Lian F,Zhao L,et al.Structural modulation of gut microbiota during alleviation of type 2 diabetes with a Chinese herbal formula[J].ISME J,2015,9(3):552-562.
[14] 喻国,岳仁宋.脾弱胃强恶性循环与糖尿病相关性探讨[J].中国中医药信息杂志,2014,21(8):117-118.
[15] 周建龙,岳仁宋,邓朵朵,等.从挽精逐浊法论治代谢性疾病[J].中华中医药杂志,2017,32(2):593-595.
[16] 邓朵朵,岳仁宋,肖恒,等.岳仁宋教授应用半夏泻心汤临床经验举隅[J].四川中医,2015,3(3):141-142.
[17] 岳仁宋,白富彬,廖秋双,等.2型糖尿病血糖波动从脾论治的思路探讨[J].辽宁中医杂志,2011,38(5):892-893.
[18] 魏佳,岳仁宋.岳仁宋教授运用半夏泻心汤加减治疗糖尿病性腹泻验案2则[J].湖南中医杂志,2015,31(3):115-118.
[19] 杨玉玲.半夏泻心汤及其拆方对2型糖尿病模型大鼠胰岛素抵抗的作用机制研究[D].成都:成都中医药大学,2016.
[20] 徐萌,王吉娥,陈继兰,等.半夏泻心汤对糖尿病胃轻瘫大鼠胰岛素抵抗的影响[J].中医杂志,2015,56(17):1502-1505.
[21] 岳仁宋,杨彩虹,王帅.苦辛运中法治疗新诊断2型糖尿病(湿热困脾型)的临床疗效观察[J].时珍国医国药,2014,25(4):887-889.
[22] 高晓斐,毛黎黎,孙子微,等.人参皂苷Rb-1与罗格列酮联合给药对2型糖尿病记忆障碍小鼠海马胰岛素信号传导通路的影响[J].中国实验方剂学杂志,2014,20(8):137-141.
[23] Qin J,Li R,Raes J,et al.A human gut microbial gene catalogue established by metagenomic sequencing[J].Nature,2010,464(7285):59-65.
[24] 邵加庆.代谢性疾病防控的新大陆——肠道菌群[J].医学研究生学报,2016,29(1):16-20.
[25] 陈秀琴,黄小洁,石达友,等.中药与肠道菌群相互作用的研究进展[J].中草药,2014,45(7):1031-1036.
[26] Zhang CH,Zhang MH,Wang SY,et al.Interactions between gut microbiota,host genetics and diet relevant to development of metabolic syndromes in mice[J].ISME J,2010,4(2):232-241.
[27] 马祥雪,王凤云,符竣杰,等.基于肠道菌群的中医健脾方剂作用机制的研究现状与思考[J].中国实验方剂学杂志,2017,23(5):210-215.
[28] 车轶文,于宁,翟双庆.脾与肠道菌群相关性的理论探析[J].世界中医药,2015,10(5):703-705,709.
[29] 邵铁娟,李海昌,谢志军,等.基于脾主运化理论探讨脾虚湿困与肠道菌群紊乱的关系[J].中华中医药杂志,2014,29(12):3762-3765.
[30] Koh A,Vadder FD,Kovatcheva-Datchary P,et al.From dietary fiber to host physiology:short-chain fatty acids as key bacterial metabolites[J].Cell,2016,165(6):1332-1345.
[31] 尚婧晔,余倩.肠道菌群代谢作用与人体健康关系的研究进展[J].中国微生态学杂志,2012,24(1):87-90.
[32] 刘彩虹,张和平.肠道菌群与肠道内营养物质代谢的相互作用[J].中国乳品工业,2014,42(5):33-36,57.
[33] 林日添,吴维,刘占举.短链脂肪酸对肠黏膜稳态免疫调节作用的研究进展[J].免疫学杂志,2017,33(10):900-904.
[34] 邢德刚,高艳华,张桂芳,等.从调整肠道菌群研究黄芪复方制剂对糖尿病大鼠的治疗机制[J].中国微生态学杂志,2000,12(6):335-336.
[35] 何旭云,贺姣姣,郑宁宁,等.黄芪多糖对肥胖小鼠的减肥作用与调节肠道菌群的关系研究[J].世界中医药,2016,11(11):2379-2384,2388.
[36] 庞书勤,辛惠明,刘玲玉,等.薯蓣粥对2型糖尿病肠道内双歧杆菌及血糖影响研究[J].中国实用内科杂志,2017,37(3):247-250.
[37] 刘小溪,李小娟,石岩,等.益气补脾法配合二甲双胍干预脾虚证2型糖尿病患者肠道菌群的临床研究[J].辽宁中医杂志,2017,44(11):2311-2313.
[38] 余仁强,袁金玲,马路一,等.益生菌对肥胖大鼠血脂紊乱及胰岛素抵抗的影响[J].中国当代儿科杂志,2013,15(12):1123-1127.
[39] 熊青,杨学军,任汐,等.肠道菌群特征与胰岛素抵抗的相关性研究[J].重庆医学,2016,45(33):4658-4660.
[40] Yatsunenko T,Rey FE,Manary MJ,et al.Human gut microbiome viewed across age and geography[J].Nature,2012,486(7402):222-227.
[41] 朱超霞,陆颖理.肠道菌群与肥胖及相关代谢性疾病关系的研究进展[J].上海交通大学学报(医学版),2014,34(12):1829-1833.
[42] Aronsson L,Huang Y,Parini P,et al.Decreased fat storage by Lactobacillus paracasei is associated with increased levels of angiopoietin-like 4 protein (ANGPTL4)[J].PLoS One,2010,5(9):855-867.
[43] Kondo S,Xiao JZ,Satoh T,et al.Anti-obesity effects of Bifidobacterium breve strain B-3 supplementation in a mouse model with high-fat diet-induced obesity[J].Biosci Biotechnol Biochem,2010,74(8):1656-1661.
[44] Xu JH,Liu XZ,Pan W,et al.Berberine protects against diet-induced obesity through regulating metabolic endotoxemia and gut hormone levels[J].Molec Med Reports,2017,15(5):2765-2787.
[45] Sun H,Wang N,Cang Z,et al.Modulation of microbiota-gut-brain axis by berberine resulting in improved metabolic status in high fat diet fed rats[J].Obesity Facts,2016,9(6):365-378.
[46] 冯新格,严育忠,曾艺鹏,等.葛根芩连汤对2型糖尿病湿热证肠道菌群的影响[J].世界中西医结合杂志,2016,11(8):1110-1112.
[47] 孙晓泽,杜芬芬,刘爱华.升降散对DM大鼠肠道菌群结构变化及炎症因子的影响[J].中国中医药现代远程教育,2017,15(8):135-137.
[2] 张爱霞,岳仁宋,杨彩虹.助脾散精法治疗2型糖尿病胃强脾弱证46例疗效观察[J].四川中医,2012,30(10):96-97.
[3] Everard A,Cani PD.Diabetes,obesity and gut microbiota[J].Best Pract Res Clin Gastroenterol,2013,27(1):73-83.
[4] Nagpal R,Kumar M,Yadav AK,et al.Gut microbiota in health and disease:an overview focused on metabolic inflammation[J].Benefit Micro,2015,7(2):181-194.
[5] Larsen N,Vogensen FK,van den Berg FW,et al.Gut microbiota in human adults with type 2 diabetes differs from non-diabetic adults[J].PLoS One,2010,5(2):e9085.
[6] Karlsson FH,Tremaroli V,Nookaew I,et al.Gut metagenome in European women with normal,impaired and diabetic glucose control[J].Nature,2013,498(7452):99-103.
[7] Qin J,Li Y,Cai Z,et al.A metagenome-wide association study of gut microbiota in type 2 diabetes[J].Nature,2015,490(7418):55-60.
[8] Tan J,Mckenzie C,Potamitis M,et al.The role of short-chain fatty acids in health and disease[J].Adv Immunol,2014,121(1):91-119.
[9] Fang S,Suh JM,Reilly SM,et al.Intestinal FXR agonism promotes adipose tissue browning and reduces obesity and insulin resistance[J].Nature Med,2015,21(2):159-165.
[10] Su B,Liu H,Li J,et al.Acarbose treatment affects the serum levels of inflammatory cytokines and the gut content ofbifidobacteria in Chinese patients with type 2 diabetes mellitus[J].J Diabetes,2015,7(5):729-739.
[11] Shin NR,Lee JC,Lee HY,et al.An increase in the Akkermansia spp. population induced by metformin treatment improves glucose homeostasis in diet-induced obese mice[J].Gut,2014,63(5):727-735.
[12] Shan CY,Yang JH,Kong Y,et al.Alteration of the intestinal barrier and GLP2 secretion inberberine-treated type 2 diabetic rats[J].J Endocrinol,2013,218(3):255-262.
[13] Xu J,Lian F,Zhao L,et al.Structural modulation of gut microbiota during alleviation of type 2 diabetes with a Chinese herbal formula[J].ISME J,2015,9(3):552-562.
[14] 喻国,岳仁宋.脾弱胃强恶性循环与糖尿病相关性探讨[J].中国中医药信息杂志,2014,21(8):117-118.
[15] 周建龙,岳仁宋,邓朵朵,等.从挽精逐浊法论治代谢性疾病[J].中华中医药杂志,2017,32(2):593-595.
[16] 邓朵朵,岳仁宋,肖恒,等.岳仁宋教授应用半夏泻心汤临床经验举隅[J].四川中医,2015,3(3):141-142.
[17] 岳仁宋,白富彬,廖秋双,等.2型糖尿病血糖波动从脾论治的思路探讨[J].辽宁中医杂志,2011,38(5):892-893.
[18] 魏佳,岳仁宋.岳仁宋教授运用半夏泻心汤加减治疗糖尿病性腹泻验案2则[J].湖南中医杂志,2015,31(3):115-118.
[19] 杨玉玲.半夏泻心汤及其拆方对2型糖尿病模型大鼠胰岛素抵抗的作用机制研究[D].成都:成都中医药大学,2016.
[20] 徐萌,王吉娥,陈继兰,等.半夏泻心汤对糖尿病胃轻瘫大鼠胰岛素抵抗的影响[J].中医杂志,2015,56(17):1502-1505.
[21] 岳仁宋,杨彩虹,王帅.苦辛运中法治疗新诊断2型糖尿病(湿热困脾型)的临床疗效观察[J].时珍国医国药,2014,25(4):887-889.
[22] 高晓斐,毛黎黎,孙子微,等.人参皂苷Rb-1与罗格列酮联合给药对2型糖尿病记忆障碍小鼠海马胰岛素信号传导通路的影响[J].中国实验方剂学杂志,2014,20(8):137-141.
[23] Qin J,Li R,Raes J,et al.A human gut microbial gene catalogue established by metagenomic sequencing[J].Nature,2010,464(7285):59-65.
[24] 邵加庆.代谢性疾病防控的新大陆——肠道菌群[J].医学研究生学报,2016,29(1):16-20.
[25] 陈秀琴,黄小洁,石达友,等.中药与肠道菌群相互作用的研究进展[J].中草药,2014,45(7):1031-1036.
[26] Zhang CH,Zhang MH,Wang SY,et al.Interactions between gut microbiota,host genetics and diet relevant to development of metabolic syndromes in mice[J].ISME J,2010,4(2):232-241.
[27] 马祥雪,王凤云,符竣杰,等.基于肠道菌群的中医健脾方剂作用机制的研究现状与思考[J].中国实验方剂学杂志,2017,23(5):210-215.
[28] 车轶文,于宁,翟双庆.脾与肠道菌群相关性的理论探析[J].世界中医药,2015,10(5):703-705,709.
[29] 邵铁娟,李海昌,谢志军,等.基于脾主运化理论探讨脾虚湿困与肠道菌群紊乱的关系[J].中华中医药杂志,2014,29(12):3762-3765.
[30] Koh A,Vadder FD,Kovatcheva-Datchary P,et al.From dietary fiber to host physiology:short-chain fatty acids as key bacterial metabolites[J].Cell,2016,165(6):1332-1345.
[31] 尚婧晔,余倩.肠道菌群代谢作用与人体健康关系的研究进展[J].中国微生态学杂志,2012,24(1):87-90.
[32] 刘彩虹,张和平.肠道菌群与肠道内营养物质代谢的相互作用[J].中国乳品工业,2014,42(5):33-36,57.
[33] 林日添,吴维,刘占举.短链脂肪酸对肠黏膜稳态免疫调节作用的研究进展[J].免疫学杂志,2017,33(10):900-904.
[34] 邢德刚,高艳华,张桂芳,等.从调整肠道菌群研究黄芪复方制剂对糖尿病大鼠的治疗机制[J].中国微生态学杂志,2000,12(6):335-336.
[35] 何旭云,贺姣姣,郑宁宁,等.黄芪多糖对肥胖小鼠的减肥作用与调节肠道菌群的关系研究[J].世界中医药,2016,11(11):2379-2384,2388.
[36] 庞书勤,辛惠明,刘玲玉,等.薯蓣粥对2型糖尿病肠道内双歧杆菌及血糖影响研究[J].中国实用内科杂志,2017,37(3):247-250.
[37] 刘小溪,李小娟,石岩,等.益气补脾法配合二甲双胍干预脾虚证2型糖尿病患者肠道菌群的临床研究[J].辽宁中医杂志,2017,44(11):2311-2313.
[38] 余仁强,袁金玲,马路一,等.益生菌对肥胖大鼠血脂紊乱及胰岛素抵抗的影响[J].中国当代儿科杂志,2013,15(12):1123-1127.
[39] 熊青,杨学军,任汐,等.肠道菌群特征与胰岛素抵抗的相关性研究[J].重庆医学,2016,45(33):4658-4660.
[40] Yatsunenko T,Rey FE,Manary MJ,et al.Human gut microbiome viewed across age and geography[J].Nature,2012,486(7402):222-227.
[41] 朱超霞,陆颖理.肠道菌群与肥胖及相关代谢性疾病关系的研究进展[J].上海交通大学学报(医学版),2014,34(12):1829-1833.
[42] Aronsson L,Huang Y,Parini P,et al.Decreased fat storage by Lactobacillus paracasei is associated with increased levels of angiopoietin-like 4 protein (ANGPTL4)[J].PLoS One,2010,5(9):855-867.
[43] Kondo S,Xiao JZ,Satoh T,et al.Anti-obesity effects of Bifidobacterium breve strain B-3 supplementation in a mouse model with high-fat diet-induced obesity[J].Biosci Biotechnol Biochem,2010,74(8):1656-1661.
[44] Xu JH,Liu XZ,Pan W,et al.Berberine protects against diet-induced obesity through regulating metabolic endotoxemia and gut hormone levels[J].Molec Med Reports,2017,15(5):2765-2787.
[45] Sun H,Wang N,Cang Z,et al.Modulation of microbiota-gut-brain axis by berberine resulting in improved metabolic status in high fat diet fed rats[J].Obesity Facts,2016,9(6):365-378.
[46] 冯新格,严育忠,曾艺鹏,等.葛根芩连汤对2型糖尿病湿热证肠道菌群的影响[J].世界中西医结合杂志,2016,11(8):1110-1112.
[47] 孙晓泽,杜芬芬,刘爱华.升降散对DM大鼠肠道菌群结构变化及炎症因子的影响[J].中国中医药现代远程教育,2017,15(8):135-137.