张颢龄 邹本良 熊伟 张广德

摘要 肠道微生态的改变影响着宿主能量代谢，参与糖尿病的发生。从中医角度分析肠道菌群在消渴发病机制中的作用，一方面认为生理上先天之本与后天之本参与了肠道菌群的形成与分布;另一方面，肠道菌群在功能上助肾推动脏腑气化，决定人之禀赋、助脾运化升清，助胃通降，因而，病理状态下，肾虚、胃强脾弱可诱发肠道菌群紊乱而病发消渴之症。在治疗方面，无论是具有滋阴补肾、清热健脾作用的中药或复方，还是低热量的饮食观念，不仅经现代研究证实可以通过调节肠道菌群结构改善葡萄糖稳态，还与中医学认识的消渴病机相契合，表明以肠道菌群为靶点，从先天之本与后天之本着手治疗糖尿病具有潜在的应用价值及发展前景。

关键词 糖尿病;肠道菌群;先天之本;后天之本;肾虚;胃强脾弱;病因病机;治疗策略

Role of “the Congenital Foundation and the Foundation of Acquired Constitution” in the Pathogenesis and Treatment of Diabetes Mellitus Based on Intestinal Flora

ZHANG Haoling1，ZOU Benliang2，XIONG Wei2，ZHANG Guangde2

（1 Graduate School of China Academy of Chinese Medical Sciences，Beijing 100700，China; 2 Xiyuan Hospital，China Academy of Chinese Medical Sciences，Beijing 100091，China）

Abstract Changes of intestinal microecology affect the host energy metabolism to participate in the occurrence of diabetes.This paper analyzes the role of intestinal flora in the pathogenesis of diabetes from the perspective of traditional Chinese medicine，and holds that “the congenital foundation and the foundation of acquired constitution” involves in the formation and distribution of intestinal flora.On the other hand，the intestinal flora functionally helps the kidney to promote the gasification，determines one′s endowment，helps the spleen to transport and ascend clear and and helps the stomach to propell food downward.Therefore，in the pathological state，kidney deficiency，stomach excess，and spleen weakness can lead to diabetes by inducing intestinal flora disorders.In terms of treatment，whether it is the single herb or compound prescription with the function of enriching yin and nourishing kidney，clearing heat and invigorating spleen，or the concept of low-calorie diet，it is not only confirmed by modern research that it can improve glucose homeostasis by regulating the structure of intestinal flora，but also in accordance with the pathogenesis of diabetes recognized by traditional Chinese medicine，indicating that it has potential application value and development prospect to treat diabetes with intestinal flora as the target from “the congenital foundation and the foundation of acquired constitution”.

Keywords Diabetes mellitus; Intestinal flora; Congenital foundation; Foundation of acquired constitution; Deficiency of the kidney; Stomach preponderance and spleen weakness; Etiology and pathogenesis; Treatment strategies

中圖分类号：R242文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.03.016

肠道菌群已被认为是导致糖代谢异常的重要因素之一。目前已被证实，肠道菌群紊乱状态下，其代谢产物短链脂肪酸减少，可抑制多条糖脂代谢通路[1];脂多糖作为革兰氏阴性菌细胞壁成分，通过受损的肠道屏障进入循环触发的低级别炎性反应，是造成胰岛素抵抗的关键因素[2];另外，胆汁酸作为多种代谢通路的信号分子，也受到肠道菌群的影响，通过激活肠道法尼醇X受体，肠神经酰胺生成增多，引发内质网应激，破坏糖代谢稳态[3]。由此可见，肠道微生态密切参与着糖尿病的发生发展，而使肠道菌群紊乱得以纠正后，可使糖代谢得到明显改善。……