潘赐明 李应红 卞晶 查学志 朱瑛 汪剑 姚政

〔摘要〕 调肝理脾法为历代医家认可，肝脾既有五行生克制化关系，又有体阴用阳的协同作用，现代医学已经阐述了肝脾参与消化系统的机制。肝脾一体的思想滥觞于《黄帝内经》，从肝治脾、从脾调肝、肝脾同治可以体现在肠道微环境改变;“肝喜调达”与“六腑以通为用”，亦从中医理论解释了肝脾一体的新内涵。

〔关键词〕 肝脾;肝脾同治;肠道微环境;肠道菌群

〔中图分类号〕R229      〔文献标志码〕A       〔文章编号〕doi：10.3969/j.issn.1674-070X.2021.04.026

recognized by the physicians of the past dynasties. The liver and spleen not only have the relationship of restraint of the five elements， but also have the synergistic effect of body Yin and Yang. Modern medicine has deciphered the mechanism of liver and spleen participating in the digestive system. The idea of the integration of liver and spleen originated in Inner Canon of Yellow Emperor. The treatment of spleen from liver， regulating liver from spleen， and the combination of liver and spleen can be reflected in the changes of intestinal microenvironment. The "liver likes to harmonize" and "six bowels unobstructed in function" also explained the new connotation of the integration of liver and spleen from the theory of traditional Chinese medicine.

〔Keywords〕 liver and spleen; treatment of liver and spleen; intestinal microenvironment; intestinal flora

《醫学衷中参西录·五期·三卷·答刘希文问肝与脾之关系及肝病善作疼之理》云：“肝脾者，相助为理之脏也。人多谓肝木过盛可以克伤脾土，即不能消食;不知肝木过弱不能疏通脾土，亦不能消食……脾胃之健运实资其辅助。为其寄生相火也，可借火以生土，脾胃之饮食更赖之熟腐。”肝脏为最大的消化腺，辅助脾胃运化水谷精微，胃肠是维持人体生命的基本器官，肠-肝轴涉及多种炎症细胞类型和细胞因子、趋化因子及其他分子，这些分子导致正常肝结构器质的破坏，其诱因尚不清楚[1]。因此，本文基于肠道微环境的角度探讨“肝脾一体”的新内涵，以现代生物学为基础，以期为深入研究该理论提供科学依据。

1 “肝脾一体”的渊源

“肝脾一体”主要体现在五行生克制化以及协同体系，如《素问·五脏生成》云：“脾之合肉也，其荣唇也，其主肝也”。黄元御《素问悬解·卷二·五脏生成论》云：“脾主肉，唇者，肌肉之本，故合肉而荣唇。脾土制于肝木，其不至湿陷者，木制之也，故所主在肝。