洪力 杜冰 王纳 姚政 王维

【摘 要】 “知肝传脾”“治肝实脾”乃中医临床治疗肝病的经典思路，肝脾之间可以相互影响，“脾气健旺，使肝有所藏”。现代研究表明，肠道微生态受到脾脏功能的调控同时，通过肠—肝轴影响肝脏。临床治疗上也把调理脾功能作为一种主要的治法，疗效显著。故文章基于对中医肝脾理论的认识，从肠道微生态角度进行探讨，初步认为脾脏的“主运化”和“主卫”功能体现在肠道微生态，进而影响肝脏的代谢和免疫功能是中医“治肝实脾”治疗非酒精性脂肪肝的重要生物学基础。

【关键词】 肠道微生态;中医;治肝实脾

【中图分类号】R1   【文献标志码】 A    【文章编号】1007-8517（2021）12-0004-05

Abstract：“Treating the liver and strengthening the spleen” is a classic treatment for liver diseases in TCM.It treats liver diseases by regulating the spleen.Traditional Chinese medicine believes that the liver and spleen can influence each other，“knowing the liver and spreading the spleen” and “the temper is vigorous，so that the liver has hidden”.Modern studies have shown that intestinal microecology affects the liver through the entero-hepatic axis and is closely related to the occurrence and development of NAFLD.This process is similar to the relationship between liver and spleen in traditional Chinese medicine.In clinical treatment，the spleen function is also taken as a main treatment，and the curative effect is remarkable.Therefore，based on the understanding of the theory of liver and spleen in traditional Chinese medicine，discuss the spleen from the perspective of intestinal microecology，and prelimly believes that the “main transportation and transformation” and “main health” functions of the spleen are reflected in intestinal microecology，and then affect the metabolism and immune function of the liver，which is an important way to treat non-alcoholic fatty liver by “treating liver and strengthening spleen” in traditional Chinese medicine.

Keywords：Intestinal Microecology;The Doctor of Traditional Chinese Medicine;Treat Liver and Strengthen Spleen

非酒精性脂肪肝（Non alcoholic fatty liver disease，NAFLD）是一種在没有摄入过量的酒精的情况下，脂肪在肝脏进行积累的疾病。目前NAFLD是慢性肝病的常见病因，随着肥胖流行程度的不断提高，NAFLD的总体患病率不断上升[1]。对于NAFLD形成的机制认识由公认的“二次打击”学说上发展为“多层次打击”[2]学说。此学说认为，肠道微生物组通过肠-肝轴与胰岛素抵抗、内毒素一起对NAFLD的形成发挥着重要作用。中医认为的脾胃的功能是分解运输营养物质，其中定植在肠道中的肠道菌群在营养物质的分解运输中扮演重要角色，肠道菌群可能是中医脾胃实现功能的生物学基础。“治肝实脾”的理论是中医脏腑学说发展出来的一种用于指导临床的治疗法则，历代名医均有提及。最早见于《难经》，之后《金匮要略》中将此观点发展为“上工治未病，见肝之病，知肝传脾，当先实脾”。……