基于“肝失疏泄”理论的糖尿病与焦虑共病现代生物学机制及中西医结合干预研究

Progress in Modern Biological Mechanisms of Comorbid Diabetes Mellitus and Anxiety from the Perspective of “Liver Dysfunction in Dispersing and Draining” and the Intervention of Integrated Traditional Chinese and Western Medicine

摘要: 糖尿病与焦虑障碍是临床常见的共病现象，二者相互影响，形成恶性循环，严重损害患者的生活质量与预后。现代医学从神经内分泌、免疫炎症、脑肠轴等角度探讨其共同病理机制，但缺乏整体性的理论框架。中医理论认为“肝主疏泄，调畅气机”，肝失疏泄是糖尿病与焦虑共病的关键病机。本文旨在系统梳理肝失疏泄的现代科学内涵，并以此为桥梁，整合现代生物学研究成果，探讨糖尿病与焦虑共病的潜在机制。文章将围绕肝失疏泄与神经–内分泌–免疫(NEI)网络紊乱、下丘脑–垂体–肾上腺(HPA)轴亢进/节律失常、胆汁酸代谢失调、脑肠轴功能异常以及生物钟节律紊乱等核心环节的关联性展开论述，阐明肝气郁滞如何通过影响多层次生理病理过程，共同导致糖代谢异常与焦虑情绪的产生。最后，结合认知行为疗法、疏肝理气中药等中西医结合干预证据，论证从肝论治糖尿病共病焦虑的科学性与应用价值，以期为该共病的临床诊疗与机制研究提供新的思路和理论依据。

Abstract: The comorbidity of diabetes mellitus and anxiety disorders is a common clinical phenomenon. They interact with each other, forming a vicious cycle that severely impairs patients’ quality of life and prognosis. Modern medicine explores its shared pathological mechanisms from perspectives such as neuroendocrinology, immune inflammation, and the gut-brain axis, but lacks an overall theoretical framework. Traditional Chinese Medicine (TCM) theory posits that “the Liver governs dispersion and drainage, regulating the flow of Qi,” and liver dysfunction in dispersing and draining is a key pathogenesis underlying the comorbidity of diabetes mellitus and anxiety. This article aims to systematically review the modern scientific connotation of liver dysfunction in dispersing and draining, and, using it as a bridge, integrate modern biological research findings to explore the potential mechanisms of this comorbidity. The discussion will focus on the connections between Liver dysfunction in dispersing and draining aspects such as dysregulation of the Neuro-Endocrine-Immune (NEI) network, hyperactivity/dysrhythmia of the Hypothalamic-Pituitary-Adrenal (HPA) axis, dysregulation of bile acid metabolism, dysfunction of the gut-brain axis, and disruption of circadian rhythms. It elucidates how Liver Qi stagnation affects multi-level physiological and pathological processes, collectively leading to abnormal glucose metabolism and the emergence of anxiety. Finally, by integrating evidence from integrated Chinese and Western medicine interventions such as cognitive behavioral therapy and TCM formulas for soothing the Liver and regulating Qi, the scientific basis and application value of treating comorbid diabetes mellitus and anxiety from the Liver perspective are demonstrated, aiming to provide new ideas and theoretical foundations for the clinical diagnosis, treatment, and mechanistic research of this comorbidity.