基于“脑肠轴”理论探讨从肝脾论治化疗相关性便秘的作用机制

Exploring the Mechanism of Treating Chemotherapy-Related Constipation from the Perspective of Liver and Spleen Based on the Brain-Gut Axis Theory

摘要: 化疗相关性便秘(CRC)是恶性肿瘤患者常见且严重影响生活质量的不良反应，其发病机制尚未完全阐明，治疗手段亦有限。本文基于“脑肠轴”理论，系统探讨CRC的现代病理机制与中医“肝脾失调”核心病机之间的内在联系。国内外诸多研究发现，CRC的发生与脑肠轴“四通道”即肠道菌群失衡、肠神经系统损伤、迷走神经–下丘脑–垂体–肾上腺轴亢进及免疫炎症反应密切相关。中医辨证认为，CRC以“肝郁脾虚”之证最为常见，肝失疏泄、脾失健运，致气机不畅、传导失司，与该病的发病机制相契合，人是一个有机整体，故心肠、脑、脾、肝相互沟通联络。文章提出“疏肝理脾、调畅气机”为中医治疗CRC的基本法则，并通过中药、针灸等手段调节脑肠轴功能，改善肠道动力与神经递质水平，为中西医结合干预CRC提供新思路与理论依据。

Abstract: Chemotherapy-related constipation (CRC) is a common adverse reaction that seriously affects the quality of life of patients with malignant tumors, and its pathogenesis has not been fully elucidated, and treatment options are limited. Based on the “brain-gut axis” theory, this paper systematically explores the internal relationship between the modern pathological mechanism of CRC and the core pathogenesis of “liver and spleen disorder” in traditional Chinese medicine. It was found that the occurrence of CRC was closely related to the imbalance of intestinal flora, enteric nervous system injury, vagus nerve-hypothalamic-pituitary-adrenal axis hyperactivity, and immune inflammatory response. Traditional Chinese medicine syndrome differentiation believes that CRC is more common with the syndrome of “liver depression and spleen deficiency”, with liver loss of drainage and spleen loss of health, resulting in poor qi and conduction failure, which is consistent with the dysfunction of the brain-intestinal axis. This paper proposes that “relaxing the liver and regulating the spleen, and regulating the qi machine” is the basic rule of traditional Chinese medicine in the treatment of CRC, and regulates the function of the brain-gut axis through traditional Chinese medicine, acupuncture and other means, improves intestinal motility and neurotransmitter levels, and provides new ideas and theoretical basis for the intervention of integrated traditional Chinese and Western medicine in CRC.