基于“心与小肠相表里”理论，探讨肠道菌群与冠心病合并焦虑抑郁状态的关系

Exploring the Relationship between Intestinal Flora and Depression in Coronary Heart Disease Based on the Theory of “Heart and Small Intestine Being Paired Organs”

摘要: “心与小肠相表里”是中医理论中阐述心与小肠通过经络相互络属、气血相通、功能协同的重要理论。现代研究表明，肠道菌群作为“小肠”功能的微观体现，与冠心病及其常伴发的焦虑抑郁状态之间存在密切关联。本文基于“心与小肠相表里”理论，系统梳理心与小肠在生理、病理上的相互关系，并结合肠道微生态研究进展，深入探讨肠道菌群失调通过菌群–肠–脑轴、免疫炎症通路、代谢产物等具体途径在冠心病与焦虑抑郁共病机制中的核心作用。进一步提出，清热化痰、疏肝理气、活血化瘀等类中药及其活性成分可通过多靶点调节肠道菌群结构、改善菌群代谢功能、修复肠屏障、调节免疫与神经递质，从而干预冠心病合并焦虑抑郁的病理进程，为“双心同治”提供中西医结合的理论依据与精准治疗新策略。

Abstract: The concept of “heart and small intestine being paired organs” is a fundamental theory in traditional Chinese medicine, describing how the heart and small intestine are interconnected through meridians, share mutual circulation of qi and blood, and function synergistically. Modern research indicates that the gut microbiota, as a microscopic manifestation of small intestinal function, is closely associated with coronary heart disease and its frequently accompanying anxiety and depression. Based on this theory, this paper systematically reviews the physiological and pathological interrelationships between the heart and small intestine. Integrating advances in gut microbiome research, it explores how dysbiosis mediates the co-morbidity of CHD and anxiety-depression through specific pathways: the microbiota-gut-brain axis, immune-inflammatory pathways, and metabolic products. Furthermore, it proposes that traditional Chinese medicine (TCM) formulations and their active components—such as those that clear heat and resolve phlegm, soothe the liver and regulate qi, and activate blood and resolve stasis—can intervene in the pathological progression of CHD with anxiety and depression. This is achieved through multi-target regulation of gut microbiota structure, improvement of microbial metabolic function, restoration of the intestinal barrier, and modulation of immunity and neurotransmitters. This approach provides a theoretical basis and precision treatment strategy for “dual-heart co-treatment” integrating Chinese and Western medicine.