“抑木扶土”调节肠道菌群治疗T2DM伴焦虑抑郁的机制

The Mechanism of Regulating Intestinal Flora by “Inhibiting Wood and Strengthening Earth” in the Treatment of T2DM with Anxiety and Depression

摘要: 2型糖尿病(type 2 diabetes mellitus, T2DM)是以高血糖为特征的慢性进行性疾病，常伴随焦虑、抑郁等情绪障碍，严重影响患者生活质量。近年来研究发现，肠道菌群与T2DM及情绪障碍的发生发展存在着密切联系，通过“肠–脑轴”调节、神经递质、免疫炎症反应等途径影响糖尿病患者的焦虑、抑郁心理。中医学认为，脾虚失运、肝失疏泄是T2DM合并焦虑抑郁的核心病机，抑木扶土法通过调和肝脾，恢复气机升降，既可改善糖脂代谢，又能调节情志活动。现代研究提示，抑木扶土法能够改善肠屏障功能、恢复肠道微生物稳态，故本文从“肠道菌群”理论出发，将中医“抑木扶土”法理论与其有机结合，剖析其调控肠道菌群从而改善T2DM合并焦虑抑郁的科学机制，以期为T2DM合并焦虑抑郁的中医临床诊疗提供新的思路及理论依据。

Abstract: Type 2 diabetes mellitus (T2DM) is a chronic progressive disease characterized by high blood sugar, often accompanied by emotional disorders such as anxiety and depression, which significantly affect the quality of life of patients. Recent studies have found that the gut microbiota is closely related to the occurrence and development of T2DM and emotional disorders. Through pathways such as the “gut-brain axis” regulation, neurotransmitters, and immune inflammatory responses, it affects the anxiety and depression of diabetic patients. In traditional Chinese medicine, spleen deficiency and failure of transportation, as well as liver failure in regulating secretion, are the core pathogenesis of T2DM combined with anxiety and depression. The method of restraining the liver and supporting the spleen can restore the balance of qi circulation and improve both sugar and lipid metabolism, as well as regulate emotional activities. Modern research suggests that the method of restraining the liver and supporting the spleen can improve intestinal barrier function and restore the stability of intestinal microbiota. Therefore, this article, based on the theory of “gut microbiota”, combines the theory of “restraining the liver and supporting the spleen” from traditional Chinese medicine and analyzes the scientific mechanism of regulating the gut microbiota to improve T2DM combined with anxiety and depression, in order to provide new ideas and theoretical basis for the clinical diagnosis and treatment of T2DM combined with anxiety and depression.