中药治疗肝源性肌少症的研究进展： 基于“肝脾肾同调”理论

Research Progress on Traditional Chinese Medicine in Treating Hepatic Sarcopenia: Based on the Theory of “Simultaneous Regulation of Liver, Spleen, and Kidney”

摘要: 目的：探讨基于“肝脾肾同调”理论的中药防治肝源性肌少症(HS)的作用机制与临床策略，为临床与研究提供参考。方法：系统检索并梳理近年来相关文献，从中医病机、临床干预(单味药、复方及中西医结合)及现代药理学机制三个方面进行综述。结果：HS的中医核心病机为肝、脾、肾功能失调，气血精微不充，筋脉肌肉失养。中药通过疏肝、健脾、补肾等治则，采用复方(如四君子汤合逍遥散、六味地黄丸等)及活性成分(如人参皂苷Rh1、Plumbagin等)进行干预，其现代机制涉及调节PI3K/Akt/mTOR、NF-κB等信号通路以改善蛋白质代谢、抑制炎症反应与氧化应激、改善胰岛素抵抗、调节肠道菌群等多靶点作用。临床研究表明，中医药在改善患者肌肉质量、肌力及身体功能方面显示出独特优势。结论：基于“肝脾肾同调”理论的中医药治疗HS具有多靶点、整体调节的优势，展现出良好潜力，但未来仍需高质量研究进一步验证疗效并阐明机制。

Abstract: Objective: To explore the mechanism of action and clinical strategies of traditional Chinese medicine (TCM) for preventing and treating hepatogenic sarcopenia (HS) based on the theory of “simultaneous regulation of the liver, spleen, and kidney,” thereby providing a reference for clinical practice and research. Methods: Relevant literature from recent years was systematically searched and reviewed, focusing on three aspects: TCM pathogenesis, clinical interventions (single herbs, compound formulas, and integrated Chinese-Western medicine), and modern pharmacological mechanisms. Results: The core TCM pathogenesis of HS involves dysfunction of the liver, spleen, and kidney, leading to insufficiency of qi, blood, and essential substances, which fail to nourish the tendons, vessels, and muscles. Through therapeutic principles such as soothing the liver, strengthening the spleen, and tonifying the kidney, TCM intervenes with compound formulas (e.g., Sijunzi Decoction combined with Xiaoyao San, Liuwei Dihuang Pills) and active components (e.g., Ginsenoside Rh1, Plumbagin). Its modern mechanisms involve multi-target effects, including the regulation of signaling pathways such as PI3K/Akt/mTOR and NF-κB to improve protein metabolism, inhibit inflammatory responses and oxidative stress, ameliorate insulin resistance, and modulate gut microbiota. Clinical studies have demonstrated that TCM exhibits unique advantages in improving muscle mass, muscle strength, and physical function in patients. Conclusion: TCM treatment for HS based on the theory of “simultaneous regulation of the liver, spleen, and kidney” offers the advantages of multi-target and holistic regulation, demonstrating significant potential. However, future high-quality studies are still needed to further validate its efficacy and elucidate its mechanisms.