基于“肺–肠轴”探讨“培土生金”法对COPD患者肺肠菌群的双向调节作用

Exploring the Bidirectional Regulatory Effect of the “Spleen-Tonifying and Lung-Replenishing” Therapy Approach on the Lung-Gut Microbiota of COPD Patients via the “Gut-Lung Axis”

摘要: 慢性阻塞性肺病(COPD)，简称慢阻肺，其发病机制复杂，病理表现繁多。中医学认为肺、脾、大肠存在着天然的母子相生、经络相关关系，肺虚及脾，脾虚累肺，相互影响，治疗时应注意“培土生金”，通过补脾来养肺，不限于肺，不忘与脾，多方兼顾，脾胃与大肠通过气化协同完成“化水谷、行津液、排糟粕”的功能；肺与大肠相表里，肺气宣降与大肠传导密切相关。现代医学提出的“肺–肠轴”理论，与中医“肺与大肠相表里”的学说相契合。而中医“脾”的功能态与现代医学肠道微生态、粘膜免疫系统存在高度的功能关联性而非简单的概念对应。近年来随着肠道微生态、“肺–肠轴”理论研究的深入，结合网络药理学、代谢组学技术的发展，证实肠道微生态与肺部疾病的发生密切相关，且“培土生金”类经方可通过其关键化学成分与肠道菌群代谢酶、宿主特异性受体相互作用，实现对肺肠菌群的精准调控。本文基于“肺–肠轴”，从功能态角度阐释中医脾与肠道微生态、粘膜免疫系统的关联，并结合现代组学技术探讨“培土生金”法对COPD患者肺肠菌群的双向调节作用及分子机制，从而可成为进一步研究其作用机制、提高临床疗效的方向。

Abstract: Chronic obstructive pulmonary disease (COPD) is characterized by complex pathogenesis and diverse pathological manifestations. In Traditional Chinese Medicine (TCM), the lung, spleen and large intestine have an intrinsic mother-child generating relationship and meridian correlation, with lung deficiency affecting the spleen and spleen deficiency impairing the lung mutually. Therefore, the therapy of “spleen-tonifying and lung-replenishing” should be emphasized in treatment, which nourishes the lung by fortifying the spleen. The spleen-stomach and large intestine synergistically perform the functions of transforming food and water, distributing body fluids and eliminating waste through qi transformation; the lung and large intestine are interior-exterior related, and the dispersion and descent of lung qi are closely linked to the conveyance of the large intestine. The modern medical theory of the “gut-lung axis” is highly consistent with the TCM doctrine of “the lung and large intestine being interior-exterior related”. The functional state of the TCM “spleen” has a high functional correlation rather than a simple conceptual correspondence with the intestinal microecology and mucosal immune system in modern medicine. With the in-depth research on intestinal microecology and gut-lung axis theory in recent years, combined with the development of network pharmacology and metabolomics technologies, it has been confirmed that intestinal microecology is closely related to the occurrence of pulmonary diseases, and the classic prescriptions based on “spleen-tonifying and lung-replenishing” can achieve precise regulation of lung-gut microbiota through the interaction of their key chemical components with intestinal flora metabolic enzymes and host-specific receptors. Based on the gut-lung axis, this paper expounds the correlation between the TCM spleen and intestinal microecology, mucosal immune system from the perspective of functional state, and explores the bidirectional regulatory effect and molecular mechanism of “spleen-tonifying and lung-replenishing” therapy on lung-gut microbiota of COPD patients combined with modern omics technologies, so as to provide a new direction for further studying its action targets and improving clinical efficacy.