基于“脾主运化”理论改善胰岛素抵抗治疗肥胖的相关机制研究

Research on the Related Mechanisms of Improving Insulin Resistance for Treating Obesity Based on the Theory of “Spleen Governing Transportation and Transformation”

摘要: 肥胖作为一种以体内脂肪过度累积为特征的慢性代谢性疾病，现有研究表明胰岛素抵抗为其发病的核心机制之一。中医认为本病可归于肥胖、脾瘅等范畴，病机为本虚标实之候，本虚在脾胃，标实在痰湿。脾虚则不能运化水谷精微，聚而成痰湿；痰湿困于中焦则进一步加重脾虚，互相因果导致肥胖；且脾运化水谷精微与胰岛素促进葡萄糖为机体提供能量高度重合，脾不散精为胰岛素抵抗的病因病机。故文章旨在从中西医理论实践双重视角，以“脾主运化”理论为基础，系统梳理近年来中医药改善胰岛素抵抗治疗肥胖的机制，并探讨肥胖的病因病机及治疗思路，以期为本病的临床诊断和治疗提供新的思路和参考。

Abstract: Obesity is a chronic metabolic disorder characterized by excessive fat accumulation in the body, with existing studies identifying insulin resistance as one of its core pathogenic mechanisms. Traditional Chinese Medicine (TCM) holds that this disease belongs to the categories of obesity, spleen dyanesthesia and other related disorders, with its pathogenesis characterized by “deficiency in root and excess in branch”—the root deficiency lies in the spleen and stomach, while the branch excess manifests as phlegm-dampness. Insufficiency of spleen function impairs its ability to transport and transform the nutrients of food and water, which then accumulate to form phlegm-dampness; in turn, phlegm-dampness stagnates in the middle jiao, further exacerbating spleen insufficiency, forming a mutual causal relationship that ultimately leads to obesity. Furthermore, the spleen’s function of transporting and transforming food nutrients is highly consistent with insulin’s role in promoting glucose metabolism to provide energy for the body, and the failure of the spleen to disperse nutrients serves as the pathogenetic basis of insulin resistance. Therefore, this study aims to systematically summarize the mechanisms by which traditional Chinese medicine improves insulin resistance in the treatment of obesity in recent years, based on the theory of “spleen governing transportation and transformation”, from the dual perspectives of TCM and modern medicine theories and practices. It also explores the etiology, pathogenesis, and treatment strategies of obesity in order to provide new insights and references for the clinical diagnosis and treatment of this disease.