基于“肠–皮轴”探讨特应性皮炎中医研究 进展

Research Progress on Traditional Chinese Medicine for Atopic Dermatitis Based on the “Gut-Skin Axis”

摘要: 目的：系统梳理肠–皮轴在特应性皮炎发病机制及治疗中的作用，探讨中医药通过调控肠–皮轴治疗特应性皮炎的现代生物学机制，为中西医结合防治该病提供理论依据。方法：广泛检索国内外关于肠–皮轴与特应性皮炎相关的文献，从肠道微生物群及其代谢产物、免疫调节、屏障功能、神经内分泌机制及中医药干预等方面进行归纳与分析。结果：肠–皮轴通过肠道微生物群衍生的短链脂肪酸、色氨酸代谢产物等信号分子，经免疫、代谢及神经内分泌通路远程调控皮肤稳态。特应性皮炎患者普遍存在肠道菌群多样性降低、有益菌减少、条件致病菌增多及短链脂肪酸代谢异常，伴随肠屏障损伤与Th2型免疫偏移。中医药基于“肺合皮毛、肺与大肠相表里”“脾主运化”等理论，采用健脾益气、清热祛湿、固肠润肤等治法，可通过调节肠道菌群结构、修复肠屏障功能、恢复Th1/Th2免疫平衡而改善特应性皮炎症状。临床及实验研究证实，培土清心方、皮炎II号方、健脾润肤粥、黄连解毒汤及黄芪、大黄等单味中药或复方均具有调控肠–皮轴的潜力。结论：肠–皮轴为理解特应性皮炎的系统性本质提供了新视角，中医药通过多靶点调节肠道微生态与免疫网络，在特应性皮炎治疗中具有独特优势。未来需加强高质量临床研究，深入解析中药复方“菌群–代谢–免疫”网络调控机制，推动从经验辨治向精准调节的转变。

Abstract: Objective: To systematically review the role of the gut-skin axis in the pathogenesis and treatment of atopic dermatitis (AD), and to explore the modern biological mechanisms by which traditional Chinese medicine (TCM) regulates the gut-skin axis in AD management, thereby providing a theoretical basis for integrated Chinese and Western medicine approaches. Methods: A comprehensive literature search was conducted on the gut-skin axis and AD. Relevant studies concerning gut microbiota and their metabolites, immune regulation, barrier function, neuroendocrine mechanisms, and TCM interventions were summarized and analyzed. Results: The gut-skin axis remotely regulates skin homeostasis through signaling molecules derived from gut microbiota, such as short-chain fatty acids and tryptophan metabolites, via immune, metabolic, and neuroendocrine pathways. AD patients commonly exhibit reduced gut microbial diversity, decreased beneficial bacteria, increased opportunistic pathogens, abnormal short-chain fatty acid metabolism, intestinal barrier dysfunction, and Th2-skewed immune responses. Based on TCM theories such as “the lung governing the skin and hair” and “the lung and large intestine being interior-exteriorly related,” as well as “the spleen governing transportation and transformation,” TCM interventions including strengthening the spleen and benefiting qi, clearing heat and removing dampness, and fortifying the intestine and moisturizing the skin have been shown to alleviate AD symptoms by modulating gut microbiota composition, restoring intestinal barrier function, and rebalancing Th1/Th2 immunity. Clinical and experimental studies have confirmed that TCM formulas such as Peitu Qingxin Formula, Dermatitis II Formula, Jianpi Runfu Porridge, Huang-Lian-Jie-Du Decoction, as well as single herbs like Astragalus membranaceus and rhubarb, possess the potential to regulate the gut-skin axis. Conclusion: The gut-skin axis provides a new perspective for understanding the systemic nature of AD. TCM exhibits unique advantages in AD treatment by multi-targetedly regulating gut microbiota and immune networks. Future research should focus on high-quality clinical studies and further elucidate the “microbiota-metabolism-immunity” network mechanisms of TCM formulas, facilitating a shift from empirical differentiation to precision regulation.