基于“一气周流”理论探讨针灸调节肠道–代谢–免疫轴治疗2型糖尿病的作用机制

Mechanism of Acupuncture in Treating Type 2 Diabetes Mellitus by Regulating the Gut-Metabolism-Immune Axis Based on the “Yi Qi Zhou Liu” Theory

摘要: 清代医家黄元御在其著作《四圣心源》中提出了“中气斡旋，土枢四象”的“一气周流”理论。即中焦作为人体气机运行的枢纽，具有上行肝气，下通肺气的作用，而中焦气机不畅会使其枢纽功能不利，致使轴轮失司引发消渴。而近年来研究发现肠道菌群的代谢产物如胆汁酸、短链脂肪酸会影响胰岛素传导，其代谢产生的调节脂多糖也通过引发慢性低度炎症加剧糖脂代谢紊乱，从而导致2型糖尿病的发病。针灸作为中国传统医学特色疗法，对于治疗糖尿病具有独特的疗效和理论。本文探讨基于“一气周流”理论，使用针灸疗法调节肠道菌群，从而干预代谢产物及消除炎症治疗2型糖尿病的机制。以求为“一气周流”理论下指导针灸经肠道–代谢–免疫轴治疗2型糖尿病提供新的理论支持。

Abstract: In his work Si Sheng Xin Yuan (Origin of the Four Sages), the Qing Dynasty physician Huang Yuanyu proposed the “Yi Qi Zhou Liu” (Cyclic Flow of Qi) theory, emphasizing that “the middle Qi rotates to pivot the four aspects”. According to this theory, the middle jiao (middle energizer) serves as the pivot for the circulation of Qi in the human body, facilitating the ascending of liver Qi and the descending of lung Qi. When the Qi mechanism of the middle jiao becomes obstructed, its pivot function is impaired, leading to the dysfunction of the pivot and wheel, which ultimately induces Xiaoke (wasting-thirst syndrome, analogous to diabetes). In recent years, studies have revealed that the metabolites of gut microbiota, such as bile acids and short-chain fatty acids (SCFAs), significantly affect insulin signaling. Furthermore, lipopolysaccharides (LPS) produced by these microbes exacerbate glucose and lipid metabolism disorders by triggering chronic low-grade inflammation, thereby contributing to the pathogenesis of type 2 diabetes mellitus (T2DM). As a distinctive therapy in traditional Chinese medicine, acupuncture has demonstrated unique efficacy and theoretical foundations in treating diabetes. This article explores the mechanism by which acupuncture, guided by the “Yi Qi Zhou Liu” theory, regulates gut microbiota to intervene in metabolic products and eliminate inflammation for the treatment of T2DM. This review aims to provide novel theoretical support for the application of acupuncture in treating T2DM via the gut-metabolism-immune axis under the guidance of the “Yi Qi Zhou Liu” theory.