基于肝脾体用互济理论与肠肝脑轴调控探讨慢传输型便秘的病理机制

Pathological Mechanism of Slow Transit Constipation: An Exploration Based on the Theory of Liver-Spleen Ti-Yong Mutual Assistance and Gut-Liver-Brain Axis Regulation

摘要: 慢传输型便秘(STC)作为临床难治性功能性肠病，其迁延反复的深层机制源于“肠肝脑轴”跨系统调控网络的整体失衡。当前现代医学以局部对症为主的干预手段难以打破该疾病的恶性病理闭环。本文立足中医学整体观念，以《辅行诀》五脏辨证模型为基石，创造性地将“肝脾体用互济”理论与现代肠肝脑轴三级联动机制进行深度交融。研究阐明，生理状态下肝脾“散缓相济”的体用协同，是维系肠肝脑轴稳态的宏观脏腑底座；而在病理演进中，脾失健运与肝失疏泄引发的跨脏腑双向传变，最终演变为“肝脾俱损”的复合病理格局。这一中医病机精准映射了微观层面肠道屏障溃败、胆汁酸代谢紊乱与中枢神经应激的级联失调，是驱动神经–内分泌–免疫全通路重塑的核心推手。基于上述中西医映射机制，本文提出“调肝脾、复体用、通轴系”的三维防治总纲，并构建了匹配不同起病格局的层级化辨治体系。这不仅为探讨中医脏腑体用理论的现代内涵提供了新视角，更为临床防治STC提供了新的中西医结合思路与参考。

Abstract: Slow transit constipation (STC) is a refractory functional bowel disorder, whose protracted and recurrent nature is deeply rooted in the systemic imbalance of the cross-organ “gut-liver-brain axis” regulatory network. Current symptomatic treatments in modern medicine often fail to break the malignant pathological cycle of this disease. Rooted in the holistic concept of Traditional Chinese Medicine (TCM) and based on the five-zang dialectical model of Fuxing Jue, this paper creatively integrates the classical theory of “Liver-Spleen Ti-Yong (substance and function) mutual assistance” with the modern three-level linkage mechanism of the gut-liver-brain axis. It is elucidated that under physiological conditions, the Ti-Yong synergy of the liver and spleen acts as the macroscopic visceral foundation maintaining the axis homeostasis. Pathologically, the bidirectional cross-organ transmission triggered by spleen transport dysfunction and liver dispersion failure ultimately evolves into a complex pattern of “impairment of both liver and spleen”. This TCM pathogenesis precisely maps to the micro-level cascade dysregulation characterized by intestinal barrier collapse, bile acid metabolic disorder, and central nervous system stress, acting as the core driver for the pathological remodeling of the neuro-endocrine-immune pathways. Based on this integrated TCM-Western mechanism, this paper shifts from conventional local laxative therapies to establish a three-dimensional prevention and treatment principle of “regulating the liver and spleen, restoring Ti-Yong, and unblocking the axis”, and constructs a hierarchical pattern-differentiation treatment system targeting various clinical onset patterns. This not only provides a new perspective for exploring the modern connotations of the TCM Ti-Yong theory but also offers new insights and references for the integrated clinical prevention and treatment of STC.