Article(id=1322923083081851039, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322923011518628427, articleNumber=null, orderNo=null, doi=10.13193/j.issn.1673-7717.2025.03.024, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=null, receivedDateStr=null, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793339041728, onlineDateStr=2026-10-30, pubDate=1741536000000, pubDateStr=2025-03-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793339041728, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793339041728, creator=13701087609, updateTime=1793339041728, updator=13701087609, issue=Issue{id=1322923011518628427, tenantId=1146029695717560320, journalId=1255847919539208197, year='2025', volume='43', issue='3', pageStart='1', pageEnd='258', issueExtLink='null', onlineDate='null', pubDate='1741536000000', pubDateStr='2025-03-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793339024666, creator='13701087609', updateTime=1793340602374, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322929628976906432, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322923011518628427, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322929628981100737, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322923011518628427, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=133, endPage=135, ext={EN=ArticleExt(id=1322923083513864352, articleId=1322923083081851039, tenantId=1146029695717560320, journalId=1255847919539208197, language=EN, title=Relationship between Intestinal Flora and Nervous System Related Diseases in Brain-Gut Axis Based on Theory of “Heart and Small Intestine Being Exterior-Interiorly Related”, columnId=1256183361521967297, journalTitle=Chinese Archives of Traditional Chinese Medicine, columnName=Target on National Project, runingTitle=null, highlight=null, articleAbstract=

Nervous system related diseases are the most common diseases that threaten human life,health and quality of life.“Brain-gut axis” is a two-way interactive pathway between brain and intestine. Intestinal flora affects the occurrence and development of nervous system related diseases through multiple pathways of brain-gut axis,forming a complex network mechanism. This paper discussed the theory of “heart and small intestine being exterior-interiorly related” in traditional Chinese medicine,the key role of intestinal flora in the brain-gut axis and its close correlation with the occurrence and development of nervous system related diseases,so as to provide new ideas for the re-understanding and innovative development of the theory of “heart and small intestine being exterior-interiorly related” in traditional Chinese medicine and the theory of “brain-gut axis” in modern medicine.

, authors=Huihui LIU, Dehong SHAN, Xue LENG, authorsList=Huihui LIU, Dehong SHAN, Xue LENG, authorCompany=null, correspAuthors=Xue LENG, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322923084470165668, articleId=1322923083081851039, tenantId=1146029695717560320, journalId=1255847919539208197, language=CN, title=基于“心与小肠相表里”理论探讨肠道菌群在脑-肠轴中与神经系统相关疾病的关联, columnId=1256183362172142382, journalTitle=中华中医药学刊, columnName=国家项目点击, runingTitle=null, highlight=null, articleAbstract=

神经系统相关疾病是目前影响威胁人类生命健康及生活质量最常见的疾病类型。“脑-肠轴”是脑和肠之间的双向交互通路,肠道菌群通过“脑-肠轴”的多途径影响神经系统相关疾病的发生发展,形成复杂的网络机制。通过探讨中医“心与小肠相表里”理论,探讨肠道菌群在“脑-肠轴”中的关键作用,以及与神经系统相关疾病发生发展的密切相关性,为“心与小肠相表里”中医理论与现代医学“脑-肠轴”理论的再认识和创新发展提供新的思路。

, authors=刘慧慧, 单德红, 冷雪, authorsList=刘慧慧, 单德红, 冷雪, authorCompany=null, correspAuthors=冷雪, authorNote=

刘慧慧(1981-),女,山东栖霞人,副教授,博士,研究方向:中西医结合防治神经系统疾病基础。

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冷雪(1983-),女,辽宁沈阳人,副教授,硕士研究生导师,博士,研究方向:中西医结合防治心脑血管疾病基础。Email:。
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刘慧慧(1981-),女,山东栖霞人,副教授,博士,研究方向:中西医结合防治神经系统疾病基础。

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刘慧慧(1981-),女,山东栖霞人,副教授,博士,研究方向:中西医结合防治神经系统疾病基础。

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基于“心与小肠相表里”理论探讨肠道菌群在脑-肠轴中与神经系统相关疾病的关联
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刘慧慧 , 单德红 , 冷雪
中华中医药学刊 | 国家项目点击 2025,43(3): 133-135
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中华中医药学刊 |国家项目点击 2025 , 43 (3) : 133 -135
基于“心与小肠相表里”理论探讨肠道菌群在脑-肠轴中与神经系统相关疾病的关联
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刘慧慧(1981-),女,山东栖霞人,副教授,博士,研究方向:中西医结合防治神经系统疾病基础。

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刘慧慧(1981-),女,山东栖霞人,副教授,博士,研究方向:中西医结合防治神经系统疾病基础。

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刘慧慧, 单德红, 冷雪
作者信息
  • 辽宁中医药大学中西医结合学院,辽宁 沈阳 110847
通讯作者:
冷雪(1983-),女,辽宁沈阳人,副教授,硕士研究生导师,博士,研究方向:中西医结合防治心脑血管疾病基础。Email:。
作者简介:

刘慧慧(1981-),女,山东栖霞人,副教授,博士,研究方向:中西医结合防治神经系统疾病基础。

Relationship between Intestinal Flora and Nervous System Related Diseases in Brain-Gut Axis Based on Theory of “Heart and Small Intestine Being Exterior-Interiorly Related”
Huihui LIU, Dehong SHAN, Xue LENG
Affiliations
  • College of Integrated Traditional Chinese and Western Medicine of Liaoning University of Traditional Chinese Medicine,Shenyang 110847,Liaoning,China
出版时间: 2025-03-10 doi: 10.13193/j.issn.1673-7717.2025.03.024
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神经系统相关疾病是目前影响威胁人类生命健康及生活质量最常见的疾病类型。“脑-肠轴”是脑和肠之间的双向交互通路,肠道菌群通过“脑-肠轴”的多途径影响神经系统相关疾病的发生发展,形成复杂的网络机制。通过探讨中医“心与小肠相表里”理论,探讨肠道菌群在“脑-肠轴”中的关键作用,以及与神经系统相关疾病发生发展的密切相关性,为“心与小肠相表里”中医理论与现代医学“脑-肠轴”理论的再认识和创新发展提供新的思路。

心与小肠相表里  /  肠道菌群  /  脑-肠轴  /  神经系统疾病

Nervous system related diseases are the most common diseases that threaten human life,health and quality of life.“Brain-gut axis” is a two-way interactive pathway between brain and intestine. Intestinal flora affects the occurrence and development of nervous system related diseases through multiple pathways of brain-gut axis,forming a complex network mechanism. This paper discussed the theory of “heart and small intestine being exterior-interiorly related” in traditional Chinese medicine,the key role of intestinal flora in the brain-gut axis and its close correlation with the occurrence and development of nervous system related diseases,so as to provide new ideas for the re-understanding and innovative development of the theory of “heart and small intestine being exterior-interiorly related” in traditional Chinese medicine and the theory of “brain-gut axis” in modern medicine.

exterior-interior relationship between heart and small intestine  /  gut microbiome  /  brain-gut axis  /  nervous system diseases
刘慧慧, 单德红, 冷雪. 基于“心与小肠相表里”理论探讨肠道菌群在脑-肠轴中与神经系统相关疾病的关联. 中华中医药学刊, 2025 , 43 (3) : 133 -135 . DOI: 10.13193/j.issn.1673-7717.2025.03.024
Huihui LIU, Dehong SHAN, Xue LENG. Relationship between Intestinal Flora and Nervous System Related Diseases in Brain-Gut Axis Based on Theory of “Heart and Small Intestine Being Exterior-Interiorly Related”[J]. Chinese Archives of Traditional Chinese Medicine, 2025 , 43 (3) : 133 -135 . DOI: 10.13193/j.issn.1673-7717.2025.03.024
随着人口老龄化,阿尔茨海默病、帕金森病和脑卒中等神经系统相关疾病一直以来都成为影响人类生存质量的常见疾病,严重影响人类健康。现代医学认为脑肠互动频繁,肠道菌群作为人体最大的微生物库,在“脑-肠轴”发挥着关键作用,特别是肠道菌群可能通过“脑-肠轴”影响大脑功能,从而成为众多脑病的潜在治疗靶点。中医学中有“心主神志”“心与小肠相表里”等理论,“心主神志”表明了“心”具有“脑”的部分功能,“心与小肠相表里”理论提示“心”与小肠具有密切关联,中医基于肠道治疗神志病的历史悠久,效果显著,但详细机制尚不清楚。本文主要以“心与小肠相表里”理论-肠道菌群-“脑-肠轴”-神经系统相关疾病为主线,围绕肠道菌群,通过探讨“心与小肠相表里”的物质基础,为“从肠论治脑病”提供相关依据,为神经系统相关疾病的防治提供新的思路,也为肠道菌群作为治疗神经系统疾病的关键靶点提供新的依据。
“心与小肠相表里”最早出现在《灵枢·本输》中,提及“心合小肠,小肠者,受盛之腑”[1],意思是心和小肠相表里,小肠是接受胃所下移的腐熟的水谷,并分别水液和糟粕的腑。心为脏,小肠为腑,二者相表里,其经脉相通。如“小肠手太阳之脉,起于小指之端,……,入缺盆络心”“心手少阴之脉,起于心中,……,下膈络小肠”(《灵枢·经脉》)。血脉充盈由心主导,心阳之温煦,心血之濡养,是维持小肠正常吸收分泌等生理功能的关键。在此基础上,小肠能够辅助“心主血脉”与“心主神明”。小肠主受盛和泌别清浊,能够承受胃所下传的水谷,进而将其分为精微和糟粕,前者得脾助而上输心肺,化为血液,从而心有所主,神有所养;后者则排入大肠而成粪便。因此,小肠损伤则水谷运化失常,不仅出现腹胀、腹痛和二便异常等,还可扰心,导致行血异常和心神紊乱,表现为精神萎靡、失眠、多梦、谵狂和昏迷等[2-5]。实际上,心病亦可下移小肠,如《诸病源候论》提出:“若心家有热,结于小肠,故小便血也”;《医宗金鉴》指出:“所见口舌生疮,小便赤黄,茎中作痛,热淋下利等证,皆心移热于小肠之证”[3]。
《标幽赋》载:“阴阳相通,表里相应也。本经者,受病之经。如心之病,必取小肠之穴兼之。”表明心系疾病可以通过手太阳小肠经腧穴进行治疗。《普济方·针灸》载“穴申脉、后溪、前谷治癫疾、呕逆吐舌”,癫狂痫等神志病可以通过后溪进行治疗。同时神门穴主治“大便脓血”表明肠腑疾病可以通过手少阴心经腧穴进行治疗[5]。临床治疗中,“心热病者,先不乐数日……刺手少阴、太阳”(《灵素节注类编·热病》),“如心之病,必取小肠之穴兼之”(《针灸大成·卷二》)。另外,导赤散中“不用黄连直泻其心,而用生地黄滋肾凉心,木通通利小肠……心经之热可导也”(《医宗金鉴·删补名医方论》)。可见,在“心与小肠相表里”理论的指导下,均体现心与小肠相通、表里相应[6]。
现代医学研究显示脑与肠之间存在密切的关系,脑与肠之间的双向互动是脑可以通过神经系统来调节肠道运动及功能,同时肠道也可以将信息反馈给脑,形成密切联系的“脑-肠轴”。中医藏象理论认为“心”与“脑”密切相关,心“主神志”为“君主之官”,以及“心藏神”等中医理论也特别强调了“心”有类似“脑”的功能。同时《医宗金鉴》曰:“脑为元神之府,以统全身”,可见“心”与“脑”描述的是相同范畴内现代医学内的“脑”(中枢神经系统)的功能。中医理论认为心不仅包括心脏的生理功能,也包括了“脑”的功能,同时也与小肠相表里[7],故可以认为中医学“心与小肠相表里”理论与现代医学提出的“脑-肠轴”理论是相通的。
近年来,现代医学也认识到脑肠之间存在密切联系,代表性观点就是“脑-肠轴”,其主要观点是脑与肠之间的双向互动是脑可以通过中枢神经系统、自主神经系统及肠神经系统来调节肠道运动及功能而发挥作用,同时肠道也可以通过不同的通路将信息反馈给脑,形成密切联系的“脑-肠轴”,在人体内发挥着重要作用[8-10]。“脑-肠轴”是将认知和情感中枢与神经-内分泌-免疫网络系统及肠神经系统联系起来的双向通路,能够将各个因素之间的联系和作用相结合,通过外部刺激(视觉、听觉和嗅觉等)及人内心的思维和情感,影响胃肠感觉、运动、分泌和炎症;同时内脏活动也反过来作用于中枢的感觉、情绪和行为[7]。
肠道菌群是“脑-肠轴”通路中的关键枢纽,一方面肠道菌群可以通过产生的不同代谢物影响神经递质的释放,另一方面也可以激活不同信号通路来影响神经内分泌系统等间接影响了脑的结构和功能,因此肠道菌群与脑和肠道神经系统形成了交互的作用网络。目前人体肠道内含有大量的不同类型的肠道菌群,数量可达到1000多种,其基因总数也超过了人体总基因数量的100多倍,作为人体“第二基因组”肠道菌群发挥着影响宿主消化、代谢、神经功能、情绪心理等活动的关键作用[11]。
目前大量研究显示,肠道菌群在“脑-肠轴”中起到影响神经系统相关疾病发生发展的关键作用,如肠道菌群可通过抑制神经-内分泌系统分泌相关物质的功能引发抑郁、癫痫、认知失调、阿尔茨海默病、脑卒中等疾病[12]。如肠道菌群及其代谢产物可影响神经递质的释放以及可以产生破坏脑神经元结构的物质,引起宿主在认知行为上的改变[13];此外肠道菌群还能够参与体内色氨酸代谢的过程,将色氨酸降解为犬尿酸,而犬尿酸代谢途径的激活会引起突触间隙内5-羟色胺水平的降低,诱发抑郁症的产生[14-15];研究还发现在脑卒中后认知障碍的患者肠道内的革兰阳性厚壁菌门和革兰阴性拟杆菌门数量较脑卒中后无认知障碍的患者的减少[16],同时发现肠道微生物群代谢产物短链脂肪酸的浓度与脑卒中后认知障碍的发生和预后有明显的相关性[17];此外菌群也影响神经系统发育,肠道菌群的缺乏将导致内脏神经元密度及神经节数量不同程度下降,而引起肠肌层氮能神经元的增加[18]。
临床报道表明,相较于无认知障碍脑卒中患者,发生认知障碍患者的肠道内革兰阳性厚壁菌门和革兰阴性拟杆菌门数量明显减少[19];肠道微生物群代谢产物短链脂肪酸的浓度与脑卒中后认知障碍的发生和预后有明显的相关性[20];在阿尔茨海默病(Alzheimer’s disease,AD)患者的研究中证实,AD患者粪便菌群组成改变明显,增加较多促炎作用菌群,而具有抗炎作用的菌群则丰度降低,这与AD病症严重程度和炎性因子水平表达呈现正向关联[21];癫痫患者肠道内菌群也发生改变,稀有菌群丰度异常增加而益生菌类菌群的数量明显减少[22];而在帕金森疾病(Parkinson disease,PD)的患者研究中发现肠道内普雷沃菌科(Prevotellaceae)减少,而这种菌群的功能是可以促进肠道神经黏膜层的生成,一旦此菌群发生减少将引发肠道通透性大幅度增加,使体内受到内毒素的干扰,进而引起α-突触蛋白的错误折叠和表达,促发PD的发生[23-24]。
研究发现,中医药也能够通过肠道菌群治疗脑卒中、帕金森病、阿尔茨海默病、抑郁症等[25]。在AD模型大鼠及小鼠动物实验研究中发现给予七圣丸、逍遥散为基础的复方中草药、芍药当归散等干预,可以改变肠道菌群组成,能够改善动物的认知功能障碍[26-28]。有研究表明给予PD模型大鼠甘松和化风丹可以通过改变其肠道内菌群结构进而改善帕金森症状[29-30]。菌群结构改变也与认知障碍有关,研究表明独参汤可以改善衰老模型大鼠认知功能障碍与改变肠道菌群结构有密切相关性[31];此外研究发现补益肝肾、平肝潜阳、活血化瘀类中药都可通过改善菌群结构,促进有益菌丰度的增加,抑制有害菌群的产生来改善高血压合并认知障碍症状[32]。屈婉等[33]发现酸枣仁可改善慢性温和不可预知应激大鼠焦虑相关症状,与影响大鼠肠道菌群结构有关;此外安石榴苷可通过优化肠道菌群结构改善小鼠抑郁行为[34];在针对卒中后抑郁患者神经功能评价的研究中发现,患者服用疏脑解郁汤后能够不同程度地提高生活能力,减轻临床症状和神经功能损害,这与疏脑解郁汤改变患者体内肠道菌群的结构和丰度有着一定关联[35]。可见肠道菌群作为中药治疗神经系统相关疾病的关键靶点有一定的可行性,具体机制还需进一步探讨。
鉴于脑病治疗困难的临床实际,众多研究基于“心与小肠相表里”的传统中医理论,开展了大量的基础与临床工作,同时结合相关肠道菌群的相关研究成果,逐渐认识到肠道菌群可能是脑肠互动的关键作用环节。本文基于以上探讨,提出肠道菌群可能是脑肠互动的桥梁之一,可以通过理化刺激肠道间接影响脑,抑或是通过其代谢产物直接到脑,而脑则通过自主神经系统和肠神经系统或相关激素等影响肠道菌群,从而形成“脑-肠道菌群-肠”功能网络(见插页ⅩⅩⅪ图1)。由此,进一步认为肠道菌群是“心与小肠相表里”的客观物质基础之一,从而为相关脑病的治疗提供理论支持。
  • 国家自然科学基金青年科学基金项目(82104552)
  • 辽宁省教育厅基本科研项目—面上项目(JYTMS20231822)
  • 辽宁省科技计划联合计划(自然科学基金-面上项目)(2024-MSLH-293)
  • 辽宁中医药大学中西医结合学院“岐济”人才支撑计划项目(2024QJ02003)
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2025年第43卷第3期
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doi: 10.13193/j.issn.1673-7717.2025.03.024
  • 首发时间:2026-10-30
  • 出版时间:2025-03-10
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国家自然科学基金青年科学基金项目(82104552)
辽宁省教育厅基本科研项目—面上项目(JYTMS20231822)
辽宁省科技计划联合计划(自然科学基金-面上项目)(2024-MSLH-293)
辽宁中医药大学中西医结合学院“岐济”人才支撑计划项目(2024QJ02003)
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    辽宁中医药大学中西医结合学院,辽宁 沈阳 110847

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冷雪(1983-),女,辽宁沈阳人,副教授,硕士研究生导师,博士,研究方向:中西医结合防治心脑血管疾病基础。Email:。
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https://castjournals.cast.org.cn/joweb/zhzyyxk/CN/10.13193/j.issn.1673-7717.2025.03.024
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2种不同金属材料的力学参数
科
Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)
属
Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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