Exploring the role of the small intestine in the pathogenesis of functional dyspepsia based on the correlation of stomach-small intestine-spleen
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摘要: 功能性消化不良(functional dyspepsia，FD)是临床常见的功能性胃肠疾病，中医学认为其基础病机为脾虚气滞，胃失和降，中焦气机升降失调。小肠作为脾升胃降的中心环节，小肠受盛化物、泌别清浊的功能与脾升清、胃降浊的过程密切相关。若小肠功能失常，则影响脾胃气机升降，中焦气机不利，最终导致FD的发生。而中医学对于小肠功能的认识是在人体解剖学的基础上结合临床实践产生的，小肠功能的实现亦需要依靠相应的人体解剖学组织。当西医学十二指肠出现异常改变，如十二指肠内脏高敏感及肠黏膜屏障受损时，中医小肠受盛化物、泌别清浊的生理功能亦会受到影响，进而容易诱发或导致FD。中医药可通过调节十二指肠高敏感和肠黏膜屏障功能对FD具有积极的治疗作用。因此，本文基于胃、小肠、脾之间的联系探讨中医小肠在FD发病中的作用，为FD的中医药防治提供了新的思路和理论依据。Abstract: Functional dyspepsia(FD) is a common clinical functional gastrointestinal disease. Traditional Chinese medicine(TCM) believes that its basic pathogenesis is spleen deficiency and Qi stagnation, failure of stomach Qi to a descendand disturbance in ascending and descending of middle jiao. The small intestine is the central link of the spleen ascending and the stomach descending. The functions of the small intestine in "containing and digesting" and "separating the clear from the turbid" are closely associated with the process of the spleen raising the clear and the stomach lowering the turbid. If the functions of the small intestine are abnormal, it will affect the rise and fall of the spleen and stomach Qi, and the middle jiao is unfavorable, which will eventually lead to the occurrence of FD. The understanding of small intestine function in TCM is based on human anatomy combined with clinical practice, and the function of the small intestine is also dependent on the organization of the human anatomy. Thus, when there are abnormal changes in the duodenum in Western medicine, such as when the duodenal viscera are hypersensitive and the intestinal mucosal barrier is impaired, the physiological functions of the small intestine "containing and digesting" and "separating the clear from the turbid" in Chinese medicine will also be affected, which in turn will easily induce or lead to FD. TCM can have positive therapeutic effects on FD by regulating duodenal hypersensitivity and intestinal mucosal barrier function. Therefore, exploring the role of the small intestine in the pathogenesis of FD based on the link between the stomach, small intestine, and spleen provides a new idea and theoretical basis for the prevention and treatment of FD.
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Key words:
- functional dyspepsia /
- duodenum /
- small intestine /
- spleen /
- stomach /
- pathogenesis
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[1] 中华医学会消化病学分会胃肠动力学组, 中华医学会消化病学分会胃肠功能性疾病协作组. 中国功能性消化不良专家共识意见(2015年, 上海)[J]. 中华消化杂志, 2016, 36(4): 217-229. https://xuewen.cnki.net/CCND-WEHU202407070012.html
[2] Aziz I, Palsson OS, Törnblom H, et al. Epidemiology, clinical characteristics, and associations for symptom-based Rome IV functional dyspepsia in adults in the USA, Canada, and the UK: a cross-sectional population-based study[J]. Lancet Gastroenterol Hepatol, 2018, 3(4): 252-262. doi: 10.1016/S2468-1253(18)30003-7
[3] 侯晓华. 站在西医的角度看中医中药治疗功能性消化不良的潜在价值[J]. 中国中西医结合消化杂志, 2023, 31(10): 744-746. https://zxyxh.whuhzzs.com/article/doi/10.3969/j.issn.1671-038X.2023.10.02
[4] 张声生, 赵鲁卿. 功能性消化不良中医诊疗专家共识意见(2017)[J]. 中华中医药杂志, 2017, 32(6): 2595-2598. https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY202403106.htm
[5] 弓淑珍, 侯丽颖, 刘江凯. 中医脾胃小肠功能的再探析[J]. 辽宁中医杂志, 2009, 36(3): 366-367. https://www.cnki.com.cn/Article/CJFDTOTAL-LNZY200903024.htm
[6] Miwa H, Oshima T, Tomita T, et al. Recent understanding of the pathophysiology of functional dyspepsia: role of the duodenum as the pathogenic center[J]. J Gastroenterol, 2019, 54(4): 305-311. doi: 10.1007/s00535-019-01550-4
[7] 李德新, 刘燕池. 中医基础理论[M]. 2版. 北京: 人民卫生出版社, 2011: 275-276.
[8] 林绍志, 王学俊. "小肠"辨析[J]. 山东中医药大学学报, 2005, 29(3): 184-185. https://www.cnki.com.cn/Article/CJFDTOTAL-SDYX200503005.htm
[9] 白宇宁, 白兆芝, 张润顺, 等. 试论小肠的气化功能[J]. 中医杂志, 2006, 47(3): 226-228. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYZ200603039.htm
[10] 尹朋, 赵烨, 朱晓宇, 等. 实验性脾虚大鼠小肠结构与免疫功能的变化[J]. 中国兽医杂志, 2010, 46(12): 16-19, 98. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSYZ201012006.htm
[11] 白兆芝, 白宇宁. 小肠生理功能探微[J]. 山西中医, 2005, 21(1): 3-5. https://www.cnki.com.cn/Article/CJFDTOTAL-SHIX200501001.htm
[12] 白宇宁, 白兆芝, 姚乃礼, 等. 中医小肠病证候规律的研究[J]. 中国中医基础医学杂志, 2010, 16(9): 737-739. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYJC201009002.htm
[13] 刘声, 杨国旺, 王笑民. "心与小肠相表里"浅释[J]. 中医学报, 2015, 30(3): 376-377. https://www.cnki.com.cn/Article/CJFDTOTAL-HNZK201503027.htm
[14] Zhao JY, Zhao LQ, Zhang SS, et al. Modified Liu-Jun-Zi Decoction alleviates visceral hypersensitivity in functional dyspepsia by regulating EC cell-5HT3r signaling in duodenum[J]. J Ethnopharmacol, 2020, 250: 112468. doi: 10.1016/j.jep.2019.112468
[15] 秦书敏, 杨元明, 吴皓萌, 等. 感染后肠易激综合征证候及病理机制研究思路探讨[J]. 中国中西医结合消化杂志, 2023, 31(1): 61-64. https://zxyxh.whuhzzs.com/article/doi/10.3969/j.issn.1671-038X.2023.01.11
[16] Komori K, Ihara E, Minoda Y, et al. The altered mucosal barrier function in the duodenum plays a role in the pathogenesis of functional dyspepsia[J]. Dig Dis Sci, 2019, 64(11): 3228-3239. doi: 10.1007/s10620-019-5470-8
[17] Lee KJ, Tack J. Duodenal implications in the pathophysiology of functional dyspepsia[J]. J Neurogastroenterol Motil, 2010, 16(3): 251-257. doi: 10.5056/jnm.2010.16.3.251
[18] Samsom M, Verhagen MA, vanBerge Henegouwen GP, et al. Abnormal clearance of exogenous acid and increased acid sensitivity of the proximal duodenum in dyspeptic patients[J]. Gastroenterology, 1999, 116(3): 515-520. doi: 10.1016/S0016-5085(99)70171-X
[19] Björnsson E, Sjöberg J, Ringström G, et al. Effects of duodenal lipids on gastric sensitivity and relaxation in patients with ulcer-like and dysmotility-like dyspepsia[J]. Digestion, 2003, 67(4): 209-217. doi: 10.1159/000072059
[20] 史孝敏, 彭燕. 辣椒素受体1在功能性消化不良上消化道中的表达及其意义[J]. 胃肠病学, 2016, 21(7): 414-418. https://www.cnki.com.cn/Article/CJFDTOTAL-WIEC201607006.htm
[21] Lee KJ, Vos R, Janssens J, et al. Influence of duodenal acidification on the sensorimotor function of the proximal stomach in humans[J]. Am J Physiol Gastrointest Liver Physiol, 2004, 286(2): G278-G284. doi: 10.1152/ajpgi.00086.2003
[22] 杨春敏, 朱鸣, 孙晓丽, 等. 十二指肠酸化对狗胃肠运动的影响[J]. 中华消化杂志, 2002, 22(2): 127-128. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHHX200202031.htm
[23] 李仪琳, 姬航宇, 张润顺, 等. 基于脾胃气化内涵探讨中医药对肠黏膜屏障的保护作用[J]. 中国中西医结合消化杂志, 2023, 31(10): 816-820. https://zxyxh.whuhzzs.com/article/doi/10.3969/j.issn.1671-038X.2023.10.17
[24] Chelakkot C, Ghim J, Ryu SH. Mechanisms regulating intestinal barrier integrity and its pathological implications[J]. Exp Mol Med, 2018, 50(8): 1-9.
[25] Enck P, Azpiroz F, Boeckxstaens G, et al. Functional dyspepsia[J]. Nat Rev Dis Primers, 2017, 3: 17081. doi: 10.1038/nrdp.2017.81
[26] Wauters L, Talley NJ, Walker MM, et al. Novel concepts in the pathophysiology and treatment of functional dyspepsia[J]. Gut, 2020, 69(3): 591-600. doi: 10.1136/gutjnl-2019-318536
[27] 李盼飞, 卢曦, 王艳, 等. 中医对现代医学肠道功能的认识[J]. 环球中医药, 2019, 12(6): 871-874. https://www.cnki.com.cn/Article/CJFDTOTAL-HQZY201906011.htm
[28] 冯骁腾, 杜敏, 张一凡, 等. 从小肠"泌别清浊"功能失调探讨中医防治冠状动脉粥样硬化性心脏病思路[J]. 时珍国医国药, 2022, 33(12): 2982-2985. https://www.cnki.com.cn/Article/CJFDTOTAL-SZGY202212044.htm
[29] 常雄飞, 沈凌宇, 张立宏, 等. 健脾理气方抑制肥大细胞改善十二指肠紧密连接蛋白表达治疗功能性消化不良的机制研究[J]. 上海中医药杂志, 2021, 55(11): 91-96. https://www.cnki.com.cn/Article/CJFDTOTAL-SHZZ202111020.htm
[30] 朱春洋, 赵鲁卿, 赵静怡, 等. 四逆散对FD大鼠十二指肠杯状细胞及MUC2的影响[J]. 世界中医药, 2020, 15(11): 1575-1578, 1584. https://www.cnki.com.cn/Article/CJFDTOTAL-SJZA202011013.htm
[31] Tack J, Camilleri M. New developments in the treatment of gastroparesis and functional dyspepsia[J]. Curr Opin Pharmacol, 2018, 43: 111-117. doi: 10.1016/j.coph.2018.08.015
[32] 赵静怡, 赵鲁卿, 朱春洋, 等. 香砂六君子汤对功能性消化不良模型大鼠胃敏感性及十二指肠五羟色胺、TRPV1表达的影响[J]. 中医杂志, 2020, 61(7): 613-618. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYZ202007018.htm
[33] 刘友章, 丁站新, 宋雅芳, 等. 为脾正名替小肠申冤[J]. 中华中医药学刊, 2007, 25(4): 654-655. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYHS200704004.htm
[34] 白宇宁, 张润顺, 白兆芝, 等. 中医小肠病治法及用药规律的临床研究[J]. 中国中医药信息杂志, 2010, 17(8): 88-90. https://www.cnki.com.cn/Article/CJFDTOTAL-XXYY201008058.htm
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