基于“脾与小肠相通”理论从脾-肠-肠道菌群轴探讨失眠的病机与辨治

Exploration on Pathogenesis and Syndrome Differentiation-Based Treatment of Insomnia from the Perspective of the Spleen-Intestine-Gut Microbiota Axis Based on the Theory of "Interconnection Between the Spleen and Small Intestine"

摘要:

失眠作为临床常见疾病与伴随症状，其病机与脾虚相关。《医学入门》“脏腑别通”理论提出“脾与小肠相通”，该理论核心在于脾主升清与小肠主降浊的功能协调。脾虚则气血化生不足，心神失养，运化不及，湿浊内生，下扰小肠，致其泌别清浊失司，酿生痰瘀气滞，蒙窍扰心。此病理过程与现代“肠-脑轴”机制相契合，即脾虚状态下的肠道菌群紊乱，可通过影响神经递质合成、诱发免疫炎症等途径，干扰睡眠-觉醒周期。文章基于“脾与小肠相通”理论，构建脾-肠-肠道菌群轴来阐述脾、肠、肠道微生态与失眠的相关性，并提出脾肠同调，以恢复脾升胃降、肠腑通利之机，从而使气血调和、神归其舍，为临床辨治失眠提供理论依据。

Abstract:

Abstract：Insomnia is a common clinical disease and accompanying symptom，and its pathogenesis is associated with spleen deficiency. The theory of "zang-fu organ extraordinary connection" in the Yi Xue Ru Men （Introduction to Medicine） proposes that "the spleen and the small intestine are interconnected." The core of this theory lies in the functional coordination between the spleen sending clarity upward and the small intestine sending turbidity downward. Spleen deficiency leads to insufficient transformation and generation of qi and blood，malnutrition of heart and spirit， impaired transportation and transformation， and internal generation of dampness and turbidity. The turbid substances descend to disturb the small intestine， leading to the disorder of separating clear from turbid， and further generate phlegm， blood stasis， and qi stagnation， which block the orifices and disturb the heart. This pathological process aligns with the mechanism of "intestine-brain axis" in modern medicine：gut microbiota dysbiosis under conditions of spleen deficiency can interfere with the sleep-wake cycle by affecting neurotransmitter synthesis and triggering immune inflammation. Based on the theory of "interconnection between the spleen and small intestine，" this article constructs a spleen-intestine-gut microbiota axis to elucidate the correlation among the spleen，the intestine，the gut microbiota， and insomnia. It further proposes the principle of simultaneous treatment of the spleen and intestine to restore the ascending of the spleen and descending of the stomach， as well as the unobstructed intestinal function， thereby harmonizing qi and blood and allowing the spirit to reside in its place，thus providing a theoretical basis for the clinical syndrome differentiation and treatment of insomnia.