Guo Jiao
Guangdong Metabolic Disease Research Center of Integrated Chinese and Western Medicine; Guangdong Key Laboratory of Metabolic Disease Prevention and Treatment of Traditional Chinese Medicine; Key Unit of Modulating Liver in Treating Hyperlipidemia SACM, Institute of Traditional Chinese Medicine Research Institute, Guangdong Pharmaceutical University, Guangzhou, 510006, China.
Chin J Integr Med. 2017 Jun;23(6):403-409. doi: 10.1007/s11655-017-2811-3. Epub 2017 Aug 10.
Hyperlipidemia, type 2 diabetes mellitus, nonalcoholic fatty liver and many other metabolic disorder are frequently co-existing in patients. In addition, these diseases are closely related in pathophysiological settings. However, increasing of the disease incidence, lacking of comprehensive prevention and control measurements against the key pathology point concomitant occurrence with the pattern of the single disease, single target therapy, that is leading therapeutic strategy for these metabolic disorders in the setting of Western medicine (WM). On the basis of the combination of the advantages of integrated Chinese medicine (CM) and WM, with unified understanding of such diseases, the new concept of glucolipid metabolic disease (GLMD) is introduced. In this new concept, disorders in glucose and lipid metabolism are recognized as the key trigger and major driving force for the progress of GLMD. The key points of pathology included dysfunction of neuronal-endocrine-immune system, insulin resistance, oxidative stress, inflammation and intestinal flora imbalance. In the core pathogenic perspective of CM, it can be explained as "Gan (Liver) Shi Shu Xie" (dysfunction of Gan in metabolism and emotion regulation) that will lead to the occurence/production of endogenous dampness and phlegm, blood stasis and turbid. This leads to the new concept of "Liver-based regulatory system for metabolic homeostasis" to be introduced further. The comprehensive prevention and control strategy "Tiao Gan Qi Shu Hua Zhuo" (modulating Gan, trigging key metabolic system to resolve pathogenic factors such as phlegm retention and dampness). Its representative formula Fufang Zhenzhu Tiaozhi Capsule () is innovated under such rationales. Comment for some commonly-used CM GLMD therapeutic drugs was presented. High-level evidence-based and epidemiological and mechanism studies should be carried out to further interpret and explain of the scientific connotation of GLMD.
高脂血症、2型糖尿病、非酒精性脂肪肝等多种代谢紊乱在患者中常同时存在。此外,这些疾病在病理生理背景上密切相关。然而,随着疾病发病率的增加,针对单一疾病、单一靶点治疗模式下关键病理点同时出现的情况,缺乏全面的预防和控制措施,这是西医治疗这些代谢紊乱疾病的主要策略。基于中西医结合的优势,对这类疾病有统一认识,引入了糖脂代谢病(GLMD)的新概念。在这个新概念中,糖脂代谢紊乱被认为是GLMD进展的关键触发因素和主要驱动力。病理要点包括神经-内分泌-免疫系统功能障碍、胰岛素抵抗、氧化应激、炎症和肠道菌群失衡。从中医核心致病角度来看,可解释为“肝失疏泄”,导致内生痰湿、血瘀、浊毒的产生,进而进一步引出“基于肝脏的代谢稳态调节系统”的新概念。综合防治策略为“调肝启枢化浊”(调理肝脏,启动关键代谢系统以化解痰湿等致病因素)。其代表方剂复方贞术调脂胶囊就是在此理论基础上创新而来。文中还对一些常用的中医GLMD治疗药物进行了评述。应开展高水平的循证医学以及流行病学和机制研究,以进一步阐释GLMD的科学内涵。