|
|
|
| Discussion on the biological connotation of “theory of thicken intestine” based on intestinal mucus barrier and its application in the diagnosis and treatment of ulcerative colitis |
| XING Yunqi LI Junxiang ZHANG Wenji HAN Haixiao SUN Zhongmei YUAN Yali MAO Tangyou |
Department of Gastroenterology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China
|
|
|
|
Abstract As a traditional Chinese medicine treatment method, “thicken intestine” appears many times in herbal medical related books and prescriptions, which mainly associated with intestinal diseases, such as bowel, diarrhoea, diuresis, and dysentery. However, due to the vague understanding of “thicken intestine” by most physician, it is generally called enhancing the function of intestine, which hindered the further development of the theory. It is not until the Qing Dynasty that some doctors gradually accurately understood the “thicken intestine” and believed that there is an inherent layer of “lipid membrane” or “ointment” in the intestine, which has the function of “protecting and guiding waste and making it go down”. The thinning of “lipid membrane” or “ointment” caused by damp heat or other reasons is the key pathogenesis of “putrid stool” and “bowel”, which is coupled with the damage of intestinal mucus barrier in modern medicine, the key pathogenesis of ulcerative colitis. Therefore, the corresponding treatment methods based on different pathogenesis of intestinal lipid membrane thinning should be adopted to “eliminate the source of damage, and the thin is thick”, so as to achieve the purpose of “thicken intestine” and finally treat ulcerative colitis, which is similar to the treatment of ulcerative colitis by reconstruction of mucus barrier function in modern medicine. By excavating the classic ancient books of traditional Chinese medicine, this paper traces and extendes the meaning of “theory of thicken intestine”, and deeply discusses its biological connotation from the perspective of intestinal mucus barrier, in order to provide new ideas and methods for the clinical treatment of ulcerative colitis.
|
|
|
|
|
|
[1] Lamb CA，Kennedy NA，Raine T，et al. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults [J]. Gut，2019，68（Suppl 3）：s1-s106.
[2] 李令，曹晖.中医清热祛湿法联合西药治疗溃疡性结肠炎的Meta分析[J].江西中医药，2019，50（5）：32-36.
[3] 吕兰婷，王丽娟.中国溃疡性结肠炎干预的卫生经济学评价研究进展[J].中国药物经济学，2019，14（1）：114-121.
[4] Capaldo CT，Powell DN，Kalman D. Layered defense：how mucus and tight junctions seal the intestinal barrier [J]. J Mol Med（Berl），2017，95（9）：927-934.
[5] Fernández-Tomé S，Ortega Moreno L，Chaparro M，et al. Gut microbiota and dietary factors as modulators of the mucus layer in inflammatory bowel disease [J]. Int J Mol Sci，2021，22（19）：10224.
[6] van der Post S，Jabbar KS，Birchenough G，et al. Structural weakening of the colonic mucus barrier is an early event in ulcerative colitis pathogenesis [J]. Gut，2019，68（12）：2142- 2151.
[7] 张冰，谢晶日，孙涛.以“厚肠”为指导的溃疡性结肠炎中医诊治探讨[J].中医药信息，2020，37（5）：21-23.
[8] 李冰，于岩波.肠黏液屏障在肠道中的作用[J].世界华人消化杂志，2017，25（19）：1764-1771.
[9] Paone P，Cani PD. Mucus barrier，mucins and gut microbiota：the expected slimy partners? [J]. Gut，2020，69（12）：2232-2243.
[10] 韩菲菲，彭丽媛，张学斐，等.肠道黏液屏障功能的研究进展[J].动物营养学报，2018，30（12）：4769-4775.
[11] Carlson TL，Lock JY，Carrier RL. Engineering the mucus barrier [J]. Annu Rev Biomed Eng，2018，20：197-220.
[12] Kayama H，Okumura R，Takeda K. Interaction between the microbiota，epithelia，and immune cells in the intestine [J]. Annu Rev Immunol，2020，38：23-48.
[13] Fang J，Wang H，Zhou Y，et al. Slimy partners：the mucus barrier and gut microbiome in ulcerative colitis [J]. Exp Mol Med，2021，53（5）：772-787.
[14] Dorofeyev AE，Vasilenko IV，Rassokhina，et al. Mucosal barrier in ulcerative colitis and Crohn’s disease [J]. Gastroenterol Res Pract，2013，2013：431231.
[15] Al-Shaibi AA，Abdel-Motal UM，Hubrack SZ，et al. Human AGR2 deficiency causes mucus barrier dysfunction and infantile inflammatory bowel disease [J]. Cell Mol Gastroenterol Hepatol，2021，12（5）：1809-1830.
[16] Kissoon-Singh V，Moreau F，Trusevych E，et al. Entamoeba histolytica exacerbates epithelial tight junction permeability and proinflammatory responses in Muc2-/- mice [J]. Am J Pathol，2013，182（3）：852-865.
[17] Johansson ME，Gustafsson JK，Sj?觟berg KE，et al. Bacteria penetrate the inner mucus layer before inflammation in the dextran sulfate colitis model [J]. PLoS One，2010，5（8）：e12238.
[18] Swidsinski A，Loening-Baucke V，Theissig F，et al. Comparative study of the intestinal mucus barrier in normal and inflamed colon [J]. Gut，2007，56（3）：343-350.
[19] 丁庞华，史利卿，石磊，等.虎地肠溶胶囊对葡聚糖硫酸钠诱导的溃疡性结肠炎小鼠黏液屏障损伤修复的作用研究[J].中国中医急症，2021，30（8）：1336-1339， 1381.
[20] 朱成雷，穆晶晶，徐静雯，等.紫甘薯花青素对DSS诱导的溃疡性结肠炎小鼠肠道屏障损伤的修复作用[J].中国病理生理杂志，2020，36（10）：1844-1853.
[21] 王志斌，陈晨，郭一，等.清肠温中方治疗轻中度溃疡性结肠炎的临床研究[J].中国中西医结合杂志，2018，38（1）：15-19.
[22] Sun Z，Li J，Wang W，et al. Qingchang Wenzhong Decoction accelerates intestinal mucosal healing through modulation of dysregulated gut microbiome，intestinal barrier and immune responses in mice [J]. Front Pharmacol，2021，12：738152.
[23] Yuan Z，Yang L，Zhang X，et al. Huang-Lian-Jie-Du Decoction ameliorates acute ulcerative colitis in mice via regulating NF-κB and Nrf2 signaling pathways and enhancing intestinal barrier function [J]. Front Pharmacol，2019， 10：1354.
[24] Chi H，Wang D，Chen M，et al. Shaoyao Decoction inhibits inflammation and improves intestinal barrier function in mice with dextran sulfate sodium-induced colitis [J]. Front Pharmacol，2021，12：524287.
[25] Dong C，Yu J，Yang Y，et al. Berberine，a potential prebiotic to indirectly promote Akkermansia growth through stimulating gut mucin secretion [J]. Biomed Pharmacother，2021， 139：111595. |
|
|
|
