） 摘要：作为脓毒症的常见并发症之一，脓毒症胃肠损伤不仅是多器官功能障碍综合征（MODS）的关键始动因素，更是决定患 者预后的重要环节。脓毒症胃肠损伤所出现的肠道屏障破坏、菌群紊乱及代谢与免疫的失衡，加剧了多器官的衰竭。该文 提出，脓毒症胃肠损伤以“中焦失和”为中医核心病机，病机特点为“脾虚为本，腑实为标”，这与脓毒症病程中肠道菌群 生态失衡存在同构性，可阐释脾胃升降失调而影响肠道微生态环境，之后引发菌群结构失衡与代谢产物异常的恶性循环， 最终导致肠上皮损伤及全身炎症风暴。其防治可采用 “调中复衡”法，即采用通降与健脾结合以恢复肠道动力、肠道菌群 与免疫稳态，临证时可通过联合运用理中汤、承气汤等代表方药，既能通过“调中”改善菌群营养微环境，又能通过“复 衡”清除菌群失衡后的代谢毒邪，从而阻延脓毒症胃肠损伤的进展。“调中复衡”法凸显中医整体观在调节代谢与免疫互作 中的独特优势，可为临床治疗脓毒症胃肠道损伤提供思路。

As one of the most common complications of sepsis，sepsis-induced gastrointestinal injury is not only a key initiating factor for multiple organ dysfunction syndrome （MODS） but also a critical determinant of patient prognosis. The intestinal barrier disruption， gut microbiota dysbiosis， and metabolic and immune imbalances observed in sepsis-induced gastrointestinal injury exacerbate multiple organ failure. This article proposes that the core traditional Chinese medicine （TCM） pathogenesis of sepsis-induced gastrointestinal injury is due to the disharmony of middle-jiao，which is characterized by spleen deficiency as the root cause and fu-organ excess as the manifestations. The pathogenesis shares similarities with the ecological imbalance of the gut microbiota during sepsis，explaining how dysfunction in the spleen’s ascending and the stomach’s descending disrupts the intestinal microecological environment. This disruption initiates a vicious cycle of imbalanced microbiota structure and abnormal metabolic products，ultimately leading to intestinal epithelial injury and a systemic inflammatory storm. The prevention and treatment of sepsis-induced gastrointestinal injury can be conducted by the approach of regulating middle-jiao and restoring balance，which combines unblocking and descending methods with spleenfortifying method to restore intestinal motility，gut microbiota，and immune homeostasis. In clinical practice，this can be achieved through the combined use of representative formulas such as Lizhong Decoction and Chengqi Decoction. This approach not only improves the microbiota’s nutritional microenvironment by regulating middle-jiao but also clears toxic metabolites produced by the dysbiotic microbiota， and then delays the progression of sepsis-induced gastrointestinal injury through the method of restoring balance. The approach of regulating middlejiao and restoring balance highlights the unique advantage of the TCM holistic concept in regulating the metabolism- immunity interaction，potentially providing insights for the clinical management of sepsis-induced gastrointestinal injury.

R259.153

国家自然科学基金项目（编号：82374216）；广东省中医药局课题（编号：20251364）