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Open Access Article

International Research in Chinese Medicine. 2026; 6: (3) ; 1-10 ; DOI: 10.12208/j.ircm.20260039.

Research progress on the mechanism of Dachaihu decoction in intervening with type 2 diabetes by regulating gut microbiota and metabolites
大柴胡汤调控肠道菌群及代谢产物干预2型糖尿病的机制研究进展

作者: 颜玮彤, 欧忠民, 周璇, 李奕廷, 张佳怡, 何银元, 刘亮晶 *

吉首大学医学院 湖南吉首

*通讯作者: 刘亮晶,单位:吉首大学医学院 湖南吉首 ;

发布时间: 2026-09-03 总浏览量: 120

摘要

2型糖尿病(type 2 diabetes mellitus, T2DM)是一种以胰岛素抵抗和胰岛β细胞功能进行性衰退为主要特征的慢性代谢性疾病。近年来研究发现,肠道菌群失衡及其代谢产物异常参与T2DM的发生发展,并可通过影响短链脂肪酸、胆汁酸、氧化三甲胺等代谢途径,调节炎症反应、肠屏障功能及糖脂代谢稳态。大柴胡汤作为“和解少阳、内泻热结”的经典方剂,其“疏、清、通”治法与T2DM“肝胃郁热”的病机特点具有一定相关性。临床研究显示,大柴胡汤联合常规治疗可改善T2DM患者代谢指标;一项纳入17项随机对照研究、共1525例患者的Meta分析显示,大柴胡汤联合治疗可降低糖化血红蛋白(HbA1c)水平(MD=-0.90%),并改善胰岛素抵抗指标HOMA-IR(SMD=-2.04)。近年来实验研究提示,大柴胡汤可能通过调节肠道菌群组成及相关代谢物水平,影响肠屏障功能、炎症反应及肠-肝轴信号通路,从而改善糖脂代谢紊乱。本文综述肠道菌群及其代谢物在T2DM中的作用基础,总结大柴胡汤调控菌群及相关代谢途径干预T2DM的研究进展,并归纳其主要活性成分的药理作用,以期为阐释大柴胡汤现代作用机制及中医药精准干预T2DM提供参考。

关键词: 大柴胡汤;2型糖尿病;肠道菌群;肠道代谢物

Abstract

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease characterized by insulin resistance and progressive decline of islet β-cell function. In recent years, studies have found that intestinal flora imbalance and abnormal metabolites are involved in the occurrence and development of T2DM, and can regulate inflammatory response, intestinal barrier function and glucose and lipid metabolism homeostasis by affecting metabolic pathways such as short-chain fat, bile acid and trimethylamine oxide. As a classic prescription of “ harmonizing Shaoyang and internal diarrhea and heat accumulation”, the treatment of “soothing, clearing and unblocking” has a certain correlation with the pathogenesis of “liver and stomach heat stagnation” in T2DM.Clinical studies have shown that Dachaihu Decoction combined with conventional treatment can improve the metabolic indexes of T2DM patients ; a meta-analysis of 17 randomized controlled trials involving 1525 patients showed that the combination of Dachaihu Decoction could reduce glycated hemoglobin A₁c (HbA1c) levels (MD = -0.90 %) and improve insulin resistance index HOMA-IR (SMD = -2.04). In recent years, experimental studies have suggested that Dachaihu Decoction may affect intestinal barrier function, inflammatory response and intestinal-liver axis signaling pathway by regulating intestinal flora composition and related metabolite levels, thereby improving glucose and lipid metabolism disorders. This article reviews the basis of the role of intestinal flora and its metabolites in T2DM, summarizes the research progress of Dachaihu Decoction in regulating flora and related metabolic pathways to intervene in T2DM, and summarizes the pharmacological effects of its main active ingredients, in order to provide a reference for explaining the modern mechanism of Dachaihu Decoction and the precise intervention of T2DM by traditional Chinese medicine.

Key words: Dachaihu decoction; Type 2 diabetes; Intestinal flora; Intestinal metabolites

参考文献 References

[1] 中华医学会糖尿病学分会. 中国糖尿病防治指南(2024版)[J]. 中华糖尿病杂志,2025,17(1):16-139.

[2] XU Y, LU J, LI M, et al. Diabetes in China part 1: epidemiology and risk factors[J]. Lancet Public Health, 2024,9(12):e1089-e1097.

[3] HAMEED I, MASOODI S R, MIR S A, et al. Type 2 diabetes mellitus: From a metabolic disorder to an inflammatory condition[J]. World J Diabetes, 2015,6(4):598-612.

[4] YANG Z, ZHANG L, LIU J, et al. Litchi Pericarp Extract Treats Type 2 Diabetes Mellitus by Regulating Oxidative Stress, Inflammatory Response, and Energy Metabolism[J]. Antioxidants (Basel), 2024,13(4)

[5] 郁娃林, 赵丹青, 曹雯,等. 肠道菌群代谢物影响2型糖尿病发生发展分子机制的研究进展[J]. 激光生物学报,2025,34(2):113-120.

[6] 蒋晓玉, 赵媛媛, 李飞,等. 基于“肠–肝”轴学说探讨肠道菌群在代谢性疾病中的作用[J]. 药物资讯,2024, 13(3):149-161.

[7] 张博荀, 赵林华, 金籽杉,等. 2型糖尿病"郁-热"病机与肠道菌群关系的思考[J]. 中国中医基础医学杂志,2022, 28(8):1286-1289.

[8] 汲晓玲, 周游, 李泽浩,等. 大柴胡汤历史沿革、临床应用和药理作用研究进展及其质量标志物预测分析[J]. 中国中药杂志,2024,49(8):2064-2075.

[9] 张卫欢, 李秋云, 杨春伟,等. 大柴胡汤加减联合利拉鲁肽对肥胖2型糖尿病患者胰岛素抵抗、β-细胞功能和低度炎症反应的影响[J]. 现代中西医结合杂志,2018,27(1):23-26,30.

[10] Zhang Z, Leng Y, Fu X, et al. The efficacy and safety of dachaihu decoction in the treatment of type 2 diabetes mellitus: A systematic review and meta-analysis. Front Pharmacol. 2022;13:918681. Published 2022 Aug 8. doi:10.3389/fphar.2022.918681

[11] CUI H, LI Y, WANG Y, et al. Da-Chai-Hu Decoction Ameliorates High Fat Diet-Induced Nonalcoholic Fatty Liver Disease Through Remodeling the Gut Microbiota and Modulating the Serum Metabolism[J]. Front Pharmacol, 2020,11:584090.

[12] QIN J, LI Y, CAI Z, et al. A metagenome-wide association study of gut microbiota in type 2 diabetes[J]. Nature, 2012,490(7418):55-60.

[13] KARLSSON F H, TREMAROLI V, NOOKAEW I, et al. Gut metagenome in European women with normal, impaired and diabetic glucose control[J]. Nature, 2013,498(7452):99-103.

[14] AHMAD A, YANG W, CHEN G, et al. Analysis of gut microbiota of obese individuals with type 2 diabetes and healthy individuals[J]. PLoS One, 2019,14(12):e0226372.

[15] LI Q, CHANG Y, ZHANG K, et al. Implication of the gut microbiome composition of type 2 diabetic patients from northern China[J]. Sci Rep, 2020,10(1):5450.

[16] FORSLUND K, HILDEBRAND F, NIELSEN T, et al. Disentangling type 2 diabetes and metformin treatment signatures in the human gut microbiota[J]. Nature, 2015,528(7581):262-266.

[17] CHEN P C, CHIEN Y W, YANG S C. The alteration of gut microbiota in newly diagnosed type 2 diabetic patients[J]. Nutrition, 2019,63-64:51-56.

[18] GAIKE A H, PAUL D, BHUTE S, et al. The Gut Microbial Diversity of Newly Diagnosed Diabetics but Not of Prediabetics Is Significantly Different from That of Healthy Nondiabetics[J]. mSystems, 2020,5(2):e00578-00519.

[19] CRUDELE L, GADALETA R M, CARIELLO M, et al. Gut microbiota in the pathogenesis and therapeutic approaches of diabetes[J]. EBioMedicine, 2023,97:104821.

[20] TOLHURST G, HEFFRON H, LAM Y S, et al. Short-chain fatty acids stimulate glucagon-like peptide-1 secretion via the G-protein-coupled receptor FFAR2[J]. Diabetes, 2012,61(2):364-371.

[21] WANG J, ZHAO Q, ZHANG S, et al. Microbial short chain fatty acids: Effective histone deacetylase inhibitors in immune regulation (Review)[J]. Int J Mol Med, 2026,57(1)

[22] LIN M Y, DE ZOETE M R, VAN PUTTEN J P, et al. Redirection of Epithelial Immune Responses by Short-Chain Fatty Acids through Inhibition of Histone Deacetylases[J]. Front Immunol, 2015,6:554.

[23] 项青青, 赖凤, 肖虹,等. 大柴胡汤缓解葡聚糖硫酸钠诱导的溃疡性结肠炎及肝损伤并与其对小鼠肠道菌群的调控作用相关[J]. 重庆医科大学学报,2025,50(8):1084-1095.

[24] GAO R, MENG X, XUE Y, et al. Bile acids-gut microbiota crosstalk contributes to the improvement of type 2 diabetes mellitus[J]. Front Pharmacol, 2022,13:1027212.

[25] TAWULIE D, JIN L, SHANG X, et al. Jiang-Tang-San-Huang pill alleviates type 2 diabetes mellitus through modulating the gut microbiota and bile acids metabolism[J]. Phytomedicine, 2023,113:154733.

[26] WANG Y, YU J, CHEN B, et al. Bile acids as a key target: traditional Chinese medicine for precision management of insulin resistance in type 2 diabetes mellitus through the gut microbiota-bile acids axis[J]. Front Endocrinol (Lausanne), 2024,15:1481270.

[27] PAN T, LI X, GUO X, et al. Electroacupuncture Improves Insulin Resistance in Type 2 Diabetes Mice by Regulating Intestinal Flora and Bile Acid[J]. Diabetes Metab Syndr Obes, 2023,16:4025-4042.

[28] WANG R, JIA F, ZHAO Z, et al. Dachaihu decoction inhibits hypernutrition-induced liver metastasis from colorectal cancer by maintaining the gut vascular barrier[J]. Cancer Pathog Ther, 2023,1(2):98-110.

[29] 缪辉来, 林木生, 张利强,等. 加味大柴胡汤对阻塞性黄疸大鼠胆汁酸代谢的影响及机制[J]. 中华实验外科杂志,2006,23(8):934-936.

[30] HUANG Y, WU Y, ZHANG Y, et al. Dynamic Changes in Gut Microbiota-Derived Metabolite Trimethylamine-N-Oxide and Risk of Type 2 Diabetes Mellitus: Potential for Dietary Changes in Diabetes Prevention[J]. Nutrients, 2024,16(11):1711.

[31] 姜晓静. TMAO在胰岛β细胞功能障碍中的作用和机制研究[D] ,2024.

[32] 戚宇琪, 郭杰. 基于内毒素血症学说探讨肠道菌群紊乱导致2型糖尿病的发病机制[J]. 世界最新医学信息文摘(连续型电子期刊),2019,19(63):85-86.

[33] HE Z, GUO J, ZHANG H, et al. Atractylodes macrocephala Koidz polysaccharide improves glycolipid metabolism disorders through activation of aryl hydrocarbon receptor by gut flora-produced tryptophan metabolites[J]. Int J Biol Macromol, 2023,253(Pt 4):126987.

[34] LU J, HUANG Y, ZHANG Y, et al. Quercetin ameliorates obesity and inflammation via microbial metabolite indole-3-propionic acid in high fat diet-induced obese mice[J]. Front Nutr, 2025,12:1574792.

[35] 瞿岳云. 消渴不可概以阴虚燥热论[J]. 中国中医基础医学杂志,2006,12(3):198-201.

[36] 何雷, 唐雪梅. 肝失疏泄与糖尿病的相关性探讨[J]. 环球中医药,2016,9(4):438-440.

[37] LI L, YANG S, LIANG X, et al. Saikosaponin D improves nonalcoholic fatty liver disease via gut microbiota-bile acid metabolism pathway[J]. Food Science and Human Wellness, 2024,13(5):2703-2717.

[38] GU Y, DUAN S, DING M, et al. Saikosaponin D attenuates metabolic associated fatty liver disease by coordinately tuning PPARα and INSIG/SREBP1c pathway[J]. Phytomedicine, 2022,103:154219.

[39] FENG J, MA H, YUE Y, et al. Saikosaponin a ameliorates diet-induced fatty liver via regulating intestinal microbiota and bile acid profile in laying hens[J]. POULTRY SCIENCE, 2023,102(12):103155.

[40] WU L, YAN Q, CHEN F, et al. Bupleuri radix extract ameliorates impaired lipid metabolism in high-fat diet-induced obese mice via gut microbia-mediated regulation of FGF21 signaling pathway[J]. BIOMEDICINE & PHARMACOTHERAPY, 2021,135(2):111187.

[41] FENG Y, WENG H, LING L, et al. Modulating the gut microbiota and inflammation is involved in the effect of Bupleurum polysaccharides against diabetic nephropathy in mice[J]. International Journal of Biological Macromolecules, 2019

[42] ZHANG A, GAO S, SHEN C, et al. Bupleuri Radix polysaccharides enhance the efficacy and intestinal absorption of baicalin via regulating intestinal β-glucuronidase activity in MASH mice[J]. PHYTOMEDICINE, 2010,145(000):16.

[43] SHIN N R, GU N, CHOI H, et al. Combined effects of Scutellaria baicalensis with metformin on glucose tolerance of type 2 diabetes patients via gut microbiota modulation[J]. AJP Endocrinology and Metabolism, 2019,318(1)

[44] ZHANG, BOWEI, SUN, et al. Anti-diabetic effect of baicalein is associated with the modulation of gut microbiota in streptozotocin and high-fat-diet induced diabetic rats[J]. Journal of Functional Foods, 2018

[45] JU M, LIU Y, LI M, et al. Baicalin improves intestinal microecology and abnormal metabolism induced by high-fat diet[J]. European Journal of Pharmacology, 2019,857:172457.

[46] CHEN L, LIU E, ZHAO X, et al. Scutellaria baicalensis Georgi in metabolic-associated fatty liver disease treatment: research progress[J]. Frontiers in Pharmacology, 2025,16(000).

[47] WEI Z, SHEN P, CHENG P, et al. Gut Bacteria Selectively Altered by Sennoside A Alleviate Type 2 Diabetes and Obesity Traits[J]. Oxidative medicine and  cellular longevity, 2020,2020:1-16.

[48] LE J, ZHANG X, JIA W, et al. Regulation of microbiota–GLP1 axis by sennoside A in diet-induced obese mice[J]. Acta Pharmaceutica Sinica B, 2019,9(4):758-768.

[49] CUI H, ZHANG L, LUO Y, et al. A Purified Anthraquinone-Glycoside Preparation From Rhubarb Ameliorates Type 2 Diabetes Mellitus by Modulating the Gut Microbiota and Reducing Inflammation[J]. Frontiers in Microbiology, 2019,10

[50] ZENG Y Q, DAI Z, LU F, et al. Emodin via colonic irrigation modulates gut microbiota and reduces uremic toxins in rats with chronic kidney disease[J]. Oncotarget, 2016,7(14):17468-17478.

[51] ZHANG J, KANG H, WANG L, et al. Chrysophanol ameliorates high-fat diet-induced obesity and inflammation in neonatal rats[J]. Pharmazie, 2018,73(4):228-233.

[52] VALERII M C, TURRONI S, FERRERI C, et al. Effect of a Fiber D-Limonene-Enriched Food Supplement on Intestinal Microbiota and Metabolic Parameters of Mice on a High-Fat Diet[J]. Pharmaceutics, 2021,13(11):1753.

[53] LIU T, LEI C, HUANG Q, et al. Hesperidin and Fecal Microbiota Transplantation Modulate the Composition of the Gut Microbiota and Reduce Obesity in High Fat Diet Mice[J]. Diabetes Metab Syndr Obes, 2024,17:3643-3656.

[54] ZHANG D, HE X, JIANG H, et al. Hesperetin-Attenuated Diabetes-Induced Vascular Endothelial Injury, Associated with Gut Microbiota Modulation and Cholesterol Homeostasis[J]. J Agric Food Chem, 2025,73(44):28202-28216.

[55] LUO C, YANG D, HOU C, et al. Paeoniflorin protects NOD mice from T1D through regulating gut microbiota and TLR4 mediated myD88/TRIF pathway[J]. Exp Cell Res, 2023,422(1):113429.

[56] OU X, YU Z, PAN C, et al. Paeoniflorin: a review of its pharmacology, pharmacokinetics and toxicity in diabetes[J]. Front Pharmacol, 2025,16:1551368.

[57] KIM Y J, SHIN Y O, HA Y W, et al. Anti-obesity effect of Pinellia ternata extract in Zucker rats[J]. Biol Pharm Bull, 2006,29(6):1278-1281.

[58] ALHAMOUD Y, AHMAD M I, ABUDUMIJITI T, et al. 6-Gingerol, an active ingredient of ginger, reshapes gut microbiota and serum metabolites in HFD-induced obese mice[J]. Journal of Functional Foods, 2023,109(000):12.

[59] WANG K, KONG L, WEN X, et al. The Positive Effect of 6-Gingerol on High-Fat Diet and Streptozotocin-Induced Prediabetic Mice: Potential Pathways and Underlying Mechanisms[J]. Nutrients, 2023,15(4):824.

[60] JIAO W, SANG Y, WANG X, et al. Metabonomics and the gut microbiome analysis of the effect of 6-shogaol on improving obesity[J]. Food Chem, 2023,404(Pt B):134734.

[61] CHE X, ZHAO Y, WANG Y, et al. Modulatory effects of black jujube melanoidins on gut microbiota and metabolic pathways in high-fat diet-induced obesity[J]. Front Nutr, 2025,12:1580439.

[62] JIAO L, ZOU J, MA H, et al. Regulatory effects of jujube (Ziziphus jujuba) polysaccharides on intestinal microbiota before and after α-galactosidase-mediated degradation[J]. Food Funct, 2026,17(2):930-941.

引用本文

颜玮彤, 欧忠民, 周璇, 李奕廷, 张佳怡, 何银元, 刘亮晶, 大柴胡汤调控肠道菌群及代谢产物干预2型糖尿病的机制研究进展[J]. 国际中医药研究, 2026; 6: (3) : 1-10.