Mechanisms of Metabolic Imbalance in MAFLD with T2DM from Theory of Middle Energizer Acting as a Balance and Traditional Chinese Medicine Intervention Strategies
10.13422/j.cnki.syfjx.20260696
- VernacularTitle:基于“中焦如衡”探讨代谢相关脂肪性肝病合并2型糖尿病代谢稳态失衡机制及中药干预策略
- Author:
Haoyang QIN
1
;
Mengge LI
1
;
Lei LUO
1
;
Xueqian KONG
2
;
Fanghua ZHANG
2
;
Zhongqin DANG
1
;
Zhibo DANG
1
Author Information
1. Henan Province Hospital of Traditional Chinese Medicine/ The Second Affiliated Hospital of Henan University of Chinese Medicine，Zhengzhou 450002，China
2. Henan University of Chinese Medicine，Zhengzhou 450046，China
- Publication Type:Journal Article
- Keywords:
metabolic dysfunction-associated fatty liver disease with type 2 diabetes mellitus;
middle energizer acting as a balance;
comorbidity mechanism;
integration of traditional and modern approaches
- From:
Chinese Journal of Experimental Traditional Medical Formulae
2026;32(21):244-253
- CountryChina
- Language:Chinese
-
Abstract:
Metabolic dysfunction-associated fatty liver disease （MAFLD） and type 2 diabetes mellitus （T2DM） have a high comorbidity rate， emerging as a major global public health issue. The concept that the middle energizer acting as a balance refers to the role of the middle energizer in maintaining the balance of Qi and blood， dryness and dampness， as well as water and fire （Yin and Yang） in the human body. The core feature of MAFLD with T2DM is the metabolic imbalance， which is closely related to the dysfunction of the middle energizer's balancing role. This article explores the mechanisms of metabolic imbalance in MAFLD with T2DM from the perspective of the middle energizer acting as a balance， proposing that middle energizer dysfunction is the root cause. Qi movement， dryness-dampness， and ministerial fire are the two ends of the balance. MAFLD with T2DM is accompanied by various seemingly contradictory pathological states and imbalances， such as "Qi stagnation and failure of free movement vs. Qi dispersion without retention"， "damp-turbidity obstruction vs. internal dryness and fluid consumption"， and "ministerial fire decline vs. hyperactivity and scorching". On this basis， the traditional Chinese medicine （TCM） intervention strategies and their microscopic mechanisms are discussed. For the root cause of middle energizer imbalance， wind-dispelling herbs and Qi-replenishing and middle energizer-invigorating herbs are used to restore the balancing role of the middle energizer （delaying glucose and lipid absorption， restoring intestinal homeostasis， and ameliorating insulin resistance in skeletal muscle and adipocytes）. For the secondary imbalances， pungent-dispersing and liver-soothing herbs combined with sour-astringent herbs are used to balance Qi movement （alleviating mitochondrial dysfunction in hepatocytes and impaired glucose transport in tissue cells）. Bitter-warm and dampness-draining herbs combined with sweet-cold and moistening herbs are used to balance dryness and dampness （reducing hepatic steatosis， cellular hyperosmotic dehydration， and intracellular metabolic disorders）. Yang-lifting and warm-invigorating herbs combined with clearing-descending and Yin-nourishing herbs are used to balance ministerial fire （ameliorating hepatocyte apoptosis and liver fibrosis processes and alleviating systemic chronic inflammation and related damage）. According to the theory of the middle energizer acting as a balance， this article explores the mechanisms of metabolic imbalance in MAFLD with T2DM and TCM intervention strategies， providing new insights and a framework for related scientific research and clinical practice.
