【摘要】 旨在探讨代谢相关脂肪性肝病(MASLD)合并2型糖尿病(T2DM)复合病机的动态演变规律。系统梳理周仲瑛教授基于整体观所总结的关于MASLD合并T2DM复合病机的演变特征：病理因素以瘀、热为核心，与湿、郁、燥、毒、虚等复合为患；病位主要涉及肝、脾，兼顾心、肺、肾、胆、胃、肠；病性以阴津亏虚为本，虚实夹杂。同时，从现代生物学视角系统阐释其病机演化的生物学机制：胰岛素抵抗表现为气阴两虚、燥湿同病；脂质代谢紊乱与湿毒内蕴、瘀热伤阴相关；肝肠循环紊乱源于胆肠通降失常、浊毒伤阴；慢性炎症则对应正邪相争，壮火食气。通过将中医整体观与现代生物医学相结合，不仅为MASLD合并T2DM的防治提供病机学依据，也为中医异病同治理论指导现代生物医学研究开拓了新的思路与方法。更多还原

【Abstract】 This paper aims to explore the dynamic evolution law of the complex pathogenesis when metabolic dysfunction-associated steatotic liver disease(MASLD) is complicated by type 2 diabetes mellitus(T2DM). It systematically elucidates the complex pathomechanism evolution characterized by Professor Zhou Zhongying′s holistic perspective: pathological factors are centered on stasis and heat, compounded by dampness, stagnation, dryness, toxicity, and deficiency. Affected organs primarily involve the liver and spleen, with secondary involvement of the heart, lungs, kidneys, gallbladder, stomach, and intestines; and the disease nature is rooted in yin-fluid deficiency with a mixture of deficiency and excess. Additionally, from a modern biological perspective, the paper systematically analyzes the biological mechanisms of its complex pathogenesis evolution: insulin resistance manifests as qi-yin deficiency with concurrent dryness and dampness; lipid metabolic disorders reflect internal accumulation of damp-toxin with stasis-heat injuring yin; hepatic-intestinal circulation disorders present as impaired gallbladder-intestinal descending function with turbid-toxin injuring yin; and chronic inflammation is characterized by the struggle between vital qi and pathogenic factors with excessive fire consuming qi. This article provides a pathogenesis basis for the prevention and treatment of MASLD with comorbid T2DM, and pioneers novel approaches for guiding modern biomedical research within the framework of "treating diverse diseases with the unified therapy" in Traditional Chinese Medicine(TCM), by integrating TCM’s holistic conceptual theory with contemporary biomedical science.更多还原