在老龄化背景下慢性创面已成为严重威胁人民生命健康的重大公共卫生问题，在中医理论的指导下，外用中药在慢性创面治疗方面形成了独特的理论和治法，并且特别重视寒热药性的影响，但其科学内涵与作用机制还有待于深入诠释以更好地服务于临床应用。最新研究表明，共生菌群能够发挥免疫调节和促愈作用，故而对于慢性创面治疗具有重要意义，绝对无菌反而不利于创面愈合。因此提出通过创面菌群调控认知探讨以马勃Calvatia gigantean为代表的外用中药“煨脓长肉”治疗慢性创面作用机制的研究思路，以及基于创面菌群-肠道菌群调控的创面外用中药寒热药性作用机制的研究思路，为科学认知和充分发挥外用中药临床独特疗效和医学生物学机制提供参考和借鉴，为外用中药治疗慢性创面的现代研究提供新思路。

Chronic wounds have become a global public health problem under the background of aging, affecting over millions of people in China. With the guidance of traditional Chinese medicine (TCM) theory, external administration of TCM established a unique theoretical system and various therapeutic approaches in treating chronic wound, particularly on the utilization of “hot” and “cold” properties of TCM. However, its scientific implication and the underlying mechanism has yet to be understood for better use in clinical practice. Recent studies report that commensal microbiota can regulate immune responses and promote wound healing, while absolute sterility is not favourable in wound repair. These findings suggest a novel direction of TCM in the treatment of chronic wounds. In the present article, commensal microbiome and wound healing was summarized, while the representative external TCM Calvatia gigantea and its roasting pus to promote regeneration role in regulating wound microbiome together with wound repair was also discussed. A research strategy based on the correlation between wound microbiome and gut microbiota was therefore raised here to further investigate hot or cold properties of TCM in the treatment of chronic wounds. This article will provide a new idea for future modern research of TCM in treating chronic wounds.

R28;R285

江苏省中药资源产业化过程协同创新中心重点项目(ZDXM-2020-25)