基于“阳常有余,阴常不足”及“相火妄动”论治消瘦型糖尿病  

The treatment of weight loss type diabetes based on the theories of“Yang is often excessive,and Yin is often insufficient”and“frenetic stirring of ministerial fire”

作　　者：李阳 滕士超[1] LI Yang;TENG Shichao

机构地区：[1]南京中医药大学附属医院,江苏南京210029

出　　处：《中医临床研究》2023年第36期111-114,共4页Clinical Journal Of Chinese Medicine

基　　金：老年肌少症患者中医证候分布规律及证型间代谢组学差异性研究(BJ20020);老年医学临床技术应用研究项目带头人(LR2021003);老年医学临床技术应用研究项目单位(老年科)(LD2021003)。

摘　　要：糖尿病是以胰岛素分泌相对或绝对不足为特征的慢性代谢性疾病。随着我国社会老龄化,糖尿病发病率逐年增长,消瘦型糖尿病多见于1型糖尿病,也可见于2型糖尿病,有时伴随乏力、精神倦怠等其他不适,对患者的生活质量及心理健康造成影响,并可能会增加骨折、肌少症、肿瘤等疾病风险。常规西医治疗该病多应用胰岛素及增重类的口服降糖药,但治疗效果并不显著,并有伴随低血糖等风险的可能,因此,临床上常常结合中医药治疗以增加疗效、改善全身症状。中医方面多认为消瘦型糖尿病基本病机为阴虚燥热,与肝肾等脏腑密切相关。基于朱震亨“阳常有余,阴常不足”及“相火妄动”理论探讨消瘦型糖尿病的病机,认为阴不足为本病发生的根本,相火炎上为诱因,同时脾失健运、血行瘀滞是本病发生发展的关键。现代医学研究发现,胰岛素分泌不足的糖尿病患者,糖的吸收利用不足,出现消瘦,这同朱震亨的病机理论相符。基于朱震亨的这个理论,结合临床经验,在消瘦型糖尿病治疗中,应以补肝肾、清相火为基本治疗原则,辅以调补中焦、活血化瘀等治法,标本兼顾,使阴阳平衡,进而达到增加体质量、平稳控制血糖的治疗目的。并附病案一则,以期为消瘦型糖尿病的临床治疗提供参考思路。Diabetes is a chronic metabolic disease characterized by relative or absolute insufficiency of insulin secretion.With the aging of the society in China,the incidence of diabetes is increasing year by year.Weight loss type diabetes is more common in type 1 diabetes and can also be seen in type 2 diabetes,sometimes accompanied by fatigue,mental burnout and other discomforts,which affecting the quality of life and mental health of patients.It may increase the risk of fractures,sarcopenia,tumors and other diseases.Conventional Western medicine mostly uses insulin and weight gain oral hypoglycemic drugs,but the treatment effect is not significant,and there may be risks such as hypoglycemia.So it is often combined with traditional Chinese medicine treatment to increase the efficacy and relieve systemic symptoms.Traditional Chinese medicine mostly believes that the basic pathogenesis of weight loss type diabetes is Yin(阴)deficiency and heat,which is closely related to the liver and kidneys and other organs.Based on ZHU Zhenheng’s theories of“Yang(阳)is often excessive,and Yin is often insufficient”and“frenetic stirring of ministerial fire”,the pathogenesis of weight loss type diabetes is explored.It is held that Yin deficiency is the root cause of this disease,frenetic stirring of ministerial fire is the trigger.At the same time,spleen failing in transportation and transformation and blood stasis are the key to the occurrence and development of this disease.Modern medical research has found that diabetic patients with insufficient insulin secretion have insufficient sugar absorption and utilization and emaciation,which is consistent with ZHU Zhenheng’s theory of pathogenesis.Based on this theory of ZHU Zhenheng,combined with clinical experience,in the treatment of weight loss type diabetes,strengthening liver and kidney and clearing ministerial fire is the basic treatment principle.Adjunct treatment is regulating the spleen and stomach and promoting blood circulation to remove blood stasis for addressing

关 键 词：消瘦型糖尿病 阳常有余 阴常不足 相火论 

分 类 号：R25[医药卫生—中医内科学]