从“三热论”辨治糖尿病心脏自主神经病变  

Differentiation and Treatment of Diabetes Cardiac Autonomic Neuropathy from"Three Heat Theory"

作　　者：苏奔 狄红杰[2] 陆明[3] 郭立中[3] 周茜 朱垚[3] SU Ben;DI Hongjie;LU Ming;GUO Lizhong;ZHOU Qian;ZHU Yao(Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai China,200032;The Second Affiliated Hospital to Nanjing University of Traditional Chinese Medicine,Nanjing Jiangsu China 210017;Workshop of Zhou Zhongying,Master of Traditional Chinese Medicine at Nanjing University of Traditional Chinese Medicine,Nanjing Jiangsu China 210029)

机构地区：[1]上海中医药大学附属龙华医院,上海200032 [2]南京中医药大学第二附属医院,江苏南京210017 [3]南京中医药大学国医大师周仲瑛工作室,江苏南京210029

出　　处：《中医学报》2024年第3期501-504,共4页Acta Chinese Medicine

基　　金：江苏省六大人才高峰项目(013034004002);江苏省333高层次人才培养工程项目(2018ⅲ-0121);全国和省名老中医药专家传承工作室基层工作站建设项目—周仲瑛传承工作室项目{苏中医科教〔2018〕3号};中国中医科学院学部委员学术传承与传播专项项目(CI2022E028XB)。

摘　　要：糖尿病心脏自主神经病变病理因素有燥、热、湿、痰、瘀等,病位以心为主,亦与脾、肝、肾关系密切,病性为本虚标实。临床中消渴虽多见燥热,但同时患者常因饮食不节,过食肥甘,以致酿生湿热。消渴日久,热灼津伤,津枯血燥,可致络热血瘀,形成瘀热。湿热、瘀热、燥热之间存在因果转化关系,三热既可单独致病,又能兼夹并见。三热交炽,阴伤气耗,形成恶性循环。国医大师周仲瑛教授结合中医经典及临床实践在辨治糖尿病及其并发症时提出“三热论”,基于此,治疗糖尿病心脏自主神经病变应以“三热”并清、气血同治、标本兼顾为基本原则,谨守病机,运用复法组方恰当施治,即清化与润燥并进、化湿祛瘀与生津凉润并举,方能充分发挥中医“圆机活法”的治疗优势。The pathological factors of cardiac autonomic neuropathy in diabetes include Dryness,Heat,Dampness,Phlegm,blood stasis,etc.The disease location is mainly Heart,and it is also closely related to Spleen,Liver,and Kidney,and the disease nature is the deficiency in root and excess in symptoms.Although Dryness and Heat is commonly seen in clinical practice,patients often experience Dampness and Heat due to improper diet and excessive consumption of fatty and sweet foods.Long term thirst,Heat burning and injury to the body as well as Dryness of the body and blood can cause meridian Heat and blood stasis,forming stasis Heat.There is a causal relationship between Dampness Heat,Stagnant Heat,and Dryness Heat,and the three types of Heat can cause diseases alone or with coexistence.Triple Heat exchange,Yin damage and Qi depletion forms a vicious cycle.Professor Zhou Zhongying,Master of Traditional Chinese Medicine,put forward the"Three Heat Theory"when treating diabetes and its complications based on the combination of traditional Chinese medicine classic theory and clinical practice.Based on this,the treatment of diabetes cardiac autonomic neuropathy should follow the basic principle of clearing the"Three Heat",Qi and blood being treated together as well as both symptoms and root causes being taken into consideration.We should adhere to the pathogenesis,and use the combination of multiple methods to properly treat it,that is,clearing and moistening Dryness,removing Dampness and blood stasis,and promoting Fluid production and cooling,so as to give full play to the treatment advantages of"flexible method"in traditional Chinese medicine.

关 键 词：糖尿病心脏自主神经病变 “三热论” 湿热 瘀热 燥热 病机辨证 周仲瑛 

分 类 号：R256.22[医药卫生—中医内科学]