基于“内热-气血津液不归正化-脉积”探讨糖尿病大血管并发症病因病机  

Exploring Macrovascular Complication of Diabetes Based on “Internal Heat-Metabolic Disorder of Qi,Blood and Body Fluid-Maiji”

作　　者：王中瑞 燕树勋[2] 邵明义[2] 韩景辉[2] 潘研[2] 朱蓉 甄倩 李真[2] 符宇[2] WANG Zhongrui;YAN Shuxun;SHAO Mingyi;HAN Jinghui;PAN Yan;ZHU Rong;ZHEN Qian;LI Zhen;FU Yu(Henan University of Chinese Medicine,Zhengzhou 450000,Henan,China;The First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450000,Henan,China)

机构地区：[1]河南中医药大学,河南郑州450000 [2]河南中医药大学第一附属医院,河南郑州450000

出　　处：《辽宁中医杂志》2024年第2期69-71,共3页Liaoning Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(81704011);中国博士后基金项目(2022M711085);河南省中医药科研专项项目(2019JDZX2026,2022ZY1005)。

摘　　要：大血管病变是糖尿病患者致残、致死的主要原因之一。中医药治疗效果确切,但理论发展相对滞后。传统的消渴病理论未能与大血管并发症联系起来以指导现代中医临床诊疗,缺少原发病与并发症之间的“桥梁性”理论。因此,基于临床实践、文献梳理和科学研究,文章提出了“内热-气血津液不归正化-脉积”的观点,认为糖尿病大血管病变早期以壮火为枢,煎灼水谷为陈气,中期以阴火为枢,引动陈气为痰瘀,晚期以虚火为枢,固化痰瘀为癥积。在治疗上,以除热消积为治疗原则,依据内热的偏重以及“陈气-痰瘀-癥积”的动态演变灵活用药。早期清透壮火,除陈气,中期调理气火,除痰瘀,晚期补虚除热,消癥积,冀为临床防治提供新的思路与方法。Macroangiopathy is one of the main causes of disability and death caused by diabetes.The therapeutic effect of traditional Chinese medicine(TCM)is definite,but the theoretical development is relatively lagging behind.The traditional theory of diabetes fails to be linked to macrovascular complications to guide modern traditional Chinese medicine clinical diagnosis and treatment,and lacks a“bridging”theory between the primary disease and complications.Therefore,based on clinical practice,literature combing and scientific research,it proposes the idea of“internal heat-metabolic disorder of Qi,blood and body fluid-pulse accumulation”.It is believed that sthenic fire is the hub for the diabetic macroangiopathy in the early stage,frying and burning water and food into accumulation and decayed Qi.In the middle stage,Yin fire is the hub,which turns accumulation and decayed Qi into phlegm and blood stasis.In the late period,the deficiency fire is the hub,and the phlegm and blood stasis become mass and accumulation.In terms of treatment,the therapeutic principle is removing heat and eliminating accumulation,and the drugs should be used flexibly according to the emphasis of internal heat and the dynamic evolution of“accumulation and decayed Qi-phlegm and blood stasis-mass and accumulation”.In the early stage,the treatment is removing heat and eliminating accumulation and decayed Qi.In the middle stage,the treatment is regulating Qi and fire and eliminating phlegm and blood stasis.In the late stage,the treatment is tonifying deficiency and eliminating heat and mass and accumulation.It is to provide new ideas and methods for clinical prevention and treatment.

关 键 词：糖尿病大血管并发症 内热 陈气 痰瘀 癥积 

分 类 号：R255.4[医药卫生—中医内科学]