经方辨治厥阴病治疗1型糖尿病胃轻瘫  

Treatment of Type 1 Diabetic Gastroparesis Based on Differentiation of Reverting Yin Syndromes

作　　者：郑悦 刘祥秀 罗仕艳 谢乃佳 ZHENG Yue;LIU Xiangxiu;LUO Shiyan;XIE Naijia(Department of Endocrinology,The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine,Guiyang 550001,China;Department of Gastroenterology,Chongqing Traditional Chinese Medicine Hospital,Chongqing 400000,China)

机构地区：[1]贵州中医药大学第一附属医院内分泌科,贵州贵阳550001 [2]重庆市中医院消化内科,重庆400000

出　　处：《基层中医药》2024年第3期6-10,共5页Basic Traditional Chinese Medicine

摘　　要：糖尿病胃轻瘫(DGP)常发生于排除机械性肠梗阻的情况下,以胃排空延迟和消化道症状为特征的1型及2型糖尿病患者,为糖尿病常见的一种慢性并发症。目前发病机制不明确,有研究指出DGP在慢性高血糖的基础上与胃肠道激素分泌异常和自主神经功能紊乱有一定相关性,并且不会随着血糖控制的改善而缓解。近年来,DGP西医治疗以调控血糖、营养神经、促胃动力为主,但其病情迁延反复,给患者的身心健康及生活质量造成了显著影响。中医方面,常将其归属于消渴继发的“痞满”“呕吐”“泄泻”等范畴。目前相关研究指出,DGP为本虚标实之证,脾胃功能失常、中焦气机逆乱为基本病机,夹有痰、瘀等病理产物。根据临床症状,辨证可分为气虚食滞、痰湿中阻、胃阴亏虚、中焦虚寒、瘀血内阻这5型,治疗还需标本兼顾,补虚泻实,以健脾疏肝为主,辅以化痰消瘀之法。在临床期间,基于《伤寒论》对患者进行辨证论治,采取经方治疗本病取得了一定的疗效,本文从病因病机、临床特点及用药特点,探究经方治疗糖尿病胃轻瘫的用药特色和规律。Diabetic gastroparesis(DGP),a common chronic diabetic complication characterized by delayed gastric emptying and gastrointestinal symptoms,frequently affects the patients with type 1 or 2 diabetes mellitus and without mechanical bowel obstruction.Although the pathophysiology of DGP remains unclear,some studies point out associations of DGP with aberrant gastrointestinal hormone secretion and autonomic dysfunction on the basis of persistent hyperglycemia.Moreover,DGP will not be alleviated even when the blood glucose is under control.Western medical treatment of this complication focuses on controlling blood glucose,nourishing nerves,and improving gastrointestinal motility,which,however,demonstrate poor effects as manifested by the high incidence and lingering symptoms and pose negative effects on the physical and mental health and quality of life of the patients.DGP is a disease of stuffiness and fullness,vomiting,and diarrhoea in traditional Chinese medicine.According to the available studies,DGP is rooted in the dysfunction of the spleen and stomach and the abnormal qi movement in the middle energizer,which results in the generation of phlegm and stasis.The DGP patients mainly present five syndromes:internal obstruction by blood stasis,phlegm and dampness obstruction of middle energizer,stomach yin deficiency,cold and deficiency in the middle energizer,and qi deficiency and food stagnation.The treatment should address both the symptoms and the root cause,following the principles of tonifying deficiency,reducing excess,invigorating the spleen,and soothing the liver.In addition,the methods of clearing phlegm and removing stasis can be adopted according to the conditions of the patients.We have applied classical formulas in the treatment of this disease based on syndrome differentiation according to the Treatise on Cold Damage(Shang Han Lun),which have demonstrated definite therapeutic effects.The article explores the medication rules of DGP from the etiology,pathogenesis,clinical characteristics,and medications o

关 键 词：1型糖尿病 胃轻瘫 伤寒论 厥阴病 当归四逆加吴茱萸生姜汤 医案 

分 类 号：R25[医药卫生—中医内科学]