基于“二阳结谓之消”探讨糖尿病性便秘病机及防治策略  

Discussion on Pathogenesis and Prevention Strategy of Diabetes Constipation Based on“Eryang Junction is Called Xiao”

作　　者：魏金艳 赵进喜[1] 黄为钧[2] 王世东[1] 罗文轩 王乐 林元媛 WEI Jinyan;ZHAO Jinxi;HUANG Weijun;WANG Shidong;LUO Wenxuan;WANG Le;LIN Yuanyuan(Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China;Beijing Key Laboratory of Chinese Internal Medicine of Ministry of Education,Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China)

机构地区：[1]北京中医药大学东直门医院,北京100700 [2]北京中医药大学东直门医院中医内科学教育部和北京市重点实验室,北京100700

出　　处：《辽宁中医药大学学报》2024年第8期141-144,共4页Journal of Liaoning University of Traditional Chinese Medicine

基　　金：北京市自然科学基金面上项目(7222278);中华中医药学会“青年人才托举工程”项目(CACM-2023-QNRC2-B28);北京中医药大学基本科研业务费揭榜挂帅重点项目(2023-JYB-JBZD-003);北京中医药大学教育教学改革专项(XJYZ23008)。

摘　　要：“二阳结谓之消”语出《素问·阴阳别论篇》,是认识糖尿病性便秘的早期记载,但目前学界多据此仅从二阳(足阳明胃经、手阳明大肠经)结滞化热来解释消渴期发生便秘的病机,存在一定局限性。通过考究发现“二阳”并不单指手足阳明经脉或胃肠二腑,而是包括胃、大肠二腑及手足阳明经脉;“结”也并不完全指结热这一病邪,而是指病邪胶结难解、疾病难以治愈的程度,并且“二阳”之热易伤血脉,造成络脉瘀滞。基于对“二阳结谓之消”的重新理解,笔者认为糖尿病性便秘在糖尿病期以“热伤气阴”为主要病机,糖尿病并发症期以热伤血络、血脉瘀滞为主要病机。治疗方面,糖尿病期以清热益气养阴为本,糖尿病并发症期以活血化瘀为核心,此外还需重视体质从化,全面把握糖尿病性便秘的诊治。The phrase“Eryang junction is called Xiao”comes from Suwen·YinyangBielun,which is an early record of understanding diabetes constipation.However,at present,the academic community only explains the pathogenesis of constipation in the diabetes period from the stagnation and heat transformation of Eryang(foot Yangming stomach channel,hand Yangming large intestine channel),which has certain limitations.After investigation,it was found that“Eryang”does not only refer to the Yangming meridians of the hands and feet or the gastrointestinal organs,but also includes the stomach,large intestine and Yangming meridians of the hands and feet;The term“junction”does not entirely refer to the pathogenic factor of heat accumulation,but rather to the extent to which the pathogenic factor is difficult to resolve and the disease is difficult to cure.Moreover,the heat of the“Eryang”can easily damage the blood vessels,causing collateral stasis.Based on the re understanding of“Eryang junction is called Xiao”,the author believes that the main pathogenesis of diabetes constipation in diabetes is“heat hurting Qi and Yin”,and the main pathogenesis of diabetes complications is heat hurts blood collateral and blood stasis.In terms of treatment,diabetes is based on clearing away heat,replenishing Qi and nourishing Yin,and diabetes complications are centered on promoting blood circulation and removing blood stasis.In addition,we need to pay attention to improving physique and comprehensively grasp the diagnosis and treatment of diabetes constipation.

关 键 词：二阳结 糖尿病性便秘 热伤气阴 血瘀 清热 益气养阴 活血化瘀 

分 类 号：R255.4[医药卫生—中医内科学] R256.35[医药卫生—中医学]