桂枝汤化裁辨治糖尿病思路探讨  

Discussion on the Treatment for Diabetes Mellitus with Modification of Guizhi Decoction(桂枝汤)

作　　者：万海萍 蔡浩斌 蔡甜甜 林松俊[1,2] 龚轩[3] WAN Haiping;CAI Haobin;CAI Tiantian;LIN Songjun;GONG Xuan(Guangzhou University of Chinese Medicine,Shenzhen 518033,Guangdong,China;Shenzhen Traditional Chinese Medicine Hospital,Shenzhen 518033,Guangdong,China;Yangtze University,Jingzhou 434023,Hubei,China)

机构地区：[1]广州中医药大学第四临床医学院,广东深圳518033 [2]深圳市中医院,广东深圳518033 [3]长江大学,湖北荆州434023

出　　处：《辽宁中医药大学学报》2024年第11期111-116,共6页Journal of Liaoning University of Traditional Chinese Medicine

基　　金：国家自然科学基金(82305113);广东省自然科学基金项目(2023A1515030265);深圳市科技创新委员会课题项目(JCYJ20190812163201666);深圳市三名工程项目(SZZYSM202111011)。

摘　　要：糖尿病是威胁人类健康的重要慢性疾病之一,其发病率和病死率仍在持续上升,因此糖尿病的防治备受关注。而糖尿病患者应“禁糖、限甜”观念深入人心,因此桂枝汤以其味甘罕用于治疗糖尿病。该文从张仲景桂枝汤原方及其化裁应用、《神农本草经》中药物的四气五味来剖析桂枝汤的组方精髓,从桂枝汤“健脾运、化津液,补气血、散里寒,和五脏、调阴阳”的机制,构建桂枝汤与糖尿病治疗的联系。通过糖尿病发病中西医机制、病理演变过程,并从“基于个体差异的同病异治、基于核心病机的异证同治、基于治未病思想无症状血糖升高的调护”三个方面阐述糖尿病的辨治原则、桂枝汤及其化裁治疗糖尿病思路。从而认为桂枝汤治疗糖尿病具有可行性,桂枝汤有效化裁可应用于糖尿病各个阶段,为临床运用桂枝汤治疗糖尿病提供理论参考,摆脱糖尿病“限糖”桎梏,为糖尿病诊疗提供新的临床思路,并为降糖复方研究提供理论参考。Diabetes mellitus is one of the important chronic diseases that threaten human health,and its morbidity and mortality are still rising,so the prevention and treatment of diabetes mellitus has attracted much attention.The concept that diabetes patients should“ban sugar and limit sweetness”is deeply rooted in people's minds,so Guizhi Decoction(桂枝汤)is rarely used to treat diabetes mellitus because of its sweet taste.This paper analyzes the essence of Guizhi Decoction from the original prescription of ZHANG Zhongjing Guizhi Decoction and its application,the four Qi and five flavors of drugs in Shennong's Herbal Classic,and constructs the relationship between Guizhi Decoction and the treatment of diabetes from the mechanism of“strengthening spleen in transportation,warming the spleen for producing fluids,invigorating qi and blood,dispersing internal cold,reconciling the five organs,regulating Yin and Yang”.Through the pathogenesis of diabetes in Chinese and Western medicine and the pathological evolution process.In addition,the principles of differential treatment of diabetes,Guizhi Decoction and its modification in treatment of diabetes were described from three aspects“:differential treatment of the same disease based on individual differences,simultaneous treatment of different syndromes based on core pathogenesis,and nursing of asymptomatic blood glucose elevation based on the idea of preventive treatment”.Therefore,it is considered that Guizhi Decoction is feasible to treat diabetes.The effective modification of Guizhi Decoction can be applied to all stages of diabetes,providing theoretical reference for clinical application of Guizhi Decoction to treat diabetes,getting rid of the shackles of diabetes“sugar restriction”,providing a new clinical idea for the diagnosis and treatment of diabetes mellitus,and providing theoretical reference for the study of hypoglycemic compounds.

关 键 词：糖尿病 桂枝汤 健脾运 化津液 补气血 散里寒 调阴阳 和五脏 

分 类 号：R255.4[医药卫生—中医内科学]