基于“脾浊络损”理论探讨糖尿病前期的发病机制与治疗  

Pathogenesis and treatment of prediabetes based on "spleen turbidity and collateral damage" theory

作　　者：张天宇[1] 刘尚建[2] 覃锦 ZHANG Tianyu;LIU Shangjian;QIN Jin(Beijing University of Chinese Medicine,Beijing 100029,China;Nephrology and Endocrinology Department,Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700)

机构地区：[1]北京中医药大学,北京100029 [2]北京中医药大学东直门医院肾病内分泌科,北京100700

出　　处：《北京中医药》2025年第4期512-515,共4页Beijing Journal of Traditional Chinese Medicine

基　　金：2022北京中医药大学东直门医院科技创新专项(DZMKJCX-2022-004)。

摘　　要：糖尿病前期是指血糖水平处于正常范围与糖尿病之间的血糖异常状态,2型糖尿病归属于中医学“消渴病”范畴,糖尿病前期即消渴病脾瘅期。“伤食致虚,脾气郁遏”为起始,“脾浊蓄积,奉行失常”为发展,“浊阻气络,郁损化热”为终点,脾浊蓄积引起的中满合并气络郁损导致的内热,共同形成消渴病“中满内热”的病机。脾之代谢物的“生成-清除”的动态平衡被彻底破坏,气络调节血糖的功能失常,最终发为脾瘅。基于“脾浊络损”病机,糖尿病前期治疗应健脾化浊、清热补虚,以改善患者的糖代谢状态,预防糖尿病及其并发症的发生。Prediabetes refers to a state of blood sugar abnormality between normal levels and diabetes.According to current traditional Chinese medicine(TCM)diagnostic standards,type 2 diabetes is classified as consumptive thirst disease,and prediabetes is considered to be in the spleen-heat syndrome stage of consumptive thirst disease.The progression of this condition can be outlined as follows.The onset stage is characterized by"food injury leading to deficiency,and stagnation of spleen qi".The development stage is marked by"spleen turbidity accumulation and dysfunction in nutrient transportation".The terminal stage is defined by"turbidity obstructing the qi collaterals and stagnation transforming into heat".The accumulation of spleen turbidity leads to abdominal fullness and depression and injury of qi collaterals lead to internal heat.Those factors form the pathogenesis of consumptive thirst disease in terms of“abdominal fullness and internal heat”.The dynamic balance of the spleen's metabolic processes("generation-clearance")is completely disrupted,and the regulation of blood sugar by qi collaterals fails,eventually resulting in spleen-heat syndrome.Based on the pathogenesis of"spleen turbidity and collateral damage",the treatment for prediabetes should focus on strengthening the spleen,transforming turbidity,clearing heat,and replenishing deficiency.This approach aims to effectively improve the patient's glucose metabolism and prevent the onset of diabetes and its complications.

关 键 词：糖尿病前期 脾浊络损 脾瘅 消渴病 

分 类 号：R259[医药卫生—中西医结合]