试用临界慢化原理探讨常见未病状态——血糖失稳态

石康乐; 刘晓玉; 胡影; 王晓聪; 杨方燕; 雷聪; 王诗尧; 于欣萍; 王娟; 于越凡; 孟庆刚

doi:10.3969/j.issn.1006-2157.2023.08.001

您当前的位置：

首页 >

文章列表页 >

试用临界慢化原理探讨常见未病状态——血糖失稳态

“中医治未病”专题 | 更新时间：2023-09-08

- 试用临界慢化原理探讨常见未病状态——血糖失稳态
- Using the principle of critical slowing down to discuss the pre-disease status of glucose homeostasis imbalance
- 北京中医药大学学报 2023年46卷第8期页码：1037-1047
- 作者机构：
  
  1.中国科学院大学　北京　100049
  2.北京中医药大学
  3.黑龙江中医药大学
- 作者简介：
  
  石康乐，女，博士
  # 孟庆刚，男，博士，教授，主任医师，博士生导师，主要研究方向：基于系统复杂性的中医药信息处理研究，E-mail: mqgangzy@126.com
- 基金信息：
  
  国家自然科学基金项目(82174530);中国科学院大学优秀青年教师科研能力提升项目(E0E48979)
- DOI：10.3969/j.issn.1006-2157.2023.08.001
  中图分类号： R211
- 收稿日期：2023-02-22，
  
  网络出版日期：2023-06-02，
  
  纸质出版日期：2023-08-30
- 稿件说明：
移动端阅览
石康乐, 刘晓玉, 胡影, 等. 试用临界慢化原理探讨常见未病状态——血糖失稳态[J]. 北京中医药大学学报, 2023,46(8):1037-1047.

SHI Kangle, LIU Xiaoyu, HU Ying, et al. Using the principle of critical slowing down to discuss the pre-disease status of glucose homeostasis imbalance[J]. Journal of beijing university of traditional chinese medicine, 2023, 46(8): 1037-1047.
石康乐, 刘晓玉, 胡影, 等. 试用临界慢化原理探讨常见未病状态——血糖失稳态[J]. 北京中医药大学学报, 2023,46(8):1037-1047. DOI： 10.3969/j.issn.1006-2157.2023.08.001.

SHI Kangle, LIU Xiaoyu, HU Ying, et al. Using the principle of critical slowing down to discuss the pre-disease status of glucose homeostasis imbalance[J]. Journal of beijing university of traditional chinese medicine, 2023, 46(8): 1037-1047. DOI： 10.3969/j.issn.1006-2157.2023.08.001.

摘要

中医学使用阴平阳秘的相对平衡状态界定人的健康，即健康是人体这个开放复杂巨系统整体动态平衡的稳态。稳态失衡则进入狭义的未病状态，邪正相争，存在向愈与向疾的两种演化趋势，一旦扰动过强或干预不力，则系统持续失稳，突变形成疾病稳态。治未病理论作为一种重要的实践原则，贯穿中医预防、诊断、治疗、康复的临床过程始终，对于多种疾病未病人群的筛查与早期干预具有重要的指导意义。本文围绕生理意义巨大、病理影响广泛的血糖失稳态，详述其防治意义、筛查现状与干预方式，系统分析其作为多种重大疾病未病状态的临界慢化原理，阐释中医治未病方法论所蕴含的基于系统整体性与开放性的藏－象映射模型思维、基于系统动态发展的临界慢化模型思维，探讨基于中医四诊合参的未病状态识别与干预路径，以期为复杂性科学视域下的中医诊疗模式研究提供参考。

Abstract

Traditional Chinese medicine uses the relative balance of yin and yang to define human health

that is

the steady-state of the overall dynamic balance of the entire open complex system. Steady-state disequilibrium means that the human body enters a narrow pre-disease state

where healthy qi and pathogenic factors compete

and there are two evolutionary trends

namely

healing and disease. Once the disturbance is too strong or the intervention is not effective

the system will continue to lose stability

and the mutation will form a stable disease state. As an important practical principle

the theory of "prevention of disease" runs through the clinical process of prevention

diagnosis

treatment

and rehabilitation of traditional Chinese medicine

and has important guiding significance for the screening and early intervention of the pre-disease population. This article focuses on blood glucose instability

which has great physiological significance and extensive pathological effects

elaborates its prevention and treatment significance

screening status

and intervention method

systematically analyzes its critical slowing principle as a pre-disease state of many major diseases

and explains the "viscera-state" mapping model based on system integrity and openness and the critical slowing model based on the dynamic development of the system contained in the disease prevention methodology of traditional Chinese medicine. This paper discusses the identification and intervention path of pre-disease status based on the "fourfold diagnosis combined with participation" of traditional Chinese medicine

with the aim to provide a reference for the diagnostic and treatment research of traditional Chinese medicine in view of complexity science.

关键词

Keywords

references

WB CANNON . Organization for physiological homeostasis [J]. Physiol Rev ， 1929 ， 9 ( 3 ): 399 - 574 .

EM ABRAHAMSON . The glucose homeostasis test [J]. Amer Jour Digest Dis ， 1955 , 22 ( 9 ): 267 - 271 .

李小英．葡萄糖激酶在葡萄糖稳态中的核心作用 [J]. 中华糖尿病杂志， 2019 ， 11 ( 7 ): 500 - 502 .

PV RODER , BB WU , YX LIU , et al . Pancreatic regulation of glucose homeostasis [J/OL]. Exp Mol Med , 2016 , 48 ( 3 ): e219 [ 2023-02-05 ]. https://www.nature.com/articles/emm20166 .

中华医学会糖尿病学分会．中国2型糖尿病防治指南(2020年版) [J]. 国际内分泌代谢杂志， 2021 ， 41 ( 5 ): 482 - 548 .

WY YANG , JM LU , JP WENG , et al . Prevalence of diabetes among men and women in China [J]. N Engl J Med , 2010 ， 362 ( 12 ): 1090 - 1101 .

Y XU , LM WANG , J HE , et al . Prevalence and control of diabetes in Chinese adults [J]. JAMA , 2013 ， 310 ( 9 ): 948 - 958 .

LM WANG , P GAO , M ZHANG , et al . Prevalence and Ethnic Pattern of Diabetes and Prediabetes in China in 2013 [J]. JAMA , 2017 ， 317 ( 24 ): 2515 - 2523 .

S SCHLESINGER , M NEUENSCHWANDER , J BARBARESKO , et al . Prediabetes and risk of mortality, diabetes-related complications and comorbidities: umbrella review of meta-analyses of prospective studies [J]. Diabetologia , 2021 ， 65 ( 2 ): 275 - 285 .

IM STRATTON , AI ADLER , HAW NEIL , et al . Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study [J]. BMJ , 2000 , 321 ( 7258 ): 405 - 412 .

R PALLADINO , AG TABAK , K KHUNTI , et al . Association between pre-diabetes and microvascular and macrovascular disease in newly diagnosed type 2 diabetes [J/OL]. BMJ Open Diabetes Res Care , 2020 , 8 ( 1 ): e001061 [ 2023-02-05 ]. https://drc.bmj.com/content/8/1/e001061 .

FS SARFO , B OVBIAGELE , J AKINYEMI , et al . Differential associations between pre-diabetes, diabetes and stroke occurrence among West Africans [J/OL]. J Stroke Cerebrovasc Dis , 2022 , 31 ( 11 ): 106805 [ 2023-02-05 ]. https://www.strokejournal.org/article/S1052-3057(22)00499-2/fulltext .

CP WEN , TY CHENG , SP TSAI , et al . Increased mortality risks of pre-diabetes (impaired fasting glucose) in Taiwan [J]. Diabetes Care , 2005 ， 28 ( 11 ): 2756 - 2761 .

YS PENG , JR LIN , BH CHENG , et al . Incidence and relative risk for developing cancers in women with gestational diabetes mellitus: a nationwide cohort study in Taiwan [J/OL]. BMJ open , 2019 , 9 ( 2 ): e024583 [ 2023-02-05 ]. https://bmjopen.bmj.com/content/9/2/e024583 .

MZ WANG , M XIA , HY YANG , et al . Interaction effect of blood glucose and pressure on the risk of chronic kidney disease: a population-based prospective cohort study [J]. Endocrine , 2022 , 77 ( 2 ): 252 - 261 .

LC PLANTINGA , DC CREWS , J CORESH , et al . Prevalence of chronic kidney disease in US adults with undiagnosed diabetes or prediabetes [J]. Clin J Am Soc Nephrol , 2010 ， 5 ( 4 ): 673 - 682 .

PK CRANE , R WALKER , RA HUBBARD , et al . Glucose levels and risk of dementia [J]. N Engl J Med , 2013 ， 369 ( 6 ): 540 - 548 .

JL LEASHER , RRA BOURNE , SR FLAXMAN , et al . Global estimates on the number of people blind or visually impaired by diabetic retinopathy: A meta-analysis from 1990 to 2010 [J]. Diabetes Care ， 2016 ， 39 ( 9 ): 1643 - 1649 .

M RAPOPORT , A CHETRIT , D CANTRELL , et al . Years of potential life lost in pre-diabetes and diabetes mellitus: data from a 40-year follow-up of the Israel study on Glucose intolerance, Obesity and Hypertension [J/OL]. BMJ Open Diabetes Res Care , 2021 , 9 ( 1 ): e001981 [ 2023-02-05 ]. https://drc.bmj.com/content/9/1/e001981 .

中国保险行业协会，中国医师协会．重大疾病保险的疾病定义使用规范(2020年修订版) [EB/OL].( 2020-11-05 )[ 2023-02-05 ]. http://www.iachina.cn/art/2020/11/5/art_8616_104704.html .

中华医学会内分泌学分会，中华医学会糖尿病学分会，中华医师协会内分泌代谢科医师分会．中国成人糖尿病前期干预的专家共识 [J]. 中华内分泌代谢杂志， 2020 ， 36 ( 5 ): 371 - 380 .

XH ZHOU , Q QIAO , LN JI , et al . Nonlaboratory-based risk assessment algorithm for undiagnosed type 2 diabetes developed on a nation-wide diabetes survey [J]. Diabetes Care , 2013 ， 36 ( 12 ): 3944 - 3952 .

JP ARMATO , RA DEFRONZO , M ABDUL-GHANI , et al . Successful treatment of prediabetes in clinical practice using physiological assessment (STOP DIABETES) [J]. Lancet Diabetes Endocrinol , 2018 ， 6 ( 10 ): 781 - 789 .

JL CHIASSON , RG JOSSE , R GOMIS , et al . Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomised trial [J]. Lancet , 2002 ， 359 ( 9323 ): 2072 - 2077 .

CS HOLLING . Resilience and stability of ecological systems [J]. Annu Rev Ecol Syst , 1973 ， 4 : 1 - 23 .

SL PIMM . The complexity and stability of ecosystems [J]. Nature , 1984 ， 307 ( 5949 ): 321 - 326 .

M SCHEFFER , SR CARPENTER , V DAKOS , et al . Generic indicators of ecological resilience: inferring the chance of a critical transition [J]. Annu Rev Ecol Evol S , 2015 ， 46 : 145 - 167 .

王永炎，张启明，于东林． “重剂起沉疴”与“轻量释顽疾”辨析 [J]. 中医杂志， 2011 ， 52 ( 19 ): 1645 - 1646 .

陆广莘．中医学的人类健康生态目标模式：万物并育而不相害　与万物沉浮于生长之门 [J]. 山西中医， 2004 ( 6 ): 37 - 39 .

张兴涛，王义国，陆广莘．浅识中医之“生生之道” [J]. 中医杂志， 2013 ， 54 ( 10 ): 896 - 897 .

理查德·泰勒，卡斯·桑斯坦．助推：如何做出有关健康、财富与幸福的最佳决策 [M]. 刘宁，译．北京：中信出版社， 2018 ： 100 - 101 .

RS WEINSTOCK , PM TRIEF , D CIBULA , et al . Weight Loss Success in Metabolic Syndrome by Telephone Interventions: Results from the SHINE Study [J]. J Gen Intern Med , 2013 ， 28 ( 12 ): 1620 - 1628 .

PM TRIEF , RS WEINSTOCK , D CIBULA , et al . Sustained weight loss one year after group telephone intervention: 3-year results from the SHINE study [J/OL]. Diabetes Res Clin Pr , 2014 , 106 ( 3 ): e74 - e78 [ 2023-02-05 ]. https://www.diabetesresearch-clinicalpractice.com/article/S0168-8227(14)00432-X/fulltext .

XH WU , XT GUO , ZW ZHANG . The Efficacy of Mobile Phone Apps for Lifestyle Modification in Diabetes: Systematic Review and Meta-Analysis [J/OL]. Jmir Mhealth Uhealth ， 2019 ， 7 ( 1 ): e12297 [ 2023-02-05 ]. https://mhealth.jmir.org/2019/1/e12297/ .

M SCHEFFER , S CARPENTER , JA FOLEY , et al . Catastrophic shifts in ecosystems [J]. Nature ， 2001 ， 413 ( 6856 ): 591 - 596 .

JD DAVIS , CM KUMBALE , Q ZHANG , et al . Dynamical systems approaches to personalized medicine [J]. Curr Opin Biotech , 2019 , 58 : 168 - 174 .

潘秋，周丽波，仝小林．从糖尿病前期谈“治未病” [J]. 中华中医药杂志， 2008 ， 23 ( 3 ): 191 - 193 .

宋郁珍，商洪才，郭利平．中医治未病思想在糖尿病预防中的价值和应用 [J]. 中华中医药杂志， 2011 ， 26 ( 2 ): 215 - 219 .

吕仁和．消渴病(糖尿病)的分期 [J]. 中国中医药现代远程教育， 2006 ， 4 ( 2 ): 18 - 19 .

方朝晖，仝小林，段俊国，等．糖尿病前期中医药循证临床实践指南 [J]. 中医杂志， 2017 ， 58 ( 3 ): 268 - 272 .

吕仁和，肖永华，刘滔波．分期论治糖尿病 [J]. 药品评价， 2008 ， 5 ( 1 ): 35 - 37 .

黄晨．基于中医脾瘅理论探讨糖尿病前期 [J]. 中医药临床杂志， 2018 ， 30 ( 3 ): 434 - 436 .

李婧，郭晓燕．郭晓燕从痰湿治疗糖尿病前期经验 [J]. 内蒙古中医药， 2022 ， 41 ( 8 ): 81 - 82 .

苏金峰，李富震，张福利．张福利基于“湿热致瘀”辨治脾瘅经验 [J]. 中医学报， 2022 ， 37 ( 4 ): 789 - 793 .

杨渤，谭宏韬，林明欣．基于“痰瘀互结”辨治糖尿病前期 [J]. 广州中医药大学学报， 2022 ， 39 ( 2 ): 448 - 451 .

杨晨，苏维广．从脾虚湿盛论治糖尿病前期 [J]. 实用中医内科杂志， 2020 ， 34 ( 5 ): 61 - 64 .

冯睿，张立双，昝树杰，等．张伯礼教授治疗糖尿病前期临床思维浅析 [J]. 天津中医药， 2020 ， 37 ( 2 ): 141 - 143 .

朱文远，连琯，王彤，等．张定华运用中药联合饮食运动疗法治疗糖尿病前期经验 [J]. 中国民间疗法， 2020 ， 28 ( 1 ): 19 - 21 .

杨明，张广德，魏子孝．魏子孝教授运用“治未病”思想辨治糖尿病前期思路浅析 [J]. 世界中医药， 2017 ， 12 ( 4 ): 846 - 849 .

李瑾，刘荔，朱法永，等．刘启廷自拟益气养阴活血汤治疗糖尿病前期经验 [J]. 湖南中医杂志， 2014 ， 30 ( 6 ): 13 - 14 .

宋朝，李佳．郭俊杰治疗脾虚湿盛型糖尿病前期经验举隅 [J]. 山西中医， 2019 ， 35 ( 3 ): 5 - 6 .

王碧莹，何泽．何泽教授从“邪伏散膏”治疗脾瘅经验撷萃 [J]. 甘肃中医药大学学报， 2017 ， 34 ( 5 ): 8 - 10 .

曹燕，王旭．脾瘅从脾论治：王旭教授临床诊治糖尿病前期经验撷萃 [J]. 浙江中医药大学学报， 2014 ， 38 ( 4 ): 408 - 410 .

李蔚然，彭宝虹，李朝喧．从脾虚湿热论治糖尿病前期病变经验 [J]. 中医研究， 2019 ， 32 ( 1 ): 51 - 53 .

S ENGIN , T AKKAN , M DAGDEVIREN , et al . Are disease-related symptoms important to predicting developing diabetes from prediabetes？ [J]. Turk J Med Sci ， 2022 ， 52 ( 4 ): 1093 - 1102 .

高志生，王旭．从脾瘅论治糖耐量低减 [J]. 中国中医基础医学杂志， 2012 ， 18 ( 1 ): 76 - 77 .

张雪娟，张奇，杨梅，等．基于“脾虚致消”理论探讨老十针加减对糖尿病前期糖代谢作用 [J]. 中医临床研究， 2021 ， 13 ( 21 ): 53 - 55 .

杨丹，吴群励，梁晓春．梁晓春从湿热论治糖尿病前期经验 [J]. 北京中医药， 2019 ， 38 ( 9 ): 890 - 892 .

邵蒙苏，毕超然，姚梦恬，等．朴春丽教授从“土壅木郁”辨治糖尿病前期经验探析 [J]. 中西医结合心血管病电子杂志， 2019 ， 7 ( 25 ): 142 .

王碧莹，何泽．何泽教授从“邪伏散膏”治疗脾瘅经验撷萃 [J]. 甘肃中医药大学学报， 2017 ， 34 ( 5 ): 8 - 10 .

颜青，汪燕燕，党翔，等．党毓起运用自拟甘松降糖方治疗糖尿病前期的经验 [J]. 国医论坛， 2017 ， 32 ( 2 ): 12 - 13 .

袁华．从谷精运化视角构建糖尿病中医辨治体系 [J]. 中华中医药杂志， 2023 ， 38 ( 2 ): 493 - 496 .

袁君，李真．李真教授治疗糖尿病前期经验 [J]. 光明中医， 2010 ， 25 ( 11 ): 1973 - 1974 .

李蔚然，彭宝虹，李朝喧．从脾虚湿热论治糖尿病前期病变经验 [J]. 中医研究， 2019 ， 32 ( 1 ): 51 - 53 .

JP CHAPUT , A TREMBLAY . The glucostatic theory of appetite control and the risk of obesity and diabetes [J]. Int J Obesity ， 2009 ， 33 ( 1 ): 46 - 53 .

E FERRANNINI . Definition of intervention points in prediabetes [J]. Lancet Diabetes Endo ， 2014 ， 2 ( 8 ): 667 - 675 .

卢绮韵，陈本坚，范冠杰．范冠杰“动-定序贯”论治糖尿病前期的经验总结 [J]. 辽宁中医杂志， 2018 ， 45 ( 8 ): 1599 - 1601 .

武敏，姚亚娟，孙新宇．孙新宇运用扶脾理肝法治疗糖尿病前期经验 [J]. 湖南中医杂志， 2021 ， 37 ( 1 ): 28 - 30 .

徐翔，倪青．糖尿病前期从肝论治七法 [J]. 环球中医药， 2020 ， 13 ( 4 ): 717 - 719 .

姬航宇，仝小林，刘文科．脾瘅源流考 [J]. 江苏中医药， 2009 ， 41 ( 1 ): 58 - 60 .

李浩冉，马蕊芳，魏亚莉，等．芦少敏主任医师基于《内经》“除陈气”“木郁达之”理论治疗糖尿病前期临床经验 [J]. 亚太传统医药， 2018 ， 14 ( 10 ): 120 - 122 .

S DEB , S BHANDARY , SK SINHA , et al . Identifying critical transitions in complex diseases [J/OL]. J Biosciences ， 2022 , 47 ( 2 ): 25 [ 2023-02-05 ]. https://link.springer.com/article/10.1007/s12038-022-00258-7 .

J LAGRO , Y SCHOON , I HEERTS , et al . Impaired systolic blood pressure recovery directly after standing predicts mortality in older falls clinic patients [J]. J Gerontol A-Biol ， 2014 , 69 ( 4 ): 471 - 478 .

IA VAN DE LEEMPUT , M WICHERS , AOJ CRAMER , et al . Critical slowing down as early warning for the onset and termination of depression [J]. Proc Natl Acad Sci USA , 2014 ， 111 ( 1 ): 87 - 92 .

S SARKAR , SK SINHA , H LEVINE , et al . Anticipating critical transitions in epithelial-hybrid-mesenchymal cell-fate determination [J]. Proc Natl Acad Sci USA , 2019 ， 116 ( 52 ): 26343 - 26352 .

C TREFOIS , PM ANTONY , J GONCALVES , et al . Critical transitions in chronic disease: transferring concepts from ecology to systems medicine [J]. Curr Opin Biotech , 2015 ， 34 : 48 - 55 .

LN CHEN , R LIU , ZP LIU , et al . Detecting early-warning signals for sudden deterioration of complex diseases by dynamical network biomarkers [J/OL]. Sci Rep ， 2012 ， 2 : 342 [ 2023-02-05 ]. https://www.nature.com/articles/srep00342 .

R LIU , K AIHARA , LN CHEN . Dynamical network biomarkers for identifying critical transitions and their driving networks of biologic processes [J]. Quant Biol ， 2013 ， 1 ( 2 ): 105 - 114 .

R LIU , XT YU , XP LIU , et al . Identifying critical transitions of complex diseases based on a single sample [J]. Bioinformatics ， 2014 ， 30 ( 11 ): 1579 - 1586 .

P CHEN , YJ LI , XP LIU , et al . Detecting the tipping points in a three-state model of complex diseases by temporal differential networks [J/OL]. J Transl Med , 2017 ， 15 : 217 [ 2023-02-05 ]. https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-017-1320-7 .

MY LI , T ZENG , R LIU , et al . Detecting tissue-specific early warning signals for complex diseases based on dynamical network biomarkers: study of type 2 diabetes by cross-tissue analysis [J]. Brief Bioinform ， 2014 ， 15 ( 2 ): 229 - 243 .

刘雷蕾，孟静岩．从中医基础理论角度认识肠道微生态 [J]. 北京中医药大学学报， 2016 ， 39 ( 9 ): 724 - 727 .

邓铁涛．中医诊断学 [M]. 上海：上海科学技术出版社， 2013 ： 31 .

SA WILBERT , JLM WELCH , GG BORISY , et al . Spatial Ecology of the Human Tongue Dorsum Microbiome [J]. Cell Rep ， 2020 ， 30 ( 12 ): 4003 - 4015 .

D RAMACHANDRAM , GW TAYLOR . Deep Multimodal Learning: A Survey on Recent Advances and Trends [J]. Ieee Signal Proc Mag ， 2017 ， 34 ( 6 ): 96 - 108 .

T BALTRUSAITIS , C AHUJA , LP MORENCY . Multimodal Machine Learning: A Survey and Taxonomy [J]. Ieee T Pattern Anal ， 2019 ， 41 ( 2 ): 423 - 443 .

许国志，系统科学 [M]. 上海：上海科技教育出版社， 2000 ： 20 - 23 .

R MILO , S SHEN-ORR , S LTZKOVITZ , et al . Network Motifs: Simple Building Blocks of Complex Networks [J]. Science ， 2002 ， 298 ( 5594 ): 824 - 827 .

刘亮，复杂网络基元研究方法及应用 [M]. 上海：上海交通大学出版社， 2018 ： 13 .

SS SHEN-ORR , R MILO , S MANGAN , et al . Network motifs in the transcriptional regulation network of Escherichia coli [J]. Nat Genet ， 2002 ， 31 ( 1 ): 64 - 68 .

李缘缘，王永发，张萍，等． EXT2基因、KCNJ11基因单核苷酸多态性与血糖的交互作用对代谢综合征阴虚证易感性的影响 [J]. 北京中医药大学学报， 2022 ， 45 ( 5 ): 526 - 533 .

宋琳莉，孟庆刚．中医药诊疗体系复杂性特征及研究思路探析 [J]. 北京中医药大学学报， 2007 ( 11 ): 736 - 739 .

浏览量

368

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

基于临界慢化理论的中医“未病”状态识别建模研究初探

基于动力系统理论的2型糖尿病未病－已病演化规律与临界转变识别策略研究