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辽宁中医药大学 沈阳 100847
胡锦浩,男,在读硕士生
#石岩,男,博士,教授,博士生导师,主要研究方向:中医药防治糖尿病,E-mail:446196375@qq.com
纸质出版日期:2025-01-30,
网络出版日期:2024-11-21,
收稿日期:2024-09-29,
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胡锦浩, 孙贵炎, 杨宇峰, 等. 气血津液视域下糖尿病时空辨证的序贯诊疗模式刍议[J]. 北京中医药大学学报, 2025,48(1):8-13.
HU JINHAO, SUN GUIYAN, YANG YUFENG, et al. Discussion of sequential diagnosis and treatment model of diabetes mellitus of spatiotemporal syndrome differentiation from the perspective of qi, blood, and fluid. [J]. Journal of beijing university of traditional chinese medicine, 2025, 48(1): 8-13.
胡锦浩, 孙贵炎, 杨宇峰, 等. 气血津液视域下糖尿病时空辨证的序贯诊疗模式刍议[J]. 北京中医药大学学报, 2025,48(1):8-13. DOI: 10.3969/j.issn.1006-2157.2025.01.002.
HU JINHAO, SUN GUIYAN, YANG YUFENG, et al. Discussion of sequential diagnosis and treatment model of diabetes mellitus of spatiotemporal syndrome differentiation from the perspective of qi, blood, and fluid. [J]. Journal of beijing university of traditional chinese medicine, 2025, 48(1): 8-13. DOI: 10.3969/j.issn.1006-2157.2025.01.002.
气血津液功能紊乱是糖尿病发病的基础。糖尿病患者的症状、体征、理化指标等反映了气血津液代谢失常之久暂、深浅、主次等病理状态,有必要从时间、空间相结合的维度构建糖尿病立体化辨证体系。糖尿病的时空辨证可依据发病之郁、热、虚、损四大阶段,分别将病位锁定于气分、营分、血分层次,进程表现为气血津液代谢失常之“气分郁滞(前驱期:无症状代谢紊乱期/气分层次前期)→气分热盛(初期:指标期/气分层次后期)→气阴亏虚(中期:三多一少症状期/营分层次期)→脏腑经络受损(后期:并发症期/血分层次期)”的病理变化趋势。根据时间进程,气分层次前期应健脾理气,以防糖浊蓄积;气分层次后期应清热化浊,荡涤糖浊郁热;营分层次期应益气养阴以补气阴之虚,改善主要症状;血分层次期应重视活血化瘀,以除并发之变证。根据糖尿病病因、病机提出理气健脾、清热化浊、益气养阴、活血祛瘀的序贯治疗模式,分阶段辨证使用厚朴三物汤、白虎加人参汤、当归六黄汤、桃红四物汤等方加减治疗。
The dysfunction of qi
blood
and fluid underlies the pathology of diabetes mellitus. The symptoms
signs
and physical and chemical indexes of diabetes mellitus patients reflect the duration
degree
primary and secondary pathological state of the abnormal metabolism of qi
blood
and fluid. It is necessary to construct a three-dimensional syndrome differentiation system of diabetes mellitus based on spatial and temporal dimensions. According to the four stages of depression
heat
deficiency
and damage
the location of the disease can be locked into qi
ying
and blood levels. The process reflects the pathological trend of the abnormal metabolism of qi
blood
and fluid: qi depression (prodromal stage: a
symptomatic metabolic disorder/early stage of qi level) → qi heat (initial stage: index stage/late stage of qi level) → deficiency of both qi and yin (middle stage: symptom stage of three more and one less/stage of ying level) → damage of zang-fu viscera and meridians (late stage: complication stage/stage of blood level). According to the time process
the treatment principles are proposed as follows: during the early stage of qi level
treatment should focus on strengthening the spleen to regulate qi flow
to prevent the accumulation of glucose; during the late stage of qi level
treatment should focus on clearing heat and resolving turbidity
to remove the stagnated heat caused by glucose; during the stage of ying level
treatment should focus on benefiting qi and nourishing yin
to improve the symptoms about deficiency of both qi and yin; during the stage of blood level
treatment should focus on promoting blood circulation and removing blood stasis
to remove the complication. According to the etiology and pathogenesis of diabetes mellitus
the sequential treatment strategy is thus proposed
which is strengthening the spleen to regulate qi flow
clearing heat and resolving turbidity
benefiting qi and nourishing yin
and promoting blood circulation and removing blood stasis. The compound prescriptions such as
Houpo Sanwu
Decoction
Baihu Jia Renshen
Decoction
Danggui Liuhuang
Decoction
and
Taohong Siwu
Decoction are used with modification in the stage-based treatment.
糖尿病气血津液视域时空辨证序贯诊疗
diabetes mellitusperspective of qi blood and fluidspatiotemporal syndrome differentiationsequential diagnosis and treatment
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