岳仁宋运用“三期辨证”治疗2型糖尿病临床经验

Clinical Experience of YUE Rensong in Treatment of Type 2 Diabetes Mellitus with Three Stages of Syndrome Differentiation

2型糖尿病(type 2 diabetes mellitus,T2DM)是由胰岛素抵抗及胰岛β细胞功能受损等因素导致的常见慢性代谢性疾病,在我国的发病率呈逐年增高趋势,给家庭及社会带来了沉重负担。四川省名中医岳仁宋教授从临床实际出发,打破"三消辨证"传统,将本病分"三期"辨证治疗。其中,早期火热炽盛,当直折火热:在根据火象所处的主要脏腑确定证型及主方基础上,亦通过火热征象进行相应"靶药"的加味;中期脾失散精,当助脾散精:着眼于脾弱胃强、脾虚湿盛、脾虚肝郁等主要病机,采取扶脾抑胃、祛痰化湿、疏肝益脾等治法;晚期精亏浊聚,当挽精逐浊:在充分调动人体机能,挽救欲脱之精微的同时,驱逐水湿、痰瘀、浊毒等致病邪气。在"三期辨证"基础上,亦需结合方证相应思维以及脏腑、八纲、气血津液等辨证策略,进一步细化证型,以使处方用药紧扣病机、方(药)证相合。

Type 2 diabetes mellitus(T2 DM)is a common chronic metabolic disease caused by insulin resistance and impaired beta cell function,and with the increasing incidence,T2 DM has brought heavy burden to families and the society.Professor YUE Rensong,a famous traditional Chinese medicine doctor in Sichuan Province,broke the tradition of“Sanxiao syndrome differentiation”and put forward the“three-stage syndrome differentiation”strategy.In the early stage,internal heat is blazing,and clearing away heat should be the main therapeutic principle.The syndrome type and main herbal prescriptions are determined according to the Zang-Fu organs invaded by the internal heat,and some“target herbs”pointing at heat-related symptoms are often added to the prescriptions.In the middle stage,spleen does not disperse the essence,and reinforcing spleen should be the core link of treatment:focusing on the main pathogenesis of spleen deficiency and stomach heat,spleen deficiency and dampness,spleen deficiency and liver depression,the corresponding treatment methods should be taken,such as strengthening the spleen and suppressing the stomach,eliminating phlegm and resolving dampness,soothing the liver and benefiting the spleen.In the late stage,the essence may remain in a state of deficiency and the turbid evil will gather,therefore,on the one hand,the human body function should be fully mobilized to save the essence that is to be removed;on the other hand,some pathogenic factors such as moisture,phlegm/blood stasis and turbid poison should be dispelled.In order to make the herbal formula more accurate and effective,it is also need to apply the theory of“correspondence of prescription and syndrome”and some other syndrome differentiation methods such as Zang-Fu organs,eight principles and Qi-blood-body fluid to further refine syndrome types.