态靶辨证在虚阳上浮型糖尿病中的应用——潜阳封髓丹加知母

Application of State-Target Strategy in diabetes with Deficiency of Yang and Upper Float:Qianyang Capping Medullary Dance and AnemarrhenaeRhizoma

糖尿病病程长、病机复杂,其可因实火不除,患者脏腑功能持续亢进,耗散元气而致脾肾阳虚,阳虚进而导致阴盛于下,虚火上浮。部分患者会出现肾阳虚证兼现真寒假热象。治疗时应仔细辨证,分清虚实,明确病机,若因见热象只以清实热之法治疗恐生变证。仝小林院士基于多年临证实践探索,提出的"态靶结合"辨证组方思想,王强医师以之为指导思想在虚阳上浮型糖尿病的辨治中取得了良好的疗效。王强以虚火上浮为态,血糖升高为靶,治疗中采用潜阳封髓丹为调态方;潜阳封髓丹主治的火热病症是阳气虚损不足而被阴邪逼迫于上的相火,其恰于虚阳上浮态的病机相符合。潜阳封髓丹方中附子为温里扶阳的要药。龟板可滋肾阴而潜浮阳;黄柏有调理心、脾、肾之义。砂仁能纳五脏之气归肾,甘草调和上下,有伏火之功,此两药合用可交通心肾,遏制元阳上越。配合以知母降糖打指标靶,态靶辨治,效如桴鼓。

The course of diabetes is long and the pathogenesis is complex.It can be caused by the persistent hyperactivity of viscera function,dissipation of vital energy and yang deficiency of spleen and kidney,which leads to Yang deficiency and leads to Yin abundance in the lower part and the floating of deficiency fire.Some patients will have kidney yang deficiency syndrome and present true winter and false heat.During treatment,syndrome differentiation should be carefully made,deficiency and excess should be distinguished,and pathogenesis should be made clear.If there is heat,only the method of clearing excess heat should be used to treat fear of change.Based on years of clinical practice and exploration,academician Tong Xiaolin put forward the thought of"combination of state and target"in syndrome differentiation and prescription,which was taken as the guiding ideology by Dr.Wang Qiang,and achieved good curative effect in the treatment of diabetes mellitus with floating deficiency Yang.Wang Qiang used Qianyang Fengsui Dan as the regulating prescription in the treatment of asthenia fire floating upward and blood sugar rising as the target;Qianyang Fengsui Dan was mainly used to treat the fire and heat disease,which was forced by Yin evil due to deficiency of Yang Qi,which was in accordance with the pathogenesis of the floating state of deficiency Yang.In Qianyang Fengsui Dan prescription,Fuzi is an important medicine for warming Li Fu Yang.Turtle shell can nourish kidney yin and float Yang;Cortex Phellodendri has the meaning of regulating heart,spleen and kidney.Amomumvillosum can absorb the Qi of the five zang organs and return to the kidney.Licorice can harmonize the upper and lower parts of the body.It has the function of subduing fire.The combination of these three medicines can communicate with the heart and kidney and restrain the rising and falling of Yuanyang.With Anemarrhenaasphodeloides hypoglycemic target,state target syndrome differentiation and treatment,the effect is as good as drum.