吕仁和辨治糖尿病医案病因、病机和病位解析

Analysis on causes,pathogeneses and locations in diabetic cases differentiated and treated by Professor LV Ren-he

目的通过对吕仁和治疗糖尿病医案中医辨证要素的统计分析,总结吕仁和教授分期辨治糖尿病的学术思想。方法 128例经吕仁和教授诊治的糖尿病医案,经过"解析和标引"的预处理之后,借助"中医医案数据库"的统计分析功能,将医案按照脾瘅期、消渴期、消瘅期三期,分别对其病因、病机、病位进行统计分析。结果劳心、郁火是脾瘅期主要病因,脾、胃、肝、肾是脾瘅期主要病位。过食厚味、怒伤是消渴期重要病因,肝、肾、胃、脾是消渴期主要病位,除肝肾阴虚外,湿热瘀阻、肝郁化热、肠胃积热、阴虚内热、心神不宁等病机在消渴期较突出。年老体衰是消瘅期的重要病因,血瘀阻络是消瘅期最重要的病机,其次为气血不足、阴阳两虚、痰瘀滞络、经脉痹阻,消瘅期病位统计显示此期五脏六腑、经脉均可受累。结论糖尿病三期医案的病因、病机、病位分析内在吻合度良好,且与吕仁和教授糖尿病中医分期理论相符合。

Objective To sum up the academic thought of Professor LV Ren-he＇s in differentiation and treatment of diabetes at stages through the statistical analysis on the factors of TCM syndrome differentiation of diabetes in cases treated by Professor LV Ren-he＇s. Methods The diabetic cases treated by Professor LV Ren-he （n = 128 ） were classified into Pidan stage, Xiaoke stage and Xiaodan stage based on the statistical function of TCM Medical Record Database after the pretreatment with resolution and indexing. The causes, pathogeneses and locations were analysed respectively. Results At Pidan stage excessive contemplation and stagnant fire were main causes, and spleen, stomach, liver and kidney were main locations. At Xiaoke stage overeating greased food and raged impairment were main causes, and liver, kidney, stomach and spleen were main locations. The prominent pathogeneses included, at Xiaoke stage, damp-heat accumulation, liver-depression transforming heat, heat accumulating in intestines and stomach, yin deficiency with internal heat, and disquieted heart spirit besides dual deficiency of liver and kidney. At Xiaodan stage senility was an important cause, blood-stasis obstructing collaterals was the most important pathogenesis, and other pathogeneses included deficiency of qi and blood, dual deficiency of yin and yang, phlegm-stasis obstructing collaterals and meridian obstruction. The location statistic showed that five zang-viscera, six bowels and meridians could all be involved at Xiaodan stage. The analysis results of diabetes of three stages were accorded with Professor LV Ren-he＇s theory of differentiation and treatment of diabetes at stages. Conclusion Professor LV Ren-he＇s theory of differentiation and treatment of diabetes at stages is correspondent with clinical practice.