基于五行圆运动探讨加味桃核承气汤防治2型糖尿病机理

Discussion About Mechanism of Flavored Peach Kernel Qi-Guiding Decoction in Prevention and Treatment of Diabetes Type II Based on the Five Elements′Circle Motion

2型糖尿病病机为"瘀热互结、气阴两伤",属于"消渴"范畴。消渴发病始于中轴脾胃,终及五脏。早期,中轴受损;中期,中轴失运;后期,中轴不运,四维倒作,瘀阻血络,病及五脏。桃核承气汤泻热逐瘀,为脾胃"减负",从而助脾胃复运。"加味桃核承气汤"在桃核承气汤基础上加用黄芪、葛根、生地黄、山药、玄参、麦冬等,旨在疏导泻热、逐瘀散滞,使中轴脾胃郁热得清,瘀滞得消,轴得健运,带动外轮,则四维复转。消渴并发胸痹者,重用桂枝,加薤白、瓜蒌、丹参、川芎等辛散之品以助肝脾升发,活血通痹;并发眩晕证属兼夹痰浊者,加茯苓、白术、法半夏、橘红温化痰浊,证属肝阳上亢者,加天麻、钩藤、牛膝、代赭石平肝潜阳。并发水肿、关格者,加茯苓、猪苓、泽泻、金樱子、山萸肉温阳利水,温固脾肾。并发视物不清者,可加枸杞子、女贞子滋补肝肾之阴,并合用柴胡、桔梗条达肝气,使阴血得以上乘于目。并发疮疡肿毒者,可短期酌加金银花、野菊花、蒲公英、紫花地丁等清热解毒、消肿排脓,待瘀毒基本消散,可重用黄芪,加党参、白术等补脾益气,扶正祛邪。

The pathogenesis of diabetes typeⅡis"intermingled blood stasis and heat accumulation,qi and yin injury",which belongs to the category of"diabetes".The onset of diabetes starts from the central axis,spleen and stomach,and ends in the five viscera.In the early stage,the central axis is damaged.In the middle stage,the central axis fails to function.In the later stage,the central axis is not moving,four-dimensional inversion appears,and blood stasis blocks collaterals,involving five zang-organs.can reduce the burden of spleen and stomach by reducing heat and removing blood stasis.On the basis of Peach Kernel Qi-Guiding Decoction,Flavored Peach Kernel Qi-Guiding Decoction adds Huangqi(Radix Astragali),Gegen(Radix Puerariae Lobatae),Shengdi(Radix Rehmanniae),Shanyao(Rhizoma Dioscoreae),Xuanshen(Radix Scrophulariae),Maidong(Radix Ophiopogonis),etc.to purge heat,remove blood stasis and disperse stagnation,make the spleen and stomach stagnant heat clear dispersed,blood stasis disappear,then the four-dimensional functions recover.For diabetes combined with chest obstruction,Guizhi(Ramulus Cinnamomi)should be heavily used,and Xiebai(Bulbus Allii Macrostemi),Gualou(Fructus Trichosanthis),Danshen(Radix Salviae Miltiorrhizae),Chuanxiong(Rhizoma Chuanxiong)and other pungent medicinals should be added to help ascend the liver and spleen,promote blood circulation and relieve obstruction.For the patients with vertigo characterized by phlegm turbidity,Fuling(Poria),Baizhu(Rhizoma Atractylodis Macrocephalae),Fabanxia(Rhizoma Pinelliae Praeparatum)and Juhong(Exocarpium Citri Rubrum)can be used to phlegm turbidity.For the patients with syndrome of hyperactivity of liver yang,Tianma(Rhizoma Gastrodiae),Gouteng(Ramulus Uncariae Cum Uncis),Niuni(Radix Achyranthis Bidentatae),and Daizheshi(Haematitum)can be used to pacify liver and subdue yang.For those with edema and anuria and vomiting,Fuling(Poria),Zhuling(Polyporus),Zexie(Rhizoma Alismatis),Jinyingzi(Fructus Rosae Laevigatae)and Shanyurou(Fructus Corni)can be added to warm yang,promote dieresis,and strengthen spleen and kidney.For those complicated with blurred vision,Gouqizi(Fructus Lycii)and Nvzhenzi(Fructus Ligustri Lucidi)can be added to nourish t liver-kidney yin,Chaihu(Radix Bupleuri)and Jiegeng(Radix Platycodonis)can also be used to regulate liver qi,so that yin blood can be reach to the eyes.For those combined with sores,Jinyinhua(Flos Lonicerae Japonicae),Yejuhua(Flos Chrysanthemi Indici),Pugongying(Herba Taraxaci),Zihuadiding(Herba Violae),etc.can be used for a short period of time to clear away heat and toxin,eliminate swelling and pus.When the blood stasis and toxin are basically dissipated,Huangqi(Radix Astragali)can be heavily used,combined with Dangshen(Radix Codonopsis),Baizhu(Rhizoma Atractylodis Macrocephalae),etc.to nourish spleen qi,strengthen healthy qi and dispel pathogens.