李赛美基于少火虚与壮火盛论治糖尿病

LI Sai-Mei’s Experience in Treating Diabetes Based on Balancing the Bias of Mild Fire Deficiency and Strong Fire Abundance

李赛美教授认为糖尿病的病机为全身虚损,局部火盛,整个疾病过程表现为虚实夹杂、寒热并存。采用少火虚与壮火盛的偏颇来阐述糖尿病患者的状态,有利于指导临床寒温并用治疗糖尿病。基于少火虚与壮火盛论治糖尿病可分3个阶段阐释:患者初见血糖高,消渴症状明显,多为"壮火"偏亢而"少火"微虚状态,此时治疗以清实热为重,兼顾扶正;经清"壮火"后,患者血糖下降,局部壮火盛逐渐得到缓解,呈现出"壮火"盛与"少火"虚并重,治疗应以清热与滋阴补气并重;患者血糖渐趋平稳后,局部火盛基本清解,但消渴病患者全身虚损的情况仍在,此时患者状态多为"壮火"微盛而"少火"更虚,治疗应以固本为重,稍清火热,可延缓患者并发症的进展。

Professor LI Sai-Mei believes that the pathogenesis of diabetes is characterized by the general deficiency and hyperactivity of local fire. The whole disease process is manifested as a mixture of deficiency interweaved with excess,and the concurrence of cold and heat. The bias of mild fire deficiency and strong fire abundance is helpful to illustrate the pathogenesis of diabetes,and is beneficial to guiding the clinical treatment of diabetes with simultaneous use of cold and warm medicine. Based on the pathogenesis of mild fire deficiency and strong fire abundance,diabetes can be differentiated into 3 stages:in the initial stage of high blood glucose,the patients have obvious diabetes symptoms and were in the state of hyperactivity of strong fire and slightly deficiency of mild fire,and the treatment should be stressed on clearing the excess heat and accompanied by supporting the healthy qi;after clearing the strong fire,the patients’ blood glucose levels decreased and the local strong fire abundance was gradually corrected, showing the predominance of both strong fire abundance and mild fire deficiency,and the treatment should lay equal stress on clearing heat,nourishing yin and replenishing qi;when the patients’ blood sugar level has gradually stabilized,the local strong fire is basically cleared, but the general deficiency of the diabetic patient is still present,the patients were mostly in the state of slightly hyperactivity of strong fire and severe deficiency of mild fire,and the treatment should be stressed on consolidating vital base and accompanied by mildly clearing the fire-heat to help delay the progression of diabetic complications.