论消渴病火热病机

Discussion on the fire-heat pathogenesis of‘Xiao Ke’disease

糖尿病属中医“消渴病”范畴,国医大师吕仁和融合古今经验并结合临床实际,将消渴病分为脾瘅、消渴、消瘅3期。消渴病基本病机为“热伤气阴”,脾瘅期以脾热为主要病机,消渴期以二阳结滞化热为主要病机,消瘅期以血脉不行、血气逆留为主要病机。而作为消渴病基本病机的火热邪气则贯穿3期始终,笔者研究发现消渴病热邪具有易损伤络脉、常造成血脉瘀滞、波及五脏六腑、常因病人体质不同而表现不同、常与有形之邪胶结、易成毒邪六大特点。治疗方面,在重视消渴病热邪属性及消渴病分期的基础上,强调重视患者体质差异、重视活血化瘀治法的应用、重视祛除有形邪气。

Diabetes mellitus belongs to the traditional Chinese medicine category of‘Xiao Ke’disease.TCM master LYU Renhe combined the ancient and modern experience and the clinical practice divide the diabetes into three phases:Pi Dan,Xiao Ke,Xiao Dan.The basic pathogenesis is‘heat injury qi and yin’.Spleen-heat is the main pathogenesis of the stage of Pi Dan.The main pathogenesis of Xiao Ke is two yang stagnation heat.Stasis of blood is the main pathogenesis of the stage of Xiao Dan.As the basic pathogenesis of‘Xiao Ke’disease,fire-heat pathogens runs through the three stages.The authors found that the fire and heat pathogen of‘Xiao Ke’disease has six characteristics:easy to damage collaterals,often cause blood stasis,affect the five Zang and six Fu organs,often have a variety of external manifestations due to the physical characteristics of patients,often bond with tangible pathogen,and easy to become toxic pathogen.In terms of treatment,on the basis of paying attention to the heat pathogen attribute of‘Xiao Ke’disease and the stages of‘Xiao Ke’disease,it emphasizes paying attention to the physical differences of patients,the application of promoting blood circulation and removing blood stasis,and the elimination of tangible pathogen.