从“少阴为枢”“厥阴为阖”辨治消渴

Differentiation and treatment of diabetes from‘Shaoyin as pivot'and Jueyin as closure'

笔者通过研读张仲景之论,认为六经气化失常皆可致消渴,提出消渴与“少阴之枢”“厥阴之阖”密切相关。治疗巧用“少阴之枢”,透邪外出,使邪气通过太阳而出。善用“厥阴之阖”调其寒热,从“开、阖、枢”入手细辨,常见少阴失枢之肾虚证、厥阴不阖之寒热错杂证、厥阴不阖之厥阴虚寒证,选取肾气丸、乌梅丸、当归四逆汤常用三方,解读其机理,说明具体用法与用量。文末附消渴治疗验案3则,以期为消渴临床治疗提供借鉴。

By studying ZHANG Zhongjing's theory,the author concludes that abnormal qi transformation in the six meridians can all lead to diabetes,and diabetes can be closely related to‘Shaoyin as pivot'and Jueyin as closure'.Treatment should focus on using the'Shaoyin as pivot'to expel the evil through Taiyang,and skillfully using Jueyin as closure'to adjust cold and heat.Based on the concepts of'opening,closure,and pivot',common clinical manifestations such as kidney deficiency due to loss of the pivot of Shaoyin,mixed symptoms of cold and heat due to the failure of the closing of Jueyin,and cold coagulation due to the failure of the closing of Jueyin can be carefully distinguished.This paper selects three commonly used clinical prescriptions:Shenqi Pills,Wumei Pills and Danggui Sini Decoction to explain the mechanism of the effects,and specifies their usage and dosage.At the end of the article,three case studies of treatment for diabetes are attached to provide guidance for clinical practice.