基于“一气周流”理论思想探析2型糖尿病的辨治思路

The differentiation and treatment of type 2 diabetes mellitus based on the theory of “Yiqi Zhouliu”

“中气斡旋,土枢四象”的一气周流理论最初由清末中医名家黄元御提出。中气为一气周流的枢纽,顾护中气应为治疗疾病的首要,中焦脾胃旋转有序,可复四维之升降,有助全身气机顺畅。徐云生教授在传承中医经典理论的同时,结合临证经验,在实际诊疗过程中,注重从“一气周流”角度对2型糖尿病(T2DM)进行辨治,认为T2DM发病与中轴失健(脾胃失常)、四维气机失常(肝木不生、肾水不藏)有关,主要病机为肝气郁滞、脾不散精、肾气亏虚、痰瘀互结,治疗原则应包括疏肝理气、助脾散精、补肾益精、化痰祛瘀,注重恢复全身气机通畅。“一气周流”理论思想为基础的T2DM辨证思路体系的提出,突破了传统阴虚燥热论治T2DM的局限性,具有重要临床意义。

The theory of“middle qi mediation,soil pivot four images”was first put forward by Huang Yuanyu,a famous TCM practitioner in the late Qing dynasty.The central qi is the hub of Yiqi Zhouliu,and the care of the central qi should be the primary treatment of disease.The spleen and stomach in the middle of Jiao rotate orderly,which can restore the four-dimensional rise and fall,and help the whole body qi flow smoothly.Professor Xu Yunsheng not only inherits the classical theories of ancient Chinese medicine,but also combines clinical experience.In the actual diagnosis and treatment process,he pays attention to the differentiation and treatment of type 2 diabetes(T2DM)from the perspective of“Yiqi Zhouliu”.It is believed that the onset of T2DM is related to the dysfunction of the central axis(spleen and stomach disorder)and the disorder of the four-dimensional-qi mechanism(liver and stomach failure,kidney water failure).The main pathogenesis is liver qi stagnation,spleen failure to dissipate essence,kidney qi deficiency and phlegm-stasis interformation.The treatment principles should include soothing the liver and regulating qi,assisting the spleen to dissipate essence,tonifying the kidney and essence,resolving phlegm and removing blood stasis,and paying attention to restoring the whole body qi patency.The proposed syndrome differentiation system of T2DM based on the theory of“Yiqi Zhouliu”breaks through the limitations of traditional yin deficiency and dryness heat treatment of T2DM,which has important clinical significance.