基于“异病同治”理论探析从脾论治糖尿病与甲状腺结节的机制

An analysis of the mechanism of treating diabetes and thyroid nodules from the aspect of spleen based on the theory of same treatment for different diseases

糖尿病和甲状腺结节是最为常见的两大内分泌代谢性疾病,严重危害人类健康。临床上糖尿病和甲状腺结节亦会相伴出现,互为因果且相互促进,因此积极探索二者在病程中的关联及中西医结合防治方法具有重要的临床价值。“异病同治”是中医诊疗特色辨证论治的具体体现,指对病机相似的不同疾病采用相同的治法。中医所认知的脾内涵丰富,代表的是一个囊括多器官、多系统的综合功能单位,涉及消化吸收、能量代谢转化、免疫功能、神经内分泌功能等多个方面。脾为后天养生之本,故脾失健运是多种疾病的共同病理基础。糖尿病患者脾之运化、散精、防御等生理功能异常,气、血、津液转输不利,痰湿凝聚则易形成结节,反过来亦会加重脾病。据此推测,脾与糖尿病、甲状腺结节的发生发展存在密切的联系,但其微观作用机制尚未完全明确。文章基于中医“异病同治”的辨证论治模式,通过挖掘糖尿病和甲状腺结节的传统理论渊源,总结分析二者共病的现代病理机制,从肠道菌群紊乱、胰岛素抵抗、免疫功能失衡这几个方面探讨“从脾论治”糖尿病与甲状腺结节的机理与可行性,以期为临床实践提供诊疗思路。

Diabetes and thyroid nodules are the two most common endocrine metabolic diseases,which seriously endanger human health and often coexist clinically,mutually causing and promoting each other.Actively exploring the correlation between the two in the development of diseases and the integrated prevention and treatment methods of traditional Chinese medicine and Western medicine has significant clinical value.The theory of same treatment for different diseases is a specific manifestation of the characteristic syndrome differentiation and treatment in traditional Chinese medicine,referring to the use of the same treatment methods for different diseases with similar pathogenesis.The concept of spleen in traditional Chinese medicine is rich in connotation,representing a comprehensive functional unit encompassing multiple organs and systems involving aspects such as digestion,absorption,energy metabolism,immune function,and neuroendocrine functions.Spleen is the foundation of acquired constitution,and spleen dysfunction is the common pathological basis for many diseases.In diabetes patients,abnormal physiological functions of transformation,dispersion of essence,and defense of spleen may lead to poor transport of Qi(气),blood,and body fluids,which can result in the formation of nodules based on phlegm-dampness accumulation,which in turn can further aggravate spleen disease.It is therefore speculated that there is a close relationship between spleen and the occurrence and development of diabetes and thyroid nodules,although the micro-mechanisms are not fully understood.This article,based on the syndrome differentiation and treatment model of same treatment for different diseases in traditional Chinese medicine,excavates the traditional theoretical origins of diabetes and thyroid nodules,analyzes the modern pathological mechanisms of the coexistence of the two diseases,and explores the mechanism and feasibility of spleen-based treatment in the treatment of diabetes and thyroid nodules,focusing on aspects such as intestinal flora disorders,insulin resistance,and immune function imbalance,in order to provide new ideas for clinical practice.