大黄黄连泻心汤及其加减方改善2型糖尿病研究进展

Dahuang Huanglian Xiexintang and Its Modified Prescription Improve Type 2 Diabetes Mellitus:A Review

2型糖尿病(T2DM)以胰岛素抵抗(IR)和胰岛素分泌缺陷为发病基础,具体机制尚未明确,目前研究涉及糖脂毒性、炎症反应、氧化应激损伤及线粒体功能障碍等机制。现代中医学者根据T2DM临床特征及自然发展进程,将其命名为“糖络病”,即早期主要表现为血糖异常,随着病程进展,逐渐致全身脉与络广泛损害,最终导致脉络病变的一类疾病。其中脾瘅(肥胖型)是T2DM临床最为常见的类型,“内热致消”贯穿T2DM发病及并发症发生的始终,内热为病机之要。对此临床应用经方大黄黄连泻心汤及其加减方治疗取得显著疗效。笔者通过梳理大黄黄连泻心汤溯源及证治特点、治疗T2DM的临床应用研究及实验基础研究,包括调节糖脂代谢紊乱、改善胰岛素抵抗、调节炎症反应、抗氧化应激损伤、调控自噬相关信号通路、调节肠道菌群、抑制细胞焦亡、减轻内质网应激等作用机制。以期为大黄黄连泻心汤及其加减方防治T2DM及相关并发症的进一步研究提供方向、为将其开发为针对肥胖型T2DM实现快速降糖的优势中成药提供参考及更好指导该药的临床推广。

Type 2 diabetes mellitus(T2DM)is based on insulin resistance(IR)and insulin secretion deficiency,with the specific mechanisms still unclear.Current research involves mechanisms such as glycolipid toxicity,inflammatory response,oxidative stress damage,and mitochondrial dysfunction.Modern traditional Chinese medicine(TCM)scholars have named it"blood glucose collateral disease"based on the clinical characteristics and natural progression of T2DM.This condition is primarily manifested as abnormal blood sugar levels in the early stages,and as the disease progresses,it gradually causes widespread damage to the body's veins and collaterals,ultimately leading to lesions in vessels and collaterals.Among these,"spleen heat"(obesity type)is the most common clinical type of T2DM.The concept of"internal heat-induced elimination"runs through both the onset and complications of T2DM,with internal heat being a key factor in its pathogenesis.The clinical application of Dahuang Huanglian Xiexintang and its modifications has achieved significant therapeutic effects.This paper reviews the origins and treatment characteristics of Dahuang Huanglian Xiexintang,along with clinical application research and experimental studies related to T2DM treatment,involving mechanisms for regulating glucose and lipid metabolism disorders,improving IR,modulating inflammatory responses,combating oxidative stress damage,regulating autophagy-related signaling pathways,modulating intestinal flora,inhibiting pyroptosis,and alleviating endoplasmic reticulum stress,with the purpose to provide direction for further research on the prevention and treatment of T2DM and its related complications,to offer reference for developing Dahuang Huanglian Xiexintang as a rapid hypoglycemic Chinese patent medicine for obese T2DM,and to better guide the clinical promotion of this drug.