糖尿病中医治法研究概况
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摘要
糖尿病是全球最常见的三大慢性非传染性疾病之一,严重威胁着人类健康。中医药具有病证同治、整体综合调治优势,在防治糖尿病及其并发症方面具有一定优势。近年来许多医家突破了以滋阴清热法治疗糖尿病的认识,提出了糖尿病中医治法新观点。通过系统检索文献,文章整理了辛开苦降法、养阴清热法、苦甘合化法、滋阴解毒法、清热解毒法、苦酸制甜法、益气养阴法、健运脾胃法、疏肝理气法、活血化瘀法、温阳补肾法、祛湿化痰法等目前治疗糖尿病的重要治法,阐述了其应用的理论依据及在减轻胰岛素抵抗、修复胰岛功能、改善糖脂代谢等方面的作用,以期为临床提供借鉴。
Diabetes mellitus is one of the three most common chronic noncommunicable diseases in the world, posing a serious threat to human health. Traditional Chinese medicine(TCM) has the advantages of comprehensive treatment of disease and syndrome in a whole, as well as certain advantages in the prevention and treatment of diabetes mellitus and its complications. In recent years, many scholars broke through the limits of the understanding of treating diabetes with nourishing yin and clearing heat, and put forward a new idea of treating diabetes with traditional Chinese medicine. The article discussed the commonly used TCM therapeutic methods of diabetes mellitus, including using herbs acrid in flavor for dispersing and herbs bitter in favor for descending, nourishing yin and clearing heat, using herbs in bitter and sweet flavor for resolving, nourishingyin and removing toxic materials, clearing heat and removing toxic materials, using herbs bitter and sour in flavor to control sweet, replenishing qi and nourishing yin, invigorating spleen and replenishing qi, soothing liver and regulating qi, activating blood and resolving stasis, warming kidney and yang, dispersing dampness and resolving phlegm. This paper clarified the theoretical basis of these therapeutic methods of the treatment of diabetes and explored their effects of improving insulin resistance and glucolipid metabolism, protecting function of pancreatic islet, so as to provide reference for clinical application.
Diabetes mellitus is one of the three most common chronic noncommunicable diseases in the world, posing a serious threat to human health. Traditional Chinese medicine(TCM) has the advantages of comprehensive treatment of disease and syndrome in a whole, as well as certain advantages in the prevention and treatment of diabetes mellitus and its complications. In recent years, many scholars broke through the limits of the understanding of treating diabetes with nourishing yin and clearing heat, and put forward a new idea of treating diabetes with traditional Chinese medicine. The article discussed the commonly used TCM therapeutic methods of diabetes mellitus, including using herbs acrid in flavor for dispersing and herbs bitter in favor for descending, nourishing yin and clearing heat, using herbs in bitter and sweet flavor for resolving, nourishingyin and removing toxic materials, clearing heat and removing toxic materials, using herbs bitter and sour in flavor to control sweet, replenishing qi and nourishing yin, invigorating spleen and replenishing qi, soothing liver and regulating qi, activating blood and resolving stasis, warming kidney and yang, dispersing dampness and resolving phlegm. This paper clarified the theoretical basis of these therapeutic methods of the treatment of diabetes and explored their effects of improving insulin resistance and glucolipid metabolism, protecting function of pancreatic islet, so as to provide reference for clinical application.
引文
[1] WANG L,GAO P,ZHANG M,et al.Prevalence and ethnic pattern of diabetes and prediabetes in China in 2013[J].JAMA,2017,317(24):2515-2523.
[2] American Diabetes Association.Diabetes statistics[EB/OL](2017-01-04).http://www.diabetes.org.Accessed January 4,2017.
[3] 马琳,陈芳,庄馨瑛,等.辛开苦降法在《伤寒论》及现代临床中的应用[J].中医杂志,2014,55(14):540-547.
[4] 陈良,仝小林,徐远,等.从辛开苦降法论治糖尿病[J].新中医,2006,38(2):1-3.
[5] 史丽伟,杜立娟,倪青.半夏泻心汤治疗糖尿病的理论探讨与临床应用[J].中医杂志,2006,38(2):1-3.
[6] 赵昱,周丽波,董柳,等.辛开苦降法治疗肥胖2型糖尿病的临床研究[J].中华中医药学刊,2007,25(12):2575-2577.
[7] 邹耀武.半夏泻心汤治疗脾虚胃热型消渴病60例疗效观察[J].云南中医中药杂志,2014,35(2):34-35.
[8] 倪青,杜立娟,孟祥,等.半夏泻心汤对初诊2型糖尿患者血浆GLP-1的影响初探[J].北京中医药,2017,36(6):549-551.
[9] 杜立娟,孟祥,倪青.半夏泻心汤对H2O2诱导的RIN-m5F细胞凋亡的影响及其机制研究[J].北京中医药,2017,36(6):494-498.
[10] 王鸿庆,崔云竹.甘苦合化法治疗糖尿病体会[J].山东中医杂志,2016,35 (2):143-144.
[11] 张毅,唐红,张敏.养阴清热法对2型糖尿病胰岛素抵抗影响[J].辽宁中医杂志,2010,37(4):689-691.
[12] 杨澄,罗梅梅,曾艺文.养阴清热法治疗2型糖尿病临床观察[J].新中医,2014,46(8):137-138.
[13] FREEMAN D J,NORRIE J,CASLAKE M J,et al.C-reactive protein independent predict of risk for the development of diabetes in the west of Scotland coronary Prevention Study[J].Diabetes,2002,51(5):1596-1600.
[14] 李双蕾,陈莉娜,赵伟,等.益气养阴清热方对2型糖尿病患者炎症因子的影响[J].中华中医药杂志,2013,28(3):746-748.
[15] LEE YS,KIM WS,KIM KH,et al.Berberine,a natural plant product,activates AMP-activated protein kinase with beneficial metabolic effects in diabetic and insulin-resistant states[J].Diabetes,2006,55(8):2256-2264.
[16] KONG W,WEI J,ABIDI P,et al.Berberine is a novel cholesterol- lowering drug working through a unique mechanism distinct from statins.Nat Med[J].2004,10(12):1344-1351.
[17] COUGHLAN KA,VALENTINE RJ,RUDERMAN NB,et al.AMPK activation:a therapeutic target for type 2 diabetes?[J].Diabetes Metab Syndr Obes.2014,7:241-253.
[18] CHENG Z,PANG T,GU M,et al.Berberine-stimulated glucose uptake in L6 myotubes involves both AMPK and p38 MAPK[J].Biochim Biophys Acta,2006,1760(11):1682-1689.
[19] BRUSQ JM,ANCELLIN N,GRONDINrondin P,et al.Inhibition of lipid synthesis through activation of AMP kinase:an additional mechanism for the hypolipidemic effects of berberine[J].J Lipid Res,2006,47(6):1281-1288.
[20] KIM SH,SHIN EJ,KIM ED,et al.Berberine activates GLUT1-mediated glucose uptake in 3T3-L1 adipocytes[J].Biol Pharm Bull,2007,30(11):2120 -2125.
[21] 赵素容,卢兖伟,陈金龙,等.地黄梓醇降糖作用的实验研究[J].时珍国医国药,2009,20(1):171-172.
[22] YAN JT,WANG CY,JIN Y,et al.Catalpol ameliorates hepatic insulin resistance in type 2 diabetes through acting on AMPK/NOX4/ PI3K/AKT pathway[J].Pharmacol Res,2018,130:466-480.
[23] 易文明,刘铜华.论滋阴解毒法治疗2型糖尿病[J].中华中医药杂志,2015,30(7):2393-2394.
[24] 庞博,赵进喜,王颖辉,等.糖尿病清热解毒治法探讨[J].中华中医药杂志,2011,26(7):1471-1473.
[25] 钟伟才,朱国福,李文龙,等.消渴病病因病机探讨[J].时珍国医国药,2012,23(7):1770-1772.
[26] 陆付耳.中医治疗糖尿病从强调“益气养阴”到兼顾“解毒扶阳”[J].中国中西医结合杂志,2009,29(4):293-295.
[27] 宋福印.试论毒损脑络与糖尿病性脑病[J].北京中医药大学学报,2000,23(5):7-8.
[28] 赵进喜,庞博.中医学“浊”的涵义及其临床意义[J].中医杂志,2009,50(7):581-584
[29] 李洪皎.苦酸制甜法保护2型糖尿病胰岛细胞功能的作用及机制研究[D].北京:北京中医药大学,2007:37-109.
[30] 吕仁和,赵进喜,王世东.糖尿病及其并发症的临床研究[J].新中医,2001,33(3):3-5.
[31] 闫秀峰,倪青,陈世波,等.对林兰糖尿病中医“三型辨证”理论的探讨[J].中医杂志,2005,46(12):885-887.
[32] 谭宏文,葛莉,陈亚民,等.仝小林治疗糖尿病经验[J].中医杂志,2006,47(1):19-20.
[33] 丁英钧,王世东,王颖辉.糖尿病“内热伤阴耗气”基本病机探讨[J].中医杂志,2008,49(5):389-391.
[34] 董振华.祝谌予治疗糖尿病经验举要[J].中国医药学报,1993,8(1):43-46.
[35] 朱玲,钱雅玉.益气养阴法治疗2型糖尿病及对胰岛素抵抗作用机制的研究进展[J].陕西中医,2017,38(9):1313-1314
[36] 徐灿坤.程益春治疗糖尿病经验撷谈[J].山东中医杂志,2010,29(10):717-718.
[37] 朱章志,黄从强,何敏.健脾益气中药对脾气虚2型糖尿病大鼠胰岛素介体的影响[J].中药新药与临床药理,2004,15(2):107-109.
[38] 张木森,张晋峰,叶小娟.浅谈糖尿病从肝郁论治[J].中国中医药现代远程教育,2011,9(9):124-125.
[39] 何雷,唐雪梅.肝失疏泄与糖尿病的相关性探讨[J].环球中医药,2016,9(4):438-440.
[40] 薛玲,石岩.活血化瘀论治糖尿病[J].实用中医内科杂志,2016,30(4):46-47.
[41] 孙冉冉,郑燕飞,李玲孺,等.从中医体质角度探讨2型糖尿病的防治[J].环球中医药,2014,7(5):375-376.
[42] 柯斌,秦鉴.中医对2型糖尿病胰岛素抵抗的认识及治疗进展[J].中医杂志,2010,51(S2):257-259.
[43] 梅笑,郭惠芳.糖尿病与痰湿关系的临床观察[J].南京中医药大学学报,1996,12(1):13-14.
[44] 梅仙月.痰湿体质与糖尿病动脉粥样硬化相关性研究[J].河南中医,2008,28 (2):83-84.
[2] American Diabetes Association.Diabetes statistics[EB/OL](2017-01-04).http://www.diabetes.org.Accessed January 4,2017.
[3] 马琳,陈芳,庄馨瑛,等.辛开苦降法在《伤寒论》及现代临床中的应用[J].中医杂志,2014,55(14):540-547.
[4] 陈良,仝小林,徐远,等.从辛开苦降法论治糖尿病[J].新中医,2006,38(2):1-3.
[5] 史丽伟,杜立娟,倪青.半夏泻心汤治疗糖尿病的理论探讨与临床应用[J].中医杂志,2006,38(2):1-3.
[6] 赵昱,周丽波,董柳,等.辛开苦降法治疗肥胖2型糖尿病的临床研究[J].中华中医药学刊,2007,25(12):2575-2577.
[7] 邹耀武.半夏泻心汤治疗脾虚胃热型消渴病60例疗效观察[J].云南中医中药杂志,2014,35(2):34-35.
[8] 倪青,杜立娟,孟祥,等.半夏泻心汤对初诊2型糖尿患者血浆GLP-1的影响初探[J].北京中医药,2017,36(6):549-551.
[9] 杜立娟,孟祥,倪青.半夏泻心汤对H2O2诱导的RIN-m5F细胞凋亡的影响及其机制研究[J].北京中医药,2017,36(6):494-498.
[10] 王鸿庆,崔云竹.甘苦合化法治疗糖尿病体会[J].山东中医杂志,2016,35 (2):143-144.
[11] 张毅,唐红,张敏.养阴清热法对2型糖尿病胰岛素抵抗影响[J].辽宁中医杂志,2010,37(4):689-691.
[12] 杨澄,罗梅梅,曾艺文.养阴清热法治疗2型糖尿病临床观察[J].新中医,2014,46(8):137-138.
[13] FREEMAN D J,NORRIE J,CASLAKE M J,et al.C-reactive protein independent predict of risk for the development of diabetes in the west of Scotland coronary Prevention Study[J].Diabetes,2002,51(5):1596-1600.
[14] 李双蕾,陈莉娜,赵伟,等.益气养阴清热方对2型糖尿病患者炎症因子的影响[J].中华中医药杂志,2013,28(3):746-748.
[15] LEE YS,KIM WS,KIM KH,et al.Berberine,a natural plant product,activates AMP-activated protein kinase with beneficial metabolic effects in diabetic and insulin-resistant states[J].Diabetes,2006,55(8):2256-2264.
[16] KONG W,WEI J,ABIDI P,et al.Berberine is a novel cholesterol- lowering drug working through a unique mechanism distinct from statins.Nat Med[J].2004,10(12):1344-1351.
[17] COUGHLAN KA,VALENTINE RJ,RUDERMAN NB,et al.AMPK activation:a therapeutic target for type 2 diabetes?[J].Diabetes Metab Syndr Obes.2014,7:241-253.
[18] CHENG Z,PANG T,GU M,et al.Berberine-stimulated glucose uptake in L6 myotubes involves both AMPK and p38 MAPK[J].Biochim Biophys Acta,2006,1760(11):1682-1689.
[19] BRUSQ JM,ANCELLIN N,GRONDINrondin P,et al.Inhibition of lipid synthesis through activation of AMP kinase:an additional mechanism for the hypolipidemic effects of berberine[J].J Lipid Res,2006,47(6):1281-1288.
[20] KIM SH,SHIN EJ,KIM ED,et al.Berberine activates GLUT1-mediated glucose uptake in 3T3-L1 adipocytes[J].Biol Pharm Bull,2007,30(11):2120 -2125.
[21] 赵素容,卢兖伟,陈金龙,等.地黄梓醇降糖作用的实验研究[J].时珍国医国药,2009,20(1):171-172.
[22] YAN JT,WANG CY,JIN Y,et al.Catalpol ameliorates hepatic insulin resistance in type 2 diabetes through acting on AMPK/NOX4/ PI3K/AKT pathway[J].Pharmacol Res,2018,130:466-480.
[23] 易文明,刘铜华.论滋阴解毒法治疗2型糖尿病[J].中华中医药杂志,2015,30(7):2393-2394.
[24] 庞博,赵进喜,王颖辉,等.糖尿病清热解毒治法探讨[J].中华中医药杂志,2011,26(7):1471-1473.
[25] 钟伟才,朱国福,李文龙,等.消渴病病因病机探讨[J].时珍国医国药,2012,23(7):1770-1772.
[26] 陆付耳.中医治疗糖尿病从强调“益气养阴”到兼顾“解毒扶阳”[J].中国中西医结合杂志,2009,29(4):293-295.
[27] 宋福印.试论毒损脑络与糖尿病性脑病[J].北京中医药大学学报,2000,23(5):7-8.
[28] 赵进喜,庞博.中医学“浊”的涵义及其临床意义[J].中医杂志,2009,50(7):581-584
[29] 李洪皎.苦酸制甜法保护2型糖尿病胰岛细胞功能的作用及机制研究[D].北京:北京中医药大学,2007:37-109.
[30] 吕仁和,赵进喜,王世东.糖尿病及其并发症的临床研究[J].新中医,2001,33(3):3-5.
[31] 闫秀峰,倪青,陈世波,等.对林兰糖尿病中医“三型辨证”理论的探讨[J].中医杂志,2005,46(12):885-887.
[32] 谭宏文,葛莉,陈亚民,等.仝小林治疗糖尿病经验[J].中医杂志,2006,47(1):19-20.
[33] 丁英钧,王世东,王颖辉.糖尿病“内热伤阴耗气”基本病机探讨[J].中医杂志,2008,49(5):389-391.
[34] 董振华.祝谌予治疗糖尿病经验举要[J].中国医药学报,1993,8(1):43-46.
[35] 朱玲,钱雅玉.益气养阴法治疗2型糖尿病及对胰岛素抵抗作用机制的研究进展[J].陕西中医,2017,38(9):1313-1314
[36] 徐灿坤.程益春治疗糖尿病经验撷谈[J].山东中医杂志,2010,29(10):717-718.
[37] 朱章志,黄从强,何敏.健脾益气中药对脾气虚2型糖尿病大鼠胰岛素介体的影响[J].中药新药与临床药理,2004,15(2):107-109.
[38] 张木森,张晋峰,叶小娟.浅谈糖尿病从肝郁论治[J].中国中医药现代远程教育,2011,9(9):124-125.
[39] 何雷,唐雪梅.肝失疏泄与糖尿病的相关性探讨[J].环球中医药,2016,9(4):438-440.
[40] 薛玲,石岩.活血化瘀论治糖尿病[J].实用中医内科杂志,2016,30(4):46-47.
[41] 孙冉冉,郑燕飞,李玲孺,等.从中医体质角度探讨2型糖尿病的防治[J].环球中医药,2014,7(5):375-376.
[42] 柯斌,秦鉴.中医对2型糖尿病胰岛素抵抗的认识及治疗进展[J].中医杂志,2010,51(S2):257-259.
[43] 梅笑,郭惠芳.糖尿病与痰湿关系的临床观察[J].南京中医药大学学报,1996,12(1):13-14.
[44] 梅仙月.痰湿体质与糖尿病动脉粥样硬化相关性研究[J].河南中医,2008,28 (2):83-84.