于世家教授中西医结合治疗新诊断2型糖尿病经验总结（附病案二例）
摘要
糖尿病,是临床常见的内分泌系统疾病之一,其死亡率在发达国家仅次于心血管、恶性肿瘤,成为世界第三大疾病。近年来,世界各国特别是发展中国家2型糖尿病的患病率均有急剧增加的趋势,这也是造成全球糖尿病患者总数剧增的主要原因。随着现代医学对于本病研究的不断深入,新诊断2型糖尿病的合理治疗在2型糖尿病的治疗全程中占有越来越重要的位置。祖国传统医学对2型糖尿病的认识历史悠久,属于祖国医学“消渴”范畴。古代医籍对本病病因病机及辨证论治的记载比较详细。导师于世家教授从事内分泌系统疾病临床研究25年,在糖尿病的中西医结合治疗方面积累了丰富的经验。他认为,传统的“三消”辩证理论已不能满足临床需要,根据消渴的证候表现及舌脉等征象,可将其辨证分为阴虚燥热型、气阴两虚型、气阴两虚兼血瘀型和阴阳两虚兼血瘀型,临床上新诊断2型糖尿病患者以前二者多见。临床治疗中,导师倡导中医辨证与西医辨病相结合的诊断模式,中药改善临床症状、控制并治疗慢性并发症、提高生存质量与西药控制血糖水平、保护β细胞功能、消除胰岛素抵抗因素相结合的治疗模式,中西医优势互补,取得了满意的临床疗效。
As an endocrinopathy, diabetes mellitus, or“tangniaobing”for short in Chinese, is a commonly encountered disease, and the rate of death is next to angiocardiopathy and tumor. For the past few years, the rate of type 2 diabetes is increasing rapidly especially in the developing countries, in the wake of the elevation of the living standard and the number of adipositas. It is the main reason why the accrescence of grand total of diabetics is so rapid. More and more clinical evidences confirm, rational therapy of newly diagnosed type 2 diabetes mellitus is more and more important in the prog. Knowledge about diabetes mellitus in the Traditional Chinese Medicine theory has a long history. Diabetes mellitus is usually regarded as the category of“XiaoKe”. In Traditional Chinese Medicine ancient books, diabetes mellitus have been described in detail. Professor Yu Shi-jia, is engaged in treating diabetes with integrated Traditional Chinese Medicine and Western Medicine for 25 years. In his opinion, the orthodox theory of three types of diabetes can not satisfy the clinical demands, according to different clinical presentations and the signs of tongue and pulse, there are four syndromes of diabetes, yin asththenia and dryness-heat, deficiency of both vital energy and yin, deficiency of both vital energy and yin and blood stasis, asthenia of both of yin and yang and blood stasis.The first and the second types are commom in newly diagnosed type 2 diabetes mellitus. Prof. Yu advocates the principal of treating diabetes with integrated Traditional Chinese Medicine and Western Medicine, the diacrisis mode of the combination of differential diagnosis of diseases and differentiation of symptoms and signs Western medicine controls the blood glucose, abscises the factors of insulin resistance, and Chinese medicine improves clinical complaints, controls chronic concurrent diseases, improves quality of life, derived satisfactory curative effects.
As an endocrinopathy, diabetes mellitus, or“tangniaobing”for short in Chinese, is a commonly encountered disease, and the rate of death is next to angiocardiopathy and tumor. For the past few years, the rate of type 2 diabetes is increasing rapidly especially in the developing countries, in the wake of the elevation of the living standard and the number of adipositas. It is the main reason why the accrescence of grand total of diabetics is so rapid. More and more clinical evidences confirm, rational therapy of newly diagnosed type 2 diabetes mellitus is more and more important in the prog. Knowledge about diabetes mellitus in the Traditional Chinese Medicine theory has a long history. Diabetes mellitus is usually regarded as the category of“XiaoKe”. In Traditional Chinese Medicine ancient books, diabetes mellitus have been described in detail. Professor Yu Shi-jia, is engaged in treating diabetes with integrated Traditional Chinese Medicine and Western Medicine for 25 years. In his opinion, the orthodox theory of three types of diabetes can not satisfy the clinical demands, according to different clinical presentations and the signs of tongue and pulse, there are four syndromes of diabetes, yin asththenia and dryness-heat, deficiency of both vital energy and yin, deficiency of both vital energy and yin and blood stasis, asthenia of both of yin and yang and blood stasis.The first and the second types are commom in newly diagnosed type 2 diabetes mellitus. Prof. Yu advocates the principal of treating diabetes with integrated Traditional Chinese Medicine and Western Medicine, the diacrisis mode of the combination of differential diagnosis of diseases and differentiation of symptoms and signs Western medicine controls the blood glucose, abscises the factors of insulin resistance, and Chinese medicine improves clinical complaints, controls chronic concurrent diseases, improves quality of life, derived satisfactory curative effects.
引文
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13.Agata Kubaszek,Jussi Pihlajam a ki,Vladislav Komarovski,et a1.Promoter Polymorphisms of the TNF-d(G-308A)and IL-6(C-174G)Genes Predict the Conversion From Impaired Glucose To lerance to Type 2 Diabetes[J].Diabetes,2003,52:1872-1876.
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17.Rob M.van Dam.Walter C.Willett,Etic B.Rimm,et a1.Dietary Fat and Meat Intake in Relation to Risk of Type 2 Diabetes in Men[J].Diabetes Care,2002,25:417-424.
18.Salmeron J,Hu FB,M anson JE,et a1.Dietary fat in take and risk of type 2 diabetes in women[J].Am J Clin Nutr,20O1,73:1019-1026.
19.Poitout,Vincent,Robettaon,et a1. dary ell failure in type 2 diabetes a convergence of glcotoxiety and lipotocicity[J].ndocrinology,2OO2,143(2):339.
20.惠晓丽,王惠芳,姚孝礼.β细胞凋亡与2型糖尿病[J].国外医学.内分泌学分册,2OO5,25 (1):22-25.
21.Baner jiMA,Chaiken RL,Lebovitz HE Long-term nomoglycemic remission in black newly diagnosed NDDM subject[J].Diabetes,1996,45(3):337-341.
22.王忆黎.试述2型糖尿病炎症发病说对中医临床的意义[J].浙江中医学院学报,2003,5 (3):20.
23.杨文英,邢小燕,林红,等.高甘油三酯血症是非胰岛素依赖型糖尿病发病的危险因素[J].中华内科杂志,1995,34(9):583-586.
24.Sail EL,Konarkowska B,Zhang S,et a1.Ultrastructural evidence that apeptoslsis the mechanism by which human amlyh evokes death in RINm5F pancreatic islet beta cells[J].Cell Bid Int,2001,(25):339-350.
25.Ritzel RA,Bulter Pc.Replication increases beta-cell vunerability to human islet amyloid polypeptide induced apoptosis[J].Diabetes,2003,(52):1701-1708.
26.王永标,倪其猛,张桂才,等.中西医结合疗法干预治疗2型糖尿病临床研究[J].中国中医药信息杂志,2006,11(11):76-77.
27.林兰,倪青,董彦敏.糖尿病中西医结合研究的思路与方法[J].医学研究通讯,2001,30(9):49-51.
28.杨春梅,张志惠.中医治疗糖尿病[J].中华临床医学研究杂志,2007,7(14):2072-2073.
29.赵希森,崔洪真.以舌脉分型治疗2型糖尿病[J].医学理论与实践,2003,16(2):136-137.
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31.焦晓明.从气血津液辨证论治糖尿病86例疗效观察[J].新中医,2002,34(1O):33-34.
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2、刘喜明,周韩军.中医治疗2型糖尿病临床研究的回顾、反思与展望[J].中国医药学报, 2003,18(6):360-362.
3、雷载权.中药学[M].上海科学技术出版社,1995年6月第1版:280.
4、陈新谦等.新编药物学(第15版) [M].人民卫生出版社,2004年6月第1版:732.
5、Shichiri M,KishiKawa H,Insulin treatment of noninisulin-dependent diabetes mellitus:strict glycemic control and its effect on insulin sensintivity.In Prevention and Treatment of NIDDM.GoTO Y,Lee TH,Kaneko T,Shigeta Y,Eds London,Smith-Gordon,1992,459-462。
1.刘喜明,周韩军.中医治疗2型糖尿病临床研究的回顾、反思与展望[J].中国医药学报,2003,18(6):360-362.
2.朱桂林.中医治疗糖尿病进展.职业与健康[J].2001,8(8):100-101.
3.周叔平.试论糖尿病气虚为本[J].新中医,1999,31(2):5-6.
4.卓国强,张才华.治疗糖尿病应注意从肝论治[J].四川中医,1992,(6):10-11.
5.常其壮,常湘云.中西医结合治疗糖尿病的临床观察[J].中国中西医结合杂志,1998,18(11):674-676.
6.官惠文.从痰瘀论治老年型糖尿病[J].新中医,1998,30(6):60.
7.崔继东,周可金.中西药合用治疗2型糖尿病30例[J].实用中医药杂志,2001,1(1):20.
8.王如沾,曲卫毅.论毒与糖尿病[J].山东中医杂志,1999,18(8):339-341.
9.毕艳. 2型糖尿病病人早期胰岛素分泌功能受损的研究进展[J].中国糖尿病杂志,2003,11(1):63-64.
10.Blbanya JC,Pant LN,Mbanya DN,et a1.Reduced insulin secretion in of spring of African type 2 diabetic parents[J].Diabetes Care,2000,(23):176.
11.Virpi I.Lindi,Matti I.J,Uusitupa,et a1.Association of the Prol2Ala Polymorphism in the PPAR-72 Gene With 3-Year Incidence of Type 2 Diabetes and Body Weight Change in the Finnish Diabetes Prevention Study[J].Diabetes,2002,51:2581-2586.
12.Deeb SS,Fajas L,Nemoto M ,et a1.A Prol2Ala substitution in PPARγ2 assosiated with decreased receptor activity,lower body mass index and improved insulin sensitivity[J].Nat Genet,1998,20:284-287.
13.Agata Kubaszek,Jussi Pihlajam a ki,Vladislav Komarovski,et a1.Promoter Polymorphisms of the TNF-d(G-308A)and IL-6(C-174G)Genes Predict the Conversion From Impaired Glucose To lerance to Type 2 Diabetes[J].Diabetes,2003,52:1872-1876.
14.陈陵霞. 2型糖尿病家系Calpainl0基因多肽性研究[J].中华医学杂志,2003,83(21): 1856-1859.
15.Baier L J,Permana P A,Yang X,et a1.A calpain-10 gene polymer phism is associated with reduced muscle mRNA levels and insulin resistance[J].J Clin Invest,2000,1O6: 69-73.
16.Noriyuki Nakanishi,Kenji Suzuki,Kozo Tatara. Alcohol Consumption and Risk for Development of Impaired Fasting Glucose or Type 2 Diabetes in Middle-Aged Japanese Men[J].Diabetes Care,2003,26:48-54.
17.Rob M.van Dam.Walter C.Willett,Etic B.Rimm,et a1.Dietary Fat and Meat Intake in Relation to Risk of Type 2 Diabetes in Men[J].Diabetes Care,2002,25:417-424.
18.Salmeron J,Hu FB,M anson JE,et a1.Dietary fat in take and risk of type 2 diabetes in women[J].Am J Clin Nutr,20O1,73:1019-1026.
19.Poitout,Vincent,Robettaon,et a1. dary ell failure in type 2 diabetes a convergence of glcotoxiety and lipotocicity[J].ndocrinology,2OO2,143(2):339.
20.惠晓丽,王惠芳,姚孝礼.β细胞凋亡与2型糖尿病[J].国外医学.内分泌学分册,2OO5,25 (1):22-25.
21.Baner jiMA,Chaiken RL,Lebovitz HE Long-term nomoglycemic remission in black newly diagnosed NDDM subject[J].Diabetes,1996,45(3):337-341.
22.王忆黎.试述2型糖尿病炎症发病说对中医临床的意义[J].浙江中医学院学报,2003,5 (3):20.
23.杨文英,邢小燕,林红,等.高甘油三酯血症是非胰岛素依赖型糖尿病发病的危险因素[J].中华内科杂志,1995,34(9):583-586.
24.Sail EL,Konarkowska B,Zhang S,et a1.Ultrastructural evidence that apeptoslsis the mechanism by which human amlyh evokes death in RINm5F pancreatic islet beta cells[J].Cell Bid Int,2001,(25):339-350.
25.Ritzel RA,Bulter Pc.Replication increases beta-cell vunerability to human islet amyloid polypeptide induced apoptosis[J].Diabetes,2003,(52):1701-1708.
26.王永标,倪其猛,张桂才,等.中西医结合疗法干预治疗2型糖尿病临床研究[J].中国中医药信息杂志,2006,11(11):76-77.
27.林兰,倪青,董彦敏.糖尿病中西医结合研究的思路与方法[J].医学研究通讯,2001,30(9):49-51.
28.杨春梅,张志惠.中医治疗糖尿病[J].中华临床医学研究杂志,2007,7(14):2072-2073.
29.赵希森,崔洪真.以舌脉分型治疗2型糖尿病[J].医学理论与实践,2003,16(2):136-137.
30.冯文才,黄晓峰,陈楚华.辨证治疗2型糖尿病300例临床观察[J].河北中医,2002,24(5):336-337.
31.焦晓明.从气血津液辨证论治糖尿病86例疗效观察[J].新中医,2002,34(1O):33-34.
32.王锁欣.中西医结合诊治2型糖尿病的思路和方法[J].时珍国医医药,2005,16(12):1320 -1321.
33.朱震.活血化瘀法治疗2型糖尿病23例临床观察[J].江苏中医药,2007,39(5):37.
34.王福仁,陈波.从脾虚挟湿挟瘀论治2型糖尿病[J].中国中医药信息杂志,2000,7(1):53.
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