温肾健脾法治疗糖尿病理论探讨
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摘要
导师孙丰雷副教授长期从事临床教学研究,通过大量病例观察,发现糖尿病(DiabetesMellitus,DM)患者患病初期即有阳气受损征象,并随病程日久阳气亏虚愈重,导致病理产物堆积,变证百出。导师指出DM患者多具有阳气虚损,尤以脾肾为重。基于此理论,导师临床擅于运用温肾健脾法治疗DM并获得满意疗效。当前,国内一些学者认识到阳虚在消渴病发病学、病机学中的重要地位,并运用温阳法治疗DM取得较好临床疗效。因此,有必要对中医治疗DM的方法进行深入思考以及重新认识。本文通过查阅大量文献资料,较为详细的介绍了DM现代医学研究进展以及古今中医对于消渴病认识,并结合导师多年临床经验,进一步分析脾肾二脏在DM发病中所占地位,认为脾肾二脏在DM发病中起重要作用,脾肾阳虚为DM重要病机,温肾健脾为本病治疗大法。
My supervisor, associate professor Sun Fenglei has been engaged in clinical teaching and researching for a long time. Through the observations of a large number of cases, he has discovered that the damage of yang has been shown in DM patients in the early period of the illness, and the damage will deteriorate as time goes on, leading to the accumulation of pathological products and various changes of symptoms. My supervisor indicates that the DM damage of yang will especially occur in pi and shen. Therefore, following the principle of treating based on the patient’s condition, my supervisor is good at treatment based on syndrome differentiation. He prescribes and uses medicine refinedly, and has achieved satisfying effectiveness in the treatment of warming shen and invigoration pi. At present, some Chinese scholars have realized the importance of yang asthenia in pathogenesis and pathology of DM, and have achieved good clinical healing efficacy. Therefore, it is essential to rediscover and make further research on the method of the treatment of DM by Chinese medicine. By reading a large amount of articles and papers, I have introduced the progress of the modern medical researches on DM and the knowledge of DM around the world throughout history in this thesis. Besides, combining my supervisor’s clinical experiences, the position of shen and pi in the outbreak of DM has also been analyzed. The thesis comes to a conclusion that pi and shen play a very important role in the outbreak of DM. The yang asthenia of pi and shen is the pathogenesis of DM, and warming shen and invigoration pi is the best method of treating.
My supervisor, associate professor Sun Fenglei has been engaged in clinical teaching and researching for a long time. Through the observations of a large number of cases, he has discovered that the damage of yang has been shown in DM patients in the early period of the illness, and the damage will deteriorate as time goes on, leading to the accumulation of pathological products and various changes of symptoms. My supervisor indicates that the DM damage of yang will especially occur in pi and shen. Therefore, following the principle of treating based on the patient’s condition, my supervisor is good at treatment based on syndrome differentiation. He prescribes and uses medicine refinedly, and has achieved satisfying effectiveness in the treatment of warming shen and invigoration pi. At present, some Chinese scholars have realized the importance of yang asthenia in pathogenesis and pathology of DM, and have achieved good clinical healing efficacy. Therefore, it is essential to rediscover and make further research on the method of the treatment of DM by Chinese medicine. By reading a large amount of articles and papers, I have introduced the progress of the modern medical researches on DM and the knowledge of DM around the world throughout history in this thesis. Besides, combining my supervisor’s clinical experiences, the position of shen and pi in the outbreak of DM has also been analyzed. The thesis comes to a conclusion that pi and shen play a very important role in the outbreak of DM. The yang asthenia of pi and shen is the pathogenesis of DM, and warming shen and invigoration pi is the best method of treating.
引文
[1]周仲英、金实等.中医内科学.北京:中国中药出版社2003:427
[2] World Health Organization. Definition,diagnosis and classification of Diabetes mellitus and its comp lication,report of a WHO consultation [R].Geneva,World Health Organization,1999:1
[3] Wild S,Roglic G,Green A,et al.Global prevalence of diabetes:estimates for the year 2000 and projections for 2030[J].Diabets care,2004,27(5):1047-1053)
[4] Yang W,Lu J,weng J,et al;China National Diabetes and Metabolic Disorders Study Group.Prevalence of diabetes among men and women in China.N Engl J Med,2010,362(12):1090-1101.
[5] Rasmussen SS,Glumer C,Sandbaek A,etal,Determinants of progression from impaired fasting glucose and impaired glucose tolerance to diabetes in a high-risk screened population:3 year follow-up in the ADDITION study ,Denmark[J].Diabetologia,2008,51(2):249-257.
[6] Maciej T.Malecki,Tomasz Klupa.Type 2 diabetes mellitus:from genes to disease.Pharmacological Reports 2005;57:20-32.
[7]周莉,孙子宁.2型糖尿病病因研究进展.实用糖尿病杂志,2007;4(2):56-57
[8] Gable DR, Stephens JW, Cooper JA, et al. Variation in the UCP2-UCP3 gene cluster predicts the development of type 2 diabetes in healthy middle-aged men. Diabetes. 2006; 55(5):1504-11.
[9]纪立农.表型驱动的糖尿病病因学研究.中华医学杂志, 2006; 86(9):4-5
[10] 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
[11] Salmeron J, Hu FB, Manson JE, et al. Dietary fat intake and risk of type 2 diabetes in women[J].Am J Clin Nutr, 2001, 73:1019~1026
[12] Matthias B, Schulze, Kurt Hoffmann, Heiner Boeing, Jakob Linseisen, Sabine Rohrmann, et al.An Accurate Risk Score Based on Anthropometric, Dietary, and Lifestyle Factors to Predict the Development of Type 2 Diabetes[J]. Diabetes Care,2006,30(3):510~515
[13]李英华.2型糖尿病发病与生活事件的相关性.中医临床康复,2004;8(15):2808-2809.
[14] Wild S. Roglic G,Green A,et al .Global Prevalence of diabetes :estimates for the year 2000 and projections for 2030[J] .Diabetes Care,2004,27(5):1047一1053
[15] Harris MI,Flegal KM,Cowie CC,et al; Prevalence of diabetes impaired fasting glucose,and Impaired glucose tolerance in U.S. adults. The Third National Health and Nutrition Examination Survey, 1988一1994[J].1998,21(4):518一524
[16]国家“九五”攻关计划糖尿病研究协作组.中国12个地区中老年人糖尿病患病率调查[J].中华内分泌代谢杂志,2002,18(4):280～284
[17]李立明,饶克勤,孔灵芝,等.中国居民2002年营养与健康状况调查[J].中华流行病学杂志,2005,26(7):478-484.
[18] Stumvoll M,Goldstein BJ, van Haeften TW.Type 2 diabetes: principles of pathogenesis and therapy.Lancet,2005, 365 (9467): 1333-1346
[19] SALTIEL A R, KAHN C R. Insulin signalling and the regulation of glucose and lipid metabolism[J]. Nature,2001, 414: 799-806
[20] FREIDENBERG G R, REICHART D, OLEFSKY J M, et al. Reversibility of defective adipocyte insulin receptor kinase activity in non-insulin-dependent diabetes mellitus. Effect of weight loss[J]. J Clin Invest, 1988, 82: 1398-1406
[21] FRIDLYAND L E, PHILIPSON L H. Reactive species and earlymanifestation of insulin resistance in type 2 diabetes[J]. Diab Obes Metab, 2006, 8: 136-145
[22] Yudkin JS.Insulin resistance and the metabolic syndrome-or the pitfalls of epidemiology[J].Diabetologia,2007,50(8):1576一1586.
[23] Anderson RA. Chromium, glucose intolerance and diabetes[J]. J Am Coll Nutr, 1998,17(6):548-555.
[24] Barbagallo M, Gupta R, Dominguez LJ,et al. Cellular ionic alteration with aging: relation to hypertension and diabetes[J]. J Am Soc Geriatrics, 2000,48:1111-1116.
[25]李春霖.糖尿病治疗的曙光-GLP-1的基础研究与临床应用〔J].中国糖尿病杂志,2009,17(12):附录1.
[26] Carling D.The role of the AMP-aetivated protein kinase in the regulation of energy homeostasis[J]. .Novartis Found Symp,2007,286:72-81
[27] Zhou G,Myers R,Li Y,etal.Role of AMP-aetivated protein kinase in meehanism ofmetformin action[J]. .J Clin Invest,2001,108(8):1167-1174
[28] Kourie JI,Culverson AL,Farrelly PV,etal. Heterogeneous amyloid-formedi on channels as a common cytotoxic mechanism:implications for therapeutic strategies against amyloidosis[J].Cell Bioehem Biophys,2002,36(2-3) 191-207
[29] Whitehouse F,Kruger DF,Fineman M,etal.A randomized study and open-label extension evaluating the long- term effieaey of pramlintide as an adjunct to insulin therapy in type 1 diabetes[J] .Diabetes Care,2002,25(4):724-730.
[30] Hollander PA,Levy P,Fineman MS,etal.Pramlintide as an adjunct to insulin therapy improves long-term glyeemie and weight control in patients with type 2 diabetes:al-year randomized controlled trial[J].Diabetes Care,2003,26(3):784-790.
[31]罗文艳,刘永学. PPAR受体双重/泛激动剂存在的问题及前景[J].中药新药杂志,2008,17(4):279-282.
[32]程益春,孙丰雷.益气健脾法治疗消渴病源流初探[J].山东中医药大学学报,1999,23(3):166-168
[33]张海燕《.黄帝内经》对消渴病的认识[J].中华中医药学刊,2007,25(6):1239-1241
[34]王评.温肾健脾法对脾肾阳虚型糖尿病疗效及生存质量的临床研究[D].广州:广州中医药大学,2010
[35]范新六.明代医家萧京脾肾元气论学术思想研究[D].福州:福建中医学院,2006
[36]萧京.轩岐救正论[M].第一版.北京:中医古籍出版,1983.26
[37]萧京.轩岐救正论[M].第一版.北京:中医古籍出版,1983.34.
[38]萧京.轩岐救正论[M].第一版.北京:中医古籍出版,1983.42.
[39]李梴.医学入门.上海:上海科学技术文献出版社,1997.70
[40]刘素荣,程益春.消渴病病因病机证治纂要[J〕.中医药学刊,2004,22(4):689-691
[41]熊曼琪,范冠杰.胰岛素抵抗的研究思路[J].新中医,2000,32(8):44-45
[42]李德珍.施今墨治疗糖尿病探析[J].中医杂志,2001,42(5):261-262
[43]吕久省,冯志海,吴佳佳,贾逵.吕靖中教授治疗糖尿病临证经验摭拾[J].中医药学刊,2004,22(3):391-392
[44]郭小舟,倪青.林兰教授治疗糖尿病经验介绍[J].新中医,2010,42(2):105-106
[45]贺文广,杨竞,钟丽红.杨竞从脾论治糖尿病的经验[J].上海中医药杂志,2005,39(3):27-28
[46]栗明,栗德林,张敏,赵娜.消渴治疗源流考[J].中医药学报, 2010, (04)
[47]严世芸.许叔微的脾肾观[J].上海中医药杂志,1982,2,25-26
[48]焦庆华,张奋蕾.赵献可《医贯·消渴论》浅析[J].中医药学刊,2002,22(12):2315.
[49]吴大真等.现代名中医糖尿病治疗绝技[M].北京:科学技术出版社,2003:35-39
[50]郭小舟,倪青.林兰教授治疗糖尿病经验介绍[J].新中医,2010,42(2):105-106
[51]唐成玉,朱章志.温阳法在糖尿病治疗中的应用[J].实用中医内科杂志,2007;21(3):76-78.
[52]谭从娥.肾虚证在糖尿病中的分布特征及其免疫遗传机制研究:[D].成都:成都中医药大学,2009 .
[53]李明龙,陈凌,徐德凤.非胰岛素依赖型糖尿病患者的免疫功能研究.上海免疫学杂志,1996,(1):27～28
[54]任彩玲,张钧,黄叔怀.老年糖尿病患者免疫状况分析[J].中国临床康复,2004,21(8):4234.
[55]孙平,王文锐.老年糖尿病中医辨证与细胞免疫关系分析[J].浙江中医药大学学报,2009,33(2):180-182.
[56]冷玉清.脾虚在糖尿病发病中的重要地位.河南中医,1999;19(5):7.
[57]李柏,王爱成.从脾胃论糖尿病发病机制[J].中国中医药信息杂志,2005,12(8):94-95
[58]张延群,李瑛,孔祥梅,等.2080例糖尿病患者证候与并发症相关性流行病学调查报告[J].上海中医药杂志,2000(l):23-25
[59]陈霞波.糖耐量低减与脾不散精[J].浙江中医杂志,2005(3):118-119.
[60]马黎,李军,邓一军.脾胃在消渴病中的作用机制浅谈.实用中医内科杂志,2007,21(6):24-25.
[61]刘振杰,熊莉华,范冠杰.浅谈糖尿病从脾胃论治[J].新中医,2006,8(8):84-85
[62]刘承琴,赵建群. 2型糖尿病胰岛素抵抗重视从脾论治的思路[J].新中医,2003,35(9):28-29
[63]王黎军,陈爱莲,蔡小平.脾弱胃强与糖尿病[J].中医杂质,2006,47(9):717
[64]王凌志,卢健.也议消渴与糖尿病「J].辽宁中医学院学报,2004,6(2):95-96
[65]韩萍.王新陆教授援药理论探析[J].中华中医药学刊,2010, 28(4):701-702
[66]孙丰雷,程益春.脾气虚证与糖尿病及慢性并发症的关系和临床干预[J].辽宁中医杂志,2002, 29(5):259-260
[2] World Health Organization. Definition,diagnosis and classification of Diabetes mellitus and its comp lication,report of a WHO consultation [R].Geneva,World Health Organization,1999:1
[3] Wild S,Roglic G,Green A,et al.Global prevalence of diabetes:estimates for the year 2000 and projections for 2030[J].Diabets care,2004,27(5):1047-1053)
[4] Yang W,Lu J,weng J,et al;China National Diabetes and Metabolic Disorders Study Group.Prevalence of diabetes among men and women in China.N Engl J Med,2010,362(12):1090-1101.
[5] Rasmussen SS,Glumer C,Sandbaek A,etal,Determinants of progression from impaired fasting glucose and impaired glucose tolerance to diabetes in a high-risk screened population:3 year follow-up in the ADDITION study ,Denmark[J].Diabetologia,2008,51(2):249-257.
[6] Maciej T.Malecki,Tomasz Klupa.Type 2 diabetes mellitus:from genes to disease.Pharmacological Reports 2005;57:20-32.
[7]周莉,孙子宁.2型糖尿病病因研究进展.实用糖尿病杂志,2007;4(2):56-57
[8] Gable DR, Stephens JW, Cooper JA, et al. Variation in the UCP2-UCP3 gene cluster predicts the development of type 2 diabetes in healthy middle-aged men. Diabetes. 2006; 55(5):1504-11.
[9]纪立农.表型驱动的糖尿病病因学研究.中华医学杂志, 2006; 86(9):4-5
[10] 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
[11] Salmeron J, Hu FB, Manson JE, et al. Dietary fat intake and risk of type 2 diabetes in women[J].Am J Clin Nutr, 2001, 73:1019~1026
[12] Matthias B, Schulze, Kurt Hoffmann, Heiner Boeing, Jakob Linseisen, Sabine Rohrmann, et al.An Accurate Risk Score Based on Anthropometric, Dietary, and Lifestyle Factors to Predict the Development of Type 2 Diabetes[J]. Diabetes Care,2006,30(3):510~515
[13]李英华.2型糖尿病发病与生活事件的相关性.中医临床康复,2004;8(15):2808-2809.
[14] Wild S. Roglic G,Green A,et al .Global Prevalence of diabetes :estimates for the year 2000 and projections for 2030[J] .Diabetes Care,2004,27(5):1047一1053
[15] Harris MI,Flegal KM,Cowie CC,et al; Prevalence of diabetes impaired fasting glucose,and Impaired glucose tolerance in U.S. adults. The Third National Health and Nutrition Examination Survey, 1988一1994[J].1998,21(4):518一524
[16]国家“九五”攻关计划糖尿病研究协作组.中国12个地区中老年人糖尿病患病率调查[J].中华内分泌代谢杂志,2002,18(4):280～284
[17]李立明,饶克勤,孔灵芝,等.中国居民2002年营养与健康状况调查[J].中华流行病学杂志,2005,26(7):478-484.
[18] Stumvoll M,Goldstein BJ, van Haeften TW.Type 2 diabetes: principles of pathogenesis and therapy.Lancet,2005, 365 (9467): 1333-1346
[19] SALTIEL A R, KAHN C R. Insulin signalling and the regulation of glucose and lipid metabolism[J]. Nature,2001, 414: 799-806
[20] FREIDENBERG G R, REICHART D, OLEFSKY J M, et al. Reversibility of defective adipocyte insulin receptor kinase activity in non-insulin-dependent diabetes mellitus. Effect of weight loss[J]. J Clin Invest, 1988, 82: 1398-1406
[21] FRIDLYAND L E, PHILIPSON L H. Reactive species and earlymanifestation of insulin resistance in type 2 diabetes[J]. Diab Obes Metab, 2006, 8: 136-145
[22] Yudkin JS.Insulin resistance and the metabolic syndrome-or the pitfalls of epidemiology[J].Diabetologia,2007,50(8):1576一1586.
[23] Anderson RA. Chromium, glucose intolerance and diabetes[J]. J Am Coll Nutr, 1998,17(6):548-555.
[24] Barbagallo M, Gupta R, Dominguez LJ,et al. Cellular ionic alteration with aging: relation to hypertension and diabetes[J]. J Am Soc Geriatrics, 2000,48:1111-1116.
[25]李春霖.糖尿病治疗的曙光-GLP-1的基础研究与临床应用〔J].中国糖尿病杂志,2009,17(12):附录1.
[26] Carling D.The role of the AMP-aetivated protein kinase in the regulation of energy homeostasis[J]. .Novartis Found Symp,2007,286:72-81
[27] Zhou G,Myers R,Li Y,etal.Role of AMP-aetivated protein kinase in meehanism ofmetformin action[J]. .J Clin Invest,2001,108(8):1167-1174
[28] Kourie JI,Culverson AL,Farrelly PV,etal. Heterogeneous amyloid-formedi on channels as a common cytotoxic mechanism:implications for therapeutic strategies against amyloidosis[J].Cell Bioehem Biophys,2002,36(2-3) 191-207
[29] Whitehouse F,Kruger DF,Fineman M,etal.A randomized study and open-label extension evaluating the long- term effieaey of pramlintide as an adjunct to insulin therapy in type 1 diabetes[J] .Diabetes Care,2002,25(4):724-730.
[30] Hollander PA,Levy P,Fineman MS,etal.Pramlintide as an adjunct to insulin therapy improves long-term glyeemie and weight control in patients with type 2 diabetes:al-year randomized controlled trial[J].Diabetes Care,2003,26(3):784-790.
[31]罗文艳,刘永学. PPAR受体双重/泛激动剂存在的问题及前景[J].中药新药杂志,2008,17(4):279-282.
[32]程益春,孙丰雷.益气健脾法治疗消渴病源流初探[J].山东中医药大学学报,1999,23(3):166-168
[33]张海燕《.黄帝内经》对消渴病的认识[J].中华中医药学刊,2007,25(6):1239-1241
[34]王评.温肾健脾法对脾肾阳虚型糖尿病疗效及生存质量的临床研究[D].广州:广州中医药大学,2010
[35]范新六.明代医家萧京脾肾元气论学术思想研究[D].福州:福建中医学院,2006
[36]萧京.轩岐救正论[M].第一版.北京:中医古籍出版,1983.26
[37]萧京.轩岐救正论[M].第一版.北京:中医古籍出版,1983.34.
[38]萧京.轩岐救正论[M].第一版.北京:中医古籍出版,1983.42.
[39]李梴.医学入门.上海:上海科学技术文献出版社,1997.70
[40]刘素荣,程益春.消渴病病因病机证治纂要[J〕.中医药学刊,2004,22(4):689-691
[41]熊曼琪,范冠杰.胰岛素抵抗的研究思路[J].新中医,2000,32(8):44-45
[42]李德珍.施今墨治疗糖尿病探析[J].中医杂志,2001,42(5):261-262
[43]吕久省,冯志海,吴佳佳,贾逵.吕靖中教授治疗糖尿病临证经验摭拾[J].中医药学刊,2004,22(3):391-392
[44]郭小舟,倪青.林兰教授治疗糖尿病经验介绍[J].新中医,2010,42(2):105-106
[45]贺文广,杨竞,钟丽红.杨竞从脾论治糖尿病的经验[J].上海中医药杂志,2005,39(3):27-28
[46]栗明,栗德林,张敏,赵娜.消渴治疗源流考[J].中医药学报, 2010, (04)
[47]严世芸.许叔微的脾肾观[J].上海中医药杂志,1982,2,25-26
[48]焦庆华,张奋蕾.赵献可《医贯·消渴论》浅析[J].中医药学刊,2002,22(12):2315.
[49]吴大真等.现代名中医糖尿病治疗绝技[M].北京:科学技术出版社,2003:35-39
[50]郭小舟,倪青.林兰教授治疗糖尿病经验介绍[J].新中医,2010,42(2):105-106
[51]唐成玉,朱章志.温阳法在糖尿病治疗中的应用[J].实用中医内科杂志,2007;21(3):76-78.
[52]谭从娥.肾虚证在糖尿病中的分布特征及其免疫遗传机制研究:[D].成都:成都中医药大学,2009 .
[53]李明龙,陈凌,徐德凤.非胰岛素依赖型糖尿病患者的免疫功能研究.上海免疫学杂志,1996,(1):27～28
[54]任彩玲,张钧,黄叔怀.老年糖尿病患者免疫状况分析[J].中国临床康复,2004,21(8):4234.
[55]孙平,王文锐.老年糖尿病中医辨证与细胞免疫关系分析[J].浙江中医药大学学报,2009,33(2):180-182.
[56]冷玉清.脾虚在糖尿病发病中的重要地位.河南中医,1999;19(5):7.
[57]李柏,王爱成.从脾胃论糖尿病发病机制[J].中国中医药信息杂志,2005,12(8):94-95
[58]张延群,李瑛,孔祥梅,等.2080例糖尿病患者证候与并发症相关性流行病学调查报告[J].上海中医药杂志,2000(l):23-25
[59]陈霞波.糖耐量低减与脾不散精[J].浙江中医杂志,2005(3):118-119.
[60]马黎,李军,邓一军.脾胃在消渴病中的作用机制浅谈.实用中医内科杂志,2007,21(6):24-25.
[61]刘振杰,熊莉华,范冠杰.浅谈糖尿病从脾胃论治[J].新中医,2006,8(8):84-85
[62]刘承琴,赵建群. 2型糖尿病胰岛素抵抗重视从脾论治的思路[J].新中医,2003,35(9):28-29
[63]王黎军,陈爱莲,蔡小平.脾弱胃强与糖尿病[J].中医杂质,2006,47(9):717
[64]王凌志,卢健.也议消渴与糖尿病「J].辽宁中医学院学报,2004,6(2):95-96
[65]韩萍.王新陆教授援药理论探析[J].中华中医药学刊,2010, 28(4):701-702
[66]孙丰雷,程益春.脾气虚证与糖尿病及慢性并发症的关系和临床干预[J].辽宁中医杂志,2002, 29(5):259-260