谈钰濛 胡骏 倪青

摘要 寒热错杂证指寒证、热证错杂并存于机体的一类证候群。《伤寒论》完善了寒热错杂证的辨治体系，形成了“寒热并用”理论，创立一系列寒热同调的方剂。在糖尿病中寒热错杂型的患者也占有一定比例，现在病因、病机等方面论述糖尿病寒热错杂证，并联系《伤寒论》中相关条文及临床上“寒热并用”经方治疗糖尿病的经验，总结了针对该型糖尿病的治疗思路为寒热并用，立足脾胃，斡旋气机，方证对应。

关键词 寒热错杂证;胃热脾寒;胆热脾寒;寒热格拒;上热下寒;伤寒论;糖尿病;治疗思路

Syndrome differentiation of Diabetes from Intermingled Heat and Cold Syndromes

TAN Yumeng，HU Jun，NI Qing

（Department of Endocrinology，Guang′anmen Hospital，China Academy of Chinese Medical Sciences，Beijing 100053，China）

Abstract Intermingled heat and cold syndromes of traditional Chinese medicine（TCM）refers to a class of syndromes that both cold syndrome and heat syndrome appear in human body.Treatise on Cold Pathogenic Diseases perfected the system of distinguishing and treating intermingled heat and cold syndromes，and formed the theory and a series of prescriptions of “combination of cold and heat medicine”.At present，a certain proportion of diabetics are with intermingled heat and cold syndromes.This paper discusses intermingled heat and cold syndromes in diabetes from the aspects of etiology and pathogenesis，and summarizes the treatment experience for this type of diabetes by referring to the relevant provisions in Treatise on Cold Pathogenic Diseases and clinical experience，which can be concluded into the combination of cold and heat medicine，based on the spleen and stomach，regulating qi activity and prescription corresponding to syndromes.

Keywords Intermingled heat and cold syndromes; Stomach heat and spleen cold syndrome; Bile heat and spleen cold syndrome; Syndrome of cold and heat repulsion; Upper heat and lower cold syndrome; Treatise on Cold Pathogenic Diseases; Diabetes; Treatment thoughts

中图分类号：R259文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.05.008

糖尿病属于中医“消渴病”的范畴，对其病症分型尚未统一，中医对于消渴病病因病机的论述十分丰富，如经典的消渴病“上、中、下三消”辨证学说、“阴虚燥热”说、“气阴两虚”说等。随着现代医学对糖尿病认识的不断深入，糖尿病及其复杂并发症的全部临床表现已难以用阴虚燥热理论进行解释。如糖尿病日久发生胃肠神经病变多出现痞满、腹泻等寒热错杂、虚实夹杂的表现。

目前但临床上已有较多关于糖尿病寒热错杂证的报道，病机上有学者也提出“消渴內热的症状是表象，实则是阳气虚衰。”[1]的观点。在糖尿病中医防治指南[2]中将糖尿病辨证分为七型其中就包含了脾虚胃热证、上热下寒证2种寒热错杂的证型。从病机上来说，寒热错杂证主要是由以脾胃（肠）脏腑功能紊乱引起，且与肝疏泄功能失调密切相关[3]。有学者[4]结合临床实践提出“消渴病四经传变”的规律，并认为消渴病上热下寒证为该病传变的关键环节，消渴病首犯阳明，因持续饮食肥甘厚味，导致足太阴脾经亏虚，后因在太阴控制不利，传至厥阴，形成寒热错杂。……