张一 倪青

摘要 糖尿病的发生与营卫失调密切相关，其病机从营气论治可结合血虚、血瘀、血浊、血毒等方面，从卫气论治可结合外感、肥胖、消瘦、久坐等方面。桂枝汤作为“仲景群方之魁”，专治营卫失调之病证。结合现代药物药理及临床研究，桂枝汤具有体温双向调节，降血糖，抗炎、抗菌、抗病毒，促汗腺分泌，保护心血管、改善心功能，调节胃肠蠕动等功能。关于糖尿病营卫失调相关疾病，如糖尿病合并外感、糖尿病泌汗功能异常、糖尿病心脏自主神经病变及糖尿病胃肠功能紊乱亦可应用桂枝汤进行治疗。

关键词 营卫失调;营气证;卫气证;糖尿病;桂枝汤;现代药理研究;临床研究;名医经验

Investigation of the Mechanism of Disharmony between Nutrient Qi and Defensive Qi Contributing

to Diabetes and the Application of Guizhi Decoction in Lowering Blood Sugar

ZHANG Yi1，NI Qing2

（1 Beijing University of Chinese Medicine，Beijing 100029，China; 2 Department of Endocrinology，Guang′anmen

Hospital，China Academy of Chinese Medical Sciences，Beijing 100053，China）

Abstract The occurrence of diabetes is closely related to the imbalance of nutrient qi（ying）and defensive qi（wei）.The pathogenesis of diabetes can be explained as a combination of blood deficiency，blood stasis，blood turbidity and blood toxin from ying qi，and of exogenous，obesity，emaciation and sedentary from wei qi.Guizhi Decoction，as “the chief of Zhongjing′s prescription”，is specialized in treating diseases and syndromes of disharmony between nutrient qi and defensive qi.Combined modern pharmaceutical pharmacology with clinical research，Guizhi Decoction has the functions of two-way regulation of body temperature，hypoglycemia，anti-inflammatory，antibacterial，anti-virus，promoting sweat gland secretion，protecting cardiovascular system，improving cardiac function，regulating gastrointestinal peristalsis，etc.Guizhi Decoction can also be used in the treatment of diabetes related diseases with syndromes of disharmony between nutrient qi and defensive qi，such as diabetes with exogenous pathogens，diabetes with abnormal sweating function，diabetes with cardiac autonomic neuropathy and diabetes with gastrointestinal dysfunction.

Keywords Disharmony between nutrient qi and defensive qi; Nutrient qi syndrome; Defensive qi syndrome; Diabetes mellitus; Guizhi Decoction; Modern pharmacological research; Clinical research; Experience of famous doctor

中圖分类号：R242文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.05.010

糖尿病是由于胰岛素缺乏和（或）胰岛素生物作用障碍导致的以慢性持续高血糖为主要特征的代谢性疾病[1]。流行病学调查显示，目前全球范围内20～79岁成年人中糖尿病总患病率为8.8%，约为4.25亿。我国20～79岁成年人糖尿病总患病率为10.9%，约为1.14亿，且在逐年增加，2017年中国范围内约有84万人死于糖尿病，给社会和经济带来了巨大的负担[2]。糖尿病作为慢性终身性疾病，西医方面尚无根治方案，仅限于控制血糖、减缓病情及并发症发展，且西药降糖不良反应等现象较为多见。

中医治疗讲究辨证论治，将人作为有机的整体协同调节，以达调和脏腑阴阳气血，疏通气机的目的，可有效降低血糖、缓解患者不适症状，且不良反应较小。糖尿病属于中医“消渴”“肥胖”等范畴。……