林湘东，向茗，陈新宇

〔摘要〕 基于脏腑整体观，本文从脾胃、肝胆、肾命门及心肺4部分详细论述糖尿病的病因病机和治法方药，提出膏浊困脾、肝失疏泄、肾失气化、心肺失调导致“脾不散精”是糖尿病发病的关键因素。临证将其分为膏浊困脾、中满内热、脾胃虚损、肝郁化火、肝郁脾虚、肝肾阴虚、胆郁痰扰、肾阴亏虚、肾阳亏虚、阴阳两虚、气阴两虚、痰瘀互结基本证侯，治以健脾和胃、开郁清热、疏肝理脾、清肝泻火、滋补肝肾、滋阴补阳、益氣养阴、化痰通络等法。

〔关键词〕 糖尿病;脏腑辨证;健脾和胃;疏肝理脾;滋补肝肾;化痰通络

〔中图分类号〕R255.4        〔文献标志码〕B       〔文章编号〕doi：10.3969/j.issn.1674-070X.2021.11.024

Treating Diabetes Based on the Holistic View of Zang-fu Organs

LIN Xiangdong1， XIANG Ming2， CHEN Xinyu1*

（1. The First Affiliated Hospital of Hunan University of Chinese Medicine， Changsha， Hunan 410007， China; 2. Department of Diagnostics in Chinese Medcine， Hunan University of Chinese Medicine， Changsha， Hunan 410208， China）

〔Abstract〕 Based on the holistic view of Zang-fu organs， this article elaborates the etiology， pathogenesis and prescription of diabetes from four parts： spleen and stomach， liver and gallbladder， kidney and Mingmen， heart and lungs. It is proposed that spleen impaired by Gaozhuo， failure of liver to convey and disperse， disfunction of kidney for activation of Qi and cardiopulmonary disorders leading to “spleen failing to disperse nutrients” are the key factors in the onset of diabetes. Clinical syndromes are divided into basic syndromes of spleen impaired by Gaozhuo， middle full internal heat， deficiency of spleen and stomach， liver stagnation and generates fire， liver stagnation and spleen deficiency， liver stagnation and kidney Yin deficiency， bile stagnation and phlegm disturbance， deficiency of kidney Yin， deficiency of kidney Yang， deficiency of Yin and Yang， deficiency of Qi and Yin， and mutual knot of phlegm and stasis. The treatment methods include： invigorating the spleen and stomach， relieving stagnation and clearing away heat， soothing the liver and regulating the spleen， clearing liver-fire， nourishing the liver and kidney， nourishing Yin and tonifying Yang， nourishing Qi and Yin， eliminating phlegm and freeing channels.

〔Keywords〕 diabetes; Zang-fu syndrome differentiation; invigorating the spleen and stomach; soothing the liver and regulating the spleen; nourishing the liver and kidney; eliminating phlegm and freeing channels

糖尿病是一组由多种原因引起的以慢性高血糖为特征的代谢性疾病。《中国2型糖尿病防治指南》（2020版）流行病学调查显示：我国糖尿病患病率仍在上升，18岁及以上人群糖尿病患病率为11.2%，其中2型糖尿病占90%以上[1]。因此，防治糖尿病的工作任重道远。

中医学无专有糖尿病病名，中医典籍中关于“消渴”“消瘅”的论述与糖尿病的典型症状相似，《外台秘要·消中消暑肾消》引《古今录验》“渴而饮水多，小便数，无脂，似麸片甜者，皆是消渴病也”。当今医家多从肺、胃、肾三脏治疗糖尿病。《灵枢·五变》云：“五脏皆柔弱者，善病消瘅。”据此，本文基于脏腑整体观论治糖尿病如下。

1 从脾胃论治

脾主运化水谷和水液，主升清，将水谷精微转输于心、肺、头目等以营养全身;胃主受纳、腐熟水谷，主通降，在脾的运化作用下将水谷化为精微物质。脾升胃降，为机体气机升降之枢纽，共同完成饮食物的消化吸收及其精微的输布，营养全身，为人体“后天之本”。……