气血津液视域下糖尿病时空辨证的序贯诊疗模式刍议OA北大核心

The dysfunction of qi,blood,and fluid underlies the pathology of diabetes mellitus.The symptoms,signs,and physical and chemical indexes of diabetes mellitus patients reflect the duration,degree,primary and secondary pathological state of the abnormal metabolism of qi,blood,and fluid.It is necessary to construct a three-dimensional syndrome differentiation system of diabetes mellitus based on spatial and temporal dimensions.According to the four stages of depression,heat,deficiency,and damage,the location of the disease can be locked into qi,ying,and blood levels.The process reflects the pathological trend of the abnormal metabolism of qi,blood,and fluid:qi depression(prodromal stage:asymptomatic metabolic disorder/early stage of qi level)→ qi heat(initial stage:index stage/late stage of qi level)→ deficiency of both qi and yin(middle stage:symptom stage of three more and one less/stage of ying level)→ damage of zang-fu viscera and meridians(late stage:complication stage/stage of blood level).According to the time process,the treatment principles are proposed as follows:during the early stage of qi level,treatment should focus on strengthening the spleen to regulate qi flow,to prevent the accumulation of glucose;during the late stage of qi level,treatment should focus on clearing heat and resolving turbidity,to remove the stagnated heat caused by glucose;during the stage of ying level,treatment should focus on benefiting qi and nourishing yin,to improve the symptoms about deficiency of both qi and yin;during the stage of blood level,treatment should focus on promoting blood circulation and removing blood stasis,to remove the complication.According to the etiology and pathogenesis of diabetes mellitus,the sequential treatment strategy is thus proposed,which is strengthening the spleen to regulate qi flow,clearing heat and resolving turbidity,benefiting qi and nourishing yin,and promoting blood circulation and removing blood stasis.The compound prescriptions such as Houpo Sanwu Decoction,Baihu Jia Renshen Decoction,Danggui Liuhuang Decoction,and Taohong Siwu Decoction are used with modification in the stage-based treatment.