摘要
中医“形气神”三位一体生命观是中医阐释生命活动的核心内涵,强调形质结构、气化功能与神机调控的动态统一。通过三者的辩证关系,即“形为神气之宅”“气为形神之枢”“神为形气之主”,构建起物质–能量–信息交互的生命模型。糖尿病脑病作为消渴日久伤脑的严重并发症,以认知衰退、情志异常为特征,其病理机制与高糖诱导的神经炎症、代谢紊乱及神经网络损伤密切相关。本团队基于中医原创思维,认为糖尿病脑病病机遵循“形损–气乱–神衰”序贯致病损伤体系:形损阶段,消渴燥热伤津、气虚血瘀,导致代谢浊毒壅滞脑络,血脑屏障被破坏而髓海失充;气乱阶段,出现中焦枢机失运,清阳不升则脑失温煦,浊阴不降则痰瘀内生,脑葡萄糖代谢率显著下降;神衰阶段,肾精亏虚致髓海不足,心肾不交致神机失统,神经网络可塑性受损,临床呈现记忆与执行功能障碍。治疗遵循三元协同策略:调形以固本,运用虫类药破瘀通络,配合血肉有情之品填精补髓以修复微结构;调气以复枢,以升清降浊法调节中焦气机,改善胰岛素抵抗及脑能量代谢;调神以启窍,取养脑益智法滋养心肾、开窍醒神,改善海马神经元损伤及突触可塑性。从“固形质–复气化–醒神机”三层次干预,为糖尿病脑病临床防治提供病证结合、形神共治的新思路。
The Xing(形)-Qi(气)-Shen(神)trinity life concept in traditional Chinese medicine(TCM)serves as the core connotation for interpreting life activities,emphasizing the dynamic unity of physical structure,Qi transformation function,and spiritual-mental regulation.Rooted in the dialectical relationship among the three factors,namely“Xing is the residence of Qi and Shen”,“Qi is the pivot connecting Xing and Shen”,and“Shen governs Xing and Qi”,a life model of matter-energy-information interaction is constructed.Diabetic encephalopathy,as a severe complication of prolonged diabetes affecting the brain,is characterized by cognitive decline and emotional disorders,with pathological mechanisms closely associated with neuroinflammation,metabolic dysfunction,and neural network damage induced by hyperglycemia.Based on the original thinking of TCM,the team posits that the pathogenesis of diabetic encephalopathy follows the sequential pathogenic pathway system of“Xing damage-Qi disorder-Shen depletion”.During the stage of Xing damage,due to dry-heat injuring bodyfluid and Qi deficiency and blood stasis in diabetes,metabolic turbid toxins are obstructed in cerebral collaterals,and the blood-brain barrier is damaged,resulting in the insufficiency of the marrow sea.During the stage of Qi disorder,dysfunction of the middle energizer disrupts the balance of clear Yang(阳)ascending and turbid Yin(阴)descending,leading to inadequate brain nourishment,internal accumulation of phlegm-stasis,and reduced cerebral glucose metabolism.During the stage of Shen depletion,kidney essence deficiency weakens the brain’s foundational support,while heart-kidney disharmony disrupts spiritual-mental control,impairing neural plasticity and manifesting as memory and executive function disorders.The treatment adopts a triune synergistic approach.First,adjusting Xing to consolidate the root,namely,using insect-derived medicines to break blood stasis and unblock collaterals,and combining with animal-based tonics to replenish essence and marrow to repair neural microstructures.Second,regulating Qi to restore the pivot,specifically,the method of elevating clear Yang and descending turbid Yin is used to regulate middle energizer Qi to ameliorate insulin resistance and cerebral energy metabolism.Third,regulating Shen to open the orifices,specifically,the method of brain-nourishing and wisdom-enhancing is used to tonify heart-kidney and restore sensory clarity,ameliorating hippocampal neuronal injury and synaptic plasticity.This three-tier intervention of“consolidating Xing-restoring Qi transformation-awakening Shen”offers a novel integrative approach of combining disease and syndrome and treating both the body and Shen in the prevention and treatment of diabetic encephalopathy.
出处
《中医临床研究》
2025年第22期117-122,共6页
Clinical Journal Of Chinese Medicine
基金
国家社会科学基金项目(18XMZ031)。
关键词
形气神
糖尿病脑病
病机
治疗策略
机制探讨
Xing-Qi-Shen
Diabetic encephalopathy
Pathogenesis
Therapeutic strategy
Mechanistic exploration
