摘要
糖尿病胃轻瘫是继发于糖尿病的一种慢性消化道并发症,临床上除血糖升高外,还伴有腹胀、痞满、早饱、恶心呕吐等症状,其发病率逐年上升,西医常采用促进胃动力、电刺激等治疗。中医学多将此病归属于脾胃,治疗上强调补脾养胃。“土得木而达”首见于《素问·宝命全形论篇》,体现了脾胃与肝胆之间的相生相制关系。文中基于此理论,进一步阐述脾胃与肝胆的生理联系、病理相关,并发现糖尿病胃轻瘫发病相关的肝肠循环、脑肠轴循环理论,皆与肝胆关系密切。故提出糖尿病胃轻瘫病因源于饮食、情志失宜,导致肝胆疏泄失司、克犯脾胃,或脾胃虚弱、肝胆来犯,发为此病。本病病位在脾胃,与肝胆关系密切,病机应责之于肝胆气机失调、脾胃纳运失司。根据脾胃肝胆的病理关系,将糖尿病胃轻瘫分为土虚木乘、木旺乘土、木郁土壅三种类型,治疗上以“土得木而达”为总则,分别采用疏肝健脾、平肝扶脾、疏肝理脾治法,并佐以化痰、祛湿、清热、化瘀等方法,随证治疗,为临床治疗糖尿病胃轻瘫提供参考。
Diabetic gastroparesis is a chronic gastrointestinal complication secondary to diabetes.Clinically,in addition to elevated blood glucose,patients present with symptoms such as abdominal distension,epigastric fullness,early satiety,nausea,and vomiting.Its incidence has been increasing year by year.In Western medicine,treatment commonly involves promoting gastric motility or using electrical stimulation.In traditional Chinese medicine(TCM),this disorder is generally attributed to dysfunction of the spleen and stomach,with treatment emphasizing strengthening the spleen and nourishing the stomach.The concept of“earth attains smoothness through wood”,first recorded in Plain Questions:Discussion on Preserving Health and Protecting Life,reflects the mutual generation and restriction relationship between the spleen-stomach and the liver-gallbladder systems.Based on this theory,this paper further elaborates on the physiological and pathological correlations between the spleen-stomach and the liver-gallbladder.It is found that modern mechanisms of diabetic gastroparesis,such as the hepato-intestinal circulation and brain-gut axis,are also closely related to the liver and gallbladder.Therefore,it is proposed that the etiology of diabetic gastroparesis lies in improper diet and emotional disturbance,leading to impaired liver-gallbladder dispersion and regulation that attack the spleen and stomach,or spleen-stomach deficiency allowing invasion by the liver and gallbladder.The disease location is in the spleen and stomach,but closely associated with the liver and gallbladder.Its pathogenesis should be attributed to disharmony of liver-gallbladder qi movement and dysfunction of spleen-stomach transportation and transformation.Based on the pathological relationship between the spleen-stomach and liver-gallbladder,diabetic gastroparesis can be categorized into three types,i.e.,“wood overacting on deficient earth”,“excessive wood overacting earth”,and“constrained wood causing stagnation of earth”.The general therapeutic principle is“earth attains smoothness through wood”,with corresponding treatment strategies of soothing the liver and strengthening the spleen,calming the liver and supporting the spleen,or regulating both the liver and spleen.These may be supplemented by methods of resolving phlegm,eliminating dampness,clearing heat,and removing stasis,providing a theoretical and clinical reference for the treatment of diabetic gastroparesis.
作者
陈睿霜
田筱婵
魏军平
CHEN Rui-shuang;TIAN Xiao-chan;WEI Jun-ping(Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053)
出处
《世界中西医结合杂志》
2025年第11期2291-2297,共7页
World Journal of Integrated Traditional and Western Medicine
基金
北京市自然科学基金(7202172)
中国中医科学院中医药循证能力建设项目(60104)
中国中医科学院科技创新工程项目(CI2021A01617)。
关键词
糖尿病胃轻瘫
土得木而达
发病机制
肝脾相关
Diabetic Gastroparesis
Earth Attains Smoothness through Wood
Pathogenesis
Liver-Spleen Correlation
