摘要
《素问·上古天真论篇》最早提出“天癸”一词,认为天癸是维持人体生长发育和生命活力的最基本物质。天癸与肾精、肾气、精血、气血、肾阴肾阳均有密切联系。中医学将糖尿病归属于“消渴病”范畴,其发病机制、病理表现及其常见合并症、并发症与“天癸”理论存在一定联系:老年糖尿病患者有着独特的病理特点,天癸亏少,肾精肾气不足,加之代谢失常,低血糖为临床常见并发症;若天癸生而不足,五脏精气薄弱,气滞、血瘀、痰饮、浊毒等病理产物内生,易发为Ⅰ型糖尿病、成人隐匿性自身免疫糖尿病等特殊类型糖尿病;糖尿病合并勃起功能障碍、多囊卵巢综合征等生殖疾患,在中医理论中均与天癸相关;糖尿病合并情志病者多见阴虚内热病机,阴虚包括肾阴、肝血、津液不足,以及天癸和肾精肾气亏虚。在基于天癸理论的糖尿病中医治疗方面,多数医家认为治疗天癸亏虚的要点在于补肾,还需考虑影响天癸施泄的其他脏腑。
The term tiangui was initially introduced in Shang Gu Tian Zhen Lun Pian(Discourse on the True Heaven in High Antiquity) of Su Wen(Plain Questions),suggesting that tiangui represents the most fundamental substance responsible for sustaining human growth,development,and vitality.Tiangui exhibits close associations with kidney essence,qi,blood,yin and yang.In traditional Chinese medicine,diabetes is classified as xiaoke,and its etiology,pathological manifestations,common complications and sequelae correspond to the theory of tiangui:elderly individuals with diabetes present distinctive pathological features.These include tiangui insufficiency,depleted kidney essence and qi,in conjunction with metabolic irregularities,frequently manifest as hypoglycemia,a common clinical complication;in those born with insufficient tiangui,organs deficiencies in essence and qi may provoke the production of internal pathological products such as qi stagnation,blood stasis,phlegm and turbid toxin,predisposing individuals to types of diabetes such as type I diabetes,latent autoimmune diabetes in adults.Diabetes accompanied by erectile dysfunction,polycystic ovary syndrome and other reproductive disorders are interconnected with tiangui in TCM theories.Patients with diabetes and emotional disorders commonly exhibit pathologies yin deficiency and internal heat.This deficiency encompasses insufficiencies in kidney yin,liver blood,body fluids,and deficiency of kidney essence and qi.In the context of TCM treatment of diabetes based on the tiangui theory,most doctors emphasize tonifying the kidney as the key approach for addressing tiangui deficiencies,while considering the influence of other visceral factors affecting tiangui discharge.
作者
刘添娇
朴春丽
LIU Tianjiao;PIAO Chunli(Shenzhen Hospital(Futian)of Guangzhou University of Chinese Medicine,Shenzhen 518000)
出处
《现代中医临床》
2024年第1期85-89,共5页
Modern Chinese Clinical Medicine
基金
国家自然科学基金面上项目(No.82374380)
广东省中医药局科研项目(No.20221329)
深圳市“医疗卫生三名工程”项目(No.SZZYSM202202010)。
关键词
糖尿病
天癸
辨证论治
中医理论
内经
diabetes
tiangui
syndrome differentiation and treatment
TCM theory
Nei Jing
