摘要
肝失疏泄,脾失健运,厚腻之品郁滞中焦变生脂浊是2型糖尿病合并非酒精性脂肪性肝病的主要病机,肝脾失调是其发病关键。张仲景言:“见肝之病,知肝传脾,当先实脾”,提出肝脾同调理论,治肝兼顾实脾,治脾兼顾疏肝,增强肝脾一体的协同作用,使肝脾调和,糖浊得消。肝阴亏损及脾证,宜益胃调脾养肝阴,方选乌梅丸;肝蕴湿热犯脾证,宜降胃下火泻肝热,方选大柴胡汤;肝滞痰凝困脾证,宜疏肝和脾消痰浊,方选柴胡桂枝干姜汤;肝旺气滞耗脾证,宜运脾理气平肝逆,方选四逆散加减;肝血瘀结阻脾证,宜益脾调肝化浊瘀,方选桃核承气汤。
The primary pathogenesis of type 2 diabetes mellitus(T2DM)with non-alcoholic fatty liver disease(NAFLD)involves liver dysfunction in dispersing and spleen dysfunction in transportation.This condition arises from rich,greasy foods stagnating in the middle energizer,transforming into lipid turbidity.The imbalance between the liver and spleen is a key factor in the disease′s development.Phlegm-dampness stagnation and lipid turbidity accumulation form a vicious cycle,ultimately leading to a combination of diabetes and liver stasis.Zhang Zhongjing stated:"When treating liver diseases,it is important to be aware that liver diseases tend to affect the spleen.Therefore,it is necessary to first enhance the function of the spleen to prevent the liver disease from spreading to it."This proposes the theory of liver-spleen coordination.This approach treats the liver while reinforcing the spleen and vice versa,promoting liver-spleen synergy to achieve balance and resolve lipid turbidity.For syndrome of liver yin deficiency harming the spleen,the treatment should focus on nourishing the liver yin and harmonize the spleen using Mume Pill.For syndrome of liver dampness-heat invading the spleen,the treatment should focus on clearing stomach heat and relieving liver heat using Major Bupleurum Decoction.For syndrome of liver yin deficiency harming the spleen,the treatment should focus on nourishing the liver yin and harmonize the spleen using Mume Pill.For syndrome of liver dampness-heat invading the spleen,the treatment should focus on clearing stomach heat and relieving liver heat using Major Bupleurum Decoction.For syndrome of liver stagnation with phlegm obstructing the spleen,the treatment should focus on soothing the liver,harmonizing the spleen,and resolving phlegm turbidity using Bupleurum and Cinnamon Twig and Dried Ginger Decoction.For syndrome of excessive liver qi consuming spleen energy,the treatment should focus on promoting spleen function,regulating qi,and calming liver reversal using Modified Frigid Extremities Powder.For syndrome of liver blood stasis obstructing the spleen,the treatment should focus on Supplementing the spleen,regulating the liver,and resolving stasis and turbidity using Peach Kernel Qi-Guiding Decoction.
作者
孙晓夏
王旭
孙晓聪
SUN Xiaoxia;WANG Xu;SUN Xiaocong(Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing,Jiangsu,China,210029;First Clinical Medical College of Nanjing University of Chinese Medicine,Nanjing,Jiangsu,China,210029)
出处
《河南中医》
2025年第1期6-10,共5页
Henan Traditional Chinese Medicine
关键词
2型糖尿病
非酒精性脂肪性肝病
肝脾同调
《金匮要略》
张仲景
type 2 diabetes mellitus
non-alcoholic fatty liver disease
liver-spleen coordination
Synopsis of the Golden Chamber
Zhang Zhongjing
作者简介
孙晓夏(1999-),女,山东济南人,硕士研究生;通信作者:王旭,E-mail:1244848252@qq.com。
