基于“一气周流”理论论治糖尿病性干眼

Treatment of Diabetic Dry Eye Based on the Theory of “Cyclical Flow of Qi”

摘要: 糖尿病性干眼是糖尿病常见的眼部并发症，属于中医“白涩症”、“神水将枯”等范畴。本文基于黄元御“一气周流”理论，探讨糖尿病性干眼的发病机制与治疗方法，认为该病的核心病机为中土失枢，四维升降失和，导致清阳下陷、浊阴上逆、目窍失养，具体表现为脾土虚弱，湿气困阻；肝木郁滞，疏泄失常；肺金不降，津液无以上承；坎阳亏虚，命门火衰。治疗上以健运脾胃、斡旋中气为主，同时疏肝达木、清降肺热、温补肾阳，以维系周流的稳定状态，为临床辨证治疗提供新思路。

Abstract: Diabetic dry eye is a common ocular complication of diabetes, falling under the categories of “dryness and astringency of the eye” and “imminent exhaustion of the divine water” in traditional Chinese medicine. This paper explores the pathogenesis and treatment of diabetic dry eye based on Huang Yuanyu’s theory of “Cyclical Flow of Qi”. It posits that the core pathogenesis involves the spleen failing to anchor the middle, disrupting the harmonious ascending and descending functions of the four dimensions. This leads to the sinking of clear yang, the rising of turbid yin, and the malnutrition of the ocular orifices. Specifically, it manifests as: weakness of the spleen earth with retention and encumbrance of dampness; stagnation of the liver wood leading to impaired diffusion and discharge functions; failure of lung metal to descend, preventing fluid ascension; and deficiency of kan yang with decline of mingmen fire. Therapeutic approaches primarily focus on strengthening spleen-stomach function and regulating central qi, while concurrently promoting liver qi flow, clearing lung heat, and warming kidney yang. This aims to maintain stable qi circulation, offering new insights for clinical pattern differentiation and treatment.