糖尿病从太阴阳明论治刍议

A Preliminary Discussion on the Treatment of Diabetes Based on the Theory of Tai-Yin and Yang-Ming

摘要: 2型糖尿病(T2DM)已日渐成为严重威胁人类健康的世界性公共卫生问题，其病因和发病机制仍未完全阐明。该文从太阴阳明这一切入点出发，深挖其理论内涵，深入阐述太阴阳明与T2DM的关系，揭示了T2DM的本质病机为太阴脾虚、阳明燥热，病机以太阴脾虚为本、阳明燥热为标，指出太阴阳明本虚标实贯穿T2DM全程，始于太阴脾虚，继发阳明燥热。基于此病机下，提出“糖炎病”理论，并将糖尿病分期与太阴阳明相联系，提出关糖尿病全程与火相关，阐述“糖炎病”的理论内涵，表明太阴阳明在T2DM的重要指导地位，提出治法以补太阴脾虚为要，同时注重阳明燥热的论治，有望为中医药论治糖尿病提供新的思路参考。

Abstract: Type 2 diabetes mellitus (T2DM) has increasingly become a global public health issue that poses a serious threat to human health, yet its etiology and pathogenesis remain incompletely elucidated. This article adopts the perspective of Taiyin-Yangming theory as an entry point to delve into its theoretical foundations, thoroughly examine the relationship between Taiyin-Yangming and T2DM, and reveal that the essential pathogenesis of T2DM lies in spleen deficiency of Taiyin and dryness-heat of Yangming, with spleen deficiency of Taiyin serving as the root cause and dryness-heat of Yangming as the manifestation. It further demonstrates that the fundamental deficiency of Taiyin-Yangming and the manifestation excess throughout the entire course of T2DM originate from spleen deficiency of Taiyin and subsequently develop into dryness-heat of Yangming. Based on this pathogenesis, the “glycotoxic disease” theory is proposed, linking diabetic progression stages to Taiyin-Yangming dynamics and asserting that the entire course of diabetes is associated with fire pathogenesis. The theoretical framework of “glycotoxic disease” is elaborated, highlighting the pivotal guiding role of Taiyin-Yangming in T2DM management. Treatment strategies are emphasized to address spleen deficiency of Taiyin while concurrently addressing dryness-heat of Yangming, offering potential new insights for traditional Chinese medicine approaches in diabetes management.