基于“君火不煦脾土”理论辨治糖尿病共病抑郁

Treatment of Diabetes Mellitus Complicated with Depression Based on the Theory of “Monarch Fire Does Not Warm Spleen Soil”

摘要: 糖尿病已成为全球性的慢性代谢性疾病，其核心病理特征为胰岛素抵抗或胰岛素分泌不足，长期可累及多脏腑功能损伤。现代医学发现，2型糖尿病(Type 2 Diabetes Mellitus, T2DM)患者中抑郁的患病率约为普通人群的2倍，二者并存不仅加重病情，严重影响生活质量，也增加了治疗难度与死亡风险。糖尿病属中医“消渴”范畴，抑郁可归于“郁证”，本文基于“君火不煦脾土”理论，系统阐述糖尿病合并抑郁的病因病机，君火不煦，不能温养脾土，导致脾失健运、气血亏虚，进而心神失养、肝气郁结，是二者并见的病理核心。文中结合现代研究，分析该理论指导下的中医药治疗糖尿病合并抑郁的临床价值与应用前景，为中医辨治这一复杂共病提供理论依据和实践思路。

Abstract: Diabetes mellitus has become a global chronic metabolic disorder, characterized centrally by insulin resistance or insufficient insulin secretion. Its long-term progression may lead to functional impairment of multiple internal organs. Modern medical research has demonstrated that the prevalence of depression in patients with type 2 diabetes mellitus (T2DM) is nearly twice that in the general population. The comorbidity of the two conditions not only exacerbates disease progression and severely impairs quality of life, but also increases treatment difficulty and mortality risk. In traditional Chinese medicine (TCM), diabetes is categorized as Xiaoke (consumptive thirst syndrome), and depression pertains to Yuzheng (depression syndrome). Based on the TCM theory of the monarch fire failing to warm and nourish the spleen earth, this paper systematically expounds the etiology and pathogenesis of diabetes complicated with depression. The failure of monarch fire to warm and nourish the spleen earth causes impaired transportation and transformation of the spleen as well as deficiency of qi and blood, which further leads to malnourishment of the heart spirit and stagnation of liver qi, constituting the core pathological mechanism for the concurrence of the two diseases. Combined with modern research, this paper analyzes the clinical value and application prospect of traditional Chinese medicine in the treatment of diabetes mellitus combined with depression under the guidance of this theory, so as to provide theoretical basis and practical ideas for the TCM syndrome differentiation and treatment of this complex comorbidity.