瘅浊与糖脂代谢病
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摘要
糖脂代谢病(GLMD)是表现为高血糖、血脂异常、非酒精性脂肪性肝病、超重、高血压、动脉粥样硬化性心脑血管病等一种或多种形式的疾病,其发病机制复杂,目前尚无特定的中医病名。本文基于中医疾病命名常用方法,从GLMD的临床症状、病情、病因、病位、病机、病性6个方面对其中医命名进行逐一解析。最终,根据文献资料与临床实践情况,从病机与病性相结合角度,将GLMD命名为"瘅浊",既能涵盖疾病内涵,又能同时反映疾病病机、病性等特点。"瘅"主要指"热""湿热""劳病",瘅之为患可损伤全身多个脏腑,包括脾瘅、胃瘅、肾瘅、胆瘅、心瘅、消瘅、肝(胆)瘅等;"浊"指湿、痰、瘀、毒等病理之浊,现代医学糖、脂代谢紊乱的病理变化及其产物如高血糖、高脂血症、非酒精性脂肪肝、超重、高血压、动脉粥样硬化等均可归属于"瘅浊"的范畴。"瘅浊"规范了GLMD中医病名及疾病范畴,丰富和发展了中医学疾病理论体系,为整体认识和一体化防控糖脂代谢性疾病提供了中医理论基础。
Glucolipid Metabolic Disorders( GLMD) is one disease which clinical feature manifest itself as one or more of these kinds of diseases such as hyperglycemia,dyslipidemia,non-alcoholic fatty liver disease( NAFLD),overweight,hypertension,atherosclerotic cardio-cerebrovascular disease,with complex pathogenesis. The traditional Chinese medicine( TCM) name of GLMD has not been defined. Based on the common methods denominating a disease of TCM,this paper analyzes the GLMD denomiation of Chinese medicines from six aspects: symptoms,conditions,etiology,location of the disease,pathogenesis and the nature of disease. On the grounds of literatures and clinical practice,and from the perspective of the combination of the pathogenesis and the nature of disease,the denomination of GLMD as Dan-Zhuo enables to not only cover its connotation but also reveals its characteristics."Dan"refers to"Heat","Dampness-heat","Consumptive disease",include "Spleen-Dan","Stomach-Dan","Kidney-Dan","Gallbladder-Dan","Heart-Dan"and"Wasting-Dan"."Zhuo"refers to dampness,phlegm,stasisand toxin and so on. Diseases like hyperglycemia,hyperlipidemia,NAFLD,overweight,hypertension,atherosclerotic cardio-cerebrovascular disease and so on can be attributed to the pathological " Dan-Zhuo" of traditional Chinese medicine. The denomination of"Dan-Zhuo"regulates category of the naming and disease of TCM in GLMD,also enriches and develops the theoretical system of TCM diseases,providing a theoretical basis for TCM understanding and integration of prevention and treatment of GLMD.
Glucolipid Metabolic Disorders( GLMD) is one disease which clinical feature manifest itself as one or more of these kinds of diseases such as hyperglycemia,dyslipidemia,non-alcoholic fatty liver disease( NAFLD),overweight,hypertension,atherosclerotic cardio-cerebrovascular disease,with complex pathogenesis. The traditional Chinese medicine( TCM) name of GLMD has not been defined. Based on the common methods denominating a disease of TCM,this paper analyzes the GLMD denomiation of Chinese medicines from six aspects: symptoms,conditions,etiology,location of the disease,pathogenesis and the nature of disease. On the grounds of literatures and clinical practice,and from the perspective of the combination of the pathogenesis and the nature of disease,the denomination of GLMD as Dan-Zhuo enables to not only cover its connotation but also reveals its characteristics."Dan"refers to"Heat","Dampness-heat","Consumptive disease",include "Spleen-Dan","Stomach-Dan","Kidney-Dan","Gallbladder-Dan","Heart-Dan"and"Wasting-Dan"."Zhuo"refers to dampness,phlegm,stasisand toxin and so on. Diseases like hyperglycemia,hyperlipidemia,NAFLD,overweight,hypertension,atherosclerotic cardio-cerebrovascular disease and so on can be attributed to the pathological " Dan-Zhuo" of traditional Chinese medicine. The denomination of"Dan-Zhuo"regulates category of the naming and disease of TCM in GLMD,also enriches and develops the theoretical system of TCM diseases,providing a theoretical basis for TCM understanding and integration of prevention and treatment of GLMD.
引文
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[7]Guo J. Research progress on prevention and treatment of glucolipid metabolic disease with integrated traditional Chinese and Western medicine[J]. Chin J Integr Med,2017,23(6):403-409.
[8]陈萌,张冬梅,刘敏,等.中医学疾病命名方式探析[J].中医杂志,2016,57(6):451-453,457.
[9]陈丝,杨关林,王群,等.基于“异病同治“探讨”从脾论治”高脂血症及动脉粥样硬化共同理论基础及临床应用[J].中华中医药学刊,2018,36(9):2200-2202.
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[11]谢红艳,高泓,富晓旭,等.从脾虚辨证探讨防治糖尿病血管病变[J].中医临床研究,2018,10(1):37-39.
[12]郭姣,朴胜华,贝伟剑.再论肝在高脂血症发病中的地位和作用[J].新中医,2011,43(2):1-3.
[13]郭姣,朴胜华.从高脂血症发病低龄化趋势探讨其中医发病机制[J].中医药信息,2008,25(6):4-6.
[14]姬航宇,仝小林,刘文科.脾瘅源流考[J].江苏中医药,2009,41(1):58-60.
[15]林轶群,逄冰.脾瘅源流考征[J].北京中医药,2017,36(6):535-536.
[16]van Greevenbroek MM,Schalkwijk CG,Stehouwer CD. Obesity-associated low-grade inflammation in type 2 diabetes mellitus:causes and consequences[J]. Neth J Med,2013,71(4):174-187.
[17]葛惠娜,孙华磊,于斐,等. 2型糖尿病患者BMI与胰岛β细胞功能及胰岛素抵抗的相关性研究[J].预防医学情报杂志,2017,33(8):723-728.
[18]朴胜华,郭姣,胡竹平.高脂血症住院患者中医证候临床研究[J].中国中西医结合杂志,2012,32(10):1322-1325.
[19]洪敏,郭姣,曾小烈,等.广东地区血脂异常中医证候分布规律初探[J].新中医,2012,44(7):11-13.
[20]王彬,章清华,陈烁,等.从浊毒分期论治非酒精性脂肪性肝病[J].中医杂志,2017,58(5):387-389.
[21]赵伟.糖尿病浊毒内蕴刍议[J].中医药信息,2009,26(5):9-10.
[22]王长荣.《内经》“清”、“浊”十解[J].湖北中医杂志,1985,6(1):10-11.
[23]王中琳."血浊"病因病机浅谈[J].中国中医药现代远程教育,2009,7(8):81-82.
[24]赵进喜,庞博.中医学“浊”的涵义及其临床意义[J].中医杂志,2009,50(07):581-584.
[25]何伟,邢玉瑞,张景明,等.现代中医浊邪理论的分析与总结[J].陕西中医学院学报,2013,36(6):13-16.
[26]吴海芳,何庆勇,刘旭东,等. 1019例血脂异常患者的中医证候分布规律研究[J].中华中医药杂志,2018,33(6):2672-2675.
[27]江丹,汤海欣,吕雄,等.益气化浊法对糖脂代谢紊乱患者血管内皮功能的影响[J].按摩与康复医学,2018,9(12):39-41.
[28]刘德山,李茹,安春耀,等.从血浊理论探讨2型糖尿病的发生发展[J].河北中医,2017,39(8):1253-1257.
[29]黄婧文,郭姣.糖脂代谢病中医证候分布规律的现代文献研究[J].世界中医药,2019,14(01):1-5.
[30]李权,张学新,刘艳军.化痰祛浊方治疗脾虚痰浊阻遏型颈动脉粥样硬化斑块的临床观察[J].河北中医,2019(01):42-46.
[31]朱文锋.中医疾病的命名形式与原则[J].陕西中医,1985,6(1):7-9.
[32]郑玉娇,逄冰,刘文科,等.脾瘅理论与肥胖刍议[J].北京中医药,2017,36(6):528-531.
[33]秦培洁,仝小林,李敏,等.论脾瘅与血浊的关系及其意义[J].江苏中医药,2010,42(4):6-7.
[34]盖成安.糖尿病性冠心病中医病机分析及组方探讨[J].中医临床研究,2014,6(32):56-57.
[35]肖遥,赵进喜.赵进喜治疗糖尿病肾病经验[J].中华中医药杂志,2018,33(1):159-162.
[2]中国成人血脂异常防治指南修订联合委员会.中国成人血脂异常防治指南(2016年修订版)[J].中国循环杂志,2016,31(10):937-950.
[3]Nengguang Fan,Liang Peng,Zhenhua Xia,et al. Triglycerides to highdensity lipoprotein cholesterol ratio as a surrogate for nonalcoholic fatty liver disease:a cross sectional study[J]. Lipids Health Dis,2019,18(1):39.
[4]朴胜华,郭姣,胡竹平.高脂血症住院患者中医证候临床研究[J].中国中西医结合杂志,2012,32(10):1322-1325.
[5]Ji L,Hu D,Pan C,et al. Primacy of the 3B approach to control risk factors for cardiovascular disease in type 2 diabetes patients[J]. Am J Med,2013,126(10):925. e11-22.
[6]郭姣,肖雪,荣向路,等.糖脂代谢病与精准医学[J].世界科学技术-中医药现代化,2017,19(1):50-54.
[7]Guo J. Research progress on prevention and treatment of glucolipid metabolic disease with integrated traditional Chinese and Western medicine[J]. Chin J Integr Med,2017,23(6):403-409.
[8]陈萌,张冬梅,刘敏,等.中医学疾病命名方式探析[J].中医杂志,2016,57(6):451-453,457.
[9]陈丝,杨关林,王群,等.基于“异病同治“探讨”从脾论治”高脂血症及动脉粥样硬化共同理论基础及临床应用[J].中华中医药学刊,2018,36(9):2200-2202.
[10]吴深涛,王斌,章清华,等.论糖尿病从“脾不散精”到“浊毒内蕴”之病机观[J].中医杂志,2018,59(22):1920-1924.
[11]谢红艳,高泓,富晓旭,等.从脾虚辨证探讨防治糖尿病血管病变[J].中医临床研究,2018,10(1):37-39.
[12]郭姣,朴胜华,贝伟剑.再论肝在高脂血症发病中的地位和作用[J].新中医,2011,43(2):1-3.
[13]郭姣,朴胜华.从高脂血症发病低龄化趋势探讨其中医发病机制[J].中医药信息,2008,25(6):4-6.
[14]姬航宇,仝小林,刘文科.脾瘅源流考[J].江苏中医药,2009,41(1):58-60.
[15]林轶群,逄冰.脾瘅源流考征[J].北京中医药,2017,36(6):535-536.
[16]van Greevenbroek MM,Schalkwijk CG,Stehouwer CD. Obesity-associated low-grade inflammation in type 2 diabetes mellitus:causes and consequences[J]. Neth J Med,2013,71(4):174-187.
[17]葛惠娜,孙华磊,于斐,等. 2型糖尿病患者BMI与胰岛β细胞功能及胰岛素抵抗的相关性研究[J].预防医学情报杂志,2017,33(8):723-728.
[18]朴胜华,郭姣,胡竹平.高脂血症住院患者中医证候临床研究[J].中国中西医结合杂志,2012,32(10):1322-1325.
[19]洪敏,郭姣,曾小烈,等.广东地区血脂异常中医证候分布规律初探[J].新中医,2012,44(7):11-13.
[20]王彬,章清华,陈烁,等.从浊毒分期论治非酒精性脂肪性肝病[J].中医杂志,2017,58(5):387-389.
[21]赵伟.糖尿病浊毒内蕴刍议[J].中医药信息,2009,26(5):9-10.
[22]王长荣.《内经》“清”、“浊”十解[J].湖北中医杂志,1985,6(1):10-11.
[23]王中琳."血浊"病因病机浅谈[J].中国中医药现代远程教育,2009,7(8):81-82.
[24]赵进喜,庞博.中医学“浊”的涵义及其临床意义[J].中医杂志,2009,50(07):581-584.
[25]何伟,邢玉瑞,张景明,等.现代中医浊邪理论的分析与总结[J].陕西中医学院学报,2013,36(6):13-16.
[26]吴海芳,何庆勇,刘旭东,等. 1019例血脂异常患者的中医证候分布规律研究[J].中华中医药杂志,2018,33(6):2672-2675.
[27]江丹,汤海欣,吕雄,等.益气化浊法对糖脂代谢紊乱患者血管内皮功能的影响[J].按摩与康复医学,2018,9(12):39-41.
[28]刘德山,李茹,安春耀,等.从血浊理论探讨2型糖尿病的发生发展[J].河北中医,2017,39(8):1253-1257.
[29]黄婧文,郭姣.糖脂代谢病中医证候分布规律的现代文献研究[J].世界中医药,2019,14(01):1-5.
[30]李权,张学新,刘艳军.化痰祛浊方治疗脾虚痰浊阻遏型颈动脉粥样硬化斑块的临床观察[J].河北中医,2019(01):42-46.
[31]朱文锋.中医疾病的命名形式与原则[J].陕西中医,1985,6(1):7-9.
[32]郑玉娇,逄冰,刘文科,等.脾瘅理论与肥胖刍议[J].北京中医药,2017,36(6):528-531.
[33]秦培洁,仝小林,李敏,等.论脾瘅与血浊的关系及其意义[J].江苏中医药,2010,42(4):6-7.
[34]盖成安.糖尿病性冠心病中医病机分析及组方探讨[J].中医临床研究,2014,6(32):56-57.
[35]肖遥,赵进喜.赵进喜治疗糖尿病肾病经验[J].中华中医药杂志,2018,33(1):159-162.