糖尿病性腹泻的中医辨证论治浅析

李勤1，高彦彬 2，谢冰昕 1

1.中国中医科学院广安门医院南区，北京 102600；2.首都医科大学中医药学院，北京 100069摘要：糖尿病性腹泻是糖尿病的慢性并发症之一，其发病与脾肾两脏关系尤为密切，从脾肾立论，抓泄泻之根本，湿邪为标贯穿泄泻始终；辨证以虚定型，以实定候；论治把证型与证候相结合，既注重顾护脾肾，祛湿为要，同时根据不同的证候变化灵活施药，可取得良好疗效。关键词：糖尿病性腹泻；脾肾立论；湿邪；辨证论治

DOI：10.3969/j.issn.1005-5304.2017.10.030

中图分类号：R259.871 文献标识码：A 文章编号：1005-5304(2017)10-0115-03

Preliminary Analysis on TCM Syndrome Differentiation and Treatment about Diabetic Diarrhea

LI Qin1, GAO Yan-bin2, XIE Bing-xin1 (1. South District of Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 102600, China; 2. School of Traditional Chinese Medicine, Capital Medical University, Beijing 100069, China)

Abstract: Diabetic diarrhea is one of the chronic complications of diabetes, which is particularly closely related to the spleen and kidney. Using these two organs as the theoretical foundation, the root of diabetic diarrhea can be grasped. Pathogenic dampness is responsible throughout the whole process of diabetic diarrhea. Using syndrome differentiation, deficiency is as the basic pattern and excess is the syndrome for diabetic diarrhea; diagnosis and treatment combine symptoms and syndromes, which not only particularly pay attention to protecting the spleen and kidney, but also clearing pathogenic dampness. At the same time, flexible medication is applied according to dynamic symptoms, which can achieve good efficacy.

Key words: diabetic diarrhea; using spleen and kidney as the theoretical foundation; pathogenic dampness; syndrome differentiation and treatment

糖尿病性腹泻属于中医学“消渴”“泄泻”范畴。其病机主要是消渴失治或迁延不愈，耗伤脾气，又复感受外邪、饮食不节、情绪失调等邪气重伤脾胃，使脾失健运，胃失受纳，水谷精微不能运化，水反为湿，谷反为滞，下趋肠道而为泄。若脾病日久及肾，肾阳虚弱，命门火衰，不能温运脾土而致久泄不止；脾肾两虚，肾为胃之关，肾虚则关门不利，亦为泄泻。该病临床表现多为顽固性、无痛性、反复性腹泻，缠绵难愈，中医治疗有其独特优势，特别从脾肾论治，能取得良好效果。兹介绍如下。

1 从脾肾立论，抓泄泻之根本

脾为后天之本，主运化，脾胃健旺，水谷腐化气血而行营卫；肾为先天之本，内寓元阳，肾中元阳与脾阳关系密切。肾阳之火助脾阳腐熟水谷，运化水谷精微。消渴患者多饮食不节，嗜食肥甘厚味、醇酒炙煿之品，损伤脾胃；或治疗不当，过用寒凉，苦寒药 通讯作者：高彦彬，E-mail：dfyynfm@163.com 物折伤脾胃；或久病缠绵，思虑过度均能导致脾胃运化失职，升降失常，清阳不升，反趋而下，渗入肠间发为泄泻。《景岳全书•泄泻》曰：“泄泻之本，无不由于脾胃……若饮食失节，起居不时，以致脾胃受伤，则水反为湿，谷反为滞，精华之气不能输布，乃至合污下降，而泻痢作矣。”《素问•藏气法时论篇》云：“脾病者，虚则腹满肠鸣，飧泄食不化。”泄泻虽病发于肠，但实属脾胃亏虚之为也。消渴病情缠绵，难以治愈，穷久及肾，肾阳亏虚，命火不足，不能暖脾助运，水谷不归正化，而致命门火衰之泄泻。《景岳全书•泄泻》曰：“肾为胃关，开窍于二阴，所以二便之开闭，皆肾脏之所主，今肾中阳气不足，则命门火衰，而阴寒独盛，故于子丑五更之后，阳气未复，阴气盛极之时，即令人洞泄不止也。”然久泻之疾，耗伤肾阴，肾阴乃人体阴液之根，肾阴亏虚而致肾不能行禁固之权，亦造成大便滑泄，且阴愈伤则泄愈重，二者互为影响，泄泻难除。《医述•泄泻》曰：“元阴有不足而泄泻者，名曰肾泄。”因此，消渴泄泻虽病机复杂，