陈家礼老中医学术思想与临床经验总结
摘要
陈家礼老中医祖籍江苏省徐州市,毕业于南京中医学院,曾师从朱良春先生,是全国第三、四批老中医药专家学术经验继承工作指导教师,山西省名中医。临床40余年来,致力于教学、临床、科研事业,成果颇丰。在学术上崇尚经典学派,潜心研究,博览群书又学古不泥,与时俱进,为中医事业默默奋斗。40年如一日,勤读书,多临床。侍诊中,感受到陈老不仅具有深厚的医学知识和丰富的临床经验,而且在工作、生活中和蔼可亲,作风严谨,一丝不苟,是我们学习的榜样。
三年的侍诊和学习,不仅看到了陈老对中医事业的孜孜一求,更是感受到陈老扎实的中医内涵和独特的诊疗技术,本文主要从三个方面进行阐述。
第一方面是对陈老学术渊源的概述。陈老不仅吸纳了《内经》中对脾胃有关生理、病理以及与其他脏腑关系方面的学说,且对张仲景、李东垣、叶天士等其他医家关于脾胃学说的思想进行了归纳,并按照各医家的学说特点,指出要深刻理解脾胃论的学术思想,饯行脾胃论思想指导临床辨证论治。
第二方面是对陈老学术思想和临床经验的总结。跟师学习三年,随诊和整理陈老病案,认为陈老学术思想：一是脾统四脏,脾旺不受邪。二是审病问诊重脾胃。三是诊法合参重舌诊。四是治病崇脾治。五是善用调气,燮理中焦。临床上从问诊到治疗总不离脾胃。
如“脾统四脏”,治病崇脾。陈老特别推崇李东垣之说：“胃虚则脏腑经络皆无以受气而俱病”。认为脾胃受损是疾病发生的内在原因,临证时从机体的整体观出发,脏腑辨证为核心,强调以脾胃为本,脾统四脏,治病当崇脾治,注重脾胃中气,处处以运脾和胃为法度,调补脾胃,顾护脾胃。
诊病辨证重脾胃。陈老受东垣“内伤脾胃,百病由生”脾胃学术思想影响,在脏腑辨证中形成了“以调理脾胃为核心”的诊疗体系。
四诊合参重舌诊。陈老指出舌象是疾病的一种比较敏感体征,“舌为脾胃之外侯,苔受胃气所熏蒸”,足太阴脾经连舌本、散舌下,开窍于口,从舌诊即可辨脾胃。
在用药上,陈老认为凡脾胃虚弱,因饮食、劳倦、七情所伤,或起居失宜,令中焦沤渍功能失常,则寒、热、食、湿、痰、瘀等病理产物内蕴,往往形成寒热错杂、虚实并存、气虚气滞、阴虚夹湿等多种复杂临床症候,临床善以对药处理；认为利用药引的功效,即可以引药入经,直达病所,提高疗效,又可以照顾兼病兼症、固护正气、降低毒性、矫除药物异味等；在制方用药上灵活加减升麻、柴胡、苍术、羌活、人参(或党参),升脾胃之阳,燮理中焦,扭转枢机。
甚至在治疗中,陈老依据“脾统四脏”理论,从脾胃为气血精微生化之源泉,五脏六腑、四肢百骸精气源于脾胃,到脾胃是人体精气、气机升降出入枢纽,脾胃通过调节气机影响其他脏器的功能。认为任何疾病的成因均因脾胃而起。五脏六腑之间有着密切的关系,疾病发生皆源于脾胃受损,升降失常。所以主张五脏从脾论治,在临床中均收到了良好的疗效。
肺病从脾论治：陈老认为肺与脾胃在病理上主要表现为气的生成不足和水液的代谢失常两个方面。气的生成主要源于肺主气,司呼吸,以及脾胃的运化受纳；当脾胃受损,“土不生金”,导致肺气不足,不能主气,司呼吸,则咳嗽气喘,治疗当用“培土生金”法。
肝病从脾胃论治：陈老在治疗肝病时,必联系与脾胃。盖因脾胃为气机升降之枢纽,肝主疏泄,与脾胃共同完成气机的升降出入；脾的运化,有赖于肝的疏泄；若肝失疏泄,则脾胃升降失常,导致“木不疏土”,出现精神抑郁,胸胁胀满,腹胀便溏,嗳气吞酸等肝脾不和或肝胃不和病理变化。正如仲景言：“见肝之病,知肝传脾,当先实脾。”
心病从脾胃论治：陈老指出心与脾胃之间存在着密切的关系。
肾病从脾论治：陈老认为五脏在阴阳五行克化之间有着密切的关系,脾胃居于中土,连通上下,气血生化之源,升降之枢纽,灌溉四旁,协调五脏功能活动。脾升胃降,主导着肝的疏泄,肺气宣肃,肾之纳气,心火下降,肾水上升,都有赖于脾胃的运化和升降功能。
在具体临床过程中,总结了湿阻病、便秘、消渴病、哮病、鹅掌风以及妊娠恶阻等疾病,进行了详细的论述与应用举例。
第三方面是临床研究。根据中医“四季脾旺不受邪”理论,运用健脾除湿通络法治疗2型糖尿病前期的患者60例,通过观察空腹血糖(FPG)、糖化血红蛋白(HbA1C)、口服葡萄糖耐量试验(OGTT)及胰岛素释放试验(INS)、胰岛素抵抗指数(HOMA-IR)等各项指标,探讨健脾除湿通络法对糖尿病前期胰岛素抵抗(IR)及痰湿体质方面的影响。
课题基于胰岛素抵抗(insulinesistance, IR)是2型糖尿病(T2DM)的主要病理基础,肥胖是2型糖尿病前期的重要临床特征,二者存在着一个共同的病理基础-胰岛素抵抗,引起B细胞凋亡,并贯穿在糖尿病发生、发展的整个过程。肥胖是糖尿病可控的危险因素,中医认为“肥人多痰”、“肥人多湿”“脾为生痰之源”,痰湿的生成主要责之于脾脏,脾虚则健运失司,机体水液代谢失常,形成痰湿体质进行临床研究。研究显示,对照组(二甲双胍组)与实验组的60例临床观察,两组在控制血糖、糖化血红蛋白、胰岛素抵抗指数等方面无统计学差异(P>0.05),在控制血脂方面与对照组比较有统计学差异(P< 0. 05 );治疗组内，治疗前后血糖、糖化血红蛋白、胰岛素抵抗指数、血脂等方面有显著差异（P<0.05, P< 0. 01 ),说明健脾除湿通络法对血糖、糖化血红蛋白、血脂的控制，改善胰岛素抵抗，降低高胰岛素血症等方面可能与二甲双胍有相同的疗效，在症状改善方面，两组间有显著差异（P< 0. 01 )，治疗组健脾除湿通络法中药复方制剂能够不同程度的减轻患者临床症状，改善腹胀纳呆、口中粘腻、倦怠乏力、口渴不欲饮、头闷、心悸失眠以及舌象和脉象方面，说明健脾除湿通络法在改善症状方面有良好的优势，此外，还观察到健脾除湿通络法对血糖的控制有一定的稳定性。因此，研究认为，脾虛是糖尿病的根本原因，水精输化异常是糖尿病的病理基础，痰浊水湿是IR的内在环境，健脾除湿通络法治疗2型糖尿病前期IR，通过健脾摄精、除湿化浊、通络活血，可以增加胰岛细胞表面受体数，改善胰岛素受体的敏感性，调整痰湿体质。通过临床观察推断，健脾除湿通络法对肥胖型2型糖尿病前期伴胰岛素抵抗的患者进行干预治疗有效。
Chen Jiali, Shanxi provincial expert of traditional Chinese medicine(TCM) is from Xuzhou city, Jiangsu province. Graduated from Nanjing College of TCM, he learned from Mr Zhu Liangchun and had been chosen as one of the third and the fourth group of the famous Chinese medical experts on inheritance of academic experience. He has been engaged in teaching, clinical working, scientific research for more than 40 years and achieved a lot. Focusing on classical theories, he concentrates on research. With a wide reading, he doesn't adhere to the ancient theory rigidly and instead, he keeps pace with the times. He contributes a lot to the TCM cause. He is diligent in reading and clinical activity all year round 40 years. He is a good example for us to follow during treating because he is strictly with his work but nice with patients.
During the three years of practising and learning, I can not only see doctor Chen's diligence in TCM cause, but also know his sound basis on TCM and unique diagnostic and therapeutic technique,which is described in three main aspects.
The First aspect is the overview of the academic origins of doctor Chen. Doctor Chen has not only assimilated the theory of physiology and pathology of spleen and stomach and their relation with other viscera, which was described in Hangdi Neijing, but also summarized Zhang Zhongjing, Li Dongyuan, Ye Tianshi and other physicians'theories about spleen and stomach. In accordance with the characteristics of physicians'theories, he points out that we should have a profound understanding of the academic thought of spleen and stomach theory, and treat with syndrome differentiation under the guidance of spleen and stomach theory.
The second aspect is a summary of the clinical experience and the academic thought of doctor Chen. After three years'learning and case arranging, I conclude five aspects of doctor Chen's academic thought:the first one is the spleen governing four zang-organs and reinforced spleen preventing invasion of pathogenic factors. The second is the emphasis on spleen and stomach when inquiring. The third is the focus on tongue when comprehensively analysing with the four diagnostic methods. The fourth is to treat other disease through treating the spleen and stomach. The fifth is to regulate qi and middle energizer. Clinically, spleen and stomach is everywhere from inquisition to treatment.
For example, "spleen governing four zang-organs" and "treating other diseasethrough treating spleen and stomach". Doctor Chen praise highly of Li Dong Yuan"stomach deficiency causing diseases'theory. He holds that spleen and stomachdamage is the immanent cause of the disease, clinical differentiation of symptomsand signs is from the overall view, visceral syndrome differentiation is as the core.Emphasizing the fundamental of spleen and stomach, spleen governing viscera, heprefers to treat diseases with the worship of spleen treatment and he also paysattention to the spleen and stomach, and tries to regulate and nourish spleen andstomach, nourish and protect both.
He emphasizes on spleen and stomach in diagnosis and syndromedifferentiation. Dong Yuan,s spleen and stomach academic thought "all diseasesare derived from spleen and stomach damage" gave some clue to doctor Chen informing "the spleen and stomach as the core" diagnosis and treatment system inthe viscera syndrome differentiation.
Focus on the tongue when comprehensively analysing with the four diagnosticmethods. Doctor Chen pointed out that the tongue is a more sensitive signs ofdisease" the tongue is the external manifestation of spleen and stomach"? spleenconnects with the tongue through meridian, and the spleen opens into the tongue,tehrefore diagnosis of spleen and stomach can be identified from tongue.
In the administration, doctor Chen think where the deficiency of the spleen andstomach is due to improper diet, overstrain, excess of seven emotions, or improperliving conditions and they will lead to the dysfunction of transformation of middleenergizer, so that cold, heat, dampness, phlegm, blood stasis, food and otherpathological products will form, and they often result in a variety of complexclinical syndromes such as cold-heat jumble, coexistence of deficiency and excess,Qi deficiency and Qi stagnation, Yin deficiency mixing with dampness and so on.Drugs can cope with it clinically; Correct administration of drugs can be effectiveadn guide the drugs to the right locations and enhance the curative effect. Thefunction of treatment is to reduce toxicity and protect vital qi. In the preparationof modified cimicifuga, bupleurum root, rhizome angelica, ginseng, promotingSpleen Yang, and body Qi.
Even in the treatment, according to the "spleen governing four zang-organs"theory, doctor Chen believes that spleen and stomach are the source of qi, bloodand essence and the subtle essence of the five zang-organs and six fu-organs and all the limbs and bones are derived from spleen and stomach. Spleen and stomachare the source of the essence of human body and body Qi with lifting and entry, thespleen and stomach influence the functions of all other viscera through regulatingthe body Qi. So damage to spleen and stomach leads to disorders. The relationsbetween disorders of other organs might result from the disorders of spleen andstomach damaged, body qi disorders. Treasting disorders of the spleen can beeffective clinically.
Lung disease can be treated through spleen and stomach: Doctor Chenbelieves that the disorders of the lung and the spleen are deficiency generation ofbody qi and fluid metabolic disorders. The generation of the body qi mainly comesfrom lung qi, lung respiratory function, and the spleen and the stomach digestivefunction. When the spleen is damaged, "earth don't give birth to metal, causeinsufficiency of lung-qi, and lower function the lung respiration and lead tocough, asthma, which should be treated with "reinforce the earth to promote themetal" method.
Liver disease can be cured via spleen and stomach: Doctor Chen alsoconsiders the spleen and stomachin the treatment of liver disease. Because thespleen and stomach is key for qi to lift and descend. The liver is responsible forpromote qi flow, and complete the rise and fall of the body qi with the spleentogether. Spleen's function of digestion depend on the liver. If the liver fails topromote qi flow, the spleen and stomach will consequently fail to lift and descendcausing "wood failing to promote the function of the earth". Disharmony betweenliver and spleen or stomach will appear and clinical manifestations are depression,chest full, abdominal distension, loose stools, belch and so on. As Zhong Jing said:"see the liver disease, know liver transmit to the spleen, then first reinforce thespleen".
Heart disease can be treated through spleen and stomach：Doctor Chen pointsout that there is a close relationship between the heart and the spleen and stomach.
Kidney disease can be cured via spleen: Doctor Chen thinks there is closerelationship between viscera in the Yin and Yang and five elements. The spleenand stomach are in middle-earth, connecting the upper and lower. They are thesource of qi blood, key of qi lifting and descending, and irrigation of all nearbyorgans, and promote visceral functions. Spleen is to lift while stomach is descend,dominated the liver dredging excretion, pulmonary dispersing and descending, thekidney storing qi, and the heart on fire reducing, the kidney water rising.
In the specific clinical process, this paper summarizes the moisture resistancedisease, constipation, diabetes, wheezing illness, pregnancy disorders arediscussed in detail and an example of applications.
The third aspect is the clinical research. According to "reinforced spleenpreventing the body from invasion of pathogenic factors" and teacher' s "takingspleen as a treament gap" academic thought, 60 patients of type II diabetes inprediabetic stage were treated by strengthening spleen, eliminating dampness anddredging collaterals and were observed in the fasting plasma glucose (FPG),glycosylated hemoglobin (HbAlC), oral glucose tolerance test (OGTT) and insulinrelease test (INS), insulin resistance index (HOMA-IR) and other index. Theinfluence of the method of strengthening spleen and eliminating dampness anddredging collaterals on pre diabetes insulin resistance (IR) and phlegm dampnessconstitution will be discussed.
Based on the subject of insulin resistance (insulin esistance, IR) is type 2diabetes mellitus (T2DM) pathological basis, obesity is the important clinicalfeaturesof type 2diabetes prophase, they are a common pathologic basis-insulinresistance, insulin resistance cause B cell apoptosis and throughout the diabetesoccurrence, development of the entire process. Obesity is a risk factor for diabetescontrollable, TCM believes that "fat people much phlegm"", "fat people more wet,"the spleen is the source of phlegm", phlegmy wet the formation of the mainresponsibility is to the spleen , insufficiency of the spleen cause transportdisorders and the water metabolism disorders, therefore form phlegmy wetphysical clinical research. Research shows that the control group (metformingroup) and the experimental group of 60 patients with clinical observations, twogroups in control blood sugar, glycated hemoglobin, insulin resistance indexhave no statistical difference (P > 0.05), in the control lipid aspects compared withcontrols ,there were statistically significant (P < 0.05); In treatment group, therewere significant differences (P < 0.05, P < 0.01)in glycosylated hemoglobin ,bloodglucose, insulin resistance index, blood fat in patients before and after treatment,the therapy of "strengthening spleen and eliminating dampness and dredgingcollaterals" and metformin have the same effect in blood sugar, glycatedhemoglobin, lipid control and improvement of insulin resistance, lower highinsulin hematic disease, etc. In improvement of symptoms, there was a significantdifference between the two groups (P < 0.01)5the compound preparation oftraditional Chinese Medicine in the treatment group can relieve the clinical symptoms of the patients in different degrees, improve the clinical symptoms,such as abdominal distension, mouth greasy, stay stuck languid, thirsty to drink,head frowsty, palpitations insomnia and tongue and pulse condition, the therapy of"strengthening spleen and eliminating dampness and dredging collaterals" inimproving the symptoms have good advantage, in addition, observed thatstrengthening spleen and eliminating dampness and dredging collaterals methodon glycemic control has certain stability.Therefore, research thinks, the deficiencyof spleen is the fundamental cause of diabetes,the abnormal water metabolism isthe pathological basis of diabetes mellitus, phlegm and dampness is the internalenvironment of IR and dehumidification validates the method of treatment for type2 diabetes were confirmed by IR, through the invigorating spleen essence,desiccant taken change chaotic, promoting blood circulation, dredging, canincrease the islet cell surface receptors number, improve the sensitivity of insulinreceptor, adjust phlegmy wet body constitution. Through the clinical observationinference is concluded that the therapy of "Strengthening spleen and eliminatingdampness and dredging collaterals" have effective intervention therapy role onobese type 2 diabetes prophase with insulin resistance in patients.
三年的侍诊和学习,不仅看到了陈老对中医事业的孜孜一求,更是感受到陈老扎实的中医内涵和独特的诊疗技术,本文主要从三个方面进行阐述。
第一方面是对陈老学术渊源的概述。陈老不仅吸纳了《内经》中对脾胃有关生理、病理以及与其他脏腑关系方面的学说,且对张仲景、李东垣、叶天士等其他医家关于脾胃学说的思想进行了归纳,并按照各医家的学说特点,指出要深刻理解脾胃论的学术思想,饯行脾胃论思想指导临床辨证论治。
第二方面是对陈老学术思想和临床经验的总结。跟师学习三年,随诊和整理陈老病案,认为陈老学术思想：一是脾统四脏,脾旺不受邪。二是审病问诊重脾胃。三是诊法合参重舌诊。四是治病崇脾治。五是善用调气,燮理中焦。临床上从问诊到治疗总不离脾胃。
如“脾统四脏”,治病崇脾。陈老特别推崇李东垣之说：“胃虚则脏腑经络皆无以受气而俱病”。认为脾胃受损是疾病发生的内在原因,临证时从机体的整体观出发,脏腑辨证为核心,强调以脾胃为本,脾统四脏,治病当崇脾治,注重脾胃中气,处处以运脾和胃为法度,调补脾胃,顾护脾胃。
诊病辨证重脾胃。陈老受东垣“内伤脾胃,百病由生”脾胃学术思想影响,在脏腑辨证中形成了“以调理脾胃为核心”的诊疗体系。
四诊合参重舌诊。陈老指出舌象是疾病的一种比较敏感体征,“舌为脾胃之外侯,苔受胃气所熏蒸”,足太阴脾经连舌本、散舌下,开窍于口,从舌诊即可辨脾胃。
在用药上,陈老认为凡脾胃虚弱,因饮食、劳倦、七情所伤,或起居失宜,令中焦沤渍功能失常,则寒、热、食、湿、痰、瘀等病理产物内蕴,往往形成寒热错杂、虚实并存、气虚气滞、阴虚夹湿等多种复杂临床症候,临床善以对药处理；认为利用药引的功效,即可以引药入经,直达病所,提高疗效,又可以照顾兼病兼症、固护正气、降低毒性、矫除药物异味等；在制方用药上灵活加减升麻、柴胡、苍术、羌活、人参(或党参),升脾胃之阳,燮理中焦,扭转枢机。
甚至在治疗中,陈老依据“脾统四脏”理论,从脾胃为气血精微生化之源泉,五脏六腑、四肢百骸精气源于脾胃,到脾胃是人体精气、气机升降出入枢纽,脾胃通过调节气机影响其他脏器的功能。认为任何疾病的成因均因脾胃而起。五脏六腑之间有着密切的关系,疾病发生皆源于脾胃受损,升降失常。所以主张五脏从脾论治,在临床中均收到了良好的疗效。
肺病从脾论治：陈老认为肺与脾胃在病理上主要表现为气的生成不足和水液的代谢失常两个方面。气的生成主要源于肺主气,司呼吸,以及脾胃的运化受纳；当脾胃受损,“土不生金”,导致肺气不足,不能主气,司呼吸,则咳嗽气喘,治疗当用“培土生金”法。
肝病从脾胃论治：陈老在治疗肝病时,必联系与脾胃。盖因脾胃为气机升降之枢纽,肝主疏泄,与脾胃共同完成气机的升降出入；脾的运化,有赖于肝的疏泄；若肝失疏泄,则脾胃升降失常,导致“木不疏土”,出现精神抑郁,胸胁胀满,腹胀便溏,嗳气吞酸等肝脾不和或肝胃不和病理变化。正如仲景言：“见肝之病,知肝传脾,当先实脾。”
心病从脾胃论治：陈老指出心与脾胃之间存在着密切的关系。
肾病从脾论治：陈老认为五脏在阴阳五行克化之间有着密切的关系,脾胃居于中土,连通上下,气血生化之源,升降之枢纽,灌溉四旁,协调五脏功能活动。脾升胃降,主导着肝的疏泄,肺气宣肃,肾之纳气,心火下降,肾水上升,都有赖于脾胃的运化和升降功能。
在具体临床过程中,总结了湿阻病、便秘、消渴病、哮病、鹅掌风以及妊娠恶阻等疾病,进行了详细的论述与应用举例。
第三方面是临床研究。根据中医“四季脾旺不受邪”理论,运用健脾除湿通络法治疗2型糖尿病前期的患者60例,通过观察空腹血糖(FPG)、糖化血红蛋白(HbA1C)、口服葡萄糖耐量试验(OGTT)及胰岛素释放试验(INS)、胰岛素抵抗指数(HOMA-IR)等各项指标,探讨健脾除湿通络法对糖尿病前期胰岛素抵抗(IR)及痰湿体质方面的影响。
课题基于胰岛素抵抗(insulinesistance, IR)是2型糖尿病(T2DM)的主要病理基础,肥胖是2型糖尿病前期的重要临床特征,二者存在着一个共同的病理基础-胰岛素抵抗,引起B细胞凋亡,并贯穿在糖尿病发生、发展的整个过程。肥胖是糖尿病可控的危险因素,中医认为“肥人多痰”、“肥人多湿”“脾为生痰之源”,痰湿的生成主要责之于脾脏,脾虚则健运失司,机体水液代谢失常,形成痰湿体质进行临床研究。研究显示,对照组(二甲双胍组)与实验组的60例临床观察,两组在控制血糖、糖化血红蛋白、胰岛素抵抗指数等方面无统计学差异(P>0.05),在控制血脂方面与对照组比较有统计学差异(P< 0. 05 );治疗组内，治疗前后血糖、糖化血红蛋白、胰岛素抵抗指数、血脂等方面有显著差异（P<0.05, P< 0. 01 ),说明健脾除湿通络法对血糖、糖化血红蛋白、血脂的控制，改善胰岛素抵抗，降低高胰岛素血症等方面可能与二甲双胍有相同的疗效，在症状改善方面，两组间有显著差异（P< 0. 01 )，治疗组健脾除湿通络法中药复方制剂能够不同程度的减轻患者临床症状，改善腹胀纳呆、口中粘腻、倦怠乏力、口渴不欲饮、头闷、心悸失眠以及舌象和脉象方面，说明健脾除湿通络法在改善症状方面有良好的优势，此外，还观察到健脾除湿通络法对血糖的控制有一定的稳定性。因此，研究认为，脾虛是糖尿病的根本原因，水精输化异常是糖尿病的病理基础，痰浊水湿是IR的内在环境，健脾除湿通络法治疗2型糖尿病前期IR，通过健脾摄精、除湿化浊、通络活血，可以增加胰岛细胞表面受体数，改善胰岛素受体的敏感性，调整痰湿体质。通过临床观察推断，健脾除湿通络法对肥胖型2型糖尿病前期伴胰岛素抵抗的患者进行干预治疗有效。
Chen Jiali, Shanxi provincial expert of traditional Chinese medicine(TCM) is from Xuzhou city, Jiangsu province. Graduated from Nanjing College of TCM, he learned from Mr Zhu Liangchun and had been chosen as one of the third and the fourth group of the famous Chinese medical experts on inheritance of academic experience. He has been engaged in teaching, clinical working, scientific research for more than 40 years and achieved a lot. Focusing on classical theories, he concentrates on research. With a wide reading, he doesn't adhere to the ancient theory rigidly and instead, he keeps pace with the times. He contributes a lot to the TCM cause. He is diligent in reading and clinical activity all year round 40 years. He is a good example for us to follow during treating because he is strictly with his work but nice with patients.
During the three years of practising and learning, I can not only see doctor Chen's diligence in TCM cause, but also know his sound basis on TCM and unique diagnostic and therapeutic technique,which is described in three main aspects.
The First aspect is the overview of the academic origins of doctor Chen. Doctor Chen has not only assimilated the theory of physiology and pathology of spleen and stomach and their relation with other viscera, which was described in Hangdi Neijing, but also summarized Zhang Zhongjing, Li Dongyuan, Ye Tianshi and other physicians'theories about spleen and stomach. In accordance with the characteristics of physicians'theories, he points out that we should have a profound understanding of the academic thought of spleen and stomach theory, and treat with syndrome differentiation under the guidance of spleen and stomach theory.
The second aspect is a summary of the clinical experience and the academic thought of doctor Chen. After three years'learning and case arranging, I conclude five aspects of doctor Chen's academic thought:the first one is the spleen governing four zang-organs and reinforced spleen preventing invasion of pathogenic factors. The second is the emphasis on spleen and stomach when inquiring. The third is the focus on tongue when comprehensively analysing with the four diagnostic methods. The fourth is to treat other disease through treating the spleen and stomach. The fifth is to regulate qi and middle energizer. Clinically, spleen and stomach is everywhere from inquisition to treatment.
For example, "spleen governing four zang-organs" and "treating other diseasethrough treating spleen and stomach". Doctor Chen praise highly of Li Dong Yuan"stomach deficiency causing diseases'theory. He holds that spleen and stomachdamage is the immanent cause of the disease, clinical differentiation of symptomsand signs is from the overall view, visceral syndrome differentiation is as the core.Emphasizing the fundamental of spleen and stomach, spleen governing viscera, heprefers to treat diseases with the worship of spleen treatment and he also paysattention to the spleen and stomach, and tries to regulate and nourish spleen andstomach, nourish and protect both.
He emphasizes on spleen and stomach in diagnosis and syndromedifferentiation. Dong Yuan,s spleen and stomach academic thought "all diseasesare derived from spleen and stomach damage" gave some clue to doctor Chen informing "the spleen and stomach as the core" diagnosis and treatment system inthe viscera syndrome differentiation.
Focus on the tongue when comprehensively analysing with the four diagnosticmethods. Doctor Chen pointed out that the tongue is a more sensitive signs ofdisease" the tongue is the external manifestation of spleen and stomach"? spleenconnects with the tongue through meridian, and the spleen opens into the tongue,tehrefore diagnosis of spleen and stomach can be identified from tongue.
In the administration, doctor Chen think where the deficiency of the spleen andstomach is due to improper diet, overstrain, excess of seven emotions, or improperliving conditions and they will lead to the dysfunction of transformation of middleenergizer, so that cold, heat, dampness, phlegm, blood stasis, food and otherpathological products will form, and they often result in a variety of complexclinical syndromes such as cold-heat jumble, coexistence of deficiency and excess,Qi deficiency and Qi stagnation, Yin deficiency mixing with dampness and so on.Drugs can cope with it clinically; Correct administration of drugs can be effectiveadn guide the drugs to the right locations and enhance the curative effect. Thefunction of treatment is to reduce toxicity and protect vital qi. In the preparationof modified cimicifuga, bupleurum root, rhizome angelica, ginseng, promotingSpleen Yang, and body Qi.
Even in the treatment, according to the "spleen governing four zang-organs"theory, doctor Chen believes that spleen and stomach are the source of qi, bloodand essence and the subtle essence of the five zang-organs and six fu-organs and all the limbs and bones are derived from spleen and stomach. Spleen and stomachare the source of the essence of human body and body Qi with lifting and entry, thespleen and stomach influence the functions of all other viscera through regulatingthe body Qi. So damage to spleen and stomach leads to disorders. The relationsbetween disorders of other organs might result from the disorders of spleen andstomach damaged, body qi disorders. Treasting disorders of the spleen can beeffective clinically.
Lung disease can be treated through spleen and stomach: Doctor Chenbelieves that the disorders of the lung and the spleen are deficiency generation ofbody qi and fluid metabolic disorders. The generation of the body qi mainly comesfrom lung qi, lung respiratory function, and the spleen and the stomach digestivefunction. When the spleen is damaged, "earth don't give birth to metal, causeinsufficiency of lung-qi, and lower function the lung respiration and lead tocough, asthma, which should be treated with "reinforce the earth to promote themetal" method.
Liver disease can be cured via spleen and stomach: Doctor Chen alsoconsiders the spleen and stomachin the treatment of liver disease. Because thespleen and stomach is key for qi to lift and descend. The liver is responsible forpromote qi flow, and complete the rise and fall of the body qi with the spleentogether. Spleen's function of digestion depend on the liver. If the liver fails topromote qi flow, the spleen and stomach will consequently fail to lift and descendcausing "wood failing to promote the function of the earth". Disharmony betweenliver and spleen or stomach will appear and clinical manifestations are depression,chest full, abdominal distension, loose stools, belch and so on. As Zhong Jing said:"see the liver disease, know liver transmit to the spleen, then first reinforce thespleen".
Heart disease can be treated through spleen and stomach：Doctor Chen pointsout that there is a close relationship between the heart and the spleen and stomach.
Kidney disease can be cured via spleen: Doctor Chen thinks there is closerelationship between viscera in the Yin and Yang and five elements. The spleenand stomach are in middle-earth, connecting the upper and lower. They are thesource of qi blood, key of qi lifting and descending, and irrigation of all nearbyorgans, and promote visceral functions. Spleen is to lift while stomach is descend,dominated the liver dredging excretion, pulmonary dispersing and descending, thekidney storing qi, and the heart on fire reducing, the kidney water rising.
In the specific clinical process, this paper summarizes the moisture resistancedisease, constipation, diabetes, wheezing illness, pregnancy disorders arediscussed in detail and an example of applications.
The third aspect is the clinical research. According to "reinforced spleenpreventing the body from invasion of pathogenic factors" and teacher' s "takingspleen as a treament gap" academic thought, 60 patients of type II diabetes inprediabetic stage were treated by strengthening spleen, eliminating dampness anddredging collaterals and were observed in the fasting plasma glucose (FPG),glycosylated hemoglobin (HbAlC), oral glucose tolerance test (OGTT) and insulinrelease test (INS), insulin resistance index (HOMA-IR) and other index. Theinfluence of the method of strengthening spleen and eliminating dampness anddredging collaterals on pre diabetes insulin resistance (IR) and phlegm dampnessconstitution will be discussed.
Based on the subject of insulin resistance (insulin esistance, IR) is type 2diabetes mellitus (T2DM) pathological basis, obesity is the important clinicalfeaturesof type 2diabetes prophase, they are a common pathologic basis-insulinresistance, insulin resistance cause B cell apoptosis and throughout the diabetesoccurrence, development of the entire process. Obesity is a risk factor for diabetescontrollable, TCM believes that "fat people much phlegm"", "fat people more wet,"the spleen is the source of phlegm", phlegmy wet the formation of the mainresponsibility is to the spleen , insufficiency of the spleen cause transportdisorders and the water metabolism disorders, therefore form phlegmy wetphysical clinical research. Research shows that the control group (metformingroup) and the experimental group of 60 patients with clinical observations, twogroups in control blood sugar, glycated hemoglobin, insulin resistance indexhave no statistical difference (P > 0.05), in the control lipid aspects compared withcontrols ,there were statistically significant (P < 0.05); In treatment group, therewere significant differences (P < 0.05, P < 0.01)in glycosylated hemoglobin ,bloodglucose, insulin resistance index, blood fat in patients before and after treatment,the therapy of "strengthening spleen and eliminating dampness and dredgingcollaterals" and metformin have the same effect in blood sugar, glycatedhemoglobin, lipid control and improvement of insulin resistance, lower highinsulin hematic disease, etc. In improvement of symptoms, there was a significantdifference between the two groups (P < 0.01)5the compound preparation oftraditional Chinese Medicine in the treatment group can relieve the clinical symptoms of the patients in different degrees, improve the clinical symptoms,such as abdominal distension, mouth greasy, stay stuck languid, thirsty to drink,head frowsty, palpitations insomnia and tongue and pulse condition, the therapy of"strengthening spleen and eliminating dampness and dredging collaterals" inimproving the symptoms have good advantage, in addition, observed thatstrengthening spleen and eliminating dampness and dredging collaterals methodon glycemic control has certain stability.Therefore, research thinks, the deficiencyof spleen is the fundamental cause of diabetes,the abnormal water metabolism isthe pathological basis of diabetes mellitus, phlegm and dampness is the internalenvironment of IR and dehumidification validates the method of treatment for type2 diabetes were confirmed by IR, through the invigorating spleen essence,desiccant taken change chaotic, promoting blood circulation, dredging, canincrease the islet cell surface receptors number, improve the sensitivity of insulinreceptor, adjust phlegmy wet body constitution. Through the clinical observationinference is concluded that the therapy of "Strengthening spleen and eliminatingdampness and dredging collaterals" have effective intervention therapy role onobese type 2 diabetes prophase with insulin resistance in patients.
引文
1.谢华编著.《黄帝内经》.北京：人民卫生出版社,1982.9.
2.张仲景著.杨鹏举,侯仙明,杨廷巍注.《金匮要略》.北京：学苑出版社,2007.4.
3.李东垣撰.文魁,丁国华整理.《脾胃论》.北京：人民卫生出版社,2005.8.
4.邢斌,韩天雄.颜德馨内科学术经验薪传.北京：中国中医药出版社.2010.2：9.
5.(清)程国彭撰.田代华整理.《医学心悟》.北京：人民卫生出版社.2006.6.1.
6.(明)龚廷贤撰.《寿世保元》.北京：中国中医药出版社,1993.2.
7.赵云燕,郭信.浅谈张锡纯脾胃学术思想及遣方用药特色.湖北中医杂志.2008,30(8)：20-30.
8.沈金鳌.《杂病源流犀烛》.北京：中国中医药出版社,1994.1.1.
9.(明)吴昆著,张宽等整理.《医方考》.北京：人民卫生出版社,2007.8.1.
10.钟海平,郑红斌.浅谈“脾胃转枢”与“脾统四脏”.实用中医药杂志,2011,27(4)：270-271.
11.(清)程国彭.《医学心悟》.沈阳：辽宁科学技术出版社,1997.8.
12.(明)张介宾,李继明等著.《景岳全书》.北京：人民卫生出版社,2007,9.1.
13.(清)周学海著,闫志安,周鸿艳校注.《读医随笔》.北京：中国中医药出版社,2007,8.1.
14.(清)黄元御著,孙洽熙校注.《四圣心源·劳伤中气》.北京：中国中医药出版社,2009,11.1.
15.(明)周之干著,武国忠点校.《周慎斋医学全书》.海南：海南出版社,2010.5.
16.(清)罗美撰,李飞,武丹丹,黄琼磁校注.《古今名医方论》.北京：中国中医药出版社,2007,7.1.
17. 陈筱云，冯俊俐.陈家礼教授临证应用温胆汤经验心得.光明中医，2011,
18. 朱震亨.《丹溪心法》.北京：人民卫生出版社，2005, 08.
1.官环,张恩毅.美国糖尿病预防计划.国外医学(老年医学分册).2003,24(3)：97-99.
2.王景云,仝丽娟,项楠楠.糖尿病的流行现状与防治对策.中国民康医学,2011,23(8)：1015.
3.肖新华,徐春.糖尿病的预防研究进展.武警医学.2007,18(2)：85-88.
4.陈纪桦.血糖调节机制及功效评估[M].食品工业,1992,34(6)：2-18.
5.裴豹。胰岛素敏感度,葡萄糖敏感度及贝它细胞分泌功能在第二型糖尿病致病机转所扮演的角色[J].中华民国内分泌暨糖尿病学会会讯,1996,4(36)：4-7.
6.巩秋红,李光伟,等.2005北京国际糖尿病预防高层论坛纪要.中华内分泌代谢杂志,2006,22(1)：94-95.
7.臧丽,母义明.胰岛素抵抗机制的新认识.国际内分泌代谢杂志,2009,29(3)：150-154.
8.朱妍,仝小林等.2型糖尿病前期临床研究进展.医学综述,2008,14(11)：1689-1692.
9.杨金奎.12早期干预改变糖尿病.国际内分泌代谢杂志,2009,29(6)：374-377.
10.马凤海.李秀钧.胰岛β细胞自身胰岛素抵抗和2型糖尿病-胰岛素抵抗研究的新领域.国外医学(内分泌学分),2004,24(3)：154-155.
11.王战建,苏杰英.糖尿病预防的最新循证医学证据(一)——DREAM.临床荟萃,2007,2(6)：444-445.
12.沈伟,王旭.2型糖尿病胰岛素抵抗的中医药研究概况.中国中医急症,2009,18(2)：279-280.
13.韩英,江平等.奥利司他对肥胖IGT人群糖尿病预防效果.广东药学,2004,14(3)：40-41.
14.申涛,黄晓华,欧亚龙,罗勤,李光琼,李向东.2型糖尿病患者中医辨证分型与胰岛素抵抗的关系.中国中医药科技,2011,18(3)：235.
15.琚婉君,杨宏杰,郑敏等.中医药治疗糖耐量减低的研究进展.上海中医药大学学报,2008,2(6)：81-82.
16.陈霞波.糖耐量减低与脾不散精[J].浙江中医杂志,2005,40(3)：118-119.
17.徐佩英.消渴病证治探迹.2009年世界中医药学会联合会糖尿病专业委员会第六次国际中医糖尿病学术交流会：70.
18.孟凤仙,倪青,闫秀峰,林兰.消渴病的中医认识思路与方法.中国中医药信息杂志,2005,12(9)：91.
19.张欣,郭叶楠.活血祛痰通腑法治疗糖耐量减低的临床观察.辽宁中医杂志,,2003,30(6)：472.
20.李小娟.中医治疗2型糖尿病胰岛素抵抗的思路与方法.中医药学刊,2005,23(4)：660-661.
21.仝小林.从糖尿病前期谈“治未病”.中华中医药杂,2008,23(3)：191.
22.裴友翠,衡先培等.2型糖尿病胰岛素抵抗的中医治疗.实用医院临床杂志,2010,07(4)：25-26.
23.刘文科,仝小林,刘喜明等.中医药疗法干预糖耐量减低的现状.医学综述,2008,14(11)：1693-1695.
24.毛竹君,董颖,栾洁等.180例2型糖尿病患者中医证候调查及证型研究.中华中医药杂志,2009,24(8)：1065.
25.仲琴,王旭.中医药治疗肥胖Ⅱ型糖尿病研究.吉林中医药,2011,31(10)970.
26.江南,刘铜华.胰岛素抵抗的中医病机探讨.中国中医基础医学杂志,2006,12(09)：691
27.张树彪,徐贵军.胰岛素抵抗的中医药治疗进展.新中医,2006,38(9)：20-21.
28.魏军平,周丽波,仝小林等.2型糖尿病患者体型与证候特点研究.中华中医药学刊,2007,25(12)：2653-2655.
29.杨辰华.从痰湿论治糖尿病胰岛素抵抗的体会.四川中医,2005,23(1)：10-11.
30.刘承琴,黄丹青.中医药治2型糖尿病胰岛素抵抗进展,山东中医杂志,2002,21(11)：697-698.
31.赵莉娟等.2型糖尿病胰岛素抵抗的中医治疗思路.世界中西医结合杂志,2008,3(2)：111-112.
32.张树彪,徐贵军.胰岛素抵抗的中医药治疗进展.新中医,2006,38(9)：20-21.
33.张彤,邵国强,叶景华.运脾活血法治疗2型糖尿病胰岛素抵抗初探[J].新 中医,2005,37(2)：7-8.
34.李小娟.中医治疗2型糖尿病胰岛素抵抗的思路与方法.中医药学刊,2005,23(4)：660-661.
35.李冀,葛鹏玲,李胜志,等.西洋参对胰岛素抵抗大鼠血糖胰岛素及血清瘦素的影响[J].辽宁中医杂志,2008,35(1)：34-35.
36.章小平,方朝晖.参丹健胰丸改善2型糖尿病胰岛素抵抗的机理研究[J].中医药临床杂志,2004.16(6)：543.545.
37.方朝晖,王佑民,王开成,等.丹蛭降糖胶囊对胰岛素抵抗大鼠PPAR-γ mRNA表达的影响.中国实验方剂学杂志,2006,12(4)：33-39
38.黄冬梅,陆付耳,黄光英.补肾通脉方对胰岛素抵抗大鼠胰岛素信号转导的影响[J].中国中西医结合杂志,2003,23(9)：684-686.
39.李洪皎,仝小林.肥胖2型糖尿病前期、早期病机证治探讨.中国中医基础医学杂志,2007,13(7)：529-530.
40.仝小林,赵昱.浅谈糖耐量减低(IGT)的中医证治[J].光明中医,2006,21(7)：24-25.
41.张一骄.丹栀逍遥散对2型糖尿病患者胰岛素抵抗的影响[J].现代中西医结合杂志,2009,18(31)：3840.
42.杨小玉,陆付耳,黄琳,等.黄连解毒汤和黄连单煎剂对胰岛素抵抗大鼠氧化应激和内质网应激的影响[J].中国医院药学杂志,2008,28(17)：1433—1437.
43.叶爱丽,陆付耳,徐丽君等.黄连解毒汤对胰岛素抵抗大鼠脂肪组织胰岛素受体及其底物信号转导的影响[J].中国中西医结合杂志,2006,26(10)：909—912.
44.吴正治,李桂云.2型糖尿病胰岛素抵抗中医药研究述评.深圳中西医结合杂志,2008,18(1)：58-61
45.孔梅,杨广山,邝吴宇.益气养阴活血中药改善2型糖尿病胰岛素抵抗研究[J].安徽中医学院学报,2009,28(4)：8-11.
46.孔德山.活血化瘀法在治疗胰岛素抵抗型糖尿病中的效应[J].实用中医内科杂志,2003,17(6)：493.
47.李学军,杨叔禹,王丽英,等.化痰方及化痰活血方对糖尿病大鼠胰岛素抵抗的影响IJ1.中国实验方剂学杂志,2006,12(5)：37—39
48.第五永长,许建秦.“胰岛素抵抗”与中医“脾不散精”相关性的理论探讨[J].四川中医,2006,24(1 0)：23—24
49.彭丽娟.健脾祛湿化痰方对2型糖尿病胰岛素抵抗的影响[J].湖北中医杂志,2006,28(8)：29.
50.齐迅,沈欣,陈马力,等.降糖调脂丸对脾虚痰湿型Ⅱ型糖尿病胰岛素抵抗的影响的实验研究[J].中国中医基础医学杂志,2004,1 0(4)：28—34.
51.邹文俊,白红艳,高小平.中药葛根改善胰岛素抵抗作用的实验研究[J].中国药理学通报,2004,20(6)：715-716.
1.陈霞波.糖耐量减低与脾不散精[J].浙江中医杂志,2005,40(3)：118-119.
2.杨明功.糖尿病流行现状及防治对策.疾病控制杂志,2000,4(3)：193-196.
3.孔树佳,付继华.胰岛素抵抗与糖、脂代谢紊乱.中国老年学杂志,200929(9)： 2404.
4.裴友翠,衡先培等.2型糖尿病胰岛素抵抗的中医治疗.实用医院临床杂志.2010,07(4)：25-26.
5.骆斌,王琦.痰湿体质论析[J].安徽中医学院学报,1999,18(5)：10-11.
6.关崧,彭继升,张波.从中医治未病的思想谈中医对糖耐量减低的干预.河北中医,2009,31(2)：216.
7.陈霞波.糖耐量减低与脾不散精[J].浙江中医杂志,2005,40(3)：118-119.
8.雷(?),周兴华.治未病的中医理论在糖尿病前期的应用.泸州医学院学报,2009,32(3)：241.
9.杨辰华,从痰湿论治糖尿病胰岛素抵抗的体会.四川中医.2005,23(1)：10.
10.郑以漫,项坤三,张蓉,等.瘦素受体基因Gln223Arg变异与某地区糖尿病患者代谢紊乱及合并高血压的关系[J].中华内科杂志,2009,39(3)：174-177.
11.周开,龚文波,苏琼,陈霞波.运用中医体质理论分期辨治2型糖尿病心得.江苏中医药,2010,42(3)：30-32.
12.柴可夫,王亚丽.从痰瘀论治胰岛素抵抗.中华中医药杂志,2005,20(9)：542-543.
13.张彤,邵国强,叶景华.运脾活血法治疗2型糖尿病胰岛素抵抗初探[J].新中医,2005,37(2)：7-8.
14.李学军,杨叔禹,王丽英,等.化痰方及化痰活血方对糖尿病大鼠胰岛素抵抗的影响[J1].中国实验方剂学杂志,2006,12(5)：37-39.
2.张仲景著.杨鹏举,侯仙明,杨廷巍注.《金匮要略》.北京：学苑出版社,2007.4.
3.李东垣撰.文魁,丁国华整理.《脾胃论》.北京：人民卫生出版社,2005.8.
4.邢斌,韩天雄.颜德馨内科学术经验薪传.北京：中国中医药出版社.2010.2：9.
5.(清)程国彭撰.田代华整理.《医学心悟》.北京：人民卫生出版社.2006.6.1.
6.(明)龚廷贤撰.《寿世保元》.北京：中国中医药出版社,1993.2.
7.赵云燕,郭信.浅谈张锡纯脾胃学术思想及遣方用药特色.湖北中医杂志.2008,30(8)：20-30.
8.沈金鳌.《杂病源流犀烛》.北京：中国中医药出版社,1994.1.1.
9.(明)吴昆著,张宽等整理.《医方考》.北京：人民卫生出版社,2007.8.1.
10.钟海平,郑红斌.浅谈“脾胃转枢”与“脾统四脏”.实用中医药杂志,2011,27(4)：270-271.
11.(清)程国彭.《医学心悟》.沈阳：辽宁科学技术出版社,1997.8.
12.(明)张介宾,李继明等著.《景岳全书》.北京：人民卫生出版社,2007,9.1.
13.(清)周学海著,闫志安,周鸿艳校注.《读医随笔》.北京：中国中医药出版社,2007,8.1.
14.(清)黄元御著,孙洽熙校注.《四圣心源·劳伤中气》.北京：中国中医药出版社,2009,11.1.
15.(明)周之干著,武国忠点校.《周慎斋医学全书》.海南：海南出版社,2010.5.
16.(清)罗美撰,李飞,武丹丹,黄琼磁校注.《古今名医方论》.北京：中国中医药出版社,2007,7.1.
17. 陈筱云，冯俊俐.陈家礼教授临证应用温胆汤经验心得.光明中医，2011,
18. 朱震亨.《丹溪心法》.北京：人民卫生出版社，2005, 08.
1.官环,张恩毅.美国糖尿病预防计划.国外医学(老年医学分册).2003,24(3)：97-99.
2.王景云,仝丽娟,项楠楠.糖尿病的流行现状与防治对策.中国民康医学,2011,23(8)：1015.
3.肖新华,徐春.糖尿病的预防研究进展.武警医学.2007,18(2)：85-88.
4.陈纪桦.血糖调节机制及功效评估[M].食品工业,1992,34(6)：2-18.
5.裴豹。胰岛素敏感度,葡萄糖敏感度及贝它细胞分泌功能在第二型糖尿病致病机转所扮演的角色[J].中华民国内分泌暨糖尿病学会会讯,1996,4(36)：4-7.
6.巩秋红,李光伟,等.2005北京国际糖尿病预防高层论坛纪要.中华内分泌代谢杂志,2006,22(1)：94-95.
7.臧丽,母义明.胰岛素抵抗机制的新认识.国际内分泌代谢杂志,2009,29(3)：150-154.
8.朱妍,仝小林等.2型糖尿病前期临床研究进展.医学综述,2008,14(11)：1689-1692.
9.杨金奎.12早期干预改变糖尿病.国际内分泌代谢杂志,2009,29(6)：374-377.
10.马凤海.李秀钧.胰岛β细胞自身胰岛素抵抗和2型糖尿病-胰岛素抵抗研究的新领域.国外医学(内分泌学分),2004,24(3)：154-155.
11.王战建,苏杰英.糖尿病预防的最新循证医学证据(一)——DREAM.临床荟萃,2007,2(6)：444-445.
12.沈伟,王旭.2型糖尿病胰岛素抵抗的中医药研究概况.中国中医急症,2009,18(2)：279-280.
13.韩英,江平等.奥利司他对肥胖IGT人群糖尿病预防效果.广东药学,2004,14(3)：40-41.
14.申涛,黄晓华,欧亚龙,罗勤,李光琼,李向东.2型糖尿病患者中医辨证分型与胰岛素抵抗的关系.中国中医药科技,2011,18(3)：235.
15.琚婉君,杨宏杰,郑敏等.中医药治疗糖耐量减低的研究进展.上海中医药大学学报,2008,2(6)：81-82.
16.陈霞波.糖耐量减低与脾不散精[J].浙江中医杂志,2005,40(3)：118-119.
17.徐佩英.消渴病证治探迹.2009年世界中医药学会联合会糖尿病专业委员会第六次国际中医糖尿病学术交流会：70.
18.孟凤仙,倪青,闫秀峰,林兰.消渴病的中医认识思路与方法.中国中医药信息杂志,2005,12(9)：91.
19.张欣,郭叶楠.活血祛痰通腑法治疗糖耐量减低的临床观察.辽宁中医杂志,,2003,30(6)：472.
20.李小娟.中医治疗2型糖尿病胰岛素抵抗的思路与方法.中医药学刊,2005,23(4)：660-661.
21.仝小林.从糖尿病前期谈“治未病”.中华中医药杂,2008,23(3)：191.
22.裴友翠,衡先培等.2型糖尿病胰岛素抵抗的中医治疗.实用医院临床杂志,2010,07(4)：25-26.
23.刘文科,仝小林,刘喜明等.中医药疗法干预糖耐量减低的现状.医学综述,2008,14(11)：1693-1695.
24.毛竹君,董颖,栾洁等.180例2型糖尿病患者中医证候调查及证型研究.中华中医药杂志,2009,24(8)：1065.
25.仲琴,王旭.中医药治疗肥胖Ⅱ型糖尿病研究.吉林中医药,2011,31(10)970.
26.江南,刘铜华.胰岛素抵抗的中医病机探讨.中国中医基础医学杂志,2006,12(09)：691
27.张树彪,徐贵军.胰岛素抵抗的中医药治疗进展.新中医,2006,38(9)：20-21.
28.魏军平,周丽波,仝小林等.2型糖尿病患者体型与证候特点研究.中华中医药学刊,2007,25(12)：2653-2655.
29.杨辰华.从痰湿论治糖尿病胰岛素抵抗的体会.四川中医,2005,23(1)：10-11.
30.刘承琴,黄丹青.中医药治2型糖尿病胰岛素抵抗进展,山东中医杂志,2002,21(11)：697-698.
31.赵莉娟等.2型糖尿病胰岛素抵抗的中医治疗思路.世界中西医结合杂志,2008,3(2)：111-112.
32.张树彪,徐贵军.胰岛素抵抗的中医药治疗进展.新中医,2006,38(9)：20-21.
33.张彤,邵国强,叶景华.运脾活血法治疗2型糖尿病胰岛素抵抗初探[J].新 中医,2005,37(2)：7-8.
34.李小娟.中医治疗2型糖尿病胰岛素抵抗的思路与方法.中医药学刊,2005,23(4)：660-661.
35.李冀,葛鹏玲,李胜志,等.西洋参对胰岛素抵抗大鼠血糖胰岛素及血清瘦素的影响[J].辽宁中医杂志,2008,35(1)：34-35.
36.章小平,方朝晖.参丹健胰丸改善2型糖尿病胰岛素抵抗的机理研究[J].中医药临床杂志,2004.16(6)：543.545.
37.方朝晖,王佑民,王开成,等.丹蛭降糖胶囊对胰岛素抵抗大鼠PPAR-γ mRNA表达的影响.中国实验方剂学杂志,2006,12(4)：33-39
38.黄冬梅,陆付耳,黄光英.补肾通脉方对胰岛素抵抗大鼠胰岛素信号转导的影响[J].中国中西医结合杂志,2003,23(9)：684-686.
39.李洪皎,仝小林.肥胖2型糖尿病前期、早期病机证治探讨.中国中医基础医学杂志,2007,13(7)：529-530.
40.仝小林,赵昱.浅谈糖耐量减低(IGT)的中医证治[J].光明中医,2006,21(7)：24-25.
41.张一骄.丹栀逍遥散对2型糖尿病患者胰岛素抵抗的影响[J].现代中西医结合杂志,2009,18(31)：3840.
42.杨小玉,陆付耳,黄琳,等.黄连解毒汤和黄连单煎剂对胰岛素抵抗大鼠氧化应激和内质网应激的影响[J].中国医院药学杂志,2008,28(17)：1433—1437.
43.叶爱丽,陆付耳,徐丽君等.黄连解毒汤对胰岛素抵抗大鼠脂肪组织胰岛素受体及其底物信号转导的影响[J].中国中西医结合杂志,2006,26(10)：909—912.
44.吴正治,李桂云.2型糖尿病胰岛素抵抗中医药研究述评.深圳中西医结合杂志,2008,18(1)：58-61
45.孔梅,杨广山,邝吴宇.益气养阴活血中药改善2型糖尿病胰岛素抵抗研究[J].安徽中医学院学报,2009,28(4)：8-11.
46.孔德山.活血化瘀法在治疗胰岛素抵抗型糖尿病中的效应[J].实用中医内科杂志,2003,17(6)：493.
47.李学军,杨叔禹,王丽英,等.化痰方及化痰活血方对糖尿病大鼠胰岛素抵抗的影响IJ1.中国实验方剂学杂志,2006,12(5)：37—39
48.第五永长,许建秦.“胰岛素抵抗”与中医“脾不散精”相关性的理论探讨[J].四川中医,2006,24(1 0)：23—24
49.彭丽娟.健脾祛湿化痰方对2型糖尿病胰岛素抵抗的影响[J].湖北中医杂志,2006,28(8)：29.
50.齐迅,沈欣,陈马力,等.降糖调脂丸对脾虚痰湿型Ⅱ型糖尿病胰岛素抵抗的影响的实验研究[J].中国中医基础医学杂志,2004,1 0(4)：28—34.
51.邹文俊,白红艳,高小平.中药葛根改善胰岛素抵抗作用的实验研究[J].中国药理学通报,2004,20(6)：715-716.
1.陈霞波.糖耐量减低与脾不散精[J].浙江中医杂志,2005,40(3)：118-119.
2.杨明功.糖尿病流行现状及防治对策.疾病控制杂志,2000,4(3)：193-196.
3.孔树佳,付继华.胰岛素抵抗与糖、脂代谢紊乱.中国老年学杂志,200929(9)： 2404.
4.裴友翠,衡先培等.2型糖尿病胰岛素抵抗的中医治疗.实用医院临床杂志.2010,07(4)：25-26.
5.骆斌,王琦.痰湿体质论析[J].安徽中医学院学报,1999,18(5)：10-11.
6.关崧,彭继升,张波.从中医治未病的思想谈中医对糖耐量减低的干预.河北中医,2009,31(2)：216.
7.陈霞波.糖耐量减低与脾不散精[J].浙江中医杂志,2005,40(3)：118-119.
8.雷(?),周兴华.治未病的中医理论在糖尿病前期的应用.泸州医学院学报,2009,32(3)：241.
9.杨辰华,从痰湿论治糖尿病胰岛素抵抗的体会.四川中医.2005,23(1)：10.
10.郑以漫,项坤三,张蓉,等.瘦素受体基因Gln223Arg变异与某地区糖尿病患者代谢紊乱及合并高血压的关系[J].中华内科杂志,2009,39(3)：174-177.
11.周开,龚文波,苏琼,陈霞波.运用中医体质理论分期辨治2型糖尿病心得.江苏中医药,2010,42(3)：30-32.
12.柴可夫,王亚丽.从痰瘀论治胰岛素抵抗.中华中医药杂志,2005,20(9)：542-543.
13.张彤,邵国强,叶景华.运脾活血法治疗2型糖尿病胰岛素抵抗初探[J].新中医,2005,37(2)：7-8.
14.李学军,杨叔禹,王丽英,等.化痰方及化痰活血方对糖尿病大鼠胰岛素抵抗的影响[J1].中国实验方剂学杂志,2006,12(5)：37-39.
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |