糖尿病患者饥饿感中医病机浅识

糖尿病患者饥饿感病机有胃火炽盛、胃强脾弱、脾胃虚弱、瘀热消谷、痰热消谷等。糖尿病初期,痰热、火热之证常见,患者出现多食易饥表现,应考虑痰热消谷、火热消谷,选用白虎汤、玉女煎、消渴方等加减治疗;病程日久,火热伤阴,壮火食气,出现气阴两虚等表现,此时出现多食易饥症状,则需考虑胃强脾弱、脾胃虚弱等病机,采用半夏泻心汤、附子理中丸、参苓白术散等治疗;瘀血贯穿糖尿病始终,故在使用以上方法治疗糖尿病患者消谷易饥效果欠佳时,可考虑瘀热消谷的因素,采用桃核承气汤、白虎汤合桂枝茯苓丸治疗。糖尿病与痰湿关系密切,针对该病机引起的饥饿感,在清热的同时,还应化痰除湿。糖尿病病程日久患者,饥饿感病机复杂,宜"观其脉证,知犯何逆,随证治之"。

On the TCM Pathogenesis of Sense of Hunger in Diabetic Patients

The pathogenesis of hunger sense in diabetic patients includes: excessive stomach fire,strong stomach and weak spleen,weak spleen and stomach,stagnated heat accelerating digestion,phlegm heat accelerating digestion. In the early stage of diabetes mellitus,phlegm heat and fire heat are common,and the patients are prone to hunger that’s why they eat more,so we should consider phlegm heat accelerating digestion,stagnated heat accelerating digestion. White Tiger Decoction,Jade Lady Decoction and Formula for Diabetes can be modified. For long-time disease characterized by burning heat injuring yin,excessive fire injuring qi,deficiency of both qi and yin,etc.,the symptoms of eating excessive food and easy hunger may appear,the pathogenesis of strong stomach and weak spleen,weak spleen and stomach need to be considered,so Pinellia Heart-Draining Decoction,Aconite CenterRegulating Pill,Ginseng and Poria and White Atractylodes Powder can be used. Blood stasis runs through diabetes all the time,so when using the above methods to treat diabetic patients with poor effect on accelerating digestion and prone to hunger,we can consider the factors of stagnated heat accelerating digestion,so Peach Kernel Qi-Guiding Decoction,White Tiger combined with Cinnamon Twig and Poria Pill can be used. Diabetes mellitus is closely related to phlegm and dampness. In view of the hunger caused by the pathogenesis,phlegm and dampness should be removed at the same time besides clearing away heat. If patients with diabetes have a long course of disease,and the pathogenesis of hunger is complex. It is advisable to " observe the pulse syndrome,know what pathogenesis,and treat based on syndrome differentiation".