缠绵脾瘅湿热起,骤然臌胀浊毒歇——臌胀合并消渴之探析
Lingering Spleen is Hot and Humid, and Suddenly the Swelling Turbidity Toxin is Removed.Analysis on the Combination of Guzhang and Diabetes Mellitus
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1.甘肃中医药大学附属医院脾胃病科,兰州 730020
2.甘肃中医药大学附属医院内分泌科,兰州 730020
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毛兰芳,刘晓,吉文举,等.缠绵脾瘅湿热起,骤然臌胀浊毒歇[DB/OL].(2023-11-13)[2023-11-13].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=43867680&Fpath=home&index=0&lang=zh
MAO Lanfang,LIU xiao,JI Wenju,et al.Lingering Spleen is Hot and Humid, and Suddenly the Swelling Turbidity Toxin is Removed.[J].,
毛兰芳,刘晓,吉文举,等.缠绵脾瘅湿热起,骤然臌胀浊毒歇[DB/OL].(2023-11-13)[2023-11-13].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=43867680&Fpath=home&index=0&lang=zh DOI:
MAO Lanfang,LIU xiao,JI Wenju,et al.Lingering Spleen is Hot and Humid, and Suddenly the Swelling Turbidity Toxin is Removed.[J]., DOI:.
病史摘要,2,患者间断口干、多饮6年余,伴腹胀、乏力1月入院。既往糖尿病6年余,近1年血糖控制欠佳;慢乙型病史20年,近3年HBeAg阴性,肝病相关指标未见异常。经过中西医结合治疗后,患者病毒得到控制,肝功能得到纠正,但血糖受饮食波动明显,反复出现消化道症状及胸腹水。本病案在国医大师周信有学术思想指导下,结合臌胀与消渴病因病机与病理特点,基于“清解、补虚、祛瘀”治疗原则,提出重在补脾,达到了显著的临床疗效。中医诊断 鼓胀病(脾肾阳虚兼虚瘀癥积证)。西医诊断 1.肝硬化失代偿期(Child-pugh B级);2.慢性乙型病毒性肝炎;3.型糖尿病。干预措施 1.中药:周老处方二号加减;2.非药物疗法:穴位贴敷,中药塌渍,雷火灸,肝病治疗仪;3.西医治疗要点:一般治疗(调饮食、畅情志、测腹围和体重),病因治疗(恩替卡韦抗病毒),抗炎保肝(舒肝宁、双环醇),营养支持(能量合剂),并发症治疗(利尿消肿、预防感染、纠正低蛋白血症、升白细胞及血小板、放腹水治疗),原发病治疗(控制血糖),内镜治疗(食管-胃底静脉曲张套扎栓塞治疗)。疗效转归 口干、多饮、腹胀、乏力等消化道症状及全身症状好转,腹部阳性体征消失,肝病及糖尿病相关指标均得到好转与控制。
Summary of case history, The patient was admitted to hospital with intermittent dry mouth, polydipsia for more than 6 years, accompanied by abdominal distension and fatigue for 1 month.Previous diabetes for more than 6 years, poor blood glucose control in the past 1 year ;The history of chronic hepatitis B was 20 years, and HBeAg was negative in the past 3 years. There was no abnormality in liver disease-related indicators.After the treatment of integrated traditional Chinese and Western medicine, the patient 's virus was controlled and the liver function was corrected, but the blood glucose was obviously fluctuated by the diet, and the digestive tract symptoms and pleural effusion were repeated.The case of this disease was under the guidance of the academic thought of Zhou Xinyou, a master of Chinese medicine.Combined with the guzhang, pathogenesis and pathological characteristics of tympanites and diabetes.Based on the treatment principle of ' clearing away, tonifying deficiency and removing blood stasis ', it is proposed to focus on tonifying the spleen, which has achieved remarkable clinical efficacy.,TCM diagnosis, guzhang disease (Spleen and kidney yang deficiency and deficiency stasis syndrome).,Western medicine diagnosis, 1.Decompensated cirrhosis ( Child-pugh B ); 2.Chronic viral hepatitis B; 3.Type 3 diabetes,Therapeutic methods, 1.Traditional Chinese medicine: Zhou Lao prescription No.2 addition and subtraction; 2.Non-drug therapy: acupoint application, Chinese medicine collapse stains, thunder fire moxibustion, liver disease treatment instrument; 3.Western medicine treatment points: general treatment ( diet, emotional, abdominal circumference and body weight ), Etiological treatment ( entecavir antiviral ), anti-inflammatory liver protection ( Shuganning, bicyclol ), nutritional support ( energy mixture ), Treatment of complications ( diuretic detumescence, prevention of infection, correction of hypoproteinemia, elevation of white blood cells and platelets, and treatment of ascites ), Primary disease treatment ( control of blood glucose ), endoscopic treatment ( esophageal-gastric variceal ligation embolization ).,Clinical outcomes, Dry mouth, polydipsia, abdominal distension, fatigue and other gastrointestinal symptoms and systemic symptoms improved; abdominal positive signs disappeared; liver disease and diabetes related indicators have been improved and controlled.
肝硬化2型糖尿病臌胀消渴
Cirrhosistype 2 diabetes mellitusguzhang diseasediabetes
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