中医杂志

总结仝小林教授运用开郁降浊法论治糖尿病前期合并超重或肥胖的临床经验。认为糖尿病前期属于中医学“脾瘅”范畴，其核心病机为中满内热，而肥胖则是加剧中满内热的始动因素，故截断超重、肥胖与糖代谢异常之间的转化对降低糖尿病发病风险具有重要意义。提出糖尿病前期合并超重或肥胖的主要病机为中焦气郁浊阻，以气郁为本、浊阻为因，形成了以开郁降浊法为核心的治疗思路。临床采用大黄黄连泻心汤为基础方，以泄浊为主、辅以行气，取寓行于降之意，澄脾瘅之源，并结合患者证候虚实灵活加减，实现个体化诊疗。

This article summarised the clinical experience of Professor TONG Xiaolin in treating prediabetes combined with overweight or obesity using the method of relieving depression and reducing turbidity. It is believed that prediabetes belongs to the category of "spleen-heat syndrome" in traditional Chinese medicine, and its core pathogene-sis is fullness in center with internal heat, while obesity is the initiating factor for exacerbating center fullness and internal heat. Therefore, it is of great significance to reduce the risk of diabetes by interrupting the transformation between overweight, obesity and glucose metabolism abnormality. It is proposed that the main pathogenesis of predia-betes combined with overweight or obesity is qi depression and turbidity obstruction in middle jiao, with qi depression as the root and turbidity obstruction as the cause, forming a treatment idea with the method of relieving depression and reducing turbidity as the core. In clinic, Dahuang Huanglian Xiexin Decoction （大黄黄连泻心汤） is used as the basic prescription, with a primary focus on directing the turbid downward, supplemented by regulating qi, which embodies the concept of "promoting movement through descent, then figuring out the root of spleen-heat syndrome. Furthermore, the treatment is flexibly modified based on the patient's deficiency-excess syndrome to ensure individualized therapy.