《黄帝内经》营卫理论视角下消渴后痈疽病机探析*

作者：杨剑锋1，李友山2，张 宁3，张锦楠1，夏颐瑄1

单位：1.北京中医药大学东直门医院，北京 100700； 2.北京中医药大学东直门医院通州院区，北京 101121； 3.浙江中医药大学附属第一医院/浙江省中医院，浙江 杭州 310006

引用：引用：杨剑锋，李友山，张宁，张锦楠，夏颐瑄.《黄帝内经》营卫理论视角下消渴后痈疽病机探析[J].中医药导报,2025,31(10):234-238,244.

DOI：10.13862/j.cn43-1446/r.2025.10.044

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摘要：

消渴后痈疽作为糖尿病中晚期严重并发症，以肢体末端溃烂难愈、高致残率为特征，其复杂病机与临床治疗困境亟待深入探讨。本文基于《黄帝内经》营卫理论，系统解析消渴后痈疽“本虚标实”之根本病机，提出营卫失调是血脉瘀阻的核心驱动因素。营卫二者，营主濡养、卫司固护，其化生有源、循行有序乃气血调和之基。消渴病者因脾瘅失运，精微不布，营卫生化匮乏，加之久病入络，营卫壅塞，卫不固表则外邪内陷，营不行脉则血滞成瘀，终致气血凝涩、邪毒壅聚，发为痈疽。故消渴后痈疽者营卫常阻滞，亦多营卫不足。消渴后血脉瘀阻实为营卫失调的具象表现，其治疗需突破“活血化瘀”之标治局限，以“调营卫、畅气血”为根本原则，结合行气活血、祛邪通经、补益脾肾等法，复营卫生化之源、通营卫循行之道。

关键词：消渴；痈疽；《黄帝内经》；营卫

Abstract：

Post-diabetes carbuncles and gangrene, as severe late-stage complications of diabetes mellitus, are characterized by refractory ulcerations at the extremities and a high disability rate. Their intricate pathogenesis and clinical therapeutic challenges demand in-depth exploration. Grounded in the Ying-Wei (Nutritive-Defensive) theory from Huangdi Neijing, this study systematically elucidates the fundamental pathogenesis of post-diabetes carbuncles and gangrene as a manifestation of "deficiency in origin and excess in manifestation," proposing that Ying-Wei imbalance serves as the core driver of blood stasis syndrome. Ying (nutritive Qi), responsible for nourishing, and Wei (defensive Qi), governing protection, rely on adequate generation and orderly circulation to maintain harmonious Qi-blood dynamics. In diabetic patients, spleen dysfunction impairs nutrient distribution, leading to insufficient Ying-Wei production. Chronic disease progression further causes Ying-Wei stagnation, compromised Wei fails to fortify the exterior, permitting exogenous pathogens to invade, while stagnant Ying obstructs vascular flow, resulting in blood stasis. This culminates in qi-blood congelation, pathogenic toxin accumulation, and necrotic tissue formation. Thus, Ying-Wei obstruction and deficiency are hallmark features of post-diabetes carbuncles and gangrene. The blood stasis observed in these conditions concretely reflects Ying-Wei dysregulation. Therapeutic strategies must transcend superficial "blood-activating and stasis-resolving" approaches, prioritizing "harmonizing Ying-Wei and regulating Qi-blood" as the foundational principle. Integrated modalities, including Qi activation and blood circulation enhancement, pathogen elimination and meridian unblocking, and spleen-kidney tonification, aim to restore Ying-Wei generation and optimize their circulation.

Key words：diabetes; ulcers; Huangdi Neijing; Ying-Wei theories

发布时间：2026-01-08

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