2型糖尿病 （T2DM） 是一种临床常见且并发症较严重的代谢性疾病，其发病机制和病机演变过程较复杂。该文从中医“壮火食气” 与现代医学的“炎症-线粒体损伤”机制探讨了T2DM的发病机制和防治思路。“壮火食气” 可反映T2DM的中医病机特点：以“壮火”为发病重要因素，“食气”为病变过程，体现了T2DM以“正气虚”为本、“郁热”为标的根本病机，揭示了痰瘀助壮火的“壮火-气虚-痰瘀”的恶性循环病机演变规律。基于现代临床研究及基础研究提出了T2DM“炎症-线粒体损伤”的机制，并指出线粒体是打破“炎症-线粒体损伤”循环的关键治疗靶点，保护线粒体是T2DM“益气清热活血”治则的潜在生物学实质。将“壮火食气”的中医病机与现代医学的“炎症-线粒体损伤”机制相结合以探讨T2DM的发病机制，有望为中西医结合防治T2DM的研究提供新的视角。

Type 2 diabetes mellitus（T2DM） is a common metabolic disease with serious complications，and its pathogenesis and evolution are complicated. This paper discussed the pathogenesis of T2DM and thoughts for its prevention from the mechanism of “vigorous fire consuming qi” in traditional Chinese medicine （TCM） and from the mechanism of “inflammation-mitochondrial damage” in western medicine. “Vigorous fire consuming qi” reflects the characteristics of pathogenesis of T2DM： “vigorous fire” becomes an important factor in the pathogenesis of T2DM，and “consuming qi” reveals the pathogenic process，indicating that the fundamental pathogenesis of T2DM is characterized by “deficiency of healthy qi” as the root and take， and “stagnated heat” as the branch. “Vigorous fire consuming qi” also reveals that the evolution of pathogenesis is in a vicious cycle of “vigorous fire-qi deficiency-phlegm and blood stasis”，in which phlegm and blood stasis boost the vigorous fire. Based on modern clinical research and basic research，the hypothesis of inflammation-mitochondrial damage in T2DM was proposed in this paper，and it was pointed out that the mitochondria is the key therapeutic target to break the cycle of inflammation-mitochondrial damage， and protecting mitochondria is the underlying biological essence of the therapeutic principle of “replenishing qi，clearing heat and activating blood” . The exploration on the pathogenesis of T2DM by combining the TCM pathogenesis of “vigorous fire consuming qi” with the mechanism of “inflammation-mitochondrial damage” in western medicine will be expected to provide new perspectives for the study of prevention and treatment of T2DM with integrated Chinese and western medicine.

R255.4；R587.1

国家自然科学基金项目 （编号：8200151369）；中央高水平中医医院临床科研业务费资助项目 （编号：DZMG-QNGG0009）；北京中医药大学新奥奖励基金项目 （编号：2019-AJLJJ-018）