国医大师张学文从内生毒邪论治糖尿病足

辨治糖尿病足应重视四毒,即糖毒、瘀毒、浊毒、热毒。糖毒是水谷精微物质过盛产生的一种毒邪,也是糖尿病及其并发症的致病基础。瘀毒和糖毒均是贯穿糖尿病足整个病程的致病因素。浊毒之邪上可煎熬肺津,中可烧灼胃阴,下可耗损肾水,入血则伤脉络,壅腐气血,导致脉道不通,局部组织液渗出。浊毒下注,足部水肿,日久化热,引发足部坏死感染。糖毒、浊毒、瘀毒日久均可变为热毒,强调糖尿病足感染期必定以湿热毒邪内盛为主。糖尿病足可分为缺血期、感染坏死期和恢复期,分期论治。缺血期采用活血化瘀解毒法;感染坏死期采用清热泻浊解毒法;恢复期采用扶正补消托毒法。

TCM Master Zhang Xuewen's Experience in Treating Diabetic Foot from Endogenous Toxin Evil Factor

Differentiation and treatment of diabetic foot,four Evil factors,namely,Sugar,Stasis,Turbid and Heat Evil factors,should be stressed. Sugar Evil factor is a poisonous Evil produced by the overwhelming storing of nutrition within body. It is also the basis of diabetes and its complications. Stasis and Sugar Evil factors are the causative factors throughout the entire course of diabetic foot. The Evil of Turbid poison can consume the Lung Yin in the upper Burner,burn the stomach Yin in the middle Burner,and consume Kidney Yin the lower Burner. When they enter into blood circulation,the veins would be injured and the blood would become rotten. The descending of Turbid Evil would lead to edema of the foot. With time,the Heat induced would cause foot necrosis infection. Suger,Turbid Stasis Evil factors can all become Heat toxins over time. It is emphasized that the diabetic foot infection period must be dominated by Damp and Heat Evil factors. Diabetic foot can be divided into ischemic period,infection necrosis period and recovery period,and that should be treated according to the character of different stages. The treatment methods are activating blood circulation,removing blood stasis and detoxification is used in the ischemic phase;the method of clearing heat,removing turbidity and detoxification is used in the infection and necrosis phase;the method of activating blood circulation,removing blood stasis and detoxification in the ischemic phase.