基于“久病入络”理论探讨糖尿病视网膜病变与瘀血的关系

糖尿病视网膜病变(diabetic retinoathy,DR)属于糖尿病微血管并发症之一,近年来,其发病率有逐年升高的趋势。中医根据症状将该病称之为"视瞻昏渺""云雾移睛""暴盲""血灌瞳神",现代医学也称之为"消渴目病"。"久病入络"理论属于络病学说的核心观点之一,其由络病理论发展而来,是清代名医叶天士提出的重要观点。DR是在糖尿病的基础上发展而来,符合"久病入络"之前提,久病必虚且虚久常瘀;同时,络脉逐层分级,延伸到眼部而为目络,目之络脉众多、纤细幽深,络中血行缓慢,易于瘀滞;消渴病暗耗气血津液,目络空虚,气亏血少推动无力,终至瘀血产生。此外,从现代发病机制而言,DR主要与微循环障碍、炎症反应、氧化应激、血液流变学异常、血小板状态等有关,以上机制或可直接产生瘀血,或为瘀血的产生创造了条件。中医学将DR归属于络病范畴,络虚血瘀是其基本病机,瘀血贯穿DR的始终,是DR发生、发展变化的关键因素。"络以通为用"也是叶氏提出的观点之一,已经在诸多学科进行了应用,疗效确切。在治疗本病时,也要严格把握"络以通为用"的基本原则,针对DR之络虚和瘀血,采用补虚通络的方法,配合虫类药、风性药、散结药和入肝经的药,使亏虚之目络得补、瘀滞之目络得通,以达到了改善症状、提高视力、延缓病情进展的目的。

Mechanism of Long Term Disease and Blood Stasis in Diabetic Retinopathy

Diabetic Retinoathy(DR)is one of diabetic microvascular complications.In recent years,its incidence rate is increasing year by year.According to symptoms,TCM calls the disease"blurred vision""cloud and mist moving eyes""sudden blindness"and"blood filling pupil spirit".Modern medicine also calls it"diabetes".The theory of"chronic disease entering collaterals"is one of the core viewpoints of collateral disease theory.It is developed from collateral disease theory and is an important viewpoint put forward by famous doctor YE Tianshi in Qing Dynasty.DR is developed on the basis of diabetes,which is in line with the premise of"long-term disease entering collaterals".Long-term disease will lead to deficiency and chronic stasis.At the same time,the collaterals are graded layer by layer and extend to the eyes to form the eye collaterals.The eye collaterals are numerous,slender and deep,with slow blood flow in the collaterals and is easily to have blood stasis.Diabetes is characterized by dark consumption of Qi,blood and body fluid,empty eyes and collaterals,deficiency of Qi and blood,lack of promotion,and eventually blood stasis.In addition,from the perspective of modern pathogenesis,DR is mainly related to microcirculation disturbance,inflammatory reaction,oxidative stress,abnormal hemorheology,platelet state,etc.The above mechanisms may directly produce blood stasis or create conditions for the generation of blood stasis.In traditional Chinese medicine,DR belongs to collateral disease.Collateral deficiency and blood stasis are its basic pathogenesis.Blood stasis runs through the whole process of DR and is the occurrence,development and change of DR.