从“取阳明”“补肾精”论治糖尿病周围神经病变

糖尿病周围神经病变(DPN)归属于中医“痹症”“痿证”“麻木”等范畴。结合临床表现看,DPN的发病是从“痹症”逐渐向“痿证”进展的过程。以中医“未病先防,已病防变”治未病理论为指导理念,结合“治痿独取阳明”和“肾藏精”理论,从气血津液精的角度探讨“阳明”“肾精”与DPN的关系。DPN病机虚实夹杂,以脾胃虚弱、肾精不足为本,痰湿血瘀夹杂为标。因此治疗上须补虚泻实,从“取阳明”“补肾精”论治DPN,治疗上强调以调补脾肾为主,恢复脾肾功能,调补气血津液精,兼以化痰活血祛瘀,使气血津液运行有常。“取阳明”“补肾精”的治疗原则应贯穿于DPN的全程治疗中,为临床防治本病提供新的治疗思路与方法。

Treatment of diabetic peripheral neuropathy from taking Yangming and tonifying kidney essence

Diabetic peripheral neuropathy(DPN)belongs to the category of arthralgia syndrome,flaccidity syndrome and numbness in traditional Chinese medicine.According to the clinical signs,the morbidity of DPN is a progressive process from arthralgia syndrome to flaccidity syndrome.Based on the concept of “prevent disease before it changes” in traditional Chinese medicine,combined with the theory of “treating flaccidity through Yangming meridian” and “kidney storing the essence”,the relationship between Yangming,kidney essence and DPN was discussed from the perspective of qi,blood,body fluid and essence.The pathogenesis of DPN is the mixture of deficiency and excess,with the weakness of spleen and stomach,the deficiency of kidney essence and the mixture of phlegm-dampness and blood stasis.Therefore,the treatment of DPN should be tonifying deficiency and reducing excess.The treatment of DPN should be based on taking Yangming and tonifying kidney essence,which should focus on regulating and invigorating spleen and kidney,restoring spleen and kidney function,tonifying qi,blood,body fluid and essence,as well as resolving phlegm,promoting blood circulation and removing blood stasis,so that qi,blood and body fluid can circulate regularly.The therapeutic principles of taking Yangming and tonifying kidney essence should be carried out throughout the whole course of DPN treatment,which can provide new treatment ideas and methods for clinical prevention and treatment of this disease.