张发荣教授补肾和络法治疗糖尿病周围神经病变经验

Experience of Professor ZHANG Farong in Treating Diabetic Peripheral Neuropathy by Tonifying the Kidney and Harmonizing Collaterals

[目的]总结全国名中医张发荣教授治疗糖尿病周围神经病变的临证经验。[方法]通过跟师侍诊,整理医案及相关文献,从病因病机、处方用药等方面总结张教授治疗糖尿病周围神经病变的经验,并附验案一则。[结果]张教授结合多年临证经验,认为糖尿病周围神经病变以“肾虚络损”为基本病机,遵循以治疗糖尿病本病为经,治疗周围神经病变为纬的“经纬论治”法,以补肾和络为基本治则,补肾善从“阴中求阳”“阳中求阴”;和络则灵活运用养阴清热宁络、益气养阴行络、健脾化湿通络、豁痰化瘀畅络、清热利湿通络、温经散寒护络等方法。临证中尤其重视虫类药物的使用,以活血通络,同时重调脾胃,不避甘温,内外合治,双管齐下。所举验案辨证为脾肾亏虚、络脉瘀阻证,张教授治以补肾活血通络,兼以健脾祛湿,临床疗效显著。[结论]张老把握糖尿病周围神经病变肾虚络损的基本病机,采用“经纬论治”法,治疗重在补肾和络,临床疗效显著,值得学习借鉴。

[Objective] To summarize the clinical experience of Professor ZHANG Farong in treating diabetic peripheral neuropathy.[Methods] Through following Professor ZHANG’s clinical work, collecting clinical cases and related literature, Professor ZHANG’s experience in the treatment of diabetic peripheral neuropathy was summarized from the aspects of etiology, pathogenesis, prescription and medication, and one case was taken as proof. [Results] Combined with many years of clinical experience, Professor ZHANG believes that diabetic peripheral neuropathy takes “kidney deficiency and collateral damage” as the basic pathogenesis, follows the “meridian and latitude treatment” method for the treatment of diabetes and peripheral neuropathy, and takes tonifying the kidney and harmonizing collaterals as the treatment principle. Tonifying the kidney is good at “seeking Yang from Yin” and “seeking Yin from Yang”;while harmonizing collaterals flexibly uses methods such as nourishing Yin, clearing heat and calming collaterals;replenishing Qi, nourishing Yin and promoting collaterals;invigorating the spleen, resolving dampness and dredging collaterals;eliminating phlegm, removing blood stasis and smoothing collaterals;clearing heat, promoting dampness and dredging collaterals;warming meridians, dispersing cold and protecting collaterals, etc. In clinical treatment, Professor ZHANG also pays special attention to the use of insect drugs to promote blood circulation and dredge collaterals, at the same time, re-regulating the spleen and stomach, not avoiding sweet and warm, treating internal and external, working along both lines. The syndrome differentiation of the cases cited were deficiency of the spleen and kidney and blood stasis of collaterals, Professor ZHANG treated with tonifying the kidney, promoting blood circulation and dredging collaterals, as well as invigorating the spleen and dispelling dampness, finally achieved remarkable curative effect. [Conclusion] Professor ZHANG grasps the basic pathogenesis of kidney deficiency and collateral damage of diabetic peripheral neuropathy, follows the methods of meridian and latitude treatment and focuses on tonifying the kidney and harmonizing collaterals, the clinical effect is remarkable, which is worth learning and using for reference.