糖尿病神经病变的诊断与中西医结合治疗

Diagnosis and treatment of diabetic neuropathy with integrative traditional Chinese and western medicine

糖尿病肾病合并常见的糖尿病神经病变主要包括:糖尿病周围神经病变,糖尿病自主神经病变,尤其是神经源性膀胱;西医治疗包括对因治疗和对症治疗,对因治疗有控制血糖、神经修复、抗氧化应激、改善微循环、改善代谢及神经营养等,对症治疗主要针对患者疼痛、胃轻瘫、便秘、腹泻及神经源性膀胱的治疗。糖尿病周围神经病变中医辨证属"消渴病痹症"范畴,分型包括气虚血瘀、阴虚血瘀、寒凝血瘀、痰瘀阻络及肝肾亏虚证;中医治疗包括辨证选择中药汤剂及中成药、熏洗法、针灸疗法及离子导入治疗。糖尿病自主神经病变的中医诊断和治疗,分属于呕吐、痞满、便秘、泄泻、心悸、癃闭、劳淋及汗证等。

The diabetic neuropathy common in patients with diabetic nephropathy mainly includes the diabetic peripheral neuropathy, diabetic autonomic neuropathy, and especially neurogenic bladder. Its treatment by western medicine can be divided into etiological treatment and symptomatic treatment. The etiological treatment includes controlling blood glucose, nerve repair, anti-oxidative stress, improving microcirculation, and improving metabolism and nerve nutrition. Symptomatic treatment mainly focuses on treating patients＇ pain, gastroparesis, constipation, diarrhea, and neurogenic bladder. By syndrome differentiation of traditional Chinese medicine （TCM）, the diagnosis of diabetic peripheral neuropathy belongs to ＂diabetes arthralgia＂ category, which includes blood stasis due to qi deficiency, blood stasis due to yin deficiency, blood stasis due to cold, phlegm-stasis blocking collateral, and liver-kidney deficiency syndromes. The treatment of diabetic peripheral neuropathy by TCM includes dialectical options of Chinese medicine decoctions and Chinese patent drugs, steaming and washing methods, acupuncture therapy, and iontophoresis therapy. The diagnosis and treatment of diabetic autonomic neuropathy by TCM belong to syndromes of vomiting, feeling of fullness, constipation, diarrhea, palpitations, retention of urine, stranguria due to overstrain,and hidrosis.