以“温润通”立法分期辨治痛性糖尿病周围神经病变

Differentiation and treatment of painful diabetic peripheral neuropathy by stages with the legislation of“wen run tong”

痛性糖尿病周围神经病变(PDPN)是糖尿病难治的并发症之一,缓解患者疼痛是治疗的难点,该病中医病名为“消渴病痛痹”,针对其阴阳气血亏虚,痰瘀痹阻脉络的本虚标实之病机特点,以“温润通”立法,即“温经散寒,濡润导阳,通络止痛”,按照病变进程分期辨治,早期治以温经养血,化痰通络为主,中期治以散寒止痛,温经通络为主,后期治以濡润益气,导阳通络为主,其中通法贯穿治疗始终。对于顽固性疼痛,可酌情选用川乌头、草乌头等辛温之品以温通经络,散寒止痛;久病入络者可加虫类药物,以化瘀通络,涤痰剔络。临证应辨病辨证相结合,以达最佳治疗效果。

Painful diabetic peripheral neuropathy(PDPN)is one of the intractable complications of diabetes,and relieving the pain of patients is a difficult point in treatment.The disease is called“limb pain of diabetes”in traditional Chinese medicine.Aiming at the pathogenesis characteristics of deficiency of yin and yang,qi and blood,and obstruction of venation by phlegm and blood stasis,it is legislated by“wen run tong”,that is,“warming meridians and dispelling cold,moistening and guiding yang,dredging collaterals and relieving pain”.According to the progress of the disease,the early treatment is mainly warming meridians and nourishing blood,resolving phlegm and dredging collaterals,the middle treatment is mainly dispelling cold and relieving pain,warming meridians and dredging collaterals,and the later treatment is mainly moistening and benefiting qi,guiding yang and dredging collaterals,among which the dredging method runs through the treatment.For intractable pain,you can choose xinwen drugs such as Aconitum carmichaelii and Aconitum kusnezoffii as appropriate to warm the meridians,dispel cold and relieve pain.Insect drugs can be added to those who have been ill for a long time to remove blood stasis,remove phlegm and dredge collaterals.In order to achieve the best therapeutic effect,disease differentiation and syndrome differentiation should be combined.