曹烨民治疗糖尿病足坏疽(筋疽型)经验撷菁

Professor Cao Yemin’s experience in treating diabetic foot gangrene(tendon gangrene)

介绍曹烨民教授治疗糖尿病足坏疽(筋疽型)的临床经验。认为本病主要病机为外感湿热、瘀血阻络、气阴亏虚,将本病分为急性发作期与好转恢复期论治。急性发作期中药内治法以清热、利湿、解毒为主,方选黄连解毒汤合茵陈蒿汤加减,联合基础治疗(控制血糖、控制感染及中药药膳改善低白蛋白血症)及祛腐清筋术外治;好转恢复期治疗上以"养"为主,气阴两虚证治以益气滋阴法,方选生脉饮合六味地黄汤加减,气血两虚证治以益气养血法,方选八珍汤加减,联合蚕食清创术外治。并举验案2则。

This paper aims to introduce Professor Cao Yemin’s clinical experience in the treatment of diabetic foot gangrene(tendon gangrene).Professor Cao believes that the main pathogenesis of tendon gangrene is exogenous damp-heat,blood stasis blocking collaterals and deficiency of qi and yin,and he divides the progress of tendon gangrene into acute onset stage and recovery stage.In the acute onset stage,the internal treatment of traditional Chinese medicine(TCM)is mainly to clear away damp-heat,promote diuresis and remove toxin by adopting modified Huanglian Jiedu Decoction plus Yinchenhao Decoction besides the conventional treatment(controlling blood sugar and infection,improving hypoalbuminemia with TCM therapeutic diet)and external treatment of removing decaying tissues along the tendons.In the recovery stage,"nourishing"is the primary therapeutic principle combined with the external treatment of rodent debridement.As for the dual deficiency of qi and yin syndrome,modified Shengmai Decoction plus Liuwei Dihuang Decoction is used to replenish qi and nourish yin;as for the dual deficiency of qi and blood syndrome,modified Bazhen Decoction is used to replenish qi and nourish blood.Two proven cases are presented.