曹烨民教授分期辨证治疗糖尿病足筋疽经验

Professor Cao Yemin’s Experience in Differentiating and Treating Diabetic Foot Gangrene by Stages and Syndrome Differentiation

曹烨民教授认为糖尿病足筋疽属本虚标实之证,既有糖尿病气阴两虚之本,又有患足红肿灼热、湿热实证之标。急则治标,宜以“清法”为主,“清法”包括清热凉血、利湿解毒为治则的内治法,也包括清创祛腐的局部外治法,常用方剂为茵陈蒿汤、犀角地黄汤、调胃承气汤等;缓解期宜“温清并用”,主要在降低清热解毒药物剂量的同时予党参、黄芪、白术、熟附片等健脾益气温阳药物,祛邪不忘扶正;恢复期以“养”为主,疾病后期以正虚为主,用药主要以人参养荣汤或十全大补汤为主加减治疗。

Professor Cao Yemin thinks that diabetic foot gangrene is of deficiency in origin and excess in superficislity pattern,which not only has the root cause of Qi and yin deficiency in diabetes,but also has the symptoms of red,swollen and scorching hot feet,excess damp-heat pattern.If the symptoms are urgent,treat the symptoms firstly with the method of clearing mainly,and the method of clearing contains internal treatment of therapeutic principle,that is,clearing away heat and cooling blood,diuresis and detoxification,and local external treatment,debridement and removing decays,the commonly-used prescriptions are Yinchenhao Tang,Xijiao Dihuang Tang.Tiaowei Chengqi Tang,etc;at remission stage,warming and clearing could be used simultaneously,mainly representing reducing the dose of the drugs of clearing away heat and detoxification,and adding the drugs of invigorating spleen,replenishing Qi and warming yang such as Dangshen(Radix Codonopsis Pilosulae),Huangqi(Radix Astragali),Baizhu(Rhizoma Atractylodis Macrocephalae),Shufupian(Prepared Common Monkshood Daughter Root)and others,eliminating the evil and enhancing healthy Qi;at the rehabilitation state,“keeping”could be taken as the main method,since the deficiency of healthy Qi is the main pattern at the later stage of the disease,modified Renshen Yangrong Tang or Shiquan Dabu Tang is used to treat the disease.