从“痿证—肉痿”探讨糖尿病周围神经病变诊疗思路

Diagnosis and Treatment of Diabetic Peripheral Neuropathy from the Perspective of“Wei(瘘) Syndrome-Flesh Wei"

认为《黄帝内经》中的痿证本质为热邪内伤五脏导致五体机能减退的结果,肉痿则是其中由热伤脾胃,湿邪内侵,引发后续热不得散,气机不畅,水液代谢失常,最终导致肌肉痹而不仁的病症。阳明热邪与太阴湿邪是该病的主要致病因素。核心病机是气机、水液运行失常。认为糖尿病周围神经病变除常规以痹证论治外,可从"痿证-肉痿"着手论治,针药结合,以燥化脾湿、清化胃热为法进行治疗。

As recorded in Inner Canon of Yellow Emperor(《黄帝内经》),the root of Wei(痿)syndrome is the hypofunction of five body constituents due to internal damage to the five zang(脏)organs by pathogenic heat.When spleen and stomach are damaged by heat and invaded by pathogenic dampness,and moreover,when the heat cannot be dissipated,and there is disturbance of qi movement and disharmony of water metabolism,the paralysis and numbness of the muscles occur,finally leading to flesh Wei.Pathogenic heat of yangming(阳明)and pathogenic dampness of taiyin(太阴)are the main pathogenic factors.Abnormal qi movement and water metabolism are the core pathogenesis.Except for the conventional treatment principle of diabetic peripheral neuropathy following"bi(痹)syndrome",it is also suggested to start from the perspective of"Wei syndrome-flesh Wei"and by combining acupuncture with medicine.