基于“伏毒损络”理论探讨糖尿病大血管病变的病机及治疗

Pathogenesis and Treatment of Diabetic Macroangiopathy Based on Theory of Hidden Pathogen Damaging Collaterals

糖尿病大血管病变的基本病理改变是动脉粥样硬化,高血糖“代谢记忆”会对大血管造成持续损害。氧化应激反应是糖尿病及其慢性并发症的共同机制,也是“代谢记忆”持续损伤大血管的发病基础,抗氧化治疗可延缓糖尿病大血管病变发生发展。中医认为“伏毒”致病具有隐匿、缠绵、痼结的特点。结合络病证治,继承发展中医血脉系统,以脉络学说、伏毒理论为指导,总结糖尿病大血管病变的病理变化是“伏邪潜藏-糖脂痰瘀内生-蓄积成毒-毒损脉络-脉搏坚”,核心病机是“伏毒损络”,基本病理改变是“脉搏坚”,病理产物及致病关键是糖毒、脂毒、痰毒、瘀毒。基于此运用活血通络、豁痰清络、流气畅络、解毒顺络等法选方遣药,可通过抑制活性氧生成,影响氧化酶系活力,增强抗氧化能力,从而调控机体氧化应激反应,保护血管内皮功能,减少糖尿病大血管损伤,延缓疾病进展,在指导临床和研究有重要意义,为中医药防治糖尿病大血管病变提供新思路。

The basic pathological change of diabetic macroangiopathy is atherosclerosis, and the metabolism legacy effect of hyperglycemia will cause continuous damage to the large vessels. Oxidative stress is a common mechanism for diabetes and its chronic complications and it is also the basis of the metabolism legacy effect which keeps damaging the large vessels. Anti-oxidant therapy can delay the course of diabetic macroangiopathy. According to the theory of traditional Chinese medicine(TCM),the pathogenicity of hidden pathogen is concealing,lingering,and refractory. On the basis of the syndrome and treatment of collateral diseases,vessel-collateral theory,and hidden pathogen theory of TCM,the pathological changes of diabetic macroangiopathy are summarized as pathogen concealment-accumulation of sugar and lipids leading to phlegm and blood stasis-accumulation of toxins-damage to vessels and collaterals-hardening vessels. The core pathogenesis is the hidden pathogen damaging the collaterals,and the basic pathological change is vessel hardening. The toxins of sugar,lipid,phlegm,and stasis are the pathological products and the key to be treated.According to this theory,the medicinal materials with the functions of activating blood to dredging collaterals,resolving phlegm to clearing collaterals,Promoting qi to unblocking collaterals and removing toxins to shunting collaterals can be selected for prescription. These medicinal materials can inhibit the generation of reactive oxygen species, affect the oxidase activity, and enhance the antioxidant capacity, thereby regulating the oxidative stress response,protecting the vascular endothelial function,reducing the damage of the large blood vessels,and slowing down the progression of the disease. Such therapy is of great significance in clinical practice and research,providing a new idea for the prevention and treatment of diabetic macroangiopathy.