仝小林态靶辨治糖尿病足溃疡验案一则

A case report about Tong Xiaolin's treatment of diabetic foot ulcer based on the differentiation of states and targets

糖尿病足是糖尿病常见的严重并发症之一,常合并血管、神经病变,进而导致足部感染、溃疡形成、深部组织坏死,所引发足部感觉异常、疼痛、溃疡、坏疽严重影响患者的生存质量。糖尿病足病因复杂,治疗困难,创口难愈合,愈合后易复发,现代医学治疗手段有限。从古至今中医在糖尿病足的治疗上积累了一定的经验。仝小林院士基于态靶医学理论体系,分析患者病情,以糖尿病损证阶段为“纬”,以“老、虚、水、湿、瘀”五态交叠所成的复合态为“经”,把握病情,调态打靶,调态以治水、湿二态为主,瘀态次之,老、虚态再次之,故以利水渗湿,益气温阳化瘀通络为主要治则以调水、湿、瘀三态,取得较好的疗效。现将该医案总结分析如下,望对糖尿病足的治疗提供一定的治疗思路、经验。

Diabetic foot is one of the common serious complications of diabetes,which,often accompanied by vasculopathy and neuropathy,leads to a foot infection,ulcer fonnation and deep tissue necrosis,resulting in abnormal foot sensations,pains,ulcers and gangrenes,seriously affecting the quality of life of patients.Characterized by its complexity in etiology,difficulty in treatment and wound healing,liability to recurrence after wound healing,diabetic foot features limited treatment methods in modem medicine.Yet,TCM is believed to have accumulated some experience in its treatment since the ancient times.Based on the theoretical system of state target medicine,academician Tong Xiaolin treats the stages of deficiency syndrome in diabetes as the"latitude",and the compound state formed by the overlapping five ones of naging,deficiency,water,"ampness and blood stasis"as the"longitude",to analyze and grasp the patients conditions and to regulate various states and handle different targets.He gives a priority to the state regulation of water and dampness,followed by the state of blood stasis and last by the aging and deficiency states,adhering to the primary treatment principles of eliminating dampness and diuresis,benefiting qi,warming yang and resolving blood stasis to unblock collaterals to regulate the three states of water,dampness and blood stasis,having achieved a better therapeutic effect.This paper summarizes and analyzes the medical case,hoping to provide some ideas and experience for the treatment of diabetic foot.