基于“糖络病”学说自拟参七糖络方防治2型糖尿病血管并发症经验探讨

Experience of treating vascular complications of type 2 diabetes with the Shenqi Tangluo decoction based on“blood glucose collateral disease”theory

糖尿病已成为当今全球重大公共卫生问题,其中以2型糖尿病患者居多。2型糖尿病血管并发症不仅是2型糖尿病常见的合并疾病,也是2型糖尿病患者致残和致死的首要原因,临床多见于心脑血管疾病、糖尿病肾病、糖尿病眼病等血管并发症。文章从糖尿病络病的概念、病因、病机、治法等方面探讨参七糖络方防治2型糖尿病血管并发症的理论依据及组方原则。糖尿病血管并发症可归属于中医学“络病”范畴,可伴随2型糖尿病发生发展的始终。根据“糖络病”学说及临床经验,将通络与降糖同治,本着以“络以通为用”为基本原则,以清热降糖、活血通络为治法,佐以扶正祛邪,以降低血糖和畅通血管,明显改善2型糖尿病临床症状。参七糖络方是在经典方剂葛根芩连汤的基础上化裁而成,由黄连、黄芩、葛根、苦瓜、知母、西洋参、三七、僵蚕、干姜9味药物组成,全方清热燥湿,益气通络。文章举例论证了参七糖络方防治2型糖尿病血管并发症的可行性,说明了参七糖络方治疗2型糖尿病及其血管并发症的思路与方法,验证了“糖络病”学说的理论。参七糖络方的应用发展了仝小林教授提出的治疗糖尿病新型诊疗模式,提高了糖尿病的治疗效果及患者的生存质量,可供临床参考。

DDiabetes has become a major public health problem in the world today,with the majority of patients suffering from type 2 diabetes.Vascular complications of type 2 diabetes are not only a common complication of type 2 diabetes,but also the primary cause of disability and death in patients with type 2 diabetes.They are commonly seen in cardiovascular and cerebrovascular diseases,diabetic nephropathy,diabetic eye diseases and other vascular complications.This paper discusses the theoretical basis and prescription principles of the Shenqi Tangluo decoction(参七糖络方)for the prevention and treatment of vascular complications of type 2 diabetes from the aspects of the concept,etiology,pathogenesis and treatment of diabetic collateral disease.Diabetic vascular complications can be classified as“collateral disease”in TCM,and can occur throughout the development of type 2 diabetes.According to the theory of“blood glucose collateral disease”theory and clinical experience,dredging collaterals and hypoglycemic therapy should be given together.Based on the basic principle of“dredging collaterals should come first”,clearing heat and hypoglycemic action,promoting blood circulation and regulating collaterals should be taken as the treatment method,combined with strenthening healthy energy and dispelling evil to reduce blood glucose and smooth blood vessels,so as to significantly relieve the clinical symptoms of type 2 diabetes.The Shenqi Tangluo decoction is based on a classical prescription,the Gegen Qinlian decoction(葛根芩连汤).It is composed of nine drugs:Huanglian(Coptis chinensis),Huangqin(Scutellaria baicalensis),Gegen(Pueraria lobata),Kugua(Momordica charantia),Zhimu(Anemarrhena asphodeloides),Xiyangshen(Panax quinquefolium),Sanqi(Panax notoginseng),Jiangcan(Bombyx Batryticatus)and Ganjiang(Zingiber officinale).The whole prescription has the effects of heat-clearing and dampness-drying,benefiting Qi(气)and dredging collaterals.The paper demonstrates the feasibility of the Shenqi Tangluo decoction in the prevention and treatment of vascular complications of type 2 diabetes with examples,illustrates the ideas and methods of the Shenqi Tangluo decoction in the treatment of type 2 diabetes and its vascular complications,and verifies“blood glucose collateral disease”theory.The application of the Shenqi Tangluo decoction has developed a new diagnosis and treatment model for diabetes proposed by Professor TONG Xiaolin,and improved the therapeutic effect of diabetes and the quality of life of patients,which can be used for clinical reference.