基于目络学说探讨糖尿病视网膜病变辨证思路与治疗

Clinical thinking of the syndrome differentiation and treatment of diabetic retinopathy based on the ocular collateral theory

糖尿病视网膜病变(DR)是工作年龄人群第一位的不可逆性致盲性眼病。张铭连教授通过长期临床实践,基于“目络学说”总结出DR的病因病机和治法方药,认为DR主要涉及肝脾肾三脏,以脏腑气血亏虚为本,络气郁滞为标,并由此进一步引起痰、瘀、热、毒等病理产物的蓄积,损伤目络,发为本病。目络病变是DR局部病机演变的核心,络郁、络瘀、络变是DR的3个发展阶段。在治疗上主张全身与局部辨证相结合,脏络同治,全程治络,分期论治。

Diabetic retinopathy(DR)is the first irreversible blinding eye disease among the working-age population.After years of clinical practice,professor ZHANG Ming-lian has summed up a unique etiology,pathogenesis and treatment idea of DR based on the ocular collateral theory.He believes that DR mainly related to the liver,spleen and kidney.The root cause of the disease is the deficiency of zang-fu organ,qi and blood,and the secondary is the collateral-qi stagnation.What’s more,collateral-qi stagnation could cause pathological products like phlegm,blood stasis,heat and toxin,obstructing or hurting the ocular collateral,and finally cause the disease.Professor ZHANG thinks that ocular collateral is the core of the entire pathogenesis,and summarizes the three stages of the development of DR pathogenesis:the collateral depression stage,the collateral stasis stage,and the collateral changing stage.In the treatment,he advocates to combine the holistic syndrome differentiation of the whole and part of body and the local syndrome differentiation,with the treatment of Zang and collateral at the same time.It should be treated based on different period,and the idea of treating collaterals treatment should be emphasized throughout the whole course of treatment.