基于“治痿独取阳明”论治糖尿病周围神经病变经验

Experience in the treatment of diabetic peripheral neuropathy based on theory of‘treatment for flaccid paralysis aiming at yangming meridian’

糖尿病周围神经病变继发于消渴病,是糖尿病常见的并发症之一,归属于中医“血痹”“痿证”等范畴。赵进喜教授在治疗糖尿病周围神经病变时,基于《黄帝内经》“治痿独取阳明”的理法,强调“取阳明”具有“补阳明之气”“养阳明之阴”“清阳明之热”“除阳明之湿”等多重内涵,同时重视糖尿病周围神经病变的核心病机“气虚血瘀、络脉瘀结”,治疗思路在补气活血、化瘀活络的基础上,酌情配合养阴、清热、除湿及补肾通督等方法。文章举验案一则,以供探讨。

Diabetic peripheral neuropathy,one of the common complications of diabetes,is secondary to emaciationthirst disease and belongs to the categories of‘blood arthralgia’and‘flaccidity syndrome’in traditional Chinese medicine.In the treatment of diabetic peripheral neuropathy,professor ZHAO Jinxi,based on the principle of‘treatment for flaccid paralysis aiming at yangming meridian’in Huangdi Neijing,emphasizes that‘yangming meridian’has multiple connotations such as‘nourishing qi of yangming’,‘nourishing yin of yangming’,‘clearing heat of yangming’and‘removing dampness of yangming’,and simultaneously puts an emphasis on the core pathogenesis of diabetic peripheral neuropathy:‘syndrome of blood stasis due to qi deficiency’.The treatment idea is based on tonifying qi,activating blood,removing blood stasis and activating collaterals,and appropriately cooperating with the methods of nourishing yin,clearing heat,removing dampness,invigorating the kidney and regulating governor pulse etc..This paper gives a case for discussion.