基于“开阖枢”理论论治糖尿病神经源性膀胱

Treatment of DNB Based on Theory of ‘Opening-Closing Pivot’

糖尿病神经源性膀胱(DNB)属中医“消渴”“癃闭”范畴,病邪痼结难解。“开阖枢”为六气升降出入、气机内连脏腑之关键所在,且自主神经功能与经脉脏腑气化的开阖枢功能相似,故本文从“开阖枢”理论对DNB病机进行分层论述,认为枢机不利,开阖失常,气化失司,水道不通为其根本病机,枢机不利为其发病关键。临证治疗时倡导以行气转枢为基本治则,肾气丸、五苓散寓含“枢”转动越之义,枢机和畅,则膀胱壅滞之气得通,基于此角度论治可为中医治疗DNB提供新思路。

Diabetic neurogenic bladder(DNB)belongs to the category of‘Xiaoke’(diabetes mellitus)and‘Longbi’(retention of urine)in TCM,which is difficult to cure.‘Opening-closing pivot’is the key for six-Qi ascending and descending,entering and exiting,as well as for Qi movement linking Zang-Fu organs.Because autonomic nervous function is similar to Qi transformation function of Zang-Fu organs and meridians,therefore,this study discusses the pathogenesis of DNB from the theory of‘opening-closing pivot’,it regards that pivot disorder,opening-closing imbalance,Qi transformation disorder and waterway blockage are the basic pathogenesis,among which pivot disorder is the crucial point.In clinical treatment,Qi-operated pivot is advocated as the basic treatment principle.Shenqi Pill and Wuling Powder are suggested to regulate the pivot,and to make Qi stagnation of bladder unobstructed.Therapies based on this perspective can provide a new idea for the treatment of DNB in TCM.