从脾肾探讨糖尿病足的病机

Discussion on Diabetic-foot Pathogenesis from Spleen and Kidney

糖尿病足近年来发病率升高,属于内分泌疾病并发症,其极易因感染而致残或致死。该病临床表现为下肢麻木感、局部皮肤破溃及肌肉骨骼坏死,最终因感染形成坏疽。脾肾两脏为先后天之本,生理状态下脾健肾和,肌肉收缩有度,骨骼坚硬支撑,协调运动,灵活自如。文章基于脾肾理论,分析糖尿病足的病机转变,依据先后天互滋的生理基础,从脾虚致病作为切入点,剖析了脾虚及肾,肾虚血瘀的发展历程。此外,从五行生克制化方面阐明了脾肾共济在糖尿病发病中的重要地位,从脾肾亏虚的中医理论探讨了糖尿病足的发病过程,亦阐明痰湿瘀互结易引起该病加剧,缠绵难愈;由此确立了健脾化湿、补肾活血、健脾补肾的主要治法,同时对兼有痰,阴亏问题,采取化痰,滋阴的治法。

The incidence of diabetic foot has increased in recent years,which is a complication of endocrine diseases.It is highly likely to be disabled or killed by infection;The clinical manifestations of this disease are numbness of the lower extremities,local skin rupture and musculoskeletal necrosis,and eventually gangrene due to infection.Spleen and kidney isinborn and acquired sources.The physiological state of spleen and kidney by muscle contraction and bone rigid support,having coordinated flexibly movements.From the theory of Spleen and Kidney being related,this paper analyzes the transformation of the pathogenesis and dissects the development process of spleen vacuity affecting the kidney,kidney deficiency and blood stasis on account of Spleen vacuity.In addition,the important position of the Spleen and Kidney in the pathogenesis of diabetes was clarified from the aspects of five elements movement,and the pathogenetical processes and peculiarities of diabetic foot were discussed from the traditional Chinese medcine theory of deficiency of the Spleen and Kidney.The basic treatment methods of removing dampness,promoting blood circulation,invigorating the spleen and kidney are established.At the same time,the problem of phlegm and Yin deficiency,the treatment methods of resolving phlegm and tonifying Yin is adopted.