张宁分期辨治糖尿病周围神经病变经验

ZHANG Ning’s Experience in Stage Differentiation and Treatment of Diabetic Peripheral Neuropathy

糖尿病周围神经病变是糖尿病常见的慢性并发症,张宁教授继承吕仁和教授思想,以“消渴病痹痿病”为该病中医病名。张教授临床将该病分为早、中、晚三期,早期即麻木为主期、中期即疼痛为主期,晚期为肌肉萎缩期。早期主治以益气养阴,以黄芪桂枝五物汤合四物汤为基础方;中期主治以补益肝肾、疏肝理气止痛,常用方为知柏地黄汤、柴胡疏肝散、一贯煎;晚期主治以健脾补肾、清热除痰利湿,常选知柏地黄汤、四妙丸、桂附理中汤加减。治疗中,活血通络贯穿全程,补血活血并举,养血滋阴同用,并重视患者的情志变化,灵活干预。

Diabetic peripheral neuropathy is a common chronic complication of diabetes.Professor ZHANG Ning inherites the thought of Professor LYU Renhe and takes“diabetic disease and paralysis disease”as the TCM name of the disease.Professor ZHANG Ning divides the disease into three clinical stages of early stage,middle stage and late stage,numbness is the main menifestion of the early stage,pain is the main menifestion of the middle stage,and muscle atrophy is the main menifestion of the late stage.In the early stage,the treatment is to replenish qi and nourish yin,which is based on Huangqi Guizhi Wuwu Decoction(黄芪桂枝五物汤)combined with Siwu Decoction(四物汤).In the middle stage,the main treatment is tonifying liver and kidney,soothing liver,regulating qi and relieving pain,the commonly used prescriptions are Zhibai Dihuang Decoction(知柏地黄汤),Chaihu Shugan Powder(柴胡疏肝散)and Yiguan Decoction(一贯煎).In the late stage,the main treatment is strengthening spleen and tonifying kidney,clearing heat and removing phlegm and dampness,Zhibai Dihuang Decoction,Simiao Pill(四妙丸)and Guifu Lizhong Decoction(桂附理中汤)are often selected.In the treatment,promoting blood circulation and dredging collaterals runs throughout the whole process,which combines invigorating blood and activating blood simultaneously,supplementing blood and nourishing yin at the same time,and attention is given to the emotional changes of patients,and flexible intervention is made.