益气活血法在糖尿病周围神经病变中的应用进展

A review on the application of supplementing Qi and activating blood therapy in the treatment of diabetic peripheral neuropathy

糖尿病周围神经病变(Diabetic Peripheral Neuropathy,DPN)是糖尿病(Diabetes mellitus,DM)持续发展所引起的常见慢性并发症之一。研究报道,50%~66%的DM患者最终均会出现该病变。DPN主要包括感觉神经、运动神经及自主神经系统的病变,其标志性临床特征是大、小神经纤维的进行性损伤。DPN患病率高、致病广泛、致残率高,给家庭及社会造成沉重负担。其所造成的反复肢体感染、溃疡甚至截肢是导致DM患者死亡和残疾的主要原因。目前,西医治疗以控制血糖、缓解氧化应激、改善微循环等疗法为主,在改善患者临床症状、控制疾病进展等方面效果有限。中医治疗本病历史悠久,认为本病病机多以气虚为本,瘀血为标,呈现虚实夹杂的病机特征。纵观文献,笔者发现诸医家论治本病多从健脾益气,活血通络入手,以黄芪桂枝五物汤、补阳还五汤等经典方剂加减论治,标本兼治,消补兼施,并以益气活血法为主,配合针刺、足浴等中医外治法实现多靶点、多途径防治本病,在改善患者临床症状、提高神经传导速度、减轻炎症反应、改善神经营养状态等方面疗效确切而显著,兹将近年益气活血法指导下的相关中医内治法包括中药汤剂、中成药及外治法在DPN中的应用进展综述如下。

Diabetic peripheral neuropathy(DPN)is one of the common chronic complications caused by the ongoing development of diabetes mellitus(DM).Studies have reported that 50%to 66%of patients with DM will eventually have this lesion.DPN mainly includes lesions of sensoriar,motor,and autonomic nervous systems,and its hallmark clinical feature is progressive damage to large and small nerve fibers.DPN has a high prevalence,widespread pathogenesis,and high disability rate,which poses a heavy burden on families and society.The resulting recurrent limb infections,ulcers,and even amputations are the leading causes of death and disability in DM patients.At present,Western medicine treatment mainly focuses on controlling blood glucose alleviating oxidative stress,improving microcirculation and other therapies,which have limited effects in relieving patients’clinical symptoms and controlling disease progression.Traditional Chinese medicine has a long history of treating this disease.It is believed that the pathogenesis of this disease is mainly based on Qi(气)deficiency and blood stasis,presenting the pathogenesis characteristics of mixed deficiency and excess.Through reviewing the literature,the author finds that the doctors treated this disease mostly from strengthening spleen and supplementing Qi,and activating blood circulation and dredging collaterals with the classic prescriptions such as Huangqi Guizhi Wuwu decoction(黄芪桂枝五物汤)or Buyang Huanwu decoction(补阳还五汤),treating both symptoms and root causes for eliminating and supplementing.In addition,supplementing Qi and promoting blood circulation was combined with acupuncture,foot bath and other external treatment methods of traditional Chinese medicine,which can achieve multi-target and multi-way prevention and treatment of the disease.This method is effective in relieving clinical symptoms of patients,increasing nerve conduction speed,reducing inflammatory response,and improving neurotrophic status.This article reviews the progress in the application of TCM internal treatment such as TCM decoction and Chinese patent medicine and external treatment under the guidance of supplementing Qi and promoting blood circulation in the treatment of DPN in recent years.