从黄汗病病机与病症特点探讨糖尿病并发症的治疗

Exploration of the Treatment of Diabetic Complications from the Pathogenesisand Symptom Characteristics of Yellowish Sweating Disease

黄汗病为《金匮要略》记载的水气病之一,其病症表现较复杂,涉及多个脏腑病变,由里热表虚,外加风、水等邪侵袭而成。黄芪芍药桂枝苦酒汤、桂枝加黄芪汤为治疗黄汗病的经方,二者均具有温卫通阳、除饮化湿之功。平素脾胃有热,外加起居不慎,风水袭表,是糖尿病的关键病机。黄汗病的临床表现、病因病机、发生发展、预后转归等与糖尿病并发症相似。临证可借鉴黄汗病的证治理论,以清热泻火、祛寒散湿、养营和卫为总则,选用相应的方药治疗糖尿病并发症如糖尿病肾病、糖尿病性心肌病、糖尿病性周围神经病变、糖尿病合并肝功能损伤、糖尿病足、糖尿病性视网膜病变等。从黄汗病的病机与病症特点探讨糖尿病并发症的治疗可拓展其中医治疗思路。

Yellowish sweating disease is one of the fluid-retention diseases recorded in Jin Gui Yao Lve(Synopsis of the Golden Cabinet).The symptoms of yellowish sweating disease are complex,involving multiple visceral lesions,which are caused by interior heat and exterior deficiency,together with the concurrent invasion of pathogens of wind and water.Huangqi Shaoyao Guizhi Kujiu Decoction(mainly composed of Astragali Radix,Paeoniae Radix Alba,Cinnamomi Ramulus and vinegar)and Guizhi Plus Huangqi Decoction(mainly composed of Cinnamomi Ramulus and Astragali Radix)are the classical formula for the treatment of yellowish sweating disease.Both of the formulas have the actions of warming defensive qi and dredging yang,removing fluid retention and resolving dampness.Usually suffering heat in the spleen and stomach,together with carelessness in daily living and wind-water pathogens attacking the exterior,contributes to the key pathogenesis of diabetes mellitus.The clinical manifestations,etiology,occurrence and progression,and prognosis of yellowish sweating disease are similar to those of diabetic complications.Therefore,the treatment of diabetes complications such as diabetic kidney disease,diabetic cardiomyopathy,diabetic peripheral neuropathy,diabetes mellitus complicated with liver dysfunction,diabetic foot,and diabetic retinopathy can follow the therapeutic principles of yellowish sweating disease,and can be achieved by the therapies of clearing heat and purging fire,dispelling cold and removing dampness,and nourishing nutritive yin and harmonizing defensive qi with the appropriate formulas.The exploration of the treatment of diabetes mellitus and its complications from the pathogenesis and symptom characteristics of yellowish sweating disease will expand the thoughts for treating diabetic complications with traditional Chinese medicine.