摘要
糖尿病性黄斑水肿为糖尿病视网膜病变常见且严重的并发症,患者视网膜微血管受到损伤,导致血–视网膜屏障破坏,引发黄斑区细胞外液积聚、视网膜增厚或硬性渗出沉积。黄斑区作为视力最敏锐的部位,水肿后会对视力造成严重影响,且多次复发可能造成黄斑区结构损害。糖尿病性黄斑水肿是导致糖尿病患者视力下降、甚至失明的常见原因,其治疗一直备受关注。该病具有易反复发作、病程长的特点,且治疗费用昂贵,控制率欠佳。针对此情况,可运用经典理论,结合临床实践,探索糖尿病性黄斑水肿的诊疗思路。“水入于经,其血乃成”理论出自张机(字仲景)的《伤寒论》,该理论诠释了水入于经中化血的过程,当水液无法顺利进入经脉化血时,会形成痰饮、血瘀等病理产物,这些病理产物停于黄斑区,阻碍血液的正常运行,导致水瘀互结,从而形成水肿。基于该理论,结合糖尿病的病因病机,夏清艳教授认为,诊治糖尿病性黄斑水肿应从糖尿病出发,重视“水入于经”过程中脾胃、肾、营卫所发挥的作用,从瘀、水认识糖尿病性黄斑水肿,在治疗上遵循健脾益气、活血化瘀、温阳补肾的原则,采用活血利水法治疗糖尿病性黄斑水肿,临床取得较好效果,为中医治疗糖尿病性黄斑水肿提供参考。
Diabetic macular edema(DME)is a common and serious complication of diabetic retinopathy.The damage of blood-retinal barrier caused by retinal microvascular injury in patients leads to the accumulation of extracellular fluid in the macular area,retinal thickening or hard exudation deposition.As the most sensitive part of vision,macular area will have a serious impact on vision once edema occurs,and multiple recurrences may cause structural damage to the macular area.DME is a common cause of vision loss and even blindness in diabetic patients,and its treatment has always attracted much attention.The disease has the characteristics of easy recurrence and long course,and the cost of Western medicine treatment is expensive with poor control rate.In view of this situation,TCM classical theory and clinical practice can be used to explore the diagnosis and treatment of DME.The theory of“body fluid participates in blood generation by the transfusion of meridians”comes from ZHANG Ji’s Shanghan Lun(《伤寒论》),and explains the process of water and body fluid entering the meridians to generate blood.Water and body fluid will form pathological products such as phlegm and blood stasis on condition that they can not enter the meridians to generate blood smoothly.These pathological products remain in the macular area and hinder the normal operation of blood,resulting in the mutual accumulation of water and blood stasis,and thus causing edema.Based on this theory and in combination with the etiology and pathogenesis of diabetes,Professor XIA Qingyan believes that the diagnosis and treatment of DME should start from diabetes,that the role of spleen and stomach,kidney,and Yingwei(营卫)during the process of“water entering the meridians”should be emphasized,and that DME should be understood from the aspects of blood stasis and water.The treatment follows the principles of invigorating spleen and replenishing Qi(气),promoting blood circulation to remove blood stasis,and warming Yang(阳)and tonifying kidney.The method of activating blood and promoting diuresis has achieved good clinical effects in the treatment of DME,which provides a reference for the diagnosis and treatment of diabetic macular edema in TCM.
出处
《中医临床研究》
2025年第21期31-34,共4页
Clinical Journal Of Chinese Medicine
关键词
糖尿病
糖尿病性黄斑水肿
活血利水法
水入于经
血水
Diabetes mellitus
Diabetic macular edema
Activating blood and promoting diuresis method
Water enters meridians
Bloody water
