摘要
糖尿病周围神经病变是临床常见的糖尿病慢性并发症之一,临床主要表现为双侧肢体对称性麻木、疼痛或感觉异常。临床研究发现,近年来糖尿病周围神经病变发病率逐渐上升,给患者造成了身心双重困扰。西医学目前主要采用对症治疗,尚无特效药物。糖尿病周围神经病变中医证型多种多样,且患者体质存在个体差异,中医辨证论治发挥了优势,不仅能改善症状,且疗效持久,在临床治疗上发挥了重要作用。中医学认为,此病源于饮食不节,如嗜食肥甘厚味,使血糖升高,营卫失常,久病入络,累及四末,导致肢体麻木、疼痛、感觉异常。营卫与血糖同为脾胃运化水谷所化生,卫行脉外,营行脉中,营主濡养四肢百骸,卫主皮肤感觉及防御功能。营卫的功能与西医的神经及微循环系统的作用相似。消渴日久,脏腑功能失调,脾肾亏虚,营卫生化乏源而亏虚,肢体失养;久病气郁,脏腑虚弱,气机运行不畅,停津为痰,积血为瘀,痰瘀痹络,导致肢体麻木、疼痛等周围神经循环异常。糖尿病病程中持续血糖异常,营卫失常,恶性循环,肢体失养,则并发糖尿病周围神经病变。脾胃化生营卫,治当健脾益肾而使营卫化生有源,营卫通过肝气布散于四肢,治当调肝通络以畅营卫之道。通补并施,使营卫得以调和,肢体得以濡养。
Diabetic peripheral neuropathy is one of the common chronic complications in diabetic patients.The main clinical manifestations are symmetrical numbness,pain or abnormal sensation of bilateral limbs.Clinical findings have shown a gradual increase in the incidence of diabetic peripheral neuropathy in recent years,causing physical and mental double-layer distress to patients.Currently,Western medicine mainly adopts symptomatic treatment,and there is no specific medicines.Diabetic peripheral neuropathy is characterized by various syndrome types in traditional Chinese medicine,and patients show individual differences in TCM constitution.TCM plays to its strengths in differentiating syndromes and treating diseases.It can not only relieve symptoms but also has a long-lasting therapeutic effect,playing an important role in clinical treatment.According to relevant theories in TCM,this disease stems from improper diet,such as excessive consumption of rich sweet and greasy foods,which elevates blood glucose level,disrupts the normal function of defense systems in the body,and leads to illness that affects the meridians and the extremities over time,resulting in numbness,pain,and abnormal sensations in the limbs.Yingwei(营卫)defenses and blood glucose are both derived from the metabolism of water and grain governing by the spleen and stomach,Wei(卫)runs outside the blood vessels,while Ying(营)runs within the blood vessels.Ying mainly nourishes the limbs and bones,while Wei mainly has the functions of skin sensation and defense.The function of Yingwei defense is similar to the roles of the nervous and microcirculatory systems in Western medicine.If one suffers from Xiaoke(消渴)for a long time,the functions of the internal organs will be disordered,the spleen and stomach will be unable to transform and transport Qi(气)and blood due to Yingwei defense deficiency,leading to loss of nourishment in the limbs.Long-term illness leads to Qi stagnation,the internal organs are weakened,and the circulation of Ying and Wei is obstructed,with stagnant body fluids as a result.Stagnant body fluid is gradually transformed into phlegm,and the accumulation of blood for a long time results in blood stasis.Phlegm and blood stasis block the meridians gradually,causing abnormal peripheral nerve circulation such as numbness and pain in the limbs.Continuous abnormal blood glucose in the course of diabetes mellitus will lead to Yingwei dysfunction,forming a vicious cycle,and the limb is not nourished,which causes diabetic peripheral neuropathy concurrently.The spleen and stomach transform and transport Yingwei defenses.The treatment should focus on strengthening the spleen and benefiting the kidneys to ensure that Yingwei defenses have a source of transformation and generation.Yingwei defenses are regulated and distributed through the liver Qi to the limbs,so it is necessary to regulate the liver and unblock the meridians to dredge the channels of Ying and Wei.By combing dredging and tonificaiton,the harmony of Ying and Wei can be achieved,and the limbs can be nourished.
出处
《中医临床研究》
2025年第28期77-80,共4页
Clinical Journal Of Chinese Medicine
基金
2022年江西省名老中医药专家学术经验继承项目(赣中医药科教字〔2022〕18号)
2023年江西省中医药科技项目(2023A0329)。
关键词
营卫理论
糖尿病周围神经病变
麻木疼痛
Yingwei theory
Diabetic peripheral neuropathy
Numbness and pain
