摘要
糖尿病远端对称性多发神经病变(Diabetic Distal Symmetric Polyneuropathy,DSPN)属于“糖尿病神经病变”范畴,是由不同病理生理机制所致、表现多样化的一组临床综合征。糖尿病神经病变是糖尿病最常见的慢性并发症,发病率高达50%,而其中最常见的类型为远端对称性多发神经病变,约占糖尿病神经病变的75%。大多数糖尿病神经病变患者早期无典型症状,临床发病隐匿。中医学根据DSPN患者常见肢体远端的发凉、痛痒、麻木、肌肉萎缩等症状,将其归纳为中医“消渴之痹证”范畴。此类病变多发生于病程长、血糖控制不佳的糖尿病患者。其证属本虚标实,基本病机为消渴阴虚燥热日久,气阴被伤;人身之阴阳互根互用,相互为本,疾病日久阴损及阳,也可见阴阳失衡的各种表现,阴阳气血亏虚,血行瘀滞,脉络痹阻,发为本病。DSPN的临床表现是一个动态演变的过程,患者的症状体征可随血糖的控制情况而变化,病机也可出现脏腑、气血、阴阳、虚实等方面的变化。临床上西医治疗以缓解症状为主,而中医治疗在“整体观念”和“辨证论治”思想的指导下,基于“守经隧”理论对患者脏腑气血受损的不同方面进行论治,具有“治病求本”和“已病防变”的优势。文章基于“守经隧”理论对DSPN相关内容展开论述,以期为临床防治DSPN提供理论参考。
Distal symmetric polyneuropathy(DSPN)falls under the category of diabetic neuropathy(DN).It represents a group of clinical syndromes with diverse manifestations caused by different pathophysiological mechanisms.DN is the most common chronic complication of diabetes,with an incidence of up to 50%,and the most common type is DSPN,accounting for about 75%of DN.Most patients with DN have no typical symptoms in the early stage,and the clinical onset is concealed.According to the symptoms of cold,itching,numbness,muscle atrophy and other symptoms in the distal extremities of DSPN patients,traditional Chinese medicine(TCM)classifies them into the category of Bi syndrome(痹病)of Xiaoke(消渴)diabetes.Such disease often occur in diabetic patients with long disease duration and poor glycemic control.The pathogenesis of this disease is based on deficiency at the root cause and excess at the symptoms.The patient suffers from Yin(阴)deficiency,dryness and heat for a long time,leading to an imbalance of Yin and Yang(阳),deficiency of Qi(气)and blood,and obstruction of the meridians,subsequently triggering DSPN.The clinical manifestations of DSPN are a dynamic evolution process,and the symptoms and signs of patients can change with the glycemic control.The pathogenesis can also show changes in organs,Qi and blood,Yin and Yang,deficiency and excess,etc.Western medical treatment primarily focuses on symptom relief,whereas TCM,guided by the principles of“holistic perspective”and“syndrome differentiation and treatment”.applies the“guarding the meridians”theory to address specific aspects of Qi and blood impairment.This approach offers advantages in“treating the root cause”and“preventing progression of established disease”.This paper explores DSPN-related content based on the“guarding the meridians”theory,aiming to provide theoretical guidance for the clinical prevention and treatment of DSPN.
出处
《中医临床研究》
2025年第30期133-137,共5页
Clinical Journal Of Chinese Medicine
