疼痛性糖尿病神经病变的中医个体化治疗思路  

Strategy of Individual Treatment for Painful Diabetic Neuropathy in Traditional Chinese Medicine

作　　者：徐蕊[1] 王果 于大猛[1] 王建伟[2] 韩玉[3] XU Rui;WANG Guo;YU Dameng;WANG Jianwei;HAN Yu(Institute of Basic Research in Clinical Medicine,China Academy of Chinese Medical Sciences,Beijing,100700;Eye Hospital,China Academy of Chinese Medical Sciences;China Academy of Chinese Medical Sciences)

机构地区：[1]中国中医科学院中医临床基础医学研究所,北京市100700 [2]中国中医科学院眼科医院 [3]中国中医科学院

出　　处：《中医杂志》2023年第4期342-345,357,共5页Journal of Traditional Chinese Medicine

基　　金：首都卫生发展科研专项首发(2020-3-4184);中央级公益性科研院所基本科研业务费专项资金(ZZ15-YQ-078,Z0738);中国中医科学院科技创新工程“中医临床基础学科”创新团队项目(CI2021B003)。

摘　　要：西医临床指南推荐的疼痛性糖尿病神经病变(PDN)的治疗措施几乎全部为对症治疗,对于改善病理性疼痛并不理想,个体化治疗是其未来的发展方向。分析了PDN西医个体化治疗的研究现状及存在问题,并总结了中医对PDN的病因、病机、病程发展规律的认识与治疗实践。基于上述结果,提出了基于“治未病”理念和中医临床分期论治PND的中医个体化治疗思路。建议“不荣”与“不通”兼顾,以补气养血类药物治疗“不荣”,以乌头类药物及活血化瘀药治疗“不通”,根据中医研究证据推荐的药物作为治疗的普适性方法;个体化治疗上,分析PDN发生与发展的外因与内因,确定关键病机来选择主要方药,并根据病程发展的不同阶段动态调整,辅以理疗和饮食干预。The strategies for painful diabetic neuropathy(PDN) recommended by western clinical guidelines are almost symptomatic treatments,which do not work well for relieving pathological pain.Individualized treatment of PDN will be the future trend.This paper analyzed the current research status and existing problems of the individualized treatment of PDN in western medicine,and summarized the understanding of the etiology,pathogenesis,and development law of the disease course of PDN,as well as the clinical practice condition in traditional Chinse medicine(TCM).Based on the above evidence,we put forward the idea of individualized treatment of PND based on the concept of “treat disease before it arises” and the clinical staging of the disease in TCM.The general idea is to treat both “the withered” and “the blocked”,using qi-supplementing and blood nourishing medicinals for the former,and Aconitum group medicinals and blood-invigorating and stasis-dissolving medicinals for the latter.Medicinals recommended by the research evidence of TCM were chosen as the general approach.In terms of individual treatment,the external and internal causes for the occurrence and progression of DPN are analyzed,and the key pathogenesis was determined to select the main prescriptions.Treatment will be dynamically adjusted in different stages of the disease,and physiotherapy and dietary intervention will be supplemented.

关 键 词：疼痛性糖尿病神经病变 个体化治疗 治未病 

分 类 号：R259[医药卫生—中西医结合] R277.7[医药卫生—中医内科学]