基于络病学说从“虚气留滞”理论浅析糖尿病性视网膜病变的病机发展与治疗思路  

Analysis on the pathogenesis development and treatment ideas of diabetic retinopathy from the theory of"qi deficiency and qi stagnation"on the basis of channel theory

作　　者：段莹莹 安学冬 张月红 康晓敏 连凤梅[2] DUAN Yingying;AN Xuedong;ZHANG Yuehong;KANG Xiaomin;LIAN Fengmei(Beijing University of Chinese Medicine,Beijing 100029,China;Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China)

机构地区：[1]北京中医药大学,北京100029 [2]中国中医科学院广安门医院,北京100053

出　　处：《吉林中医药》2023年第5期501-505,共5页Jilin Journal of Chinese Medicine

基　　金：国家公益行业专项课题(201507001-11);国家中医药多学科交叉创新团队项目(ZYYCXTD-D-202001)。

摘　　要：糖尿病性视网膜病变是糖尿病常见的微血管并发症,临床多表现为视力下降,视物模糊甚或失明,已成为成年人致盲的主要原因,严重影响患者的生活质量。目前西医疗法存在不良反应多、适应证严格等诸多不足,中医整体观和辨证论治的理念有助于医者从多角度论治疾病。本文以络病学说为基础,从“虚气留滞”理论探讨糖尿病性视网膜病变的病机变化,并借此拓展临床治疗思路。“虚气”是病机之本,发病之因,根据病情轻重程度可分为气阴两虚、肝肾亏虚和阴阳两虚。“留滞”为病机之标,“虚气”之果,且“留滞”之瘀血、痰湿等病理代谢产物与现代医学的病理表现有一定相关性。“虚气”与“留滞”相互影响,形成糖尿病视网膜病变本虚标实的病机特点。临床治疗中应以“补虚通滞”为法,根据患者个体情况,采取益气通络、滋补肝肾、健脾补中、调肝通络、活血化瘀、祛湿化痰等治法,提高临床疗效。Diabetic retinopathy,a common microvascular complication of diabetes,is mostly manifested as decreased vision,blurred vision or even blindness in clinic,having become the main cause of blindness in adults and seriously aff ecting the quality of life of patients.At present,as western medicine features many shortcomings such as various adverse reactions and strict indications,holism and the concept of treatment based on syndrome diff erentiation of traditional Chinese medicine can help doctors treat it from multiple perspectives.Based on the channel theory,this paper discusses the pathogenesis changes of diabetic retinopathy from the theory of"qi defi ciency and qi stagnation",to expand its clinical treatment ideas."Qi defi ciency"is the root of its pathogenesis and the cause of the disease,which can be further divided into defi ciency of both qi and yin,defi ciency of the liver and kidney,and defi ciency of both yin and yang according to the severity of the disease.While"qi stagnation"is the manifestation of its pathogenesis and the result of"qi defi ciency",and its pathological metabolites,such as blood stasis and phlegm-damp,are related to its pathological manifestations of modern medicine.The two factors interact with each other,forming its pathogenesis characteristics of defi ciency in root and excess in manifestation.Diabetic retinopathy should clinically be treated by adhering to the principle of"tonifying defi ciency and eliminating stagnation",and based on the individual conditions of patients,adopting the methods of benefiting qi and activating collaterals,nourishing the liver and the kidney,invigorating the spleen and the stomach,regulating the liver and dredging collaterals,promoting blood circulation and removing blood stasis,removing dampness and resolving phlegm an so on,improving its clinical effi cacy.

关 键 词：中医 糖尿病视网膜病变 虚气留滞 病机 

分 类 号：R276.7[医药卫生—中医五官科学]