糖尿病足溃疡“毒损络脉”病机探微  

Pathogenesis of"Toxin Induced Collateral Damage"in Diabetes Foot Ulcer

作　　者：杨剑锋 李友山[2] 夏颐瑄 张宁 张艳 余清璇 张力睿 YANG Jianfeng;LI Youshan;XIA Yixuan;ZHANG Ning;ZHANG Yan;YU Qingxuan;ZHANG Lirui(Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine,Beijing China 100700;Tongzhou Branch of Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine,Beijing China 101121;The Third Affiliated Hospital to Beijing University of Chinese Medicine,Beijing China 100029)

机构地区：[1]北京中医药大学东直门医院,北京100700 [2]北京中医药大学东直门医院通州院区,北京101121 [3]北京中医药大学第三附属医院,北京100029

出　　处：《中医学报》2024年第7期1408-1412,共5页Acta Chinese Medicine

基　　金：国家自然科学基金项目(81973849)。

摘　　要：糖尿病足溃疡创面常因肉芽组织生成不良与有效微循环无法建立而难以愈合。过量的炎性细胞浸润与炎性因子释放、代谢废物蓄积、细菌感染等可能是引起创面难以愈合的重要原因。在中医理论中,上述物质均可视作“痈疽之毒”。消渴所致痈疽之毒,因脏腑久伤而起,因气血经络瘀滞壅塞而加剧,毒聚络脉,足跗又为肢体末节,络脉交叠,最易中伤,易发为消渴后足跗痈疽。故而治法当以拔毒提脓祛腐为首,脓出腐去,痈疽之毒可尽,新肉可生,创口可敛。因此,“毒损络脉”或为糖尿病足溃疡的关键病机,明确病机,对临床治疗该病有重要意义。Diabetic foot ulcer wounds are often difficult to heal due to poor granulation tissue generation and failure to establish effective microcirculation.Excessive inflammatory cells infiltration and inflammatory factor release,metabolic waste accumulation,as well as bacterial infections,might be important cause of undesirable healing.In TCM theory,those above could be regarded as"Toxin of carbuncle".As a result of diabetes,the ulcer or carbuncle arises from the long-time injury of Zang and Fu and was aggravated by the Qi and Blood stagnation in meridians.The foot back,at the end of the limb,is prone to diabetic foot ulcer when the Toxin is accumulated in the interlacing collaterals.From this prospect,the treatment of it should be dispelling Toxin from interior and drain pus first to remove necrotic tissues thoroughly to promote flesh generation,so that the sore is healed.It is believed that"Toxin induced collateral damage"may be the key pathogenesis of diabetic foot ulcer,which is of great significance for the clinical treatment of the disease.

关 键 词：糖尿病足溃疡 痈疽 消渴 “毒损络脉” 拔毒 托脓去腐 

分 类 号：R261[医药卫生—中医外科学]