基于气络学说及线粒体功能障碍论治糖尿病周围神经病变  

Treatment of Diabetic Peripheral Neuropathy Based on Qi Collateral Theory and Mitochondrial Dysfunction Mechanism

作　　者：邱林景 王晓磊 吴长江 李文慧 张菁[1,2] 张涛静 QIU Linjing;WANG Xiaolei;WU Changjiang;LI Wenhui;ZHANG Jing;ZHANG Taojing(Beijing University of Chinese Medicine,Beijing China 100029;Dongfang Hospital,Beijing University of Chinese Medicine,Beijing China 100078)

机构地区：[1]北京中医药大学,北京100029 [2]北京中医药大学东方医院,北京100078

出　　处：《中医学报》2025年第2期255-260,共6页Acta Chinese Medicine

基　　金：国家自然科学基金项目(82374268,81774223)。

摘　　要：糖尿病周围神经病变是糖尿病常见并发症,发病率高且危害巨大。近年来研究发现,线粒体功能障碍是糖尿病周围神经病变的重要发病机制。随着络病理论研究的不断深入,气络被应用于包括神经病变等一系列疾病的辨治中,其内涵为气运行之通路。糖尿病周围神经病变从络辨证当以气络为病位,络气虚滞为病机之关键,以络气虚为本,瘀血、痰凝等病理因素为标。周围神经依靠线粒体供给能量以实现正常生理功能,可类比气络依靠络气的激发和推动以维持正常运转。线粒体功能障碍、能量供应不足和氧化应激、细胞凋亡等机制可能是糖尿病周围神经病变“络气虚滞”的微观体现。临证应以“通补”为指导思想,以补气通络为治疗大法,以补气药配伍活血通络类药物,使络气得蓄、气络得通。Diabetic peripheral neuropathy is a common complication of diabetes mellitus with high incidence and great harm.In recent years,mitochondrial dysfunction has been found to be an important pathogenesis of diabetic peripheral neuropathy.With the research progress of collateral theory,Qi collateral has been applied to the identification and treatment of a series of diseases,including neuropathy,and its connotation is the pathway of Qi operation.The diagnosis of diabetic peripheral neuropathy is based on Qi and collateral,and the deficiency of collateral and Qi is the key to the pathogenesis,with the deficiency of collateral and Qi as the basis,and stasis of blood,Phlegm and other pathological factors as the displayed symptoms.Peripheral nerves rely on mitochondria to supply energy to achieve normal physiological function,which can be compared to Qi relying on the excitation and promotion of Qi to maintain normal operation.Mitochondrial dysfunction,insufficient energy supply,oxidative stress,apoptosis,and other mechanisms may be the microcosmic manifestation of"collateral Qi deficiency"in diabetic peripheral neuropathy.Therefore,the treatment should be guided by the principle of"tonifying and complementing"and be based on tonifying Qi and opening up the closed collateral,by using Qi tonifying drugs with blood-activating and collaterals-opening drugs,so as to make the collateral Qi strengthened and the Qi collateral dredged.

关 键 词：糖尿病周围神经病变 气络学说 线粒体功能障碍 络气虚滞 补气通络 黄芪桂枝五物汤 补阳还五汤 

分 类 号：R255.4[医药卫生—中医内科学]