糖尿病（消渴病）临床常见慢性并发症的中医文献研究
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摘要
目的糖尿病慢性并发症对糖尿病人的健康构成严重危害,影响他们的生存质量,致残率和致死率高。其对社会经济也带来庞大的负担。医学界一直重视研究该病,然而未见重大突破。古代中医曾详细探讨过该病,亦遗留了很多至今仍然有效的治疗糖尿病并发症的方法和处方。本文希望通过进行中医文献研究,从而深入地探讨糖尿病临床常见慢性并发症的相关内容,包括：
1)综合有关的古代中医文献资料,结合现代认识,由临床角度思考,独立剖析每种常见的糖尿病慢性并发症的古代中医认识,研究着眼于为临床服务,以期挖掘古代中医珍贵智慧,弥补当今对糖尿病慢性并发症诊治的不足。
2)通过收集、整理、分析古代中医文献,从历史发展的角度出发,对历代医家关于糖尿病并发症的论述进行全面总结和回顾,探析中医对糖尿病并发症认识的发展及演变轨迹。
3)通过比较现代关于糖尿病并发症的文献,发现古代中医与现代中医在糖尿病慢性并发症的认识上的异同,期望能把古代的认识与现代的实践联系,借鉴古代中医的诊治认识,使现代临床诊疗糖尿病并发症变得更充实。
4)将古代治疗糖尿病并发症的方药建立数据库,利用统计分析方法,对其进行频数分析,找出古代中医治疗糖尿病慢性并发症的常用药物,分析古代用药规律及特点,期望能为有效治疗糖尿病慢性并发症提供更多借鉴和新的思路。
方法研究方法主要分为两种：文献研究和统计分析。
文献研究内容：翻查的中医书籍文献主要分古代中医文献和近代文献两种。古代中医文献以1911年为下限,并有近代中医文献以1949年为下限,文献类型包括综合性医书、方书、专书、本草、从书、类书、医案、医论、医话等。方法先以《中华医典》检索“消”、“消渴”、“三消”、“上消”、“中消”、“下消”、“脾瘅”、“鬲消”、“消瘅”、“消中”、“内消”、“肾消”、“肺消”、“渴利”、“消利”、“消肾”、“急消”、“脾消”等病名相关的并发症如“并病”、“变证”、“兼证”、“目疾”“视瞻昏渺”、“内障”、“雀目”、“胸痹”、“腰痛”、“水肿”、“水病”、“眩晕”、“关格”、“虚劳”、“尿浊”、“肾衰”、“胀满”、“吐逆”、“络病”、“疖”、“痈”、“痈疽”、“痹证”、“筋痹”、“脉痹”、“麻木”、“偏枯”、“痿证”、“脱疽”、“腹胀”、“痞满”、“呕吐”、“反胃”、“吞酸”、“骨痿”、“骨痹”等关键词,再通过翻阅了超过160种与糖尿病相关的重要中医书籍,抽取与糖尿病慢性并发症相关印象的文献内容,加以整理、分析。从历史的角度理顺文献的先后次序,综合地探讨每个时代中医对糖尿病慢性并发症的发展和演变。又独立地抽取关于每种糖尿病并发症相关的内容,包括病名、病因病机、症状描述、证型、治则治法、方剂、药物、剂型、煎煮法、预后、预防、调摄、医案、医话等,经过比较、整理、分析,并结合临床思维,总结出关于每种并发症的中医指南。
现代文献主要从中医核心期刊、《科学引文索引》(SCI)期刊、糖尿病专书、糖尿病指南、世界卫生组织(WHO)、美国糖尿病协会(ADA)网页中取得。检索工具主要使用《中国知网》(CNKI)、Pubmed及互联网等,查找关于“糖尿病”、“糖尿病慢性并发症”、“糖尿病心血管病变”、“糖尿病脑血管病变”、“糖尿病周围神经病变”、“糖尿病肾病”、“糖尿病白内障”、“糖尿病视网膜病变”、“糖尿病胃轻瘫”、“糖尿病性功能障碍”、“糖尿病皮肤感染”、“糖尿病足”、“糖尿病肺结核”等关键词。撰写关于每种糖尿病慢性并发症的现代认识,希望通过比较,分析出古代中医治疗该并发症的异同,取长补短,目的是为提高临床疗效。
统计分析：在翻阅文献资料的同时,把相关治疗糖尿病并发症的处方、药物、剂量、剂型、出处等记录下来。用数据库软件Microsoft Excel 2007建立数据库,分门别类,列于各种糖尿病慢性并发症之下,当中确保没有重复药物名称或别名。用Excel进行频数分析,总结古代治疗糖尿病慢性并发症的用药规律,并作出分析,从而推断古代中医治疗某糖尿病慢性并发症的处方、用药规律。
结果糖尿病肾病属中医“肾消”、“消渴”并发“水肿”、“淋证”、“癃闭”、“尿浊”、“血尿”、“关格”、“虚劳”等范畴。其病位在肾,与肺、脾、肝、三焦、膀胱关系密切,亦涉及其余脏腑；病性为本虚标实,本虚为肝脾肾虚,五脏气血阴阳俱虚,标实为气滞、血瘀、痰浊、浊毒、湿热等。临床常见水肿、尿多、尿少、无尿、蛋白尿、气尿等症状。其主要有气阴两虚、肝肾阴虚、阴虚热结、气血两虚、脾虚气陷、脾阳虚衰、肾气亏虚、肾阳衰惫、脾肾阳虚、水湿浸渍、膀胱湿热、肝阳上亢、浊毒犯胃、水凌心肺、溺毒入脑等15种证型。选取古代常用处方共12首。附有相关医案参考。分析古代治疗该病处方,可以看到,以往中医重视健脾、补肾、利水治疗糖尿病肾病,常用处方如肾气丸、六味地黄丸、七味都气丸、麦味地黄丸、四君子汤、五苓散等。比较现代认识,现代中医较强调活血通络的方法,补气药则尤其重视黄芪,又强调排毒泄浊的重要性,在治疗方法上有进步。
糖尿病眼病属中医“消渴”并发“圆翳内障”、“视瞻昏渺”、“云雾移睛”、“暴盲”、“青盲”、“血灌瞳神”、“眼底血证”、“雀目”等范畴。病位在目,涉及五脏,以脾、肝、肾为主；病性为本虚标实,虚实夹杂,寒热并见。本虚为气阴两虚、阴阳俱虚,标实为瘀血、痰浊阻络。临床表现可有不同程度视力减退,眼前黑影飞舞,或视物变形、视直如曲,甚至失明。有肝肾亏虚、脾虚气弱、脾虚湿困、心脾两虚、肝热上扰、阳亢动风、湿热蕴蒸、阴虚挟湿热、虚火伤络、气滞血瘀等10种证型。选了3个合适古方和3个医案。处方统计分析发现以往中医重视健脾补气、滋养肝肾、理气活血、化痰除湿的方法治疗糖尿病眼病,常用处方包括四物汤、六君子汤、人参养荣汤、生脉散、六味地黄丸、麦味地黄丸、左归饮、二陈汤等。
糖尿病足属于中医“脱疽”、“筋疽”的范畴。病性属本虚标实,以气血阴阳亏虚为本,以湿热、邪毒、络阻、血瘀为标,病位在血、脉、筋。临床表现主要有足部感觉异常、感染、坏疽、痿缩、畸型。有湿热毒蕴、热毒阴虚、气血两虚、肝肾阴虚、脾肾阳虚、气滞血瘀等6种证型。选了3个合适古方和3个医案。处方统计分析发现古代中医很重视内虚的情况,重视补益气血和清热解毒的方法,常用方剂有四妙勇安汤、八珍汤等。现代认识可以见到中西医结合治疗糖尿病足,比单纯西医治疗效果好。
糖尿病心病属中医“消渴”并发“胸痹”、“厥心痛”、“心痛”、“心胃痛”、“真心痛”、“心悸”、“水肿”等范畴。病位在心,与肾、脾、肺相关。病性为本虚标实,以心气血阴阳亏虚为本,以寒凝、血瘀、痰阻、水停为标。主要临床表现包括心悸、怔忡、胸闷、胸痛、烦躁、气短、乏力等。有心气不足、心血不足、心肾不交、心阳不振、寒凝心脉、痰浊阻滞、心脉瘀阻、水饮凌心、阴阳两虚等9种证型。选了3个合适古方和4个医案。处方统计分析可以看出治疗糖尿病心病用得最多的是补气益血的药物,其次是安神镇静的药物。常用方剂有四君子汤、生脉散、人参养荣汤、交泰丸、朱砂安神丸。现代认识益气活血方法可以有效防治糖尿病心脏病。
糖尿病脑血管病变属于中医“消渴”并发“中风”、“偏枯”、“仆击”、“昏厥”、“头痛”等范畴。其病位在脑,涉及心、肝、肾诸脏。病性属本虚标实,与虚、火、风、痰、气、血相关,上实下虚,阳气夹风、夹痰、夹瘀、夹火,气逆于上,阴血不足亏虚于下,阴阳气血不相顺接。主要表现为突然昏迷或无昏迷,肢体瘫痪或偏瘫或麻木,轻则只感肢体变得无力,重则或见头痛剧烈,伴恶心、呕吐,或有抽搐。可分为风邪中络、肝阳上亢、肝阳闭窍、痰热腑实、风痰阻络、痰蒙清窍、气虚血瘀、阴虚风动、元气衰败、肝肾亏损等10种证型。统计分析中发现芍药用得最多,用得较多的还有补益气血的药物,育阴潜阳的龟版、清肝热的黄芩、祛除风痰的南星亦是常用之品。现代认识糖尿病合并脑梗塞的主要证型为阴虚为主,兼气虚、瘀血阻络。益气养阴、活血通络为基本治法。
糖尿病周围神经病变属于中医“消渴”兼“痹证”、“血痹”、“络病”、“痿蹙”、“麻木”、“不仁”、“痛证”、“痿证”等范畴。其病性属本虚标实,以气血亏虚、气阴两虚为本,瘀血、痰浊阻络为标。病位在脉络,与肝、肾、脾相关。主要表现为感觉异常和疼痛。有气虚血瘀、寒凝血瘀、阴虚血瘀、痰瘀阻络、气滞血瘀、湿热瘀阻、脾虚气陷、脾肾阳虚、肝肾亏虚等9种证型。合适古方选用5首,相关医案选用4个。处方统计分析可以看到,以往中医重视补益气、阴、血、肾以治疗糖尿病周围神经病变,常用处方如十全大补汤、生脉散、六味地黄丸等。现代认识糖尿病周围神经病变的病机主要是气阴两虚、经络瘀阻。以益气养阴、通经活络为基本治法。
此外,本论文还阐述了有关糖尿病并发皮肤感染、糖尿病性阳萎、强中、糖尿病性胃肠病等糖尿病慢性并发症的中医认识。
结论通过查找大量古、近代有关糖尿病慢性并发症的中医文献,结合现代认识和中医临床思维,总结糖尿病慢性并发症的综合病机是：本虚标实,五脏的气血阴阳亏虚为本,瘀痰络阻为标。古代中医治疗糖尿病慢性并发症常用的治法有健脾、养肝、滋肾、补气、补血、养阴、行气、活血等。再结合古代处方统计分析和现代认识,这研究启示我们应该重视治本补虚,重视使用补益药物以治疗糖尿病慢性并发症的重要性。
Purpose By comprehending information about chronic diabetic complications from Traditional Chinese Medicine (TCM) literatures, and collaborating with modern and clinical knowledge, the research was in order to analyze each diabetic chronic complication from TCM scope of view. By comparing with modern diagnosis and-treatment, there was hope to integrate ancient TCM wisdom into modern clinical practice. By collecting and analyzing ancient TCM works, the research also targeted to review the historical transition of TCM dealing with chronic diabetic complications. Finally, by collecting information of ancient TCM prescriptions for chronic diabetic complications, and data analyzing, the research was to find out the most frequent use of herbs for each complication.
Method There were two study methods in this research:literature study and data analysis. Literature study included ancient TCM literatures, with the year 1911 marked as the lower limit, amounting more than 160 books. By collecting, sorting out and analyzing useful information about chronic diabetic complications, it was to clarify from historical perspective how the ancient TCM managed to understand diabetic chronic complication. And by collecting information of each chronic complication, the research was to find out the name, pathogenesis, clinical features, syndromes, treatment, prescriptions, herbs, prognosis, prevention, case study, etc. of each complication, in terms of TCM. And the information was to be written as a guide to deal with chronic diabetic complications.
By collecting information of prescriptions and herbs for chronic diabetic complications, and building up database about names of prescriptions and herbs, dosage, origin, etc. using Microsoft Excel 2007, the research was to find out the high tendency of particular use of drugs via frequency analysis.
Results According to TCM, the pathogenesis of diabetic nephropathy was related to kidney, mostly owning to deficiency of kidney, spleen, liver, Qi, blood, Yin and Yang, also blood stasis, phlegm, toxin and damn heat.15 syndromes were found out. It was discovered that ancient TCM emphasized on improving spleen and kidney and diuresis to treat the disease.
The pathogenesis of diabetic retinopathy was related to eye, as well as spleen, liver and kidney, mostly owning to deficiency of Qi, Yin and Yang, also blood stasis and phlegm.10 syndromes were summarized. It was discovered ancient TCM emphasized on improving spleen, liver and kidney, replenishing qi, improving blood circulation and removing phlegm to treat the disease.
The pathogenesis of diabetic foot was mainly related to deficiency of Qi, blood, Yin and Yang, also damn heat, toxin, and blood stasis.6 syndromes were summarized. The ancient TCM emphasized on replenishing Qi and blood to treat the disease.
The pathogenesis of diabetic heart disease was related to deficiency of Qi, blood, Yin and Yang of the heart, and also cold, phlegm, stasis of blood and water.9 syndromes were summarized. The Ancient TCM emphasized on replenishing Qi and blood, also sedation to treat the disease.
The pathogenesis of cerebral vascular disease related to diabetes was mainly associated with deficiency of Yin of liver and kidney, rising up of Yang, Qi and blood, combining with phlegm, heat and wind.10 syndromes were found out. The ancient TCM emphasized on replenishing Qi and blood, combining with replenishing Yin and lowering Yang, clearing heat of liver, removing phlegm and wind to treat the disease.
The pathogenesis of diabetic peripheral neuropathy was mainly related to deficiency of Qi, blood and Yin, as well as blood stasis and blockage of phlegm.9 syndromes were discovered. The ancient TCM emphasized on replenishing Qi, blood, Yin and kidney to treat the disease.
Other complications were also described from TCM point of view.
Conclusion The research reviewed more than 6 kinds of chronic diabetic complications. The names, pathogenesis, clinical features, syndromes, treatment and herbs of each kind were reviewed. The research was written as a guide to treatment of chronic diabetic complications, providing a good amount of TCM discussions about the complications. Finally it reminded the importance of replenishing Qi, blood, Yin and Yang to treat them.
1)综合有关的古代中医文献资料,结合现代认识,由临床角度思考,独立剖析每种常见的糖尿病慢性并发症的古代中医认识,研究着眼于为临床服务,以期挖掘古代中医珍贵智慧,弥补当今对糖尿病慢性并发症诊治的不足。
2)通过收集、整理、分析古代中医文献,从历史发展的角度出发,对历代医家关于糖尿病并发症的论述进行全面总结和回顾,探析中医对糖尿病并发症认识的发展及演变轨迹。
3)通过比较现代关于糖尿病并发症的文献,发现古代中医与现代中医在糖尿病慢性并发症的认识上的异同,期望能把古代的认识与现代的实践联系,借鉴古代中医的诊治认识,使现代临床诊疗糖尿病并发症变得更充实。
4)将古代治疗糖尿病并发症的方药建立数据库,利用统计分析方法,对其进行频数分析,找出古代中医治疗糖尿病慢性并发症的常用药物,分析古代用药规律及特点,期望能为有效治疗糖尿病慢性并发症提供更多借鉴和新的思路。
方法研究方法主要分为两种：文献研究和统计分析。
文献研究内容：翻查的中医书籍文献主要分古代中医文献和近代文献两种。古代中医文献以1911年为下限,并有近代中医文献以1949年为下限,文献类型包括综合性医书、方书、专书、本草、从书、类书、医案、医论、医话等。方法先以《中华医典》检索“消”、“消渴”、“三消”、“上消”、“中消”、“下消”、“脾瘅”、“鬲消”、“消瘅”、“消中”、“内消”、“肾消”、“肺消”、“渴利”、“消利”、“消肾”、“急消”、“脾消”等病名相关的并发症如“并病”、“变证”、“兼证”、“目疾”“视瞻昏渺”、“内障”、“雀目”、“胸痹”、“腰痛”、“水肿”、“水病”、“眩晕”、“关格”、“虚劳”、“尿浊”、“肾衰”、“胀满”、“吐逆”、“络病”、“疖”、“痈”、“痈疽”、“痹证”、“筋痹”、“脉痹”、“麻木”、“偏枯”、“痿证”、“脱疽”、“腹胀”、“痞满”、“呕吐”、“反胃”、“吞酸”、“骨痿”、“骨痹”等关键词,再通过翻阅了超过160种与糖尿病相关的重要中医书籍,抽取与糖尿病慢性并发症相关印象的文献内容,加以整理、分析。从历史的角度理顺文献的先后次序,综合地探讨每个时代中医对糖尿病慢性并发症的发展和演变。又独立地抽取关于每种糖尿病并发症相关的内容,包括病名、病因病机、症状描述、证型、治则治法、方剂、药物、剂型、煎煮法、预后、预防、调摄、医案、医话等,经过比较、整理、分析,并结合临床思维,总结出关于每种并发症的中医指南。
现代文献主要从中医核心期刊、《科学引文索引》(SCI)期刊、糖尿病专书、糖尿病指南、世界卫生组织(WHO)、美国糖尿病协会(ADA)网页中取得。检索工具主要使用《中国知网》(CNKI)、Pubmed及互联网等,查找关于“糖尿病”、“糖尿病慢性并发症”、“糖尿病心血管病变”、“糖尿病脑血管病变”、“糖尿病周围神经病变”、“糖尿病肾病”、“糖尿病白内障”、“糖尿病视网膜病变”、“糖尿病胃轻瘫”、“糖尿病性功能障碍”、“糖尿病皮肤感染”、“糖尿病足”、“糖尿病肺结核”等关键词。撰写关于每种糖尿病慢性并发症的现代认识,希望通过比较,分析出古代中医治疗该并发症的异同,取长补短,目的是为提高临床疗效。
统计分析：在翻阅文献资料的同时,把相关治疗糖尿病并发症的处方、药物、剂量、剂型、出处等记录下来。用数据库软件Microsoft Excel 2007建立数据库,分门别类,列于各种糖尿病慢性并发症之下,当中确保没有重复药物名称或别名。用Excel进行频数分析,总结古代治疗糖尿病慢性并发症的用药规律,并作出分析,从而推断古代中医治疗某糖尿病慢性并发症的处方、用药规律。
结果糖尿病肾病属中医“肾消”、“消渴”并发“水肿”、“淋证”、“癃闭”、“尿浊”、“血尿”、“关格”、“虚劳”等范畴。其病位在肾,与肺、脾、肝、三焦、膀胱关系密切,亦涉及其余脏腑；病性为本虚标实,本虚为肝脾肾虚,五脏气血阴阳俱虚,标实为气滞、血瘀、痰浊、浊毒、湿热等。临床常见水肿、尿多、尿少、无尿、蛋白尿、气尿等症状。其主要有气阴两虚、肝肾阴虚、阴虚热结、气血两虚、脾虚气陷、脾阳虚衰、肾气亏虚、肾阳衰惫、脾肾阳虚、水湿浸渍、膀胱湿热、肝阳上亢、浊毒犯胃、水凌心肺、溺毒入脑等15种证型。选取古代常用处方共12首。附有相关医案参考。分析古代治疗该病处方,可以看到,以往中医重视健脾、补肾、利水治疗糖尿病肾病,常用处方如肾气丸、六味地黄丸、七味都气丸、麦味地黄丸、四君子汤、五苓散等。比较现代认识,现代中医较强调活血通络的方法,补气药则尤其重视黄芪,又强调排毒泄浊的重要性,在治疗方法上有进步。
糖尿病眼病属中医“消渴”并发“圆翳内障”、“视瞻昏渺”、“云雾移睛”、“暴盲”、“青盲”、“血灌瞳神”、“眼底血证”、“雀目”等范畴。病位在目,涉及五脏,以脾、肝、肾为主；病性为本虚标实,虚实夹杂,寒热并见。本虚为气阴两虚、阴阳俱虚,标实为瘀血、痰浊阻络。临床表现可有不同程度视力减退,眼前黑影飞舞,或视物变形、视直如曲,甚至失明。有肝肾亏虚、脾虚气弱、脾虚湿困、心脾两虚、肝热上扰、阳亢动风、湿热蕴蒸、阴虚挟湿热、虚火伤络、气滞血瘀等10种证型。选了3个合适古方和3个医案。处方统计分析发现以往中医重视健脾补气、滋养肝肾、理气活血、化痰除湿的方法治疗糖尿病眼病,常用处方包括四物汤、六君子汤、人参养荣汤、生脉散、六味地黄丸、麦味地黄丸、左归饮、二陈汤等。
糖尿病足属于中医“脱疽”、“筋疽”的范畴。病性属本虚标实,以气血阴阳亏虚为本,以湿热、邪毒、络阻、血瘀为标,病位在血、脉、筋。临床表现主要有足部感觉异常、感染、坏疽、痿缩、畸型。有湿热毒蕴、热毒阴虚、气血两虚、肝肾阴虚、脾肾阳虚、气滞血瘀等6种证型。选了3个合适古方和3个医案。处方统计分析发现古代中医很重视内虚的情况,重视补益气血和清热解毒的方法,常用方剂有四妙勇安汤、八珍汤等。现代认识可以见到中西医结合治疗糖尿病足,比单纯西医治疗效果好。
糖尿病心病属中医“消渴”并发“胸痹”、“厥心痛”、“心痛”、“心胃痛”、“真心痛”、“心悸”、“水肿”等范畴。病位在心,与肾、脾、肺相关。病性为本虚标实,以心气血阴阳亏虚为本,以寒凝、血瘀、痰阻、水停为标。主要临床表现包括心悸、怔忡、胸闷、胸痛、烦躁、气短、乏力等。有心气不足、心血不足、心肾不交、心阳不振、寒凝心脉、痰浊阻滞、心脉瘀阻、水饮凌心、阴阳两虚等9种证型。选了3个合适古方和4个医案。处方统计分析可以看出治疗糖尿病心病用得最多的是补气益血的药物,其次是安神镇静的药物。常用方剂有四君子汤、生脉散、人参养荣汤、交泰丸、朱砂安神丸。现代认识益气活血方法可以有效防治糖尿病心脏病。
糖尿病脑血管病变属于中医“消渴”并发“中风”、“偏枯”、“仆击”、“昏厥”、“头痛”等范畴。其病位在脑,涉及心、肝、肾诸脏。病性属本虚标实,与虚、火、风、痰、气、血相关,上实下虚,阳气夹风、夹痰、夹瘀、夹火,气逆于上,阴血不足亏虚于下,阴阳气血不相顺接。主要表现为突然昏迷或无昏迷,肢体瘫痪或偏瘫或麻木,轻则只感肢体变得无力,重则或见头痛剧烈,伴恶心、呕吐,或有抽搐。可分为风邪中络、肝阳上亢、肝阳闭窍、痰热腑实、风痰阻络、痰蒙清窍、气虚血瘀、阴虚风动、元气衰败、肝肾亏损等10种证型。统计分析中发现芍药用得最多,用得较多的还有补益气血的药物,育阴潜阳的龟版、清肝热的黄芩、祛除风痰的南星亦是常用之品。现代认识糖尿病合并脑梗塞的主要证型为阴虚为主,兼气虚、瘀血阻络。益气养阴、活血通络为基本治法。
糖尿病周围神经病变属于中医“消渴”兼“痹证”、“血痹”、“络病”、“痿蹙”、“麻木”、“不仁”、“痛证”、“痿证”等范畴。其病性属本虚标实,以气血亏虚、气阴两虚为本,瘀血、痰浊阻络为标。病位在脉络,与肝、肾、脾相关。主要表现为感觉异常和疼痛。有气虚血瘀、寒凝血瘀、阴虚血瘀、痰瘀阻络、气滞血瘀、湿热瘀阻、脾虚气陷、脾肾阳虚、肝肾亏虚等9种证型。合适古方选用5首,相关医案选用4个。处方统计分析可以看到,以往中医重视补益气、阴、血、肾以治疗糖尿病周围神经病变,常用处方如十全大补汤、生脉散、六味地黄丸等。现代认识糖尿病周围神经病变的病机主要是气阴两虚、经络瘀阻。以益气养阴、通经活络为基本治法。
此外,本论文还阐述了有关糖尿病并发皮肤感染、糖尿病性阳萎、强中、糖尿病性胃肠病等糖尿病慢性并发症的中医认识。
结论通过查找大量古、近代有关糖尿病慢性并发症的中医文献,结合现代认识和中医临床思维,总结糖尿病慢性并发症的综合病机是：本虚标实,五脏的气血阴阳亏虚为本,瘀痰络阻为标。古代中医治疗糖尿病慢性并发症常用的治法有健脾、养肝、滋肾、补气、补血、养阴、行气、活血等。再结合古代处方统计分析和现代认识,这研究启示我们应该重视治本补虚,重视使用补益药物以治疗糖尿病慢性并发症的重要性。
Purpose By comprehending information about chronic diabetic complications from Traditional Chinese Medicine (TCM) literatures, and collaborating with modern and clinical knowledge, the research was in order to analyze each diabetic chronic complication from TCM scope of view. By comparing with modern diagnosis and-treatment, there was hope to integrate ancient TCM wisdom into modern clinical practice. By collecting and analyzing ancient TCM works, the research also targeted to review the historical transition of TCM dealing with chronic diabetic complications. Finally, by collecting information of ancient TCM prescriptions for chronic diabetic complications, and data analyzing, the research was to find out the most frequent use of herbs for each complication.
Method There were two study methods in this research:literature study and data analysis. Literature study included ancient TCM literatures, with the year 1911 marked as the lower limit, amounting more than 160 books. By collecting, sorting out and analyzing useful information about chronic diabetic complications, it was to clarify from historical perspective how the ancient TCM managed to understand diabetic chronic complication. And by collecting information of each chronic complication, the research was to find out the name, pathogenesis, clinical features, syndromes, treatment, prescriptions, herbs, prognosis, prevention, case study, etc. of each complication, in terms of TCM. And the information was to be written as a guide to deal with chronic diabetic complications.
By collecting information of prescriptions and herbs for chronic diabetic complications, and building up database about names of prescriptions and herbs, dosage, origin, etc. using Microsoft Excel 2007, the research was to find out the high tendency of particular use of drugs via frequency analysis.
Results According to TCM, the pathogenesis of diabetic nephropathy was related to kidney, mostly owning to deficiency of kidney, spleen, liver, Qi, blood, Yin and Yang, also blood stasis, phlegm, toxin and damn heat.15 syndromes were found out. It was discovered that ancient TCM emphasized on improving spleen and kidney and diuresis to treat the disease.
The pathogenesis of diabetic retinopathy was related to eye, as well as spleen, liver and kidney, mostly owning to deficiency of Qi, Yin and Yang, also blood stasis and phlegm.10 syndromes were summarized. It was discovered ancient TCM emphasized on improving spleen, liver and kidney, replenishing qi, improving blood circulation and removing phlegm to treat the disease.
The pathogenesis of diabetic foot was mainly related to deficiency of Qi, blood, Yin and Yang, also damn heat, toxin, and blood stasis.6 syndromes were summarized. The ancient TCM emphasized on replenishing Qi and blood to treat the disease.
The pathogenesis of diabetic heart disease was related to deficiency of Qi, blood, Yin and Yang of the heart, and also cold, phlegm, stasis of blood and water.9 syndromes were summarized. The Ancient TCM emphasized on replenishing Qi and blood, also sedation to treat the disease.
The pathogenesis of cerebral vascular disease related to diabetes was mainly associated with deficiency of Yin of liver and kidney, rising up of Yang, Qi and blood, combining with phlegm, heat and wind.10 syndromes were found out. The ancient TCM emphasized on replenishing Qi and blood, combining with replenishing Yin and lowering Yang, clearing heat of liver, removing phlegm and wind to treat the disease.
The pathogenesis of diabetic peripheral neuropathy was mainly related to deficiency of Qi, blood and Yin, as well as blood stasis and blockage of phlegm.9 syndromes were discovered. The ancient TCM emphasized on replenishing Qi, blood, Yin and kidney to treat the disease.
Other complications were also described from TCM point of view.
Conclusion The research reviewed more than 6 kinds of chronic diabetic complications. The names, pathogenesis, clinical features, syndromes, treatment and herbs of each kind were reviewed. The research was written as a guide to treatment of chronic diabetic complications, providing a good amount of TCM discussions about the complications. Finally it reminded the importance of replenishing Qi, blood, Yin and Yang to treat them.
引文
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