基于燥热怫郁理论辨治糖尿病痛性神经病变

Differentiation and Treatment of Painful Diabetic Peripheral Neuropathy Based on Theory of Dryness-Heat Constraint and Stagnation

摘要:

糖尿病痛性神经病变（PDN） 是常见的糖尿病慢性并发症，病机复杂。刘完素“燥热怫郁”理论深刻揭示了津伤气郁、由燥致瘀的动态病理过程。本文基于此理论，突破了传统PDN辨治多从“阴虚寒凝”或“气虚血瘀”立论的局限，系统剖析了PDN“燥热内蕴为始动、气阴两虚致血瘀为核心转折、瘀热互结痹阻络脉为发病关键”的核心病机演变规律。创新性地构建了分期论治体系：早期清泄燥热、固护气阴（方选清燥救肺汤化裁），以安未病之络；中期益气养阴、调和气血（方选芍药甘草汤合四物汤），以荣已损之络；后期创新性运用“辛润通络”法（方选血府逐瘀汤合四妙勇安汤），以通痹阻之络；全程辅以针灸外治。本研究为PDN的中医辨治提供了理法方药兼备的新思路，深化了“消渴痛痹”的理论认识。

Abstract:

Abstract： Painful diabetic neuropathy （PDN） is a common chronic complication of diabetes with a complex pathogenesis. The theory of "dryness-heat constraint and stagnation" proposed by LIU Wansu profoundly reveals the dynamic pathological process of fluid impairment，qi stagnation，and progression from dryness to stasis. Based on this theory，this article transcends the limitations of traditional PDN differentiation and treatment，which often focus on "yin deficiency and cold coagulation" or "qi deficiency and blood stasis. " It systematically analyzes the core pathogenic evolution of PDN："internal accumulation of dryness-heat as the initial trigger，qi and yin deficiency leading to blood stasis as the pivotal transition， and the binding of stasis and heat obstructing the collaterals as the key to disease manifestation." Addressing the shortcoming of traditional therapeutic methods， an innovative stage-specific treatment system is constructed： in the early stage， clearing and draining dryness-heat while consolidating qi and yin （using modified Qingzao Jiufei Decoction） to protect unaffected collaterals； in the middle stage， supplementing qi and nourishing yin，harmonizing qi and blood （using Shaoyao Gancao Decoction combined with Siwu Decoction） to nourish damaged collaterals； in the late stage， innovatively applying the pungent-moistening and collateral-unblocking method （using Xuefu Zhuyu Decoction combined with Simiao Yongan Decoction） to unblock obstructed collaterals， supplemented with acupuncture and moxibustion for external therapies throughout the course. This study provides a new perspective on the differentiation and treatment of PDN in traditional Chinese medicine， integrating principles， methods， prescriptions， and herbs， and deepens the theoretical understanding of "diabetes-related painful impediment."