从络病探讨糖尿病性脑血管病的辨治思路
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摘要
糖尿病性脑血管病是糖尿病的常见并发症之一。络病是广泛存在于糖尿病慢性并发症中的病理状态,也是糖尿病性脑血管病的重要病理机制。糖尿病性脑血管病的基本病机为肝肾气阴亏虚,风、火、痰、瘀血阻滞脑络,基本病理环节为络气虚滞、络脉瘀阻、络脉拙急、络脉瘀塞、络脉瘀结。从审证求因、通补结合,善用虫蚁、祛邪通络,滋补肝肾、重视气血,起居调摄、防治结合等方面对治疗方法进行阐述,以探讨糖尿病性脑血管病的辨治思路。
Diabetic cerebrovascular disease is one of the common complications of diabetes. The collateral disease is widely existed in the diabetic chronic complications. It is the important pathological mechanism of diabetic cerebrovascular disease. The basic pathogenesis is qi and yin deficiency in liver and kidney and with wind,fire,phlegm,blood stasis blocking the brain collateral. The basic pathological processes are qi deficiency of collaterals,the blood stasis resistance in the brain collateral,contraction of the brain collateral,blood stasis in brain collateral. To discuss the ideas about syndrome differentiation and treatment of diabetic cerebrovascular disease,the following points are set forth. The determination of etiologic factors should be based on differentiation. The reinforcing method and reducing method are combined together. The insect drugs should be made the most of to eliminate pathogens and drege collaterals.It is very important to nourish the liver and kidney and tonify qi and blood. Diabetic cerebrovascular could be prevented by lifestyle measures,such as diet and exercise,or medication.
Diabetic cerebrovascular disease is one of the common complications of diabetes. The collateral disease is widely existed in the diabetic chronic complications. It is the important pathological mechanism of diabetic cerebrovascular disease. The basic pathogenesis is qi and yin deficiency in liver and kidney and with wind,fire,phlegm,blood stasis blocking the brain collateral. The basic pathological processes are qi deficiency of collaterals,the blood stasis resistance in the brain collateral,contraction of the brain collateral,blood stasis in brain collateral. To discuss the ideas about syndrome differentiation and treatment of diabetic cerebrovascular disease,the following points are set forth. The determination of etiologic factors should be based on differentiation. The reinforcing method and reducing method are combined together. The insect drugs should be made the most of to eliminate pathogens and drege collaterals.It is very important to nourish the liver and kidney and tonify qi and blood. Diabetic cerebrovascular could be prevented by lifestyle measures,such as diet and exercise,or medication.
引文
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[11]高彦彬.络病与糖尿病慢性并发症[J].北京中医药大学学报(中医临床版),2008,15(3):17-20.
[12]尤在泾.金匮翼[M].上海:上海卫生出版社,1957:20.
[13]高想.虫类药的应用历史与展望[J].中华中医药杂志,2010,25(6):807-808.
[14]何大平,丁学屏.丁学屏论治糖尿病性脑血管病变的经验[J].光明中医,2016,31(24):3563-3564.
[15]沈艳,周端,曹敏.虫类药治疗心血管疾病临床应用[J].吉林中医药,2014,34(7):681-684.
[16]倪青.糖尿病脑血管病的中西医结合诊断与治疗[J].实用糖尿病杂志,2001,7(1):58-60.
[17]戴原礼.秘传证治要诀及类方[M].沈凤阁,点校.北京:人民卫生出版社,1989:120.
[18]叶天士.临证指南医案[M].苏礼,焦振廉,张琳叶,等,整理.北京:人民卫生出版社,2006.
[2]冯兴中,姜敏,周铭.糖尿病合并脑血管病中医诊疗标准[J].世界中西医结合杂志,2011,6(4):357-364.
[3]李杲.兰室秘藏[M].刘更生,臧守虎,点校.天津:天津科学技术出版社,2012:26.
[4]王履.医经溯洄集[M].左言富,点注.南京:江苏科学技术出版社,1985:45.
[5]张介宾.景岳全书[M].上海:上海科学技术出版社,1959:334.
[6]沈金鳌.杂病源流犀烛[M].田思胜,整理.北京:人民卫生出版社,2006.
[7]周晖,高彦彬,罗文益,等.中西医结合治疗Ⅱ型糖尿病合并代谢综合征病例回顾研究[J].中国民族民间医药,2009,18(1):73-75.
[8]刘成.糖尿病并发脑血管疾病的临床分析[J].中国医药指南,2012,10(31):167-168.
[9]刘完素.素问玄机原病式[M].丁侃,校注.北京:中国医药科技出版社,2011:40.
[10]吴以岭.络病学[M].北京:中国中医药出版社,2006:48.
[11]高彦彬.络病与糖尿病慢性并发症[J].北京中医药大学学报(中医临床版),2008,15(3):17-20.
[12]尤在泾.金匮翼[M].上海:上海卫生出版社,1957:20.
[13]高想.虫类药的应用历史与展望[J].中华中医药杂志,2010,25(6):807-808.
[14]何大平,丁学屏.丁学屏论治糖尿病性脑血管病变的经验[J].光明中医,2016,31(24):3563-3564.
[15]沈艳,周端,曹敏.虫类药治疗心血管疾病临床应用[J].吉林中医药,2014,34(7):681-684.
[16]倪青.糖尿病脑血管病的中西医结合诊断与治疗[J].实用糖尿病杂志,2001,7(1):58-60.
[17]戴原礼.秘传证治要诀及类方[M].沈凤阁,点校.北京:人民卫生出版社,1989:120.
[18]叶天士.临证指南医案[M].苏礼,焦振廉,张琳叶,等,整理.北京:人民卫生出版社,2006.