杨玲 陈志刚

[摘要]周围神经病的病因复杂、病程不一、临床表现多样。陈志刚教授提出根据周围神经病西医分类，针对不同的病程、病因“辨病论治”。急性/亚急性周围神经病与感受外邪有关，治疗当以祛外邪为主，并强调补益气血；慢性周围神经病应从内伤、积损角度考虑，需根据上中下三焦辨证确定问题所在，治疗上除着重气血问题外，应适当加用补肾药物；复发性周围神经病需从“伏邪理论”角度认识，核心病机是正气虚衰、脏腑失调而致痰浊毒瘀内生，治疗当以“益气扶正，化浊解毒”为法。

[關键词]周围神经病；中医药；辨病论治；验案

[中图分类号] R741 [文献标识码] A [文章编号] 1674-4721（2018）4（c）-0112-04

Pro. CHEN Zhi-gang′s experience in treating peripheral neuropathy based on disease differentiation

YANG Ling1 CHEN Zhi-gang2▲

1.Department of Encephalopathy，Beijing Moslem People′s Hospital，Beijing 100054，China；2.Department of Encephalopathy，Dongfang Hospital of Beijing University of Chinese Medicine，Beijing 100078，China

[Abstract]Peripheral neuropathy disease have complex etiologies，various courses and diverse clinical manifestations.Disease differentiation treatment is proposed by professor CHEN Zhi-gang，which is based on different courses and etiologies according to the classification of peripheral neuropathy in western medicine.Acute/subacute peripheral neuropathy is associated with exogenous pathogens，and removing pathogens is considered to be the primary treatment，supplementing qi and blood should be emphasized.Chronic peripheral neuropathy should be considered in terms of internal and accumulated damages.It is necessary to identify the problem according to syndrome differentiation of sanjiao theory.In addition to emphasizing qi and blood，invigorating kidney drugs should be properly used .The recurrent peripheral neuropathy needs to be understood from the perspective of "hidden pathogen theory".Its core pathogenesis is deficiency of vital qi，disorder of zang and fu viscera generating turbid phlegm，toxin and stasis.Treatment should be "benefiting vital qi，resolving phlegm and removing toxicity".

[Key words]Peripheral neuropathy；Traditional Chinese Medicine；Disease differentiation treatment；Proved cases

周围神经病是指累及脊神经及发自脑干腹外侧脑神经的一大类疾病，病因、病位范围及病程各异。病因包括自身免疫、变性、中毒、营养缺乏、遗传代谢、机械压迫及神经元损伤等；病程可分为急性、亚急性、慢性、再发或复发性等；受累病理形式包括沃勒变性、轴索变性、神经元变性、节段性脱髓鞘等；临床症状、体征包括运动神经刺激或麻痹症状、腱反射减弱或消失、感觉障碍、畸形及营养障碍、自主神经功能障碍等。不同疾病的诊断方法、治疗及预后存在较大差异。神经传导速度和肌电图检查有助于周围神经病的诊断。多种周围神经病临床治疗困难，预后不佳[1]。

中医对周围神经病各家看法不同，辨证不一，治疗各异。多数周围神经病可划归中医“痿证”范畴[2]。“痿”并非一个独立的疾病，而是以手足软弱无力、筋脉弛缓不收、肌肉萎缩为主要特征的一类疾病的总称，记载首见于《素问·痿论》，指出五脏均可致“痿”，并将之分为“脉痿”“筋痿”“肉痿”“骨痿”“痿躄”等不同类型。……