陈玉鹏 汤怡婷 张美珍 郝晓晖 倪青

摘要 柴胡桂枝干姜汤能温寒通阳，解结生津，具有寒热并用的特点，为厥阴代表方剂之一。糖尿病周围神经病变病机错综复杂，呈现寒热错杂、正虚与邪实并存的特点。现引证相关经典原文结合临床分析糖尿病周围神经病变病机，阐释柴胡桂枝干姜汤方证，论述应用柴胡桂枝干姜汤从厥阴病论治糖尿病周围神经病变的理论基础，为本病的治疗提供一个新思路。

关键词 柴胡桂枝干姜汤;糖尿病周围神经病变;厥阴病;经方;伤寒论;六经辨证;寒热错杂;中医

Discussion on Chaihu Guizhi Ganjiang Decoction in Treatment of Diabetic Peripheral

Neuropathy from the Perspective of Jueyin Disease

CHEN Yupeng1，TANG Yiting1，ZHANG Meizhen2，HAO Xiaohui2，NI Qing2

（1 Graduate School of Beijing University of Chinese Medicine，Beijing 100029，China; 2 Guang′anmen Hospital，

China Academy of Chinese Medical Sciences，Beijing 100053，China）

Abstract Chaihu Guizhi Ganjiang Decoction can warm yang and dispel cold，dissolve the stagnation，and promote fluid production，with the characteristics of both cold and heat，which is one of the representative prescriptions of Jueyin disease.The pathogenesis of diabetic peripheral neuropathy is complicated，showing the characteristics of intermingled cold and heat，healthy qi deficiency and excessive pathogen.This paper quotes relevant classical texts combined with clinical analysis of the pathogenesis of diabetic peripheral neuropathy，explains the ingredient and efficacy of Chaihu Guizhi Ganjiang Decoction，and discusses the theoretical basis of applying Chaihu Guizhi Ganjiang Decoction for the treatment of diabetic peripheral neuropathy from the perspective of Jueyin disease，in order to provide a new idea for the treatment of this disease.

Keywords Chaihu Guizhi Ganjiang Decoction; Diabetic peripheral neuropathy; Jueyin disease; Classic prescription; Treatise on cold pathogenic diseases; Syndrome differentiation of six channels theory; Syndrome of intermingled heat and cold; Traditional Chinese medicine

中图分类号：R255.4文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.05.002

糖尿病周围神经病变（Diabetic Peripheral Neuropathy，DPN）是糖尿病常见的慢性并发症，发生在一半以上的糖尿病患者中[1]。其临床表现为肢体麻木、疼痛、灼热或其他异常感觉等症状，伴有肌肉无力和萎缩，肢体局部浅感觉减退，腱反射减弱或消失等体征。DPN是糖尿病足部溃疡的主要诱发因素，也是大多数高收入国家非创伤性下肢截肢的最常见原因[2]。DPN严重影响患者生命质量，降低预期寿命，给家庭与社会带来巨大的财政负担。西医在控制血糖的基础上，予以神经修复、抗氧化应激、改善微循环、改善代谢紊乱、止痛等治疗[3]。现代医学对于DPN发病机制尚未完全明确，临床缺乏特异性治疗手段，疗效不明显，部分药物存在费用高、不良反应大等问题。因此DPN的治疗仍然是医学领域的难点。中医药治疗该病有其独特优势，可明显缓解患者的症状。荟萃分析结果表明中药联合依帕司他在改善DPN的临床有效率、正中神经感觉及运动传导速度、腓总神经感觉及运动传导速度方面皆优于单用依帕司他[4]。……