王静茹 倪青

摘要 糖尿病神经病变属于痹证、血痹等范畴。现基于《伤寒论》六经辨证理论，对该病进行分期、分经论治，提出六经辨治用药思路，以期指导本病临床遣方用药。

关键词 糖尿病神经病变;《伤寒论》;六经辨证;辨证论治

Thought and Method of Treatment of Diabetic Neuropathy from the Perspective

of Syndrome Differentiation of Six Channels Theory

WANG Jingru1，NI Qing2

（1 Department of Endocrinology，South Branch of Guang′anmen Hospital，China Academy of Chinese Medical Sciences，

Beijing 102600，China; 2 Guang′anmen Hospital，China Academy of Chinese Medical Sciences，Beijing 100053，China）

Abstract According to traditional Chinese medicine（TCM），diabetic neuropathy（DN）belongs to the category of bi disease，especially blood bi.Based on syndrome differentiation of six channels theory from Treatise on Cold Pathogenic Diseases，this paper proposed that DN should be treated according to stages and channels，with a prescribing method according to the syndrome differentiation of six channels theory，in order to guide the medication and prescription of DN clinically.

Keywords Diabetic neuropathy; Treatise on Cold Pathogenic Diseases; Syndrome differentiation of six channels theory; Treatment based on syndrome differentiation

中图分类号：R242;R249文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.05.009

糖尿病神经病变临床表现多样，如头面部多汗、四肢远端对称或非对称性麻木、刺痛、烧灼感、蚁走感，双下肢有袜套样的感觉减退或缺失，跟腱和膝腱反射减退或消失，心慌气短，腹泻或便秘，失眠，皮肤瘙痒等。此病可结合主要临床症状，归属中医“血痹”“痹证”“汗证”“便秘”“心悸”等病症范畴讨论。《伤寒论》六经辨证体系是融经络、脏腑、阴阳、邪正、气化、疾病发展阶段、治法、方药、调护在内的综合性临床辨证论治体系[1]。“六经诠百病”，疑难杂病均可按六经辨证论治。我们临床采用六经辨证方法治疗糖尿病神经病变，体会较其他辨证方法有简便、治疗目标明确、选方用药灵活、疗效可靠等特点。兹不揣冒昧介绍如下，就正于同道。

1 六经六病统筹，病证结合辨证

《伤寒论》每篇均以“辨××病脉证并治”为题，这里的“病”指的是六经病，即太阳病、阳明病、少阳病、太阴病、少阴病、厥阴病糖尿病周围神经的临床症状，可从六经辨证。“脉”指脉象，是辨证诊断的重要依据。“证”指每类病的主要证型，如太阳病有太阳伤寒证、太阳中风证等，厥阴病有上热下寒证、厥证等。“治”应该理解为综合治疗方法与步骤，包括治则、治法、遣方、用药、用药、减法、服法、针灸、理疗、禁忌等等。……