基于《黄帝内经》“五脏痹”探析糖尿病自主神经病变

Analysis of diabetic autonomic neuropathy based on "Wuzang bi" in the Inner Canon of Yellow Emperor

关键词:  黄帝内经  五脏痹  糖尿病  自主神经病变

Key words:  Inner Canon of Yellow Emperor  Wuzang bi  diabetes  autonomic neuropathy

摘要:

现代疾病涉及中医“痹证”的种类有许多，包括自身免疫相关疾病、神经肌肉疾病、感染与代谢相关疾病等。《黄帝内经》中“五体痹”和“五脏痹”的提出对后世影响深远，糖尿病神经病变中以气血经络痹阻所致的肢体麻木、疼痛、怕凉、乏力为主者，具有类似“五体痹”表现，现代中医将其称为“消渴病痹症”。而糖尿病自主神经病变作为糖尿病神经病变的另一类别，其病变主要累及内脏自主神经和交感神经，表现为内脏系统功能失调，与“五脏痹”有诸多相通之处，如糖尿病引起的心脏、胃肠、泌尿生殖内脏自主神经病变和调节泌汗功能交感神经病变，亦与“五脏痹”之心痹、脾痹、肝痹、肺痹、胞痹等表现有高度的相似性。文章试从《黄帝内经》“五脏痹”病因病机、症候特征、治疗原则等方面，探析对糖尿病自主神经病变的认识。

Abstract:

There are numerous forms of diseases that involve bi syndrome of traditional Chinese medicine,including autoimmune diseases,neuromuscular diseases,infection,and metabolism-related diseases. The proposal in the Inner Canon of Yellow Emperor of "Wuti bi" and "Wuzang bi" has had a long-term impact on subsequent generations. Diabetic peripheral neuropathy,also known in modern Chinese medicine as "Xiaoke bi",is characterized by limb numbness,pain,feeling of cold,and weariness caused by qi and blood meridian obstruction,comparable to "Wuti bi". Another type of diabetic neuropathy is diabetic autonomic neuropathy,which primarily affects the visceral autonomic nerve and sympathetic nerve,resulting in dysfunction of numerous visceral systems and sharing many parallels with "Wuzang bi". For example,the autonomic neuropathy of the heart,gastrointestinal,urogenital organs,and sympathetic neuropathy of regulating sweat secretion induced by diabetes are highly similar to those of "Wuzang bi",such as heart bi,spleen bi,liver bi,pulmonary bi,and bladder bi. From the perspectives of etiology and pathogenesis,syndrome features,and therapeutic concepts of "Wuzang bi" in the Inner Canon of Yellow Emperor,the author attempts to analyze the understanding of diabetic autonomic neuropathy.