气虚血瘀在糖尿病性膀胱病中致病意义及治疗.docVIP

气虚血瘀在糖尿病性膀胱病中致病意义及治疗 　　摘要：糖尿病性膀胱病的病因病机主要是脾肾气虚，致膀胱及三焦气化不利，开阖失司，加之瘀血败精阻塞尿路，其主要病机为气虚血瘀，脾肾气虚为本，瘀血内停为标，因虚致实，虚实相杂，属于本虚标实之证，临床应用补气行瘀散结法治疗糖尿病性膀胱病有良好的临床疗效 关键词：糖尿病性膀胱病；气虚血瘀；补气行瘀散结法 DOI：10.3969/j.issn.1005-5304.2017.04.029 中图分类号：R228；R259.872 文献标识码：A 文章编号：1005-5304（2017）04-0111-02 Pathogenic Significance and Treatment of Qi Deficiency and Blood Stasis in Diabetic Cystopathy CHEN Qin-mei， WANG Ai-jun （Yancheng Hospital of Traditional Chinese Medicine， Yancheng 224001， China） Abstract： The etiology and pathogen of diabetic cystopathy is mainly due to qi deficiency of spleen and kidney， which leads to bladder and Sanjiao hypo-function of vital energy， losing opening and closing. In addition to blood stasis injury essence， it blocks the urinary tract. The main pathogen is qi deficiency and blood stasis. The qi deficiency of spleen and kidney is the fundamental aspect， while the blood stasis is the surface aspect. Excess resulted from deficiency， intermingled deficiency and excess， belong to asthenia in origin and asthenia in superficiality. Clinical application of method of invigorating qi， removing blood stasis and eliminating stagnation for diabetic cystopathy has a good clinical efficacy. Key words： diabetic cystopathy； qi deficiency and blood stasis； method of invigorating qi， removing blood stasis and eliminating stagnation 糖尿病性膀胱病（diabetic cystopathy，DCP）是?R床常见的糖尿病慢性并发症之一，以糖尿病性神经病变导致膀胱充盈的感觉障碍、逼尿肌收缩功能下降及剩余尿量增加为特征，其起病隐匿，早期诊断困难，晚期主要表现为慢性尿潴留及尿路感染反复发作。据报道43%～87%的糖尿病患者可并发此症[1]。目前，西医治疗DCP除控制血糖外，还包括营养神经、抗氧化等，但疗效不佳。中医辨证治疗本病疗效尚可。笔者认为气虚血瘀是DCP发病的病机关键，临证以补气行瘀散结法治疗获得满意疗效。兹介绍如下 1 病因病机 1.1 脾气亏虚 根据临床症状，DCP可归属中医“消渴”“癃闭”范畴。《灵枢“脾脆，善病消瘅。”指出脾气亏虚是消渴重要原因。《素问“饮入于胃，游溢精气，上输于脾，脾气散精，上归于肺，通调水道，下输膀胱，水精四布，五经并行。”消渴患者平素饮食不节，过食肥甘，损伤脾胃，致脾气亏虚，不能履行其“蒸津液、化精微”之功，使气机升降乖戾，清气不升，浊阴不降，中气下陷，转输无力，无以气化，则生癃闭。此即《灵枢“中气不足，溲便为之变。”另外，脾主肌肉，排尿功能依赖于膀胱肌肉的收缩，脾气虚则膀胱肌肉收缩无力，故临床可见排尿无力、时欲小便而不得出、小腹坠胀、肛门重坠、食欲不振、遇劳即发等症状 1.2 肾气不足 肾主水，与膀胱相表里，膀胱贮尿与排尿功能均依赖于肾脏气化作用。消渴患者先天禀赋不足，或年老体弱，或日久脾虚及肾，肾气不足，肾阳虚衰，致膀胱气化无权，开阖失司，气