中西医协同治疗糖尿病周围神经病变的机制、优势与整合策略

Integrative treatment of diabetic peripheral neuropathy with traditional Chinese and Western medicine: mechanisms, advantages, and integrated strategies

摘要

糖尿病周围神经病变（DPN）是糖尿病最常见的慢性并发症之一，约半数糖尿病患者在病程中会出现DPN，由此带来的肢体麻木、感觉异常和疼痛不仅降低了生活质量，也增加了足部溃疡与截肢的风险。西医以控糖、抗氧化应激和营养神经为主要手段，靶点清楚但难以逆转已经形成的神经损伤，长期用药的不良反应也不容忽视。中医药在缓解症状、促进神经修复方面积累了较多经验，但中西医协同治疗的整体效果尚不明确，已有的证据尚待系统整理。为此，文章系统梳理DPN中西医各自的发病机制与治疗证据，在此基础上构建一个便于临床操作的中西医协同策略框架，为临床决策提供参考。西医认为DPN由代谢紊乱、氧化应激、微血管病变、神经炎症及神经营养因子缺乏五类因素交织而成，单一药物难以覆盖全部病理环节。中医将其归为“消渴病痹证”，核心病机围绕“虚、瘀、痰”三者展开，络脉病变与微血管病变在病理逻辑上高度同构，按2016年版中医临床诊疗指南分为六种证型。这一“病机同构”的特性，构成了中西医协同的理论基础。治疗证据方面，中药内服以黄芪、当归、鸡血藤、桂枝为核心药物，针灸以足三里、三阴交、合谷为核心穴位。现有研究已形成西药联合中药、西药联合针灸、三联疗法等多种协同模式，依托“病机同构”的理论基础，以“西医控制血糖与急性并发症，中医改善临床症状、促进周围神经修复、减轻西药不良反应”为分工原则，在此基础上按病程早晚和中医证型选择不同的协同组合。这一“分阶梯协同”策略为DPN的规范化整合治疗提供了可操作的思路。

Abstract

Diabetic peripheral neuropathy (DPN) is one of the most common chronic complications of diabetes, affecting approximately half of patients during their disease course. The resulting limb numbness, paresthesia, and pain not only deteriorate the quality of life but also increase the risks of foot ulcers and amputation. Western medicine primarily focuses on glycemic control, anti-oxidative stress, and neurotrophic therapies; while having specific targets, these approaches struggle to reverse established nerve damage, and the adverse effects of long-term medication cannot be ignored. Traditional Chinese medicine (TCM) has accumulated substantial clinical experience in alleviating symptoms and promoting nerve repair. However, the overall efficacy of integrated Chinese and Western medicine requires a systematic review of existing evidence. This article systematically reviewed the pathogenesis and therapeutic evidence of DPN in both Western medicine and TCM, and constructed a clinically applicable integrative strategy framework to provide a reference for clinical decision-making. From a pathophysiological perspective, Western medicine considers DPN a complex outcome of metabolic disorders, oxidative stress, microangiopathy, neuroinflammation, and neurotrophic factor deficiency, making it difficult for monotherapy to cover all pathological pathways. TCM categorizes DPN as “Xiaoke Bi syndrome”, with its core pathogenesis centered on “deficiency, stasis, and phlegm”. The collateral vessel pathology in TCM is highly isomorphic with microangiopathy in Western medicine. According to the 2016 TCM clinical practice guidelines, DPN is classified into six syndromes. Regarding therapeutic evidence, the core herbs for internal application include Astragali Radix (Huangqi), Angelicae Sinensis Radix (Danggui), Spatholobi Caulis (Jixueteng), and Cinnamomi Ramulus (Guizhi); acupuncture primarily targets ST36 (Zusanli), SP6 (Sanyinjiao), and LI4 (Hegu). Current research has established various synergistic models, including Western medicine combined with Chinese herbs, acupuncture, or triple therapy. The integrative treatment of DPN relies on the theoretical foundation of “isomorphic pathogenesis”, adopting a collaborative principle where Western medicine manages glycemic control and acute conditions, while TCM alleviates symptoms, promotes nerve repair, and mitigates Western drug toxicities. Based on this, different synergistic combinations are selected according to the disease stage and TCM syndromes. This “stepped synergistic” strategy offers an actionable approach for the standardized integrative treatment of DPN.

关键词

糖尿病周围神经病变 / 中西医协同 / 针灸 / 中药

Key words

Diabetic peripheral neuropathy / Integrated Chinese and Western medicine / Acupuncture / Traditional Chinese medicine

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基金资助

广东省中医药局科研项目(20261493)

中西医协同“旗舰”科室建设项目(国中医药综结合函[2024]221号)

宁夏回族自治区重点研发计划项目(2022BEG02040)