魏子孝教授辨治糖尿病性视网膜病变经验

张颢龄 张广德

摘要 糖尿病性视网膜病变是糖尿病常见的微血管并发症之一，目前现代医学治疗以控制血糖、血压、血脂、改善微循环等基础治疗方法为主，严重者采取激光光凝、手术或局部糖皮质激素治疗。中医药辅助治疗在减少潜在致盲并发症的发生率，延缓病情进展等方面具有独特的疗效。魏子孝教授参考眼底检查抓住患者“主证”，运用中医药理论辨治糖尿病性视网膜病变，主要针对非急性眼底出血糖尿病性视网膜病变。治疗上注重整体与眼部微观辨证相结合，以滋补肝肾、养血明目为基础，佐以化痰祛瘀、活血利水等祛邪通络之法;注意起居调护，如疏肝理气、润肠通便药物的应用，以避免眼底再次出血，临床效果明显。

关键词 @ 魏子孝;糖尿病性视网膜病变;中医药疗法;视瞻昏渺;滋补肝肾;养血明目;化痰祛瘀;活血利水;起居调护;名医经验

Clinical Experience of Professor WEI Zixiao in the Treatment of Diabetic Retinopathy

ZHANG Haoling1，ZHANG Guangde2

（1 Graduate School，China Academy of Chinese Medical Sciences，Beijing 100700，China;

2 Xiyuan Hospital，China Academy of Chinese Medical Sciences，Beijing 100091，China）

Abstract Diabetic retinopathy is one of the common microvascular complications of diabetes.At present，Western medicine mainly adopts basic treatment methods such as controlling blood glucose，blood pressure，blood lipid and improving microcirculation，and in severe cases，laser photocoagulation，surgery or topical corticosteroids therapy are adopted.Traditional Chinese medicine（TCM）has unique efficacy in reducing the incidence of potential blinding complications and delaying the progression of the disease.Professor WEI Zixiao refers to patients with fundus examination to seize “primary symptom”，and used TCM theory to distinguish and treat diabetic retinopathy，mainly aiming at diabetic retinopathy without acute fundus hemorrhage.He paid attention to the combination of systemic and miro syndrome differentiation.The treatment was based on tonifying liver and kidney，nourishing blood and improving eyesight，supplemented by eliminating phlegm and blood stasis，activating blood circulation and promoting water，etc.In addition，he emphasized the importance of daily care，such as the use of drugs to soothe the liver and regulate qi and moisten the bowel to relieve constipation，so as to avoid the fundus bleeding again，with obvious clinical effects.

Keywords @ Professor WEI Zixiao; Diabetic retinopathy; Therapy of traditional Chinese medicine; Blurred vision; Nourish liver and kidney; Nourish blood and improve eyesight; Eliminate phlegm and blood stasis; Activate blood circulation and promote water; Daily care; Experience of famous TCM doctors

中图分类号：R249.2/.7文献标识码：Bdoi：10.3969/j.issn.1673-7202.2021.02.024

糖尿病性视网膜病变（Diabetic Retinopathy，DR），是糖尿病常见的微血管并发症之一[1]。它是以眼底毛细血管扩张、出血、渗出、水肿及新生血管形成，甚则可引起视野缺损，玻璃体混浊、积血为主要临床特征，对视力造成严重损害，严重者可引起视网膜脱离，是目前中年人群最常见的致盲原因[2]。目前尚无有效控制其发展的防治手段，现代医学治疗以控制血糖、血压、血脂、改善微循环等基础治疗方法为主，严重者采取激光光凝、手术或局部糖皮质激素治疗[3]，疗效不一，且不良反应大、不良反应发生率高[4]，病情易反复[5]。……