从"病络三态论"探讨糖尿病并发症的辨治OA

Diabetic complications(DC)can affect multiple organs and systems throughout the body.Diabetic kidney disease,diabetic retinopathy,diabetic peripheral neuropathy,and diabetic foot are common and representative chronic complications that pose serious threats to patients' health and major challenges to clinical prevention and management.However,as a form of"panvascular disease,"DC is characterized by systemic involvement and complexity,making it difficult to manage effectively within traditional specialty-based care models.This paper proposes the"three-state theory of diseased collaterals,"which summarizes three dynamically evolving and interrelated pathological states:collateral distension,collateral obstruction,and collateral accumulation.This theory reveals the complete spatiotemporal evolution of DC pathogenesis,from early functional disturbance to late-stage structural damage.Collateral distension represents the initiating stage of diseased collaterals,characterized mainly by glucose-toxin injury and a dual deficiency of qi and yin,indicating a common pathological origin among various diabetic complications.Collateral obstruction represents the progressive stage,characterized by the intermingling of phlegm,blood stasis,and toxins that obstruct the collateral pathways.This stage manifests distinct pathological tendencies because of differences in lesion sites:dampness predominates in diabetic kidney disease,heat predominates in diabetic retinopathy,and deficiency is more prominent in diabetic peripheral neuropathy and diabetic foot.Collateral accumulation represents the terminal stage,characterized by the congealing and formation of persistent pathogenic factors and the internal binding of masses and accumulations.Therapeutically,the principle should be to unblock and activate the collaterals while applying stage-based treatment.For collateral distension,treatment should focus on clearing heat,unblocking the collaterals,activating blood,resolving stasis,and supplementing healthy qi as an adjunct.For collateral obstruction,treatment should emphasize removing blood stasis,unblocking the collaterals,eliminating phlegm,dispelling dampness,and strengthening healthy qi.For collateral accumulation,treatment should focus on reinforcing healthy qi,unblocking the collaterals,dispersing accumulations,resolving masses,transforming turbidity,and eliminating toxins.These principles should be flexibly adapted according to the specific pathogenesis of each diabetic complication.This theory provides a new perspective for the prevention and treatment of DC with traditional Chinese medicine.