针药治疗糖尿病周围神经病变的临床研究进展

Clinical Research Advances in Acupuncture and Herbal Medicine for the Treatment of Diabetic Peripheral Neuropathy

摘要: 糖尿病周围神经病变(DPN)是糖尿病的常见并发症，临床表现为肢体麻木、疼痛、感觉减退等，严重影响患者生活质量。现代医学治疗以控制血糖、营养神经、镇痛为主，但存在疗效有限、副作用明显等问题。中医将DPN归属于“消渴病”兼证“痹证”“痿证”等范畴，以气阴两虚为本，瘀血痰浊阻络为标，治疗强调辨证论治、整体调节。本文系统综述了近年来中药与针灸治疗DPN的临床研究进展，涵盖中医病因病机、中药治疗(包括经典方剂、中药单体、中药外治法)、针灸治疗(包括针刺、艾灸、穴位注射等)及其联合应用。研究表明，中药与针灸可通过改善微循环、抗氧化应激、调节神经生长因子、抑制炎症反应等多途径发挥治疗作用，且两者联合应用具有协同增效的优势。未来需进一步开展高质量临床与机制研究，以推动中医药在DPN治疗中的规范化与个体化应用。

Abstract: Diabetic peripheral neuropathy (DPN) is a common complication of diabetes mellitus, clinically manifested as limb numbness, pain, hypoesthesia, and other symptoms, which severely impact patients’ quality of life. Modern medical treatment primarily focuses on glycemic control, nerve nourishment, and analgesia, yet it faces limitations such as suboptimal efficacy and notable side effects. In Traditional Chinese Medicine (TCM), DPN is classified under the categories of “Xiaoke disease” (wasting-thirst disorder) with concurrent patterns such as “Bi syndrome” (impediment syndrome) and “Wei syndrome” (wilting syndrome). Its pathogenesis is rooted in deficiency of both qi and yin, with internal dampness and static blood obstructing the collaterals serving as the secondary manifestations. TCM treatment emphasizes pattern differentiation and holistic regulation. This article provides a systematic review of recent clinical research progress in the treatment of DPN using Chinese herbal medicine and acupuncture. It encompasses TCM etiology and pathogenesis, herbal interventions (including classical formulations, single-herb extracts, and external therapies), acupuncture and moxibustion therapies (including needling, moxibustion, acupoint injection, etc.), and their combined application. Studies indicate that Chinese herbal medicine and acupuncture can exert therapeutic effects through multiple pathways, such as improving microcirculation, alleviating oxidative stress, modulating nerve growth factors, and inhibiting inflammatory responses. Furthermore, the combined application of these modalities demonstrates synergistic advantages. Future directions necessitate higher-quality clinical and mechanistic research to promote the standardized and personalized application of TCM in managing DPN.