督陽灸治療糖尿病自主神經病變汗證的臨床觀察

林家坤 楊俊瑤 楊輝林

【摘要】 目的：探究督陽灸治療糖尿病自主神經病變汗證的臨床效果。方法：選取2017年7月-2019年12月本院收治的糖尿病自主神經病變汗證的患者60例，按隨機數字表法分為觀察組和對照組，每組30例。對照組給予甲鈷胺治療，觀察組在對照組基礎上給予督陽灸治療。比較兩組治療前后汗出癥狀計分、治療效果、不良反應及安全性情況。結果：治療后，觀察組日間與夜間汗出癥狀計分均低于對照組（P<0.05）。觀察組治療總有效率為93.33%高于對照組的46.67%（P<0.05）。兩組均未出現嚴重不良反應。兩組安全性評價均為1級29例，2級1例。結論：采用督陽灸治療糖尿病自主神經病變汗證能有效改善汗出癥狀，提高臨床效果且安全可靠。

【關鍵詞】 督陽灸 糖尿病 自主神經病變 汗證 甲鈷胺

[Abstract] Objective： To explore the clinical effect of Du Yang moxibustion in the treatment of diabetic autonomic neuropathy with sweat syndrome. Method： A total of diabetic autonomic neuropathy 60 patients with sweat syndrome admitted to our hospital from July 2017 to December 2019 were selected. They were divided into observation group and control group according to the random number table method， with 30 patients in each group. The control group was treated with Mecobalamin and the observation group was treated with Du Yang moxibustion on the basis of the control group. The scores of sweating symptoms before and after treatment， treatment effect， adverse reactions and safety were compared between the two groups. Result： After treatment， the scores of daytime and nighttime sweating symptoms in the observation group were lower than those in the control group （P<0.05）. The total effective rate of treatment in the observation group was 93.33%， higher than 46.67% in the control group （P<0.05）. There were no serious adverse reactions in both groups. The safety assessment of the two groups were level 1 for 29 cases and level 2 for 1 case. Conclusion： Du Yang moxibustion can effectively improve the sweating symptoms in diabetic autonomic neuropathy with sweat syndrome， improve the clinical effect and is safe and reliable.

[Key words] Du Yang moxibustion Diabetes mellitus Autonomic neuropathy Sweat syndrome Mecobalamin

First-authors address： Pingxiang Hospital of Traditional Chinese Medicine， Pingxiang 337000， China

doi：10.3969/j.issn.1674-4985.2020.26.033

糖尿病患者長期高血糖水平會對患者的血管、心臟、神經等機體組織造成損傷，其中糖尿病自主神經病變汗證為常見并發癥之一[1]。糖尿病自主神經病變汗證的發病機制是長期高血糖水平致微血管發生病變，導致神經及交感神經節后纖維發生營養障礙而病變，終而引起汗腺功能失常而出現汗液排出異常[2]。其主要臨床癥狀表現為上半身代償性多汗，在運動后、高溫環境中或進食時出汗癥狀最為顯著，嚴重者會全身大汗淋漓，同時患者在睡眠時也容易出汗，醒后汗止[3]。西醫目前治療原則主要是控制血糖和糖化血紅蛋白水平、抗氧化應激、改善代謝紊亂、改善微循環、神經營養修復和對癥治療，缺乏特異性病因療法。糖尿病自主神經病變造成的汗出異常在中醫可歸屬為“汗證”范疇，其發生總屬人體陰陽失衡，腠理不固[4]。糖尿病學術帶頭人林家坤針對消渴汗證主張從陽著手，陽氣為元陽、腎陽，是生命之根本，是人體的正氣，對人體起到了溫煦和衛外的作用，提出了督陽灸治療之傳統外用方法治療糖尿病汗出異常[5]。……