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Article(id=1322928217564250705, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926740955341011, articleNumber=null, orderNo=null, doi=10.13193/j.issn.1673-7717.2025.10.009, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=null, receivedDateStr=null, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793340265884, onlineDateStr=2026-10-30, pubDate=1760025600000, pubDateStr=2025-10-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793340265884, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793340265884, creator=13701087609, updateTime=1793340265884, updator=13701087609, issue=Issue{id=1322926740955341011, tenantId=1146029695717560320, journalId=1255847919539208197, year='2025', volume='43', issue='10', pageStart='1', pageEnd='258', issueExtLink='null', onlineDate='null', pubDate='1760025600000', pubDateStr='2025-10-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793339913834, creator='13701087609', updateTime=1793340753123, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322930261259846420, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926740955341011, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322930261259846421, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926740955341011, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=45, endPage=48, ext={EN=ArticleExt(id=1322928219019674194, articleId=1322928217564250705, tenantId=1146029695717560320, journalId=1255847919539208197, language=EN, title=Application of Modified Liuwei Dihuang Pill（六味地黄丸加减）in Muscle Atrophy of Patients with Diabetes Peripheral Neuropathy, columnId=1256183361521967297, journalTitle=Chinese Archives of Traditional Chinese Medicine, columnName=Target on National Project, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the effect of Liuwei Dihuang Pill（六味地黄丸）on muscle atrophy in patients with diabetic peripheral neuropathy.

Methods

A total of 80 patients with diabetic peripheral neuropathy treated in the hospital from November 2022 to March 2024 were included in the study.They were divided into two groups by random number table method.Forty patients in the control group were treated with conventional western medicine，and the other 40 patients in the observation group were treated with Liuwei Dihuang Pill on the basis of control group.The treatment effect，blood glucose change and nerve conduction velocity change of Toronto Clinical Scoring system（TCSS）were compared between the two groups.

Results

The total effective rate of the observation group was 95.0%（38/40），which was much higher than that of the control group（72.5%，29/40），and the difference was significant（P<0.05）.After treatment，TCSSscore and blood glucose index of the observation group were lower than those of the control group（P<0.05）.After treatment，motor nerve conduction velocity（MNCV）and sensory nerve conduction velocity（SNCV）of common peroneal nerve and median nerve in the observation group were higher than those in the control group（P<0.05）.After treatment，the average latency，dispersion and abnormality rate of F waves in the median nerve，ulnar nerve，common peroneal nerve and tibial nerve in the observation group were lower than those in the control group（P<0.05）.

Conclusion

The application of Liuwei Dihuang Pill in the treatment of diabetic peripheral neuropathy can effectively improve the numbness，pain and other related symptoms，reduce the severity of neuropathy，increase the nerve conduction speed and relieve the muscle atrophy，and plays a positive role in the prognosis of patients.

, authors=Haiyan FENG, Yuehong LI, Yunfeng LIU, Xiaojuan FENG, Shaoqun LUAN, authorsList=Haiyan FENG, Yuehong LI, Yunfeng LIU, Xiaojuan FENG, Shaoqun LUAN, authorCompany=null, correspAuthors=Shaoqun LUAN, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322928220152136285, articleId=1322928217564250705, tenantId=1146029695717560320, journalId=1255847919539208197, language=CN, title=六味地黄丸加味对糖尿病周围神经病变患者肌肉萎缩期的应用研究, columnId=1256183362172142382, journalTitle=中华中医药学刊, columnName=国家项目点击, runingTitle=null, highlight=null, articleAbstract=
目的

分析六味地黄丸加味治疗糖尿病周围神经病变患者肌肉萎缩期的应用效果。

方法

纳入2022年11月—2024年3月医院收治的80例糖尿病周围神经病变患者为研究对象，随机数字表法分为两组，40例对照组采用常规西药进行治疗，40例观察组在对照组基础上予以六味地黄丸加味治疗，对比两组治疗效果、血糖变化、多伦多临床评分系统（Toronto clinical scoring system，TCSS）神经传导速度变化情况等。

结果

观察组治疗总有效率为95.0%（38/40），远高于对照组的72.5%（29/40），组间比较差异有统计学意义（P<0.05）；治疗后观察组TCSS、血糖指标均低于对照组（P<0.05）；治疗后观察组腓总神经、正中神经运动传导速度（motor nerve conduction velocity，MNCV）、感觉传导速度（sensory nerve conduction velocity，SNCV）高于对照组（P<0.05）；治疗后观察组正中神经、尺神经、腓总神经、胫神经F波平均潜伏期、离散度及异常率均低于对照组（P<0.05）。

结论

对糖尿病周围神经病变患者应用六味地黄丸加味治疗可有效改善患者肢体麻木、疼痛等相关症状，减轻神经病变严重程度，提高神经传导速度，改善肌肉萎缩情况，对患者预后起到积极作用。

, authors=冯海燕, 李月红, 刘云峰, 冯晓娟, 栾绍群, authorsList=冯海燕, 李月红, 刘云峰, 冯晓娟, 栾绍群, authorCompany=null, correspAuthors=栾绍群, authorNote=

冯海燕（1978-），女，河北邢台人，副主任医师，学士，研究方向：神经电生理。

, correspAuthorsNote=
栾绍群（1984-），男，河北邢台人，副主任医师，硕士，研究方向：癫痫、神经肌肉病。E-mail：。
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冯海燕（1978-），女，河北邢台人，副主任医师，学士，研究方向：神经电生理。

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冯海燕（1978-），女，河北邢台人，副主任医师，学士，研究方向：神经电生理。

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糖尿病周围神经病变之中医病因病机理论框架研究［J］. 辽宁中医药大学学报，2023，25（2）：162-166., articleTitle=糖尿病周围神经病变之中医病因病机理论框架研究, refAbstract=null), Reference(id=1322928229270553258, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928217564250705, doi=null, pmid=null, pmcid=null, year=2024, volume=277, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=［27］, rfOrder=26, authorNames=YUE W, SUN N, ZHANG J, journalName=Int JBiol Macromol, refType=null, unstructuredReference=YUE W，SUN N，ZHANG J，et al. 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Growth-promoting activity of Sanyak（Dioscoreae rhizoma）extract on injured sciatic nerve in rats［J］. JAcupunct Meridian Stud，2009，2（3）：228-235., articleTitle=Growth-promoting activity of Sanyak（Dioscoreae rhizoma）extract on injured sciatic nerve in rats, refAbstract=null), Reference(id=1322928229958419121, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928217564250705, doi=null, pmid=null, pmcid=null, year=2023, volume=317, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=［34］, rfOrder=33, authorNames=SHE M, HUANG M, ZHANG J, journalName=J Ethnopharmacol, refType=null, unstructuredReference=SHE M，HUANG M，ZHANG J，et al. Astragulus embranaceus（Fisch.）Bge-Dioscorea opposita Thunb herb pair ameliorates sarcopenia in senile type 2 diabetes mellitus through Rab5a/mTORmediated mitochondrial dysfunction［J］. J Ethnopharmacol，2023，317：116737., articleTitle=Astragulus embranaceus（Fisch.）Bge-Dioscorea opposita Thunb herb pair ameliorates sarcopenia in senile type 2 diabetes mellitus through Rab5a/mTORmediated mitochondrial dysfunction, refAbstract=null)], funds=[Fund(id=1322928225038500493, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928217564250705, awardId=1998-12, language=CN, fundingSource=国家中医药管理局WHO合作项目(1998-12), fundOrder=null, country=null), Fund(id=1322928225126580878, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928217564250705, awardId=20211630, language=CN, fundingSource=河北省卫生健康委员会医学科学研究项目(20211630), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1322928220378628702, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928217564250705, xref=null, ext=[AuthorCompanyExt(id=1322928220387017311, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928217564250705, companyId=1322928220378628702, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Xingtai People’s Hospital，Xingtai 054000，Hebei，China), AuthorCompanyExt(id=1322928220395405920, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928217564250705, companyId=1322928220378628702, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=邢台市人民医院，河北 邢台 054000)])], figs=[ArticleFig(id=1322928223801180803, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928217564250705, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数显效有效无效总有效
观察组4026（65.0）12（30.0）2（5.0）38（95.0）
对照组4016（40.0）13（32.5）11（27.5）29（72.5）
χ2值7.268 6
P值0.001 5
), ArticleFig(id=1322928223872483972, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928217564250705, language=CN, label=表1, caption=

两组糖尿病周围神经病变患者临床疗效比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数显效有效无效总有效
观察组4026（65.0）12（30.0）2（5.0）38（95.0）
对照组4016（40.0）13（32.5）11（27.5）29（72.5）
χ2值7.268 6
P值0.001 5
), ArticleFig(id=1322928223956370053, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928217564250705, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数治疗前治疗后t值P值
观察组4011.27±2.144.62±1.265.191 70.000 0
对照组4011.28±2.178.62±1.988.149 60.000 0
t值0.881 214.435 7
P值0.381 40.000 0
), ArticleFig(id=1322928224086393478, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928217564250705, language=CN, label=表2, caption=

两组糖尿病周围神经病变患者TCSS评分情况比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数治疗前治疗后t值P值
观察组4011.27±2.144.62±1.265.191 70.000 0
对照组4011.28±2.178.62±1.988.149 60.000 0
t值0.881 214.435 7
P值0.381 40.000 0
), ArticleFig(id=1322928224191251079, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928217564250705, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数空腹血糖/（mmol/L）餐后2 h血糖/（mmol/L）HbA1 c/（%）
治疗前治疗后治疗前治疗后治疗前治疗后
观察组4012.72±2.846.45±1.23*15.22±3.248.68±1.45*8.26±1.526.22±0.41*
对照组4012.75±2.868.72±1.26*15.27±3.5211.72±2.16*8.29±1.577.92±0.21*
t值0.234 721.244 70.817 73.604 50.774 49.356 5
P值0.262 10.028 30.416 50.011 20.441 30.021 0
), ArticleFig(id=1322928224505823880, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928217564250705, language=CN, label=表3, caption=

两组糖尿病周围神经病变患者血糖水平变化情况比较()

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数空腹血糖/（mmol/L）餐后2 h血糖/（mmol/L）HbA1 c/（%）
治疗前治疗后治疗前治疗后治疗前治疗后
观察组4012.72±2.846.45±1.23*15.22±3.248.68±1.45*8.26±1.526.22±0.41*
对照组4012.75±2.868.72±1.26*15.27±3.5211.72±2.16*8.29±1.577.92±0.21*
t值0.234 721.244 70.817 73.604 50.774 49.356 5
P值0.262 10.028 30.416 50.011 20.441 30.021 0
), ArticleFig(id=1322928224593904265, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928217564250705, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间MNCV/（m/s）SNCV/（m/s）
腓总神经正中神经腓总神经正中神经
观察组40治疗前38.52±3.2140.52±4.2129.52±3.1736.25±5.21
治疗后47.25±5.2151.36±2.4236.25±4.2546.85±5.24
t值9.254 510.926 58.164 59.425 7
P值0.000 00.000 00.000 00.000 0
对照组40治疗前38.61±3.2240.32±4.2528.52±3.1835.72±4.72
治疗后42.25±5.1245.63±3.4831.25±2.1541.52±3.25
t值7.584 28.365 410.264 711.486 8
P值0.000 00.000 00.000 00.000 0
两组治疗前比较t值0.182 60.357 50.355 20.148 5
两组治疗前比较P值0.294 60.248 70.247 60.249 6
两组治疗后比较t值11.254 89.746 58.997 29.422 3
两组治疗后比较P值0.000 00.000 00.000 00.000 0
), ArticleFig(id=1322928224702956170, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928217564250705, language=CN, label=表4, caption=

两组糖尿病周围神经病变患者神经传导速度变化情况

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间MNCV/（m/s）SNCV/（m/s）
腓总神经正中神经腓总神经正中神经
观察组40治疗前38.52±3.2140.52±4.2129.52±3.1736.25±5.21
治疗后47.25±5.2151.36±2.4236.25±4.2546.85±5.24
t值9.254 510.926 58.164 59.425 7
P值0.000 00.000 00.000 00.000 0
对照组40治疗前38.61±3.2240.32±4.2528.52±3.1835.72±4.72
治疗后42.25±5.1245.63±3.4831.25±2.1541.52±3.25
t值7.584 28.365 410.264 711.486 8
P值0.000 00.000 00.000 00.000 0
两组治疗前比较t值0.182 60.357 50.355 20.148 5
两组治疗前比较P值0.294 60.248 70.247 60.249 6
两组治疗后比较t值11.254 89.746 58.997 29.422 3
两组治疗后比较P值0.000 00.000 00.000 00.000 0
), ArticleFig(id=1322928224786842251, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928217564250705, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数神经类型F波平均潜伏期F波离散度F波异常率
观察组40正中神经28.25±2.14*4.12±0.25*5（12.5）*
尺神经26.25±2.17*4.05±0.24*4（10.0）*
腓总神经42.25±3.15*5.11±0.27*6（15.0）*
胫神经45.25±2.47*5.13±0.28*5（12.5）*
对照组40正中神经37.52±3.157.05±0.2423（57.5）
尺神经39.25±4.156.42±0.2725（62.5）
腓总神经58.25±3.257.04±0.1429（72.5）
胫神经60.25±4.257.24±0.3427（67.5）
), ArticleFig(id=1322928224925254284, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928217564250705, language=CN, label=表5, caption=

两组治疗后F波平均潜伏期、离散度及异常率比较（）

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组别例数神经类型F波平均潜伏期F波离散度F波异常率
观察组40正中神经28.25±2.14*4.12±0.25*5（12.5）*
尺神经26.25±2.17*4.05±0.24*4（10.0）*
腓总神经42.25±3.15*5.11±0.27*6（15.0）*
胫神经45.25±2.47*5.13±0.28*5（12.5）*
对照组40正中神经37.52±3.157.05±0.2423（57.5）
尺神经39.25±4.156.42±0.2725（62.5）
腓总神经58.25±3.257.04±0.1429（72.5）
胫神经60.25±4.257.24±0.3427（67.5）
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六味地黄丸加味对糖尿病周围神经病变患者肌肉萎缩期的应用研究
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冯海燕 , 李月红 , 刘云峰 , 冯晓娟 , 栾绍群
中华中医药学刊 | 国家项目点击 2025,43(10): 45-48
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中华中医药学刊 |国家项目点击 2025 , 43 (10) : 45 -48
六味地黄丸加味对糖尿病周围神经病变患者肌肉萎缩期的应用研究
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冯海燕, 李月红, 刘云峰, 冯晓娟, 栾绍群
作者信息
  • 邢台市人民医院，河北 邢台 054000
通讯作者:
栾绍群（1984-），男，河北邢台人，副主任医师，硕士，研究方向：癫痫、神经肌肉病。E-mail：。
作者简介:

冯海燕（1978-），女，河北邢台人，副主任医师，学士，研究方向：神经电生理。

Application of Modified Liuwei Dihuang Pill（六味地黄丸加减）in Muscle Atrophy of Patients with Diabetes Peripheral Neuropathy
Haiyan FENG, Yuehong LI, Yunfeng LIU, Xiaojuan FENG, Shaoqun LUAN
Affiliations
  • Xingtai People’s Hospital，Xingtai 054000，Hebei，China
出版时间: 2025-10-10 doi: 10.13193/j.issn.1673-7717.2025.10.009
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摘要
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目的

分析六味地黄丸加味治疗糖尿病周围神经病变患者肌肉萎缩期的应用效果。

方法

纳入2022年11月—2024年3月医院收治的80例糖尿病周围神经病变患者为研究对象，随机数字表法分为两组，40例对照组采用常规西药进行治疗，40例观察组在对照组基础上予以六味地黄丸加味治疗，对比两组治疗效果、血糖变化、多伦多临床评分系统（Toronto clinical scoring system，TCSS）神经传导速度变化情况等。

结果

观察组治疗总有效率为95.0%（38/40），远高于对照组的72.5%（29/40），组间比较差异有统计学意义（P<0.05）；治疗后观察组TCSS、血糖指标均低于对照组（P<0.05）；治疗后观察组腓总神经、正中神经运动传导速度（motor nerve conduction velocity，MNCV）、感觉传导速度（sensory nerve conduction velocity，SNCV）高于对照组（P<0.05）；治疗后观察组正中神经、尺神经、腓总神经、胫神经F波平均潜伏期、离散度及异常率均低于对照组（P<0.05）。

结论

对糖尿病周围神经病变患者应用六味地黄丸加味治疗可有效改善患者肢体麻木、疼痛等相关症状，减轻神经病变严重程度，提高神经传导速度，改善肌肉萎缩情况，对患者预后起到积极作用。

糖尿病周围神经病变  /  肌肉萎缩期  /  六味地黄丸  /  神经传导速度
Objective

To analyze the effect of Liuwei Dihuang Pill（六味地黄丸）on muscle atrophy in patients with diabetic peripheral neuropathy.

Methods

A total of 80 patients with diabetic peripheral neuropathy treated in the hospital from November 2022 to March 2024 were included in the study.They were divided into two groups by random number table method.Forty patients in the control group were treated with conventional western medicine，and the other 40 patients in the observation group were treated with Liuwei Dihuang Pill on the basis of control group.The treatment effect，blood glucose change and nerve conduction velocity change of Toronto Clinical Scoring system（TCSS）were compared between the two groups.

Results

The total effective rate of the observation group was 95.0%（38/40），which was much higher than that of the control group（72.5%，29/40），and the difference was significant（P<0.05）.After treatment，TCSSscore and blood glucose index of the observation group were lower than those of the control group（P<0.05）.After treatment，motor nerve conduction velocity（MNCV）and sensory nerve conduction velocity（SNCV）of common peroneal nerve and median nerve in the observation group were higher than those in the control group（P<0.05）.After treatment，the average latency，dispersion and abnormality rate of F waves in the median nerve，ulnar nerve，common peroneal nerve and tibial nerve in the observation group were lower than those in the control group（P<0.05）.

Conclusion

The application of Liuwei Dihuang Pill in the treatment of diabetic peripheral neuropathy can effectively improve the numbness，pain and other related symptoms，reduce the severity of neuropathy，increase the nerve conduction speed and relieve the muscle atrophy，and plays a positive role in the prognosis of patients.

diabetic peripheral neuropathy  /  muscular atrophy  /  Liuwei Dihuang Pill（六味地黄丸）  /  nerve conduction velocity
冯海燕, 李月红, 刘云峰, 冯晓娟, 栾绍群. 六味地黄丸加味对糖尿病周围神经病变患者肌肉萎缩期的应用研究. 中华中医药学刊, 2025 , 43 (10) : 45 -48 . DOI: 10.13193/j.issn.1673-7717.2025.10.009
Haiyan FENG, Yuehong LI, Yunfeng LIU, Xiaojuan FENG, Shaoqun LUAN. Application of Modified Liuwei Dihuang Pill（六味地黄丸加减）in Muscle Atrophy of Patients with Diabetes Peripheral Neuropathy[J]. Chinese Archives of Traditional Chinese Medicine, 2025 , 43 (10) : 45 -48 . DOI: 10.13193/j.issn.1673-7717.2025.10.009
正文
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糖尿病为临床常见慢性代谢性疾病，糖尿病周围神经病（diabetic peripheral neuropathy，DPN）变为其常见并发症之一，以肢端感觉异常为主要表现，早期可表现为感觉过敏、疼痛，后期可表现为感觉丧失，运动神经受累等，致使患者出现手足小肌群萎缩，随着病情的进展可导致足部溃疡，甚至截肢，是糖尿病性致残的主要原因之一[1-2]。目前临床主要通过营养神经、控制血糖、改善微循环等综合方式进行治疗，以改善患者症状，但其效果有限，停药后极易复发[3]。近年来中医在临床广泛应用，强调辨证论治，整体调理，以达到缓解患者症状，延缓病情发展的目的[4]。六味地黄丸出自《太平惠民和剂局方》，被广泛用于肾阴虚亏相关病症，为中医经典方剂，具有补肾固精、滋阴润燥、滋肝补肾的功效[5]。鉴于此，本次研究对糖尿病周围神经病变患者应用六味地黄丸加味治疗，获得较好效果。现报道如下。
1　资料及方法
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1.1　一般资料
纳入2022年11月—2024年3月河北省邢台市人民医院内分泌科收治的80例糖尿病周围神经病变患者为研究对象，随机数字表法分为两组。纳入标准：1）西医诊断。①患者有明确糖尿病史，随机静脉血糖水平≥11.1 mmol/L或空腹血糖水平≥7.0 mmol/L，或服用75 g无水葡萄糖负荷后2 h血糖水平≥11.1 mmol/L，符合《中国2型糖尿病防治指南》[6]制定的相关诊断标准；②存在肢体麻木、刺痛、感觉障碍等情况。2）中医诊断。参照《中药新药临床研究指导原则》[7]中关于糖尿病周围神经病变的相关诊断标准，辨证为肝肾亏虚型，主症表现为肢体屈伸不利，萎软无力，甚至肌肉萎缩；次症表现为腰膝酸软、神疲倦怠、头晕耳鸣，骨松齿摇，舌质淡，少苔，脉沉细无力。兼具上述主症及3项以上次症，结合舌、脉即可明确诊断。排除标准：①合并糖尿病酮症酸中毒、高血糖高渗状态等严重急性并发症者；②颈腰椎如神经根压迫、椎管狭窄等其他疾病引起的神经病变；③存在足部溃疡或感染者；④合并恶性肿瘤者；⑤合并精神类疾病者，无法配合研究者。对照组40例包括22例男性与18例女性，年龄55～77岁，平均（59.25±3.20）岁；病程2～12年，平均（5.72±2.17）年；合并高血压病者22例，合并高脂血症者18例。观察组40例包括21例男性与19例女性，年龄51～77岁，平均（52.36±3.25）岁；病程2～13年，平均（5.24±2.16）年；合并高血压病者25例，合并高脂血症者15例。两组患者上述资料比较差异无统计学意义（P>0.05）。本研究经伦理委员会审批通过，患者均签署同意书以表知情。
1.2　方法
1.2.1　对照组
予以常规西药治疗给予亚宝药业集团股份有限公司甲钴胺片（国药准字H20041767，规格0.5 mg）口服，每次0.5 mg，每天3次。治疗期间予以饮食、运动指导，患者控血糖药物剂量不变。
1.2.2　观察组
在对照组基础上予以六味地黄丸加味治疗，药用：熟地黄20 g，山茱萸15 g，山药12 g，泽泻10 g，茯苓10 g，牡丹皮10 g；根据患者症状加减，血瘀较甚者加丹参8 g，川芎8 g；肝肾阴虚较甚者加枸杞子8 g，麦冬8 g，百合8 g。将上述中药以水煎煮至250 mL，每天1剂，分早晚服用。两组持续治疗3个月。
1.3　观察指标
①疗效评价：经过治疗后患者肢体麻木、疼痛等症状显著改善，相较于治疗前神经传导速度增加10%以上，肌腱反射明显恢复，则为治疗显效；经过治疗后患者肢体麻木、疼痛等症状有所缓解，神经传导速度较治疗前幅度增加5%以上，但不足10%，则为治疗有效；治疗后患者症状体征改善不明显，神经传导速度增加幅度不足5%，则为治疗无效。总有效率＝显效率+有效率。②多伦多临床评分系统（Toronto clinical scoring system，TCSS）：采用TCSS对患者神经病变严重程度进行评价，包括神经反射、神经症状、感觉测试三方面，总分19分，分值越高表示其症状越严重[8]。③血糖变化：采集两组空腹肘静脉血3 mL，采用全自动生化分析仪检测空腹血糖、餐后2 h血糖、糖化血红蛋白，观察其治疗前后血糖变化情况。④神经传导速度：采用肌电图仪检测患者治疗前后正中神经、腓总神经运动传导速度（motor nerve conduction velocity，MNCV）、感觉传导速度（sensory nerve conduction velocity，SNCV）变化情况。⑤F波平均潜伏期、离散度及异常率比较。
1.4　统计学方法
利用SPSS 23.0软件完成统计学分析。数据资料均符合正态分布，临床疗效以例数或百分率表述，F波异常率以百分比表述，采用χ2检验；多伦多临床评分系统、血糖、神经传导速度、F波平均潜伏期、F波离散度等指标用表示，用t检验。统计学意义设定为P<0.05。
2　结果
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2.1　两组临床疗效比较
观察组治疗总有效率为95.0%，远高于对照组的72.5%，组间比较差异有统计学意义（P<0.05）。见表1。
2.2　两组TCSS评分情况比较
治疗前两组TCSS评分情况比较差异无统计学意义（P>0.05）；治疗后两组TCSS评分均有所降低（P<0.05），相较于对照组，观察组分值降低，差异有统计学意义（P<0.05）。见表2。
2.3　两组血糖水平变化情况比较
治疗前两组空腹血糖、餐后2 h血糖、HbA1c水平比较差异无统计学意义（P>0.05）；治疗后两组上述3项指标水平均有降低（P<0.05），且相较于对照组，观察组血糖指标降低更为明显（P<0.05）。见表3。
2.4　两组神经传导速度变化情况
治疗前两组腓总神经、正中神经MNCV、SNCV比较差异无统计学意义（P>0.05）；治疗后两组上述指标水平均有所提高（P<0.05），且相较于对照组，观察组提高更为明显（P<0.05）。见表4。
2.5　两组治疗后F波平均潜伏期、离散度及异常率比较
治疗后观察组正中神经、尺神经、腓总神经、胫神经F波平均潜伏期、离散度及异常率均低于对照组（P<0.05）。见表5。
3　讨论
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糖尿病周围神经病变为糖尿病患者常见血管病变之一，关于其发病机制目前仍不明确，可能与神经营养不足、代谢紊乱、血液微循环障碍等因素存在密切关系[9]。该病以四肢麻木、疼痛、肌肉萎缩、无力等为临床主要表现。由于该病隐匿性较强，且起病较为缓慢，多数患者在初诊时已存在神经传导异常[10]。目前国际上，DPN的研究主要集中在病理机制的深入探讨和新型治疗策略的开发上。近年来，研究者们发现了与DPN相关的多条分子通路，包括氧化应激、炎症反应、线粒体功能障碍等，并正在开发相应的靶向治疗药物。此外，一些新型的诊断技术，如神经影像学和生物标志物检测，也在逐步应用于临床。国内的研究主要集中在DPN的早期诊断和中医药治疗方面。中医理论认为，糖尿病周围神经病变属于消渴症的继发痹证范畴，可以归为“痿证”“血痹”等[11]。《续名医类案》记载消渴后出现“后膝痿弱”，《王旭高医案》描述消渴日久导致手足麻凉[12]。长时间的消渴会使脏腑气血虚衰，气血无法达到四肢末梢，筋脉得不到濡养，导致慢性并发症。中医认为，消渴日久会加重气阴双重损伤，促进津液蒸发，血液凝结成瘀块，阻塞筋脉[13]；气虚影响阳气，血液运行不畅，四肢得不到气血滋养，筋脉失去濡养，导致麻木疼痛、无力、萎缩[14-15]。肝肾不足、气阴两虚是本病的重要病理基础，导致病情迁延不愈[16-17]。因此，治疗应遵循益气养阴、滋阴补肾、固精填髓的原则。
六味地黄丸最初记载于宋代的医学经典《太平惠民和剂局方》中，该方由宋代名医钱乙所著，自成方以来，其应用得到不断发展，被广泛应用于肾阴虚相关的病症治疗中[18]。本次研究对糖尿病周围神经病变患者应用六味地黄丸加味治疗，结果显示治疗后观察组TCSS评分、血糖指标均低于对照组。可见通过六味地黄丸加味治疗可有效控制患者血糖水平，并减轻患者肢体麻木、疼痛、感觉异常等相关症状。这是由于六味地黄丸方中重用熟地黄，为方中君药，熟地黄归为肝肾经，善于生精血、长肌肉、填骨髓，故具有滋阴补肾、填精益髓的功效[19]；山茱萸归于肝肾经，其性温而不燥，补而不峻，既可补益肾精，又可温肾助阳，有补益肝肾、收敛固涩的作用[20]；山药具有益气养阴，补益脾阴的功效，与山茱萸共为臣药[21]。熟地黄、山茱萸、山药三药相配，称为三补，可达到滋养肝脾肾的功效。配伍泽泻利水渗湿、化浊降脂，可防熟地黄之滋腻恋邪[22]；茯苓益脾逐水，生津导气，善于泻肾经之火热，有利于膀胱之湿，具有利水润湿，健脾泄泻的功效，可助力山药之健运[23]；牡丹皮具有清热凉血、活血化瘀的功效，可制山萸肉之温涩；泽泻、茯苓、牡丹皮为方中佐药，为三泻，渗湿浊，清虚热，平其偏胜以治标[24]。六味合用，三补三泻，其中补药用量重于“泻药”，是以补为主；肝脾肾三阴并补，以补肾阴为主[25-26]；故诸药合用共奏益气养阴、滋阴补肾、固精填髓的功效。相关研究表明，随着患者病情的发展，其MNCV、SNCV越慢，F波潜伏期越长，F波离散度也越高。故通过检测上述指标可反映患者近端神经损害情况。本组治疗后观察组腓总神经、正中神经MNCV、SNCV高于对照组，且F波平均潜伏期、离散度及异常率均低于对照组（P<0.05）。可见该种治疗方式能有效提高患者神经传导速度，从而减轻其肌肉萎缩情况。分析原因可能是由于六味地黄丸方中熟地黄中成分可对醛固酮水平起到调节作用，而达到改善阴虚的症状，此外熟地黄的关键生物活性化合物熟地黄多糖（RGP），具有免疫调节特性，可以通过上调调节性T细胞中HDAC6 mRNA的表达改善糖尿病周围神经病变周围神经病理性疼痛[27]，有较强的抗氧化作用，可增加细胞的运作能力[28-29]；组方中山茱萸的活性成分环烯醚萜类和黄酮类具有显著抗氧化和神经保护作用，能够通过调节血液循环和降低氧化应激，减缓神经退行性病变，从而在糖尿病周围神经病变中发挥作用[30]，牡丹皮可能通过增加组织器官的血液供应和营养，减轻糖尿病微血管病变等机制来改善血液高凝状态[31]；山药中的山药多糖则具有良好的降血糖、降血脂、抗氧化的作用[32]，山药提取物山药多糖可有效促进受伤的周围神经元的再生反应[33]，山药提取物通过影响mTOR信号通路，可以帮助修复肌肉功能和神经损伤，尤其对糖尿病引发的肌肉萎缩期具有潜在的保护作用[34]。故通过六味地黄丸进行治疗不仅能显著改善患者的临床不适症状，而且还可提高患者的神经传导速度，促进患者预后改善。但本次研究样本数有限，关于中医结合治疗的优势及安全性，仍需进一步分析。
综上所述，对糖尿病周围神经病变患者应用六味地黄丸加味治疗可有效改善患者肢体麻木、疼痛等相关症状，减轻神经病变严重程度，提高神经传导速度，改善肌肉萎缩情况，对患者预后起到积极作用。
基金
收起
  • 国家中医药管理局WHO合作项目(1998-12)
  • 河北省卫生健康委员会医学科学研究项目(20211630)
文献
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2025年第43卷第10期
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doi: 10.13193/j.issn.1673-7717.2025.10.009
  • 首发时间：2026-10-30
  • 出版时间：2025-10-10
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基金
国家中医药管理局WHO合作项目(1998-12)
河北省卫生健康委员会医学科学研究项目(20211630)
作者信息
    邢台市人民医院，河北 邢台 054000

通讯作者:

栾绍群（1984-），男，河北邢台人，副主任医师，硕士，研究方向：癫痫、神经肌肉病。E-mail：。
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2种不同金属材料的力学参数
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Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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